170 Understanding Microdentistry with Rok Stern : Dentistry Uncensored with Howard Farran

it is a huge honor today to be interviewing with who I call the rock his first name is our okay at last name stirred I’m just gonna say he’s from Slovenia I’ve been there but I there’s no way I can pronounce the city is that the capital you live in yeah it is it and how do you say it you know okay and for up you know they say if you know uh two languages you’re bilingual and if you know what language you’re an American so I’m almost both so for our American forehead say it again slowly a couple times so they mighta they might try to attempt this in their car as their community to work you Jana and it’s horrible for me to be interviewing this morning because I’m short fat bald you’re rockin red red a headset and all that gorgeous hair your to stop I’m telling you your your dental cases I mean you are a rock star whether you call it are ok your name RR 0 ck I mean really you you publish them you post you posted a thousand times on dental town and it’s just an honor to be talking to you today well Donner’s like why thank you and and sylvania I’m I’ve been there with my son Greg when we when I was lecturing in Venice we drove up we rented a car and went up so so you border I’m crew Italy where I entered from Croatia we went down there austria-hungary I mean that that’s a cool part of the world I mean it’s just gorgeous you know where I live in Phoenix an old historical building is about fifty years old yeah and how old are some of the structures in your country I know at least 500 years old yeah it is nice it is so gorgeous I mean unbelievably gorgeous so I I’d like to start out with first of all and we have listeners from all 206 countries listen to this stuff so for people around the world I think a lot of people just wondering like if you could describe like what’s it like being a dentist in Slovenia I mean how many people are there many dentists are there do they have water fluoridation or not really um is do they drink a lot of sugar water coke soft drinks is there a lot of decay on you know to talk about two people around the world what’s it like being a dentist er well we have populations about two million people and ljubljana the cat who has about four to five hundred thousand and we have about 1,500 dentists and I think that includes all the specialists like or don’t ologist surgeons and stuff like that so we’re pretty spread out around the country most dentists working Liana if you say per person that lives in brown and there are probably most dentists the most saturated market or not we have water fluoridation but nuts as much as in the United States the concentrations are lower and but we don’t have a lot of decay because of that you know it’s enough the children usually don’t drink a lot of candy are soft drinks and stuff like that but they drink natural juices so they have a bit of detail from that but not as extreme is the mountain Dumas that you see in the state you know so I’d say the overall oral health isn’t this bad as you think it will be I’d say the worst is periodontitis I mean most dentists that are in the public sector which is something like Medicaid in the States don’t really treat peritonitis they just three decade and test because they’re all cool they didn’t even teach the last 25 years maybe they started teaching about periodontitis and personal periodontal disease here and how to treat it but they get really low reimbursements from the insurance companies so they don’t treat it it’s like like less than two dollars or 23 it so as I didn’t do it so do you do you think they have a lot of pathologies because it hasn’t been treated or are there other factors that I mean you think slovenia has more peril disease than some other countries for some reasons no no I don’t think that but it’s it’s it’s noticeable that most people have problems that say but I don’t think it’s I’d say if we compare it to sweeteners or the northern countries we have more but difficult like Albania and Macedonia then they have more than we did because you know um it’s um some things I’m or sensitive to talk about but I had an older periodontist tell me that he thought

there were three types of teeth more associated with races that caused gum disease he said the the Chinese and the Asians had the most constricted cervical neck to where the tooth really constricts and that precipitated more calcium and phosphorus in calculus and then the the Europeans were kind of in the middle and the Africans had the most bulbous and they didn’t really precipitate as much calculus and what was funny is years later up Pete Adonis told me that it was harder to keep a chrome still crown on an African child because you didn’t have the undercut from the constricted cingulum but I never seen many people talking about that but I do notice when I am China seems like everybody has gum disease in China I haven’t been to China so kind but but then the other variable in China is the joking Islam you know in America they have a smoking section and a non-smoking in China it’s the smoking section and the chain smoking section so I’m sure moat like most things are multifactorial the work could be a constrictor cervical neck a big increase so so gum disease is how many dental schools you have in Slovenia 11 and how many hours does it take to drive from one end to the other of Slovenia well if you go straight across diagonally it takes about a 10 maximum three hours okay so it’s pretty much highway for mental and so you can run faster right on so I’m what did you what did you want to talk about today I mean your cases are a man for all wouldn’t you say that you’re I mean you’re really into dentistry what what type of data what type of dentistry gets you most excited what what is your core competencies or special teaser what type of cases do you like to photo document and post the most on dental come well I do it pretty much everything I do except surgery I don’t document surgery because it’s it’s a nice and I don’t have anybody to take pictures for me enough because i just put another pair of gloves over my gloves to take pictures and i could take all my pictures myself there’s very core sometimes down by jason lidsky and I’ve learned a lot from that and I don’t do it between surgery because I usually have the sterile gloves on and I don’t want to put another pair of gloves or them and you know so I like the state of composite and interior composites and full mouth reconstruction I do a lot of telescope work you don’t do that a lot in the States but no more what do you mean by telescope work even you mean a microscope no no no telescopic or dentures Oh telescopic over that yeah microscope I’m buying one till the end of this year I had the pleasure to test the prototype of cars neons microscope for a week and I think I’ll buy one of his hopes when they officially come out at the end of this year now do you work with the dental assistant yeah but you like to take your own photos yes you don’t like to delegate that out no because we most of the dentists over here don’t have the same relationship with their assistance as you do in the States as I’ve seen from from other people’s posts on Delta they don’t they can’t do a lot of stuff over here like provisionals or Kleenex or like you have those assistants who can actually make feelings we don’t have anything like that over here so they’re just chairside assisting and it’s easier for me to snap a picture then tell her what I want from the picture every single time enough mm-hmm now do they legally do can they make an egg’s do expanded functions or is it a law that says no I think they can make nothing permanent they could make provisionals take pictures and stuff like that but anything that is invasive no so but most hope most dentists over here only have one assistant and how they chairs one two maybe three but what would you say the average dennis has one chair or two once you run assistant one chair one assistant would they have a front office person too or just one Dennis one employee one chair well over here is like that you have a system to this controlled by the government and private practice to that separate or not so in the public system you are delegated by the insurance company what you have so everybody who works in the public system and that’s probably at least a half of all the dentist you only have one assistant and one chair and no front off is nothing then you have people who work for the insurance companies but out of the system they also have one assistant

one chair maybe two chairs if they really have enough production and then you have private practice and some people who practice have two three chairs and two three assistants in the hygienist because our hygienic school or hygienist is only producing argenta students I think the first graduate class was 2012 but one in yeah we didn’t have any hygienist because then it is clean calculus so now it’s starting to develop a little bit our periodontic professor made exclude for hygienist because he saw it in the United States and you can decide if he wants to do something about that so he started exclude for for dental hygienist that is so amazing this is like a walk back through time for when I first went to Australia I think it was in I forgot what year is the 90s but there were no hiking schools and most everybody had one chair and now I just got back there last week and now you know now hygienists are really getting corporated in and multiple chair that’s amazing and what percent of the dentists live in their dental office the worse their home and their office I’d say it’s a really small percentage r is small percent yeah maybe five percent actually if I think about it I maybe no one and they don’t even live in the same how they have a separate passport office in their house is really close by like a hundred meters apart oh yeah i love i love lecturing in different countries my goal is the lecture in every single country and I want a podcast on a very different country because so much of this is cultural because like in the United States in the in the West their day off is friday but in the Northeast they’ll take off when filthy two days tuesday then they’ll take off wednesday they’ll go back to do you know thursday friday saturday and you only see dentist living in their house in the very north east like New York you know around area New Jersey but many many countries they actually you know the dental office is the first floor and they live upstairs um but uh very very very interesting um so so you said I’m let’s talk first about telescopes talk about that and why do you think you uh you love them and why do you think you don’t see them used as much well it’s they are used a lot but not in the States there is a lot in Germany they do if you go to a German forum dental forum there’s probably in this moment at least 20 cases suck about telescopes how to do what to do what to preserve and stuff like that I just think that you it’s a technique that i think was developed in germany about 30-40 years ago i think you had to move it more on your podcast right I he knows about that he wants to do that more in the States but the dentists don’t know about it so I made that post on on on the removable prosthodontics sub forum and I think it explains a lot somebody will try the problem is that i can i push that case out on social media like Facebook Google+ Oh is that more private for dental town no you can okay I never I never post a private case on dental town on social media unless I get the doctor’s permission and I like to do it because I think a lot of people have no idea there’s two million dentists on earth and it blows my mind the only 200,000 have found dental town to me blows our mind that I mean the four million posts on dental town from guys like you are just amazing okay but start from scratch I think you were throwing around the word telescope and you got a lot of people this thing like okay what does that even mean so start from scratch and explain it and III know all Americans are interested in anything out of Germany because you think a German you think of a mercedes-benz Audie pours those guys are just I I don’t think there’s a jerk when I think of making something high quality i pretty much only think in Germany Japan when I think of American manufacturing I just think of a really good marketing and advertising department i mean the Americans can sell snow to Eskimos but the Germans and the Japanese I mean God dang they’re just they’re just the land of engineering so why talk about the telescope and and what it is and then what would be the equivalent to whether it Americans doing it and why do you think more Americans should look at this German technique well telescopes are basically a process where you conserve pretty much Steve that that would be lost in most American cases I see all these faces on downtown where people just go all in for all our sakes you know it’s correct everything about full implants and maybe it’s because of money over here implants are really expensive

so telescopes are a way of using the teeth that are left let’s say to 260 or arch and cover them with an over denture by covering them with no denture you get nice aesthetics because you don’t have the transition between the white and erratic the pink aesthetics and pretty much if any of the supporting p failed you just make a simple repair to the old entrant and the patient has their teeth in the same they are made day so it’s it’s similar like Cohen assist you know kono system yes but the main difference is that the telescopes are 0 degrees conesus our friction lock they’re like like simcom from angelos on implants they have 54 56 degrees i think they they’re just staying with four degrees now and they interlock and the connection is really rigid and the patient usually has a hard time removing such the adventure with telescopes it’s zero degrees it’s friction fit but the patent of insertion is just one so the patient usually easily removes the adventure but there’s no way that it will fall out unless there may be only one two remaining for the whole large okay but if they’re zero degree and you got two or three or four or five or six things how would you ever get them to be parallel how would you ever get them to line up you need a great technician you know you went when you prep a prep for a telescope is pretty aggressive so you remove pretty much a lot of to structure but especially in on the anterior teeth because you need room for the primary telescope and then the secondary coping and then the tool that covers everything so we need more room to produce aesthetics you don’t need to align the piece zero degrees you just prep them roughly in the same direction and then the technician who produces the primary coping primary copings he then makes them parallel to each other if he can’t be compared another if something is wrong by heavy case for her head 16th remaining 1 molar was a bit out of line you sent me back either cost you said you need to remove a little bit more from there and then I can fix everything you know but I think that’s why it’s not really made a lot in America because you needed great technician and they usually cost a lot so in America probably cause the sameness of for implant or denture you know and and what it what it one of our listeners on you know most of my listeners an hour commute to work so when they get to work and they log on dental town what would they type in on the search bar to find a thread with the title of your case have the word telescope in it so they did a surgery I post a lot of cases but they should search for the 101 telescope track the white the 101 telescope train the 101 telescope thread yeah awesome and Ryan it’s I want to get um I’m gonna am at it additional monitor so that when I’m getting spark as I could actually pull pull it up that would be rad and i also want to switch from my boring black headphones and I’m gonna steal rocks idea I guess rocking hot red ones so I’m so I’m the telescope how many tell how many teeth do you like I mean do you like to on the lower two on the upper do you prefer for like you know like a like a table has four legs so there’s no locking or what what is your ideal number of the buffets well the perfect is for like a chair yeah it’s it’s like the same that you want with a classic removable denture if you’ve got a molar aquella and canine mauler that’s the perfect you can get removable denture and it’s the same for telescopes but have done cases with one and the maximum i did was 60 you could in theory do it with 16 feet but nobody you’re on so these teeth don’t have to have root canals no it actually is better that they don’t and why is it better that they go the patients have a different different feeling when removing and inserting on vital teeth than on non-violence apiece so if it’s fun all non-vital they tend to break them because they lose a bit of depth perception really we’re cracking yeah I did not know that I’ve always wish I am had a root canal just to know what it was like and what it felt like but I you know that’s why I think women go to women gynecologist because you know back in the 50s and 60 they got sick and tired of men telling him you know who’s all in their head you know i i’d rather if I the woman I’d rather go to a woman doctor um that’s in Turing but you do say they’re more expensive why are they more expensive just the lab bills more

expensive yeah and i usually use high noble percentage gold so for the primary and secondary coping so for each tooth that’s a bit let’s say one hundred fifty dollars of gold and white why do you feel that that’s worth it as opposed to using a low cost base metal they last longer the friction last longer and it’s more precise and everything it’s and also my lab really really prefers working with final word for cases like that because it’s much easier to fit to work with a high number alloy and what lab did you believe the same lab a local app local fur I use a local app for everything but for telescopes I use one less specifically locally yeah locally but has that lab owner ever posted any cases on metal tone no I don’t think so well you should tell them to do that that probably that I’m some of the lab men and that i know that i posted on dental town say it’s it’s their entire marketing budget it’s just instead of paying money to advertise they just pay in time and post cases on dental town and they say it’s just a slot machine business we don’t have advertising cure is it illegal is it illegal for dentists death wow talk about that so what does the rule say you what can you not do and you can you have a sign in front of your office you can have a sign that says dentists here you can you can have advertisements but they need to be educational you know they have to tell you why periodontal disease is back for you and why should you get checked up for your dentist and stuff like that so if it’s too straightforward you’ll get reprimanded by the chamber I don’t think anybody has ever lost license but i also don’t see a lot of commercials the worst thing about that is that croatian dentist do a lot of advertising in slovenia and we can’t do anything about it and we can tender advertise yourself so people just see that that old facebook and internet and jumbo boards and stuff like that and weekend we can’t advertise it also it’s a bit lopsided graph yeah then I also heard back during on during the war in that area and that a lot of the nation’s said that it if you’re a war refugee you can come here and we’ll accept your license whether you’re an architect and engineer what a dentist whatever and that a lot of people just got degrees on the internet and went to other countries in the region saying I’m an architect or a dentist or an engineer and they weren’t really what is that still an issue in twenty nor did they I know actually heard about it so we have a lot of it we have a lot of foreign trained dentists now because within the European Union and we don’t have any restrictions of moving people from other countries in the European Union so we got a lot to tent this from Bulgaria from Macedonia coming over here so so so social Vinny is part of the EU how many countries are they you I think 27-28 of Germany Sweden so so you pick so you could take your license and practice in all 28 countries of the EU you got as far as in this would you have to take an additional board exam or license or no you’re not usually not so so that I’m curious I’m so why um why do you Dennis move around from one country other is is it is it more lucrative to practice in some countries versus the other not my name money money but if money is the main money’s the answer what’s the question and so do you stay in Slovenia because you think it’s a it’s a better economic situation if you cross the border to say hungry it league Frazier Austria no I think if I go to Austria or Germany I could have a salary that would be the at least twice twice as I I have right here now so but maybe I’ll move I don’t know it’s hard to move in where we are more titles than people in America who like to move and then retire to our houses you know it’s hard for us to sell house and move I think it’s just psychologically over here but my brother for example is just moving to Switzerland the cheereek and he got a job there so he will move and me and why my wife also think about that but for now we are staying here their daughter yeah well yeah there’s nothing more home sweet home than home I yeah that is it but back to the telescope or extracting

the teeth one word flood flag I’ve always had from dentists you know that when they when they say that the world’s major religions the only sentence or paragraph that’s in common in all the major religions is only one phrase there’s no name of a person place thing City nothing except for the one phrase treat other people like you want to be treated and red flags for me and dentistry or when like Dennis and they’re their own daughter to have orthodontics and bleaching but then when it’s a patient and they can’t do orthodontics a file down the teeth and do veneers another red flag for me on implants is when the dentist goes and gets a root canal and a retreat and all these heroic procedures to save his tooth but then doesn’t blink on pulling it on a patient and place an implant so I always think that’s the best litmus test on every single patient just like you just look at that patient and thank you know just what would I even though we have more money as dentists than most of our patients I still want to always think you know you know why before you throw that tooth away if it was in your mouth would you go to an Adonis and have it retreated or what have you so um so what other cases what other besides uh what would your next top you want to talk about I feel like I could talk to you on any clinical subject what what else has got you excited and passionate well I think isolation especially revered I’m isolation I use the rubber band for pretty much every procedure except surgery extractions but I’ve used it for prosthodontics and obviously restorative it’s actually really nice when you prep a tooth for crown the first time when you have a rubber dam wat you don’t have food ton gets in your way achik that’s in your way you’ve got a nice field of view it’s a nice contrast you know not like the mouth when you got red and black and stuff like that you got a smooth surface behind it to it and you can really see the depth of the preparation everything so the first time I prepped the truth with the rubber dam on it was on a patient who had half of his tongue removed because of carcinoma and he couldn’t put his tongue far back enough to seal his mouth so every little drop that’s break cost him a coughing fit so I had to prep with the rubber diamond and it was it was a great experience so I’ve done it a lot of times since then for restorative Lee reasons obviously you don’t have saliva you don’t have blood you don’t have anything you don’t have a tongue it’s realized to work it’s it it saves me more time than it takes me to put it on what percent of the dentist of the 1500 innocence Lavinia do you think put a rubber day i’m on a tooth before they prep her for a crown zero yeah so since that is so rare maybe so you just really love the isolation yeah and i agree with you that the time to put on the rubber dam always say you know for every one minute of time you’re putting on a rubber dam it usually saves at least five six seven made me ten minutes of time I mean it is just I mean it just is that’s just the way it is and then a lot of them is you don’t user / damn they’ll numb up the patient and then they’ll leave the room to go see the crown or do a hygiene check and all they had to do is tell their assistant to place the rubber dam because you had an assistant sitting in the whole time and they don’t even take the energy to just turn to this as they put on a rubber dam have you ever tried the isolate I know I’ve seen it in action but I didn’t try it I really don’t like the crusty suction say I’m a big and that that sound it really makes my ears hurt you know so usually when I put a rubber dam on that I I don’t I think the saliva ejector out of their mouth so it’s nice and quiet so when you say you’re a big dad is that from dental high-speed sounds are you nasty no no no not for mental not true I see it sound so at least not yet I see if it gets worth where I am you know every once in a while um it’ll pop up you know kavo has those electric hand speeds there’s electric high speeds and the massive tort they don’t go as fast but the torque is unreal and that’s another cultural thing I see when you go around the world like Americans always put in a air compressor and go with air driven high speeds and then other countries are they don’t have that they don’t they don’t do that they just go electric would you say the 1500 dentist in sylvania are they mostly high speed or electric yea high speed high speed high speed and over there in the EU do you see any countries that are more likely to be on electric hand piece versus air tour I don’t think yeah but most most of the younger dentist stopped using the turbines you know we just use the high

speed handpiece is red red and blue for me I just use irvine it up okay I’m gonna you’re saying the younger dentists do not use the air driven turbine and use elected vice no no no we all use air driven but we stopped using the turbine what does that mean stop using the turbine it’s a campus is it turbine the electric no electric motor now their own hand a driven they’re all are driven got a turbine I don’t know how you call it in the States it’s a high really high speed handpiece that has low torque and then you have the red hand piece that’s a bit slower but that’s hard work and the blue pink blue and green hand p square much slower let’s say for preventing removal in various or and the preps can you do me a favor can you do me a huge favor his I don’t even get that I still that will you start a threat on that because I haven’t heard the blue in the red and the eyes I wish you would sort of thread and explain because because the what one of the things that I’ve noticed in the I’ve been a Dennis year 30 I’m 53 um go back in the day there were countries that were pretty much on electric hand pieces only and and then Americans were all air turbine now it’s just it’s really changing i really be curious to see of the 206 countries on you know who was all electric and went to air who was air went electric or our howdy how do you feel that’s progressing in the the EU do you think there’s a shift towards more electric or less electric or do you think that air driven the air driven german handpieces as dominated the market yeah that they do over here it’s pretty much every commercial we get we don’t get any other to 10 pieces we just get there jack are you gonna back slovenia or the Holy you I would say most of the I know for sure for Germany and Austria I don’t know for France and Italy so so Germany is going all Air turban yeah I think most of them most of them oh that’s ironic because the the electric am peace comes from cave O&K vose from Germany yeah because I think pretty much every cable chair that today they have over here because on the abdomen pieces on please well you know back in the day I did put in the electric hand pieces and I I told the day I think I was when I had come back from lecturing in another country and I said you know look we were just born in air driven and we’re gonna do electric but the three of us we just the feel was so different it wasn’t that high speed Vanessa the feather was more of a slower and yet total torque you could not ever stop a burr yeah but it’s a totally different feel yes that one I’m dental down like you say that they like the electric had pieces to finish the preparations to they they say they have no more precise I just kind of fancifully wanted the electric campus to win because you don’t have all that plumbing infrastructure that’s uh that’s problematic and you know it’s it’d just be so much nicer not that just to have a something that plugs into electricity instead of something that plugs into air um so what else did you want to talk about well no Mike microscopes are really something that I’m into right now you’re still you’re still using the one that you’ve been are demoing no I don’t have one now i’m currently not really working because i’m waiting for my knee surgery that’s in 33 weeks i’m going to for my second ACL reconstruction and why did why did what did you do that made your wife hit your knee with a baseball bat I plays well ago Oh volleyball volleyball injury were you diving for the ball I know I was jumping pretty high so I dared it when I was 16 for the first time I know I’m I probably tore it again soon but I lived with it and now I really need to get it taste it’s a really unstable e well I’m sorry about that that’s all I know we do yeah but better Annie though then I like a lower back or the neck or something yeah so tell us your thoughts on a microscope what we’re done so let me let me tell you the first red flag on my shelf a lot of Dennis said man I can see everything better and the quality goes up so much but man it slows me down they say it takes me twice as long to do it so do you see do you see that your quality going up and your speed going down or do you not really well at first from the s because you see so much more but then also you diagnose much more because when

you look at the crack get 15 16 magnification you really see what’s in there you know and you see a lot of things that you can’t see with your parent ok maybe if you’re using four and a half loops you already see a lot but I’m 30 and a part of the thought process on a microscope is that it’s an insurance comp policy for me for my neck from my back to my next 30 40 years that i’ll be working dental or i mean i use loops all the time but I still sometimes get neck pain and back pain but with the scope you just you can’t flex your neck when you use the scope you just have to look straight forward if you don’t see anything so it is a learning curve but when I got my first demo machine I think I needed 12 patients to get used to it and then it may cook me five minutes longer then it was me they can tell it’s it’s might be my only regret in dentistry I me I have loved I wouldn’t be Dennis in the sixth grade when a holiday in the sixth grade 12 and I’m 53 I mean 41 years I wanted to be a dentist and but the only is I if I had to just say was there anything negative about it yeah I was trashing my neck and and it was by the time I was because I hung my 10 pound bowling ball head over trying to get dry even though I looked through a mirror and then and here’s a big secret to save neck I’m not just magnification but why you Dennis always use that little half-inch or three-quarter inch mirror you can buy an inch and a half mirror a two inch mirror I mean get bigger mirrors it throws in more light you can see the draw with the whole arch I i if I walked in 10 dentists offices in all we two key right now and looked on the tray set they all have the same little size small mirror and you walk into my offset and I might have three or four mirrors anywhere from three quarters of an inch to two and a half inch but so I did a lot of direct vision but my gut so finally have 50 it when I driving a car if I just even turn my head to see if i can change lanes or as an electric went and finally a dentist friend of mine his wife talked me into go into a hot bikram yoga and I I did it this morning I mean I I do it at least three days women and that’s just uncheck my neck so yeah if anything in fact I’m Ryan didn’t we we have an ergonomic lady coming on one of these podcasts yeah and because yeah I really want to preach more ergonomics and moral that because when you’re 30 you think you’re going to live forever but when you’re 53 do you realize the price you paid by not sitting up straight and also the chairs have change there’s a lot of chairs I don’t have the back and you guys here too yeah and you kneel into the chair there’s a lot of big exciting things on organ ah miix um so um cosmetics anterior bonding you you you you post some amazing anterior work talk about your interior work well I’d say I’m pretty far off in the interior section it says it’s something I like to do but there are other guys online that you just can’t believe that it is it directly on ax especially on on facebook you’ll see some cases but then again you have to see if that case took I don’t know 12 hours to finish well uh but I but I’m old enough to be able to say in 1998 a lot of those legends we’re posting on dental school and they’d never done any case so just because just because there’s some older guy that’s a legend doesn’t mean that you’re the next guy in the batting cage I mean a lot of these dentists um you know I remember their first questions asking what is this and now they’re actually out there they’re legends teaching it so you know life’s a journey and if anybody was going to be a legend and anything any type of clinical it would have to be you because you you are you you got the attitude is really going for it so so what type of anterior work do you like do you like or what would you like to master do you like doing direct composite veneers do you like prepping teeth into an end direct veneers no well everything it’s it’s I think if a lot of this has to do with case selection you have to know what do you want to do in what specific age you want to do I mean with the microscope you can really finish a part in 20 point one point to sew mach my lab works with the scope so if i give them a 230 spreads to point one point two they can actually make near that fits on that on that chapter let me let me ask you the you know i love i love dat i think the most informative things we can do on podcast does not talk about anything everyone yeah but always go after the uncomfortable question um you know what

i have heard a hundred dentist in my lifetime at least say that I don’t care who you are I can spot your veneer case across the room they’re just not natural and some of the biggest legends that do these veneer works you know I just always have Dennis saying yeah it’s great it’s pretty it’s whatever but hey come on we’re Dennis you can still tell its fake from across the table and I still think the most natural work on veneers I ever see is always direct composite and then you gotta ask the dentist himself um you know what do you think’s better to do filing down to veneer or doing it direct I think a lot of veneers are done because the dentist says I don’t want to spend all the time doing this I’d rather have my land man do it but um if I was gonna have veneers I i would do direct so what are your thoughts on what is your mind thinking about prepping off the enamel a millimeter and a half and do an indirect veneers versus doing direct bonding well you have as I said before it’s all about case selection when when you get the case that a patient at once and you smile it’s always best for me to take an impression some photos you know like digital file design and then make a wax up and then the mall cop and when we do that flash woke up we see if we need to remove everything or just add so if I just need to add maybe I’ll go I can go direct composites it’s a less invasive that’s for sure but it takes a lot of time and a lot of patience and it’s really hard to pull off so if you have it look really really nice and if you go on on facebook microvision group there are guys here in Europe there’s a really minimal prep design maybe even not prep many years and I don’t think anybody can do from direct composite like they do with felspar peak veneers you know they really thin even not no prep so and now we have lasers and you can debug the porcelain prep practically in one piece you don’t have to worry if if something goes wrong you just pop it off make a new one so I think indirect if you really want the best looking I’d say indirect uh but is it anyway what and what porcelain would you like um for your sake feltham attic yeah or emacs if I if I need to do a crown that I use Ruby max if I do many others in its first party and that’s kind of like asking a painter do you like watercolors or do you like oils do you like acrylic so talk about when would you like see max which is probably the biggest brand i imagine that probably four out of five and terrier crowns or veneers or emacs versus feldspathic which is the old schools talk about what you’re thinking when you think about ew feldspathic or emacs well usually if i go full coverage to TM x + 4 veneers it’s almost usually always respected keep stock talk about that why exactly why i still think that first party person person gives better aesthetics especially if you compare some of the cases from Europe and the United States I talked to glenn vanness in Prague this year and all of his cases were bleached white and if he said it’s really easy to make a bridge in Canada when everyone was bleach white and over here you see a lot of really really nice person work and it’s almost all it’s for its felt buttock and but if I go full coverage it’sit’s emacs and sometimes even layer he makes or layer ciconia but you know I’m again the most fun thing about being alive half a century is I remember when I lectured in London at the Royal College of canadia of the Royal College of Dentistry a lot of Dennis would tell me they’d they’d say kind of guarded they don’t you think a lot of American cosmetic work is to white I mean kind of likes goofy and there they Americans our teeth are too white they put on too much makeup and their boob jobs are obnoxiously too big and it was good but now when you go to Europe you’re starting to see a lot more of this what they just are not like 25 years ago it’s like the the bleach white clown face is getting a little more popular what what do you think are major differences between Europe and North America is terms of what the average person ceases beauty or cosmetic or well if we limit that’s due to two teeth I think we are at least two shades darker than you are so if you go bleach white I don’t think we have anything later than a one here

good agree agree but what asides teeth what other things in beauty you know like I noticed like I noticed back in the the late 80s Early 90s um shaving legs wasn’t very popular no no that best popular it is far more it’s far more popular now than it was on yet decades ago and I think in France their sales some ladies not showing their armpits maybe Italy but i think that’s that’s I’m minority not the majority so uh but did you but was that the way it was do you think 20 years ago like slavonia 20 years ago did your mom and grandma did they shave their legs and armpits huh I don’t even know yeah again when I woke up I wonder if the I wonder if the whole world’s moving towards one you know one kind of a cosmetic look yeah I think it will be because of the globalization you know it is you know I think it’s very cute whenever you’re in a Asia around there they the dominant fashion music culture is Korea and if you’re in China and you walk in there and like if we all have black headsets on you walked in with the red fancy ones they’d say uh you’re looking Korean and so so whatever you’re looking fanciful and they’d say you look Korea is they’re the ones with the most pizzazz ur flash music ER and they all want white skin when I was in Thailand the their beauty concept is white so all the girls that the naturally dark skin to put a lot of white makeup on so they would look less than and over here pretty much every girl wants to do more more time yeah the motioning salaams I ever saw in my life was in Poland I mean they caught them what did they call him what’d he say said um um since knew I wasn’t gonna do I forget the dentist first omote illogical and the the Sun Tanning I forgot was it soma some some I think it had but my god they were on every corner yeah I almost thought Poland was a was the land of tanning beds I never saw somebody tanning bed the world but the most ridiculous thing is I live in the desert of Phoenix Arizona yeah and there’s a tanning salon on every corner and we’re only nine miles from the Sun I mean you could just uh pull up to a tanning salon lay on the hood of your own car and have a melanoma in an hour and they and pay money and say how do you how I mean that just shows you that you can sell it when it dennis is whining to me about how patients won’t pay money for their teeth is like in the desert they pay money for a tanning salon you can sell anything to any human humans of us are so funny and incredibly complex so what else is so on you’re up dude you direct composites yeah yes I do I do anterior and posterior everything like what you’re I like to play with toughest ear composite you know time I want I want to ask you the UM I’m gonna ask you the most controversial question I can think of and that is Simon asks you you’re a very smart guy and I’m a big fan of your thousand posts what do you think last longer on a first molar an mo d3 surface filling an amalgam or a direct composite well I think it depends on how it’s made and who’s making it you know it’s with composite it’s it’s really more operator dependent or let’s say people don’t use take their time that’s needed for a direct composite so Matt amalgam you can get a lot away with a lot of things you know you just stopped in there and it will usually lasts as long as it’s not it’s sealing properly with composite if you get some saliva contamination on the margin it’s going to fail catastrophic you down the road so yeah a drug composite is extremely tightening sensitive and if you have gone fast if you’re going fast and you’re cutting corners um your malgo about much better it’s better to use the most so of the 1500 dentist in slovenia for your standard you know the first molar is a tooth most likely be missing decayed filled root canal crown replaced there but if your average first of all in sylvania and 400 fillings were done on what percent would be amalgamated in your country ah I’d say it’s about 5050 not fifty-fifty and with that line up perfectly with the public versus the private insurance system you said dennis for public no you let’s say

fee-for-service we only have maybe five to ten percent of dentist a fee-for-service the rest work privately but they have a contract insurance company like PPO in the next eight okay but they have a limitation of how much they can produce each year they have a contract for let’s say 100 thousand two hours per year and that’s all they can make from the insurance company so people now pay extra patients pay extra for posterior composite composites like from premolars and back only from canine to canine is fully insurance paid for and the rest is then paid extra by the patient themselves and they a more patients decide to have white fillings now especially in ljubljana okay and and the number one feedback I get from my podcast is on they would say on this like you said you do post your composite so the feedback would say well will you what kind what bonding agent no they dentists are like chefs they want a recipe you know they don’t want to hear you talking about oh yeah I make lasagna they’re like well that doesn’t tell me anything what noodle did you make was a pork sausage beef so walk me through your posterior composite use and mentioning the name brands yeah well I use a total I system it’s up to bunt FL for care it’s for generation so primer in the piece if and then heading composite usually mostly genial from GC or garage from GC for composites and optimum developer for most all fillings or maybe excite that I don’t I think it’s I know it what company makes excited but mostly of the bunt FL and I has great results with that so I’m just sticking with it so then let me ask the most are the most controversial question I can thing on that a lot of Dennis listening is to say dude I i tried total edge and i had sensitivity and i switched to a self-etch like a clear fill SE um why do why do you like total edge and and why do you think you don’t have problems with sensitivity why are you not using a selfish you think again it’s just technique isolate yeah sensitivity I’m sorry have you put in words your mouth why why do you use total latch and why did you never go to a self edge because I never really had any problem and it doesn’t take me any more time to do it then with self at you know but i think is if you just stick to the instructions you won’t have any problems with any bonding agent it doesn’t matter what you use as long as you read the manual and follow the instructions it’s a simple event I mean I talked to two I see a lot of ports and level bound about sensitivity issues I mean just just follow the instructions it’s as simple as that I mean isolation follow instructions and it’s it’s I don’t do anything special I have my wife you went with curves bonding agent how come you didn’t go with curves composite why did you switch over and use curse Bonnie a gym but then switch over to GC on to use their composite gratia was that a cosmetics was it no I I don’t have a specific reason I switch the genial for that’s the better for composite from from GC for aesthetics so that’s what I use for interiors and I’ll probably and switch to GC color that’s the top and composite from from GC or here we don’t have those the same branches you do we have GC but we don’t have I see a lot of personnel time with using composites that we don’t have like from apex dental and stuff like that like yes I I still have the I’m still shocked that you know we started they don’t kind of 98 and now it’s 2015 17 years later and you still have these companies that make the same product and put it in a different name in Australia than they do the United States I’m like dude the internet killed nationalism there’s people’s identity is no longer if they’re their identities more as I’m a dentist then well I madness from Australia New Zealand so so I I think the Internet is killed nationalism people’s identity like some people will you’ll their identity might be their country some of my V their religion a lot of dennis assigned identities earth is their profession and with the internet and Facebook and Twitter you can’t call a product different in different countries because you’re confusing the market yeah there’s lots of us on bethel town we’re actually trying to figure out if this product is the same as another product and do you think I don’t gotta I shouldn’t say this but do you think GC is more notorious for that than other companies of calling necks different in different countries I don’t know that I’m sure they got a care

but to anybody who’s listening from the dental manufacturing world when you’re on the internet I mean it’s a flat earth I mean we all live in one little town and it’s called dental town it’s called the internet it’s called your smartphone and it’s extremely confusing to the dentist when the exact same thing is called literally 15 different things in 15 different entries because because we were classically trained in a minute when i went to mba school the 90s I mean they said think global but act local and that’s what they’re still playing on but that was and that was a pre-internet concept after the internet you just can’t think like that um how do you um what do you what do you finish your composite would you like diamonds do you like carbides do you use sandpaper disk like 3 m’s there this series what do you what do you do for finishing up anteriors for interiors I go with stuff like this disk I go with course and then with fine and then I’ll polish with diamond face and that goat skin most Kimber so that’s that’s my polishing process for their anteriors for the posterior side I just use the define rubber soft flex disc it’s Robert so it’s not the nuts and papers everything you just said there was um pretty agreed upon I’m sure by the listeners but i think the rarest thing you said is the diamond pace i think that’s a very very rare thing used anymore talk about the diamond pace what brand why do you use a diamond pace I assume it’s in a pro pick up yeah or you use some special party shirts from another company right now we have a whole set from I can’t remember the name but it comes in three densities dumb face and you use the special the special process to finish it but it is actually a pace are you talking about yeah it’s a face it’s a base it’s in a tube but you don’t use it as much as you would use like toothpaste just a bit and polish it so it gives you a nice nice nice finish yeah and how that on answer work do you have is it common in your practice have people coming every three to six months for a cleaning if they in our practice they do every six months but our hygienist doesn’t so you have I dentist yes the office that I work and we have a hygienist and what what percent of the offices would you say have a hygienist now since its kind of knew i’d say maybe five percent I’ve said and I and I’m not surprised that you’re in the five percent so Ali got you for three minutes on um what what do you wouldn’t what do you want to close on in three minutes I don’t know mmm how odd it yes go ahead um how could we get more on um I want to do a podcast interview with the dentist from every country I just think that would be cool if you have any uh friends and Austria Italy hungry whatever I would love to fix me up I i think that would I I didn’t get so interesting cuz i think i’d say you wouldn’t have a problem finding some from it italy i think there are at least five or six guys understand from italy and they post some really good work so i think from italy won’t be problem and well I’ve done some podcasts with Italian doctors you got any friends and Hungary in Austria no I’m not really maybe somewhat in Croatia Croatia I love crazy crazy that the on the beach the beaches in Croatia are just as gorgeous as the ones in Italy but it’s just a fraction of the price and the cost of the resort I mean for every whatever cost a dollar in Italy what would you say it would cost on the resort on the beach in Croatia well I think it’s not that much cheaper anymore overland yeah because when you look at the Croatia they have a lot of German and Dutch patients the tourist center that drives a bit the price of you know and you know what the most undeveloped beaches on the Mediterranean that are the most beautiful and my opinion is Albania yeah that’s really you can you can go find beautiful beaches in Albanian there’s just there’s zero development for as far as the eye can see yeah yeah and they’re looking at this thing wow this could all be resorts and condos and I mean this that means just gorgeous well hey that is our time and I just want to say to you seriously I think your name is rock are okay and you are a rock star dr. rocks turn big fan who knows I I can’t think of a you only graduated in 2012 yeah and here i am

working for two years yeah and you’ve only worked two years you’ve got a thousand post of some of the most amazing cases on dentistry i mean i’m trying to think about when I was two years out of school I I look at where I was two years out of school and I wonder if I had feet so to my wrist instead of hands I you I i use I can’t think of one kid who’s done more the first two years out of school than use so buddy uh you’re a rock star uh yeah it’s ten am right now in Phoenix what time is it in Slovenia seven pm-7 p.m. all right well it sounds like it’s time for dinner good luck with your knee surgery and thank you for all you’ve done for dentistry and for dental town thank you all right bye bye