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VIDEO - DUwHF #876 - Luke Kahng
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AUDIO - DUwHF #876 - Luke Kahng
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Luke S. Kahng, CDT, is a world renowned master ceramist with nearly thirty years of experience as a dental technician. He has developed a national and international following. His mission is: build the world’s best high-end dental laboratory - with affordable prices for all - in Naperville, IL.
The lab handles all aspects of restoration cases. As Owner and Director of Operations, Luke trains and oversees LSK121’s team of 40 technicians who fabricate fixed, removable and combo-implant full-mouth restoration cases. Luke utilizes his decades of experience to ensure that LSK121 maintains its reputation for providing high-quality, world-class, sophisticated work.
Through his passion for providing the most natural – looking and life-like restorations possible, he invented his own revolutionary shade guide system in 2009 to help dental professionals everywhere who struggle with shade matching and color. In 2010 he updated the system, finally creating his Ceramic Shade Guide system in 2012 which currently provides the most detailed shade tabs available for clear and succinct communication between dentists and laboratories regarding tooth shades and characteristics. It is a world-wide best seller.
His lectures have been presented both nationally and internationally, creating world-wide sales for his shade system and his various books, including Anatomy from Nature, Esthetic Guide Book and Smile Selection Plus CS3 Clinical Cases. In 2016, he will again publish a book about custom shade matching entitled Replicating Naturalism, with over 300 illustrated pages of real patient cases in hardcover format.
He regularly publishes articles in various dental journals, since 2005, totaling over 110 at this writing. The publications he has worked with are among the following: AAED, QDT, The Journal of Cosmetic Dentistry, Inside Dentistry, Dentaltown, Dentistry Today, Compendium, PPAD, Spectrum Dialogue, Teamwork, LMT, Dental Lab Products, Inside Dental Technology and JDT.
www.LSK121.com
Howard: It is just a huge honor for me to be podcast interviewing Sukwon Kahng all the way from Naperville, Illinois, and he is with LSK121 Oral Prosthetics - and it's LSK because in America it's just easier to go by Luke, so, he added Luke, but his real name is Sukwon Kahng, CBT, is a world-renowned master ceramist with nearly thirty years of experience as a dental technician. He has developed a national and international following. His mission is build: the world's best high-end dental laboratory, with affordable prices for all - in Naperville, Illinois. The lab handles all aspects of restoration cases. As owner and Director of Operations, Luke trains and oversees LSK121's team of forty technicians who fabricate fixed, removable and combo-implant full-mouth restoration cases. Luke utilizes his decades of experience to ensure that LSK121 maintains its reputation, providing high quality, world class, sophisticated work. Through his passion providing the most natural-looking and lifelike restorations possible, he invented his own revolutionary shade guide system in 2009 to help dental professionals everywhere who struggle with shade matching and color. In 2010 he updated the system, finally creating his ceramic shade guide system in 2012, which currently provides the most detailed shade tabs available for clear and succinct communication between dentists and laboratories regarding tooth shades and characteristics. It is a worldwide bestseller. His lectures have been presented both nationally and internationally, creating worldwide sales for his shade system and his various books, including 'Anatomy from Nature', 'Aesthetic Guide Book' and 'Smile Selection Plus CS3 Clinical Cases'.
In 2016 he will again publish a book about custom shade matching entitled 'Replicating Naturalism', with over three hundred illustrated pages of real patient cases, in hardcover format. He regularly publishes articles in various dental journals since 2005, totaling over one hundred and ten. The publications he has worked with are among the following: AAED, QDT, The Journal of Cosmetic Dentistry, Inside Dentistry, Dentaltown, Dentistry Today, Compendium, PPAD, Spectrum Dialogue, Teamwork, LMT, Dental Lab Products, Inside Dental Lab Technology and JDT. Luke, I can't tell you how honored I was to get you to come on the show today. Thank you so much for spending an hour of your precious life with me. On your lab name, LSK121 Oral Prosthetics, where does the 121 come from?
Luke: Actually, the Bible, Psalms 121.
Howard: And what is that quote? Psalms 121.
Luke: Where does my help come from.
Howard: [00:02:56] Text me that, right. [0.6] What does it say?
Luke: It says, "Where does my help come from, who made the heaven and earth."
Howard: Wow. So, your name is from Psalms and when you came to America from South Korea, you chose the name, Luke. It sounds like you're a very spiritual man.
Luke: Try. Try best I can.
Howard: Well, my two older sisters who are nuns, I can already tell, will just love you. So, what did you want to talk about today? You know, I always think dentists, you know, they need to work with their value chain, you know, they need to go meet the dental insurance CEO in their state who's sending them a check for all kinds of money and learn what their side of the business looks like. So many dentists just take an impression, put it in a box, mail it around the world and I feel, so many dental laboratories, they need to communicate more with the dentists, but a lot of times the labs say they're afraid of some dentists because they're afraid if they say, “This impression isn't very good”, that they'll quit using you as a lab. What percent of your clients do you feel safe with, where you could say, Hey, Howard, this is a horrible impression, your preps ugly, you didn't give me enough reduction. How many dentists make you feel safe to share your side of the story so that the patient gets better dentistry versus how many are you kind of afraid to piss off and lose their business?
Luke: Well, we are so lucky because I established my business 1996, which is almost two decades, and then I went through all of this story, which is I've been there. So, what I'm currently, right now, probably only five percent, they decline, or I hesitate to tell them, but most of them, over ninety percent dentists, they're really good. Meaning, we work together, we communicate together, because we must handle with a lot of complex cases, from the fixed and the removable and implant and removables, so those kind in a lot of complex cases, we talk together, we work together, we are really fortunate. We only, I would say, probably five percent, that's about it.
Howard: If you're a dentist listening to this right now, when you get to work ... Howie's homework for you today is, I want you to call your lab tech and say, Look, I want you to feel safe with me. I want to be a better dentist. I don't want you to be worried to give me feedback. And, in fact, also you should go to your lab - even if your lab's out of the State. Well, maybe that could be your next vacation, maybe. I mean, you're a suburb of Chicago, right?
Luke: Correct.
Howard: So, next ... so, if you're using Luke as a client, well, next time you go to Chicago Med midwinter meeting, stop by the lab, press the flesh, run for mayor, because you could probably walk them through the lab and give them a lot of information by showing them cases you're working on.
Luke: Absolutely. Yeah. They all the time did it, they came by my office, they saw my facility, that we personally talk to each other face to face and then we'd discuss about their cases with the complex cosmetic, which is more tough case and most likely more for most types, either [00:06:20] five implant, [0.8] from two implant from locators, do implant from [00:06:24] Hader bar [1.0] or four implant or [00:06:27] room for tie-ups, [1.2] and then we're talking about a denture, All on Four [00:06:30] [...] full mouth zirconia with [3.6] the layer or [00:06:35] mano, [0.7] or we can offer them a titanium base with top of the single crowns, cement together. We're talking about the occlusion. So many things we can share. So, we are so lucky, most likely we got a lot of spouse cases and dentists cases, fathers cases, we all the time discuss with the big case and communicated in order to finalize it. Which means we have a tough case which is I love it, it makes me feel better and alive. Instead of the single, I don't know much about talking about single, especially whoever sent me [00:07:13] triple tray and, [1.4] like you said, I want to be a better dentist. They have to change the impression technique, which means a full arch impression and then communicate with [00:07:23] the coloring through [1.6] email. So, I want to see the documentation instead of them talking about drawing. Probably, they said A1 or B1, all the time say that is not much difference when you prescribe A1, I give you A1, what look like crown is A1. Is that better? No. So, a lot of dentists confused, why do they have to use LSK121. There's a reason. I would highly recommend them to use with a picture with the shading guide, and then write it down, what do they need, and then we can choose a proper [...] selection from the opacity and transparency. So, we try to match the patient's mouth as much as possible and then that one's better, you know, idea.
Howard: It seems to me, watching your career over the years, that shade guide must be a big problem because you've spent so much time working on it, shade guide. I mean, is that a big problem and that's why you've spent so much of your career perfecting a new shade guide?
Luke: That's exactly because we've been work with traditional company, which they said A1, B1, 3D color, [00:08:46] vida, [0.4] shade tab, which is great, great guide. The problem is, is you know who need the crown? Most likely elderly people. Who ... if someone need a crowd, twenty years old, how did they need a crown, maybe inlay, because they don't have any cavity. Who need a crown? Let's think about it. Whoever has the enamel is gone. There's lot of cavity. They already have a filling but it's not right. They need a crown, or, guess what, surrounded by their teeth is lower opacity, low opacity, which is high translucency. The problem is currently our shade tab is a high opacity, meaning it's not relevant when doctors or technicians trying to take the color in the mouth, it never match it. Only match whoever has fake crown, is a match. So, that frustration lead to me, so, I'm all the time thinking about the label. How can I save my time? And then I'm starting about the high-end technicians, my crown fee, right now about $400 to $600 if I do by myself, meaning they will organize it, they know what they're doing. So, they send the case. They may ... I may [00:10:16] did want to ask about cosmetic for [1.9] most cases but I'm all the time thinking about what's the problem, my employee about education. That's why I had a lot of passion. Anyway [00:10:30] I worked overtime twelve, thirteen hours [1.8] every day. So, I got the natural teeth, his name's David Schubert, is Illinois guy, he's nice guy, super-nice guy. He is a very spiritual guy. He went to Haiti all the time. He pulled out the teeth. I told him, Can I have the all bad teeth? Great. So, he pulled out the teeth, he hand that to me. So, I collect probably three thousand natural teeth. So, I selected. Is really dirty, I mean, really smell is bad. But I organize it, I just mellowed out, not only that, I saw a lot of patients in-house. Fortunately, doctors send patients to our laboratory. So, I took the custom shade and then I write it down, wrote it down all the time thinking. Then I talked to my colleague, which is high end, which is good [00:11:26] create laboratory [1.1] technician. They're all the time say that, Look, it's not possible to organize natural teeth. Well, all the time thinking, No, it is possible. So, I fabricated the enamel. So, I narrowed down. So, I found it was common part, which mean common part is patients, we need a shade guide the low value or medium value. That is more matching toward natural teeth. That's the key. Second, we need the characteristics. Meaning, think about it. If patient is beautiful lady, thirty years old, they bleaching five times. Bleaching, bleaching, bleaching, bleaching, right. So, they have a cosmetic surgery but unfortunately, she broke the teeth number nine. How can you match? So, we have to know those kind of directions. For example, the other one is a manual worker guy, they never brush teeth, but drink the wine, whatever. You see a lot of characteristic stain here and there. So, I made characteristics. Meaning is enamel characteristic creates [00:12:34] line and the [...] of [3.0] a dark color, whatever, so, I made it. So, I narrowed down. So, second key is whoever use my shade tab, it is already match. Now, a lot of dentists ask me, Luke, which porcelain did I use, my technician - I've been using my technician thirty years. I love this guy. And then, you know, I don't know he's [00:12:58] [...] [0.4] or what but here's a very simple: porcelain is porcelain, with the [00:13:02] [...] [0.8] from Vida Company, GC America or any other company is pretty much the same. So, here's a key: enamel overlay to the dentine and then they can put the characteristic. I told them, “We do have a recipe, we give it to them.” Two things I found out. One thing is: technician refuse it, they don't want to learn. Other technician, they willing to learn. But I break down really easy job. My goal is here, I want to match the color with a simple recipe, method, and then affordable price to the doctor and patient - that's my goal.
Howard: Wow, that is amazing. It sounds like with all of what you just said, we put up about four hundred and fifty-one hour courses on Dentaltown and they're coming up on a million views. You should create an online CE course on how to take a shade, your shade guide and other secrets to working better with your lab. I think that would be a very informative presentation.
Luke: So, Dr. Farran, after I fabricated my shade guide, which is called Seasons of Life, so, one shade tab, about twenty, I call young. And then second is middle age, which has twenty shade tabs. Third is elderly person, sixty, and then fourth, I made the occlusion enamel and canine and then five shade tab is custom prep color and gum color. I would say, I do have a lot of fans, they love it, but I do have negative response from them. Number one, they said, “Luke, I got that, looks great, but to me too complicated because hundred shade.” And second, they said, “Too expensive.” So, now I'm almost set up my factory line, I'm trying to narrow down with one shade to thirty, with the [00:15:10] zirconia [0.5] shade tab. We want to launch with you next February. That's so exciting! Then I can definitely [00:15:17] involve more how [1.2] to take color, how to proceeding the match adjacent teeth. Not only that communication, which is a simple photo concept. I definitely, you know, going to help you guys too. Appreciate the offer.
Howard: I know you're driving to work right now so, what I do is I like to re-tweet my guest's last tweet on Twitter so that they can follow me @HowardFarran. So, you're @LSK121.
Luke: Yes.
Howard: I'm going to re-tweet. You just tweeted an hour ago, 'My mission is accomplished. Thanks, Dr. Derrick Johnson, Arkansas. And that was an amazing case.' So, I just re-tweeted that.
Luke: Okay.
Howard: So, let's talk more specifics on ... a lot of podcasters are young, they're more likely be Millennials. And I noticed that you said elderly was sixty and over. You got to get a new name because next week I turn fifty-five, that means in five years I'm going to be elderly! Can we change 'elderly' to, like, 'sexy senior citizen' or 'grandpa with all that and a bag of chips'? I mean, I just don't like the elderly word. I can't be five years away from being elderly!
Luke: I know, good point! But I did not say older, I did not say older. I said elderly. It could be seventy-five. It could be sixty-four.
Howard: So, a lot of these young kids, you know, they get out of dental school and the first thing they need to do for a couple of years ... it's kind of like football, you need to learn your basic block, tackle, reception, pass. They're doing a lot of single units. When do they need to use a quadrant tray, and what type of tray do you like? When do they need to take full mouth impression, and when does that full mouth impression need to be sent to you on a semi-adjustable articulator? Go through the criteria of that.
Luke: Okay, so, you know, sadly the young dentists owe a lot of money after they graduate school. So, I completely understand. They have to pay the bills, they have to buy the car, you know, they have to get a home. So, when they have the single, let's say, molar, you know, unfortunately you have to take the quadrant, a quadrant or a triple tray. They have to, not a problem. But when do they have a three unit or four unit bridge cases, then I recommend a full mouth impression, a full impression is better because I have to see the adjacent teeth - shade and contour, right?
Howard: Now, is it okay to use a triple tray, a quadrant tray, if it's a second molar and you don't have a tooth behind it, or if there is no tooth behind it do you like full mouth, or if you're doing a second molar and a quadrant tray only picks up the first molar and the two bicuspids and canine, is that okay?
Luke: Yeah. Yeah. So, if there was a good crown and the quadrant just took a course there, take the opposing with the [00:18:18] alginate or [0.5] another impression, or they can make triple trays, okay. The problem in triple tray, probably five percent does not fit because they took it out, the impression is wobbling, but that's only negative things. Yes, single crown, you know, they cannot take full arch impression, I completely understand, because when they took the full arch impression, the problem is when I'm mounting together the other occlusion has already erupted or bubbled, meaning I have to re-equilibrate the matter, which means it leaves a high occlusion. So, at that moment, young dentists, they can use triple tray quadrant, totally fine for molar crown.
Howard: You know, the dentist only sees what they use but you get to see what everybody uses. Do you have any favorite triple trays? You know, there's metal ones, there's plastic ones, there's, you know, Premier makes one - what triple tray do you like?
Luke: Well, metal is good, much better than plastic.
Howard: Metal is much better than plastic.
Luke: Plastic, and then I hope they can involve more a digital dentistry, meaning they just ... they have to buy the scanner and then they just send the [00:19:32] STL file [0.5] to laboratory. So, they completely remove the impression materials, that one's another option.
Howard: Okay, well, when you talk about scanner. How many different types of scanners are you receiving? Which ... I mean, 3M makes one called True Definition; there's a bunch of different scanners, there's...
Luke: Shape.
Howard: What's that?
Luke: Yeah, 3Shape.
Howard: 3Shape. Which one is your favorite?
Luke: Well, this is ... I like ... [00:20:01] iTero, [1.1] 3Shape, that one is, you know, most comfortable, most good case. [00:20:08] GC Aadva, [1.5] they're a good scanner too. Just recently...
Howard: GC Admer?
Luke: Aadva. GC America.
Howard: Yeah, GC America.
Luke: Okay, the name is Aadva - A-A-D-V-as in victory-A-as in apple.
Howard: So, A-A-D-V-A. GC America A-A-D-V-A.
Luke: Yes.
Howard: And their North American headquarters is near you. Aren't they in Chicago? You're in Naperville.
Luke: Yes, about forty-five minutes from my office. They do have a great stuff and they made digital scanners really well.
Howard: And also, Bisco is right around the corner from you.
Luke: Correct. They're a cement company.
Howard: Yeah. And do you ever hang out with Byoung Suh.
Luke: Well, we knew each other but not really because I'm more inside the laboratory. My heart is more here. My passion is here. So, I ... this is my problem. I hardly do networking. That's the problem.
Howard: Well, you got to go meet Byoung. He's my buddy and he's right ... I think he's in ... is he in the same town as you? No, he's in - starts with an S.
Luke: Yeah, thirty-five minutes.
Howard: What's the name of that town?
Luke: Schaumburg.
Howard: Schaumburg. He's in Schaumburg. You're in Naperville. So, you like the 3Shape, you like the iTero, you like the GC America. I notice you didn't mention 3Ms True Def.
Luke: Yeah, that one's good too.
Howard: That one's good. Any others that I missed?
Luke: No. There's Carestream.
Howard: Carestream. So, talk about why should a dentist ... I mean, let's say you use Impregum from 3M, that's seventeen bucks of material an impression; a True Def scanner is seventeen thousand. Why should a dentist stop using a $17 Impregum impression or a polyether, and switch to a $17000 3M True Definition scan? Talk to the dentists on why you think that's a good idea.
Luke: Not only they can scan for a single crown, they can scan with identurous cases, they can scan with the partial cases, they can scan with the implant cases. So, we can talk more about digital dentistry. So, we got the information from [00:22:37] STL [0.4] file. So, we do have a printer, so, we've got most accurate, I'm seeing the occlusion, they hardly get the bubble, sometimes I do have a little bit about [00:22:48] [...]. [0.7] However that's most clean and accurate, more great communication, so, they can do more than they think. Not only that, we can do virtual tours. They can do digital planning with us. So, we can make surgical guide or digital denture or digital partial, and not only that, they can scan in then we can design it; we can make the [00:23:16] model list [0.7] too, but I'm not really a fan of [00:23:19] model list. [0.9] So many things they can do. But, impression, like you said, yes. But I will say the thirty, forty percent, they have a little issue here and there, either margin or [00:23:32] after prop the [0.8] model [00:23:34] occlusion [0.5] area has a bubble or [00:23:37] interproximal [0.3] has a bubble. So, then leave us as open [00:23:42] contact [0.4] or a high type bite, etc. That is why. Number one. So, when they calculate the money, I mean, I know there's another costs but initially they don't have to spend money but that's their investments.
Howard: So, what percent of your incoming cases are coming in digital versus impression material?
Luke: Probably twenty percent.
Howard: Twenty percent! And this is 2017, right.
Luke: Yes.
Howard: So, what was it five years ago in 2012? It's twenty percent now. What was it five years ago?
Luke: Zero.
Howard: Zero. When did it start? What year did you have your first one?
Luke: Probably, four years ago.
Howard: Four years ago. So, I was off by one - I said five years ago. I should have said four years ago. My gosh. And what is your ... do you think your remake rate is lower, the same or higher with digital versus impression material?
Luke: Digital is tricky from our laboratory end. For example, I have to see if the digital cases, even though they scan properly, we have to look at it with a computer, which is clearly. So, sometimes it's not clear, but the issue is laboratory need a great printer, model printer, right, so, we do have an EnvisionTEC, it's a great digital, big, huge chunk of the model printer and also dentist company, Genesis, has a great printer too. So, after we'll load with a model to printing. There is related with the accuracy too.
Howard: So, you like the EnvisionTEC printer.
Luke: Right, and also Dentist Genesis.
Howard: Okay, so, you like EnvisionTEC and Genesis.
Luke: Correct, we have a 3D printer here.
Howard: And, so, you mentioned, so, now you've gone from zero, four years ago to now twenty percent - that's a very fast adoption rate. You mentioned five scanners: Carestream, 3M True Definition, 3Shape, iTero, GC America. What is the market share coming in? I mean, who is the most common, the next one? The point I'm asking this is, a lot of dentists feel a lot of safety by market share information because they know their colleagues all have eight, ten, twelve years of college and are buying this with their own money, as opposed to an advertisement. So, it means a lot to dentists. That's why we do the Townie Choice Awards every year because a lot of dentists want to know what everyone's using. So, what would you say is the most popular to the least popular that you're seeing now?
Luke: [00:26:30] Best is pay [1.1] for molar and single types, we do have more GC America Aadva types but whenever we involve the implant and [00:26:42] 3Shape, [0.8] cases will guide.
Howard: So, 3Shape is more coming in with people placing implants.
Luke: Right.
Howard: And GC America Aadva is more people sending in single unit crowns.
Luke: Correct. Single unit and three unit bridge is like that.
Howard: You just mentioned three unit bridge, a lot of people thought when dental implants were going to come out, that the three unit bridge would be dead. Is the three unit bridge dead? What percent of ... when you were replacing a first molar ten years ago in 2007, what percent of those would have been a three unit bridge versus a single implant; versus now, ten years later, in 2017 if someone is missing a first molar, would it be a three unit bridge versus an implant? How has that changed in the last ten years?
Luke: Honestly, not much changing. I don't know why, it is not much changing. I don't know if it is more logically, they have to place implants instead of the grinding adjacent teeth in order to make three unit bridge. But whenever we see the our cases, I don't see much differences. Either way we working with the nationwide dentist, about sixty five percent North America. We have a lot of case from Arkansas, Texas, Florida, California, you know.
Howard: So, what percent ... when a patient is missing a first molar in America, you said its sixty five percent of your business, what percent of the time would a dentist do a three unit bridge versus an implant crown?
Luke: Probably the same.
Howard: But, I mean, but what percent ... you said it’s the same, it hasn't changed over the last ten years, but what percent is it though?
Luke: Right now, three unit, four unit bridge, probably ten percent, twenty percent, yes, quite a bit.
Howard: Three unit bridge would be ten to twenty percent.
Luke: Yes, and four, quite a bit. Yes.
Howard: And an implant crown would be eighty percent.
Luke: No, no, no, no, no. Okay, let's talk about the pie. Hundred percent, right. So, our laboratory, most likely thirty percent about full mouth restorations - full mouth, meaning all are four implants, six implants, eight implants, and screw-retained dentures and screw-retained [00:29:07] zirconia, [0.8] fixed teeth twenty-eight unit or combo K-6 unit attachment and [00:29:13] Hader bars [0.8] so. Our laboratory is very unique, so, I mean, our laboratory, almost about sixty million Dollars revenue. So...
Howard: Six million?
Luke: Yep. About, we do have sixty-three employees. So, we got every day three, four full mouth cases every day. Three, four full mouth cases. Our lab's very unique because I don't know why we don't get much single crown. We do have a lot of full mouth case. For example, I do have a [00:29:47] three implant [0.9] left and right and anterior, they want me to do the wax-up design and make temporary case, not only the lower teeth, I had to re-do about [00:29:56] very old, [0.1] you know, taking out old crown and bridge, and then we make the flex partial lower for temporarily and then when do have a surgery in the two implant, two implant, we have the mobile digital planning tool, so, we make the digital guide too. So, that part about thirty percent. Now, cosmetic, about thirty percent, cosmetic meaning four unit, six unit anterior, eight unit, ten unit anterior, twelve unit. That was thirty percent too. Our single molar, twenty percent. I don't know why. And then three unit, five unit, probably thirty percent. So, our [00:30:32] worst implant [0.8] in running to my name company is very unique, is very real, which is what I'm looking for. Dr. Farran, think about it. A lot of young dentists bought the machine, the mill, and then they just mill, they just make one color is posterior, two, three, whatever. But I don't have any objection. Five years later I will get the four implants. I will get four unit bridge from them. I will encourage them, I can correct their occlusion concept with TMJ and vertical dimension. I could reset up from class two, class three. So, I mean me or my technician, we all the time educate those kinds of fracture which is really working with the combination cases, meaning the temporization implant, implant the fixed cases, night guard. So, that is why is very weird level to reach, is what I'm looking for. So, I'm glad. So, kind of little different [00:31:34] talking, [0.6] whenever you talk to somebody, probably my lab ... other laboratory got seventy percent single three unit, four unit seventy percent. In our laboratory, I mean, over ten unit, probably most like over forty five percent. So, that's the difference. So, that's why I publish with LinkedIn, Facebook, Instagram, Twitter, and ... so that I could show them that's [00:31:59] [...] [0.6] we, you know, new cases we just publish them. So, that's why we are different.
Howard: Yeah, I just went ... that EnvisionTEC, their website is 3HTI.com, 3HTI.com. I wonder what HTI stands for. But, anyway, they say that the EnvisionTEC prints down to a point zero three millimeter accuracy. So, that's the printer that you like?
Luke: Yes.
Howard: What did that cost you?
Luke: I do have a [00:32:30] Vida, [0.2] the big machine. So, around $100000.
Howard: $100000. Wow!
Luke: Yeah, wow. And then, there are machines that we can make the probably forty models a day. Well, include job printing, including [00:32:47] old formatter [0.9] and then I have another small one too, is a [00:32:53] Vida. [0.6] And that one I can do a surgical guide and night guard, we can make that. And then I have a Genesis Model 2, that one I can make the verification index, digital denture. So, I heavily involved digital dentistry, from the analogue side to make the final digital ... digitalize it. That's my goal too.
Howard: And do you like digital dentures?
Luke: Digital dentures has pros and cons, meaning right now currently looking decent. Meaning it's not fancy, it's not high end, but what I can do, I can sit down to do, to make the [00:33:34] gradia composite [1.4] from GC America and then I put the characteristic for gum and the teeth we add with the [00:33:42] Optiglaze [1.0] or composite, we can change it. But think about it, that's a lot of labor. But, what I'm saying, when we receive from the digital identurous cases [00:33:54] that relay read the final [2.3] restoration, for example, [00:33:57] immediate denture. [0.8] That's good. And then a [00:34:01] bite plug [0.5] is good because at the teeth and the back and forth for starter's good. Virtual tool, we could make that as good. So, that's another part of digital dental was, I would say, okay.
Howard: Amazing. So, let's go back instead of the lifestyles of the rich and famous of all these dentists that can afford all these scanners. Let's go back to the poor dentists. You said on quadrant trays, you prefer metal over plastic.
Luke: Correct.
Howard: What about ... do you prefer polyether or polyvinyl polysiloxane?
Luke: Well, it depends on the rigid impression when they have implant cases, as you know, right. So, otherwise they can use polyether, is okay. And I forgot to tell you, you asked me about [00:34:51] semi-adjustable [0.7] articulator, right. So, when do they have six [00:34:55] [...] [0.6] anterior cases. I recommend then face bow or stick bite in a horizontal and vertical. And then we can mounting with any other articulations. So, whenever they have articulation which is more transferable types, I would say, [00:35:12] Artex, Panadent, SAMS, table, [5.0] those are articulation I recommend to them. So, they have another articulation, so, when do they need in full mouth cases, the diagnosis cases, the wax-up, ecoblation, whatever. So, they have to bite the one articulations. If they need the mounting, they have send it to the laboratory. Laboratory have them mounted, for them is a much better idea. But sometimes [00:35:44] cross-mounting has [1.0] a little bit issue, unless they have to do good calibrations.
Howard: So, you were naming those four ... those were articulator companies you were naming?
Luke: [00:35:57] [...] [0.1] is more predictable.
Howard: Which one?
Luke: Sam's Articulation.
Howard: Sam's Articulation?
Luke: Yes, S-A-M-S.
Howard: That's a semi-adjustable articulator?
Luke: Well, you can buy it, but there's a laboratory side. Yes, semi-adjustable articulator too. Perident is good.
Howard: Perident. P-E-R-I-D-E-N-T?
Luke: Yeah, P-A-N-A.
Howard: P-A-N-A.
Luke: Dent. Panadent.
Howard: P-A-N-A-DENT. Panadent.
Luke: Panadent, yes. And Artex.
Howard: How do you spell that?
Luke: A-R-T-E-X.
Howard: Artex.
Luke: And Kavo Articulations are good. K-A-V-O. That one's good too. Yeah, [00:36:54] those are most I favorite their articulations. [2.6]
Howard: Oh, that is amazing. And you said you like polyether, like Impregum, better than polyvinyl siloxane because it's more rigid?
Luke: Right. I mean, depends on their cases. When do they have the implant case of that using the more rigid impression.
Howard: So, if it's an implant case, you want polyether, you want Impregum.
Luke: Correct.
Howard: And what about if it's just a tooth, a natural tooth?
Luke: Honestly, my dentists use both.
Howard: But which one do you like better?
Luke: Well, I don't see much huge differences.
Howard: Okay.
Luke: I'm talking about filling. I'm talking about margin integrity. I don't see much huge differences.
Howard: I was trying to think of those what ... g*d, when I got out of school thirty years ago, a lot of the dentists ... what was that green stuff that you put in the tube, you had the hot water bath and you put in the green stuff. What was that called?
Luke: I don't know.
Howard: You don't? You remember that?
Luke: I don't remember that. I don't remember.
Howard: Oh, my gosh, I can't believe it. It was green, green in a tube and you had these hot water deals, these hot water bags, and you'd have it in there warming it up.
Luke: Wow.
Howard: And then a rubber base.
Luke: Wow.
Howard: You remember that?
Luke: No.
Howard: When I opened up in '87, you could always tell which dentists were over sixty, because they were still using for crown and bridge, rubber base and this green stuff. But you don't remember the green stuff, huh?
Luke: No, no.
Howard: That's funny. But, gosh, you're just a wealth of information.
Luke: Thank you.
Howard: So, okay, [00:38:29] [...]. [0.9] What else do you think ... what do you think are the top things dentists don't realize from their end, that you realize better at the lab? What are you seeing? I mean, they only see their work. They only see what they do. What do you think are better practices that the dentists that you ... how many dentists do you work with?
Luke: Probably five hundred dentists, you know, North America.
Howard: So, when you are dealing with five hundred dentists and...
Luke: Think of it, dentists been using [00:39:05] [...] [0.1] for a lab, as you know.
Howard: Yeah.
Luke: So...
Howard: But you get to use ... but you get to see in-coming work from five hundred dentists.
Luke: Correct.
Howard: The dentist listening to you right now only sees their work. What do you think, what have you learned, what is better, higher quality, faster, easier, higher quality dentistry coming in? What are they doing that is better than the ones that are having more problems?
Luke: Well, number one, as I mentioned earlier, about coloring. The color communication between the lab, patient, dentist, which mean medium value and lower value, in order to increase their productivity and more profitability in the future. So, they don't see much but they have to keep communicating with their laboratory. How can they improve the color in order to make teeth better fit in patient's mouth regardless material selection? And number two, implantology. So, when they have the question about multiple implants or a complex cases, they have to discuss with their laboratory, then share with the final destinations, including patient budget. Sometimes patients don't have very much money, so they have to talk together about that one. And then third, they have to talk about the occlusion too, about the occlusion contact, [00:40:34] [...] or [...] contact. [0.5] So, they have to talk to the technician too. And then, you know, unfortunately lot of lab, to be honest with you, is not qualified. [00:40:47] Just like we've made a living every day, doesn't mean crown. [4.2] They don't know what they're doing. Just made, you know, just a cookie cutter, just made it, just made it every day. So, I completely understand dentists' thinking, but they have to find out why lab technicians they discuss together and then, for their goal, I mean, most people their goal is different. Yeah, I can prep the thirty crown, I can prep the fifty crown, whatever. It depends on their goal. They want to be great dentistry, or they want to make a living. But they all the time talking about the laboratory. And so, I recommend them they have to contact the laboratory regarding implants and digital dentistry and, you know, I only mention it, something like that.
Howard: So, there's a thread on Dentaltown today and I wish you'd weigh in on it. It says, Question for lab owners regarding [00:41:39] alginate impressions. [1.1] This person is working for a dentist and the dentist, when they take alginates, will put the alginates ... they routinely ship their alginate impressions wrapped in wet paper towels, in a Ziploc bag and they ship that to the lab owner, who's going to pour them up two days later. What do you think of that technique? What do you think of when they take alginates, wrap it in a wet paper towel in a Ziploc bag and then send that in to you?
Luke: Okay, only thing they have to worry about it, when they took the alginate, do not use a paper towel and soak in, otherwise that alginate will going to erupted. Otherwise, it is okay, they can wrap it around the water but depends on the weather. They have to [00:42:27] pour up the, you know, model [1.7] immediately. Immediately! That's my recommendation. Otherwise, it will going to erupt the teeth, so, it's not going to fit, the final whatever they want, night guard, is not going to work.
Howard: I just remembered what that green stuff was called.
Luke: Yeah.
Howard: [00:42:43] Hydrocolloid. [0.9]
Luke: Oh, that one is good too! I love it.
Howard: You love that.
Luke: I love it. I still have some case from the doctor. That's great accuracy too. The problem is I don't have any second model. They only pick the only one model.
Howard: Okay, now I'm going to ask you the most controversial question in all of dentist/dental laboratory relationships. Remakes. Who pays for the remake, what's fair? You know, some dentists say, Well, it didn't fit, it's not my fault, it's your fault, you remake it for free. A lot of the labs are sitting there saying, You. I feel bad about this because that was a horrible prep, a horrible impression. Hell, you sent me a quadrant impression and it still had the bloody cotton roll in it. Do you still have dentists sending you impressions with bloody cotton rolls stuck in the impression?
Luke: Very little, but that's not huge effect, but effect meaning eruption, effect meaning margin integrity. So, so many things. So, usually we remade for them. But, we all the time recommend them take the impression. You will get problem. So, we usually eat it. However, when you have a more issue then we recommend the doctor, we not the right laboratory for you. We can explain that because people are not going to change it. We cannot keep on remake without, you know, charge it but, we just stand behind them, but we trying to train them. So, nobody like the remake, right. So, do you?
Howard: So, you're saying that if the lab should recognize that this impression is not right and send it back, and if the lab doesn't recognize the impression is not right and goes and makes a crown that doesn't fit, then you remake it for free.
Luke: Yep. So, but, here's the thing, is criteria. Number one, is really bad, really bad meaning I cannot read margin. Absolutely send it back. Number two, I see this slightly bubble, right. We can cut it. We make them happening. Number three, we just work with their impression. For example, when we have a full mouth cases, let's say fourteen unit lower. They prep the individual teeth. Now, I notice, even though doctor took the three impression, I notice that after pour up the model, number of twenty-eight, number of nineteen has a bubble. We call the doctor. We let them know. And then you will get remake this [00:45:21] open margin. [0.0] However, we make everything for them. So, we expect the two crown. Usually, I don't charge them. Why? You know how hard it is take the fourteen single crowns, take the impression? How hard is you call the patient, have them come, give them numb and then take new impression? No, I'm not those kind of guy. I just eat it two crown. Well, surprisingly, everything is okay. Probably, I'm right, or something like that. Or they send me one crown, everything cemented, and take the one impression for twenty-eight, we no charge them. It's very fair to them. So, depends on the cases. Single impression so bad I had to call them, we let them know, single impression, single crown, small bubble, no problem. But fourteen, especially twenty-eight teeth, and the three bubble, hard to read it, we made it here. And then we let them know, three crown will get a problem. So, we replace for them. Why? There's twenty-eight teeth. It's a very expensive cases. So, we give them benefit.
Howard: A lot of people are talking about, you know, E-Max versus zirconia. I want to talk a little about that. To me a lot of the discussion is crazy. Like, I've been talking to you right now for fifty minutes.
Luke: Right.
Howard: I have not laid eyes on any of your molars. I mean, you know, when people start talking about cosmetic just ... I almost think they're insane because I'm a dentist. I am always talking to people. I don't ever see people's molars. Like, all my restorations. Have you seen any of my restorations?
Luke: Yeah, I saw that before.
Howard: They're what?
Luke: I saw that, yeah, when you talk, I saw the one molar over there.
Howard: And what was it?
Luke: No, just color. I saw this color.
Howard: But what color was it? What kind of restoration was it?
Luke: I don't know.
Howard: Well, I only have seven restorations in my mouth, they're all gold inlays and onlays.
Luke: Right, okay.
Howard: And no-one ... you just don't see them.
Luke: Right.
Howard: So, I hear these people talking about, “Well, it's the first molar, and she's pretty and she's a girl and, you know, do you think E-Max is, you know, should I do zirconia?” It's like, “Well, first of all, how about you just realize no one's ever going to see it.” I mean, look at people, go on Facebook. Go on Facebook and scroll for an hour at every girl taking a picture of herself eating pizza at ... you know, you just don't see these molars. So, you know, I think it's crazy that people don't do gold on at least their maxillary second molars. But, what do you think about first molar? Let's just only talk about first molar, because when you look at a hundred million insurance claims, you just have four huge spikes on the four six-year molars. It's basically this, there's [00:48:21] barely units crawling [1.9] along and then it spikes at number three, fourteen, nineteen, thirty-one, that's the tooth most likely to have a filling, a crown, a root canal, extracted, an implant. So, going back to just the four six-year molar, do you really care if it's [00:48:39] Empress or [1.3] zirconia?
Luke: Well, here is the thing, is I all the time put my priority. Longevity, number one. Number two, cosmetic. So, depends on adjacent teeth, so we can utilize with longevity. I don't like the fracture. So, we can go to zirconia [00:49:01] [...]. [0.3] Right now, zirconia technology is so fast, so we can utilize more [00:49:06] centering [0.7] techniques or make the colors better. For example, when whoever has the grinder, [00:49:11] [...] [0.9] grinder, so, you have to go with [00:49:14] [...] [0.0] or zirconia is better, or full gold crown, right.
Howard: Right.
Luke: So, E-Max full model is not going to work for that. But beautiful lady, [00:49:22] [...] [0.9] not much grinding. I want to go to E-Max because less, I mean, higher translucency, you know, almost all. So that's why, yeah. Highest translucency and beautiful aesthetics, so, I can go with that E-Max with who has the no grinder. But whoever grinder, I can go to zirconia or gold, like you said. But, using my goal, no matter what, regardless they see or not, whenever we open it, my job is here, I want to make the better. I want to make better. That's it. Then we lay with another next year, next five year, then is a crown, same thing. Five years later then is the anterior, same thing. So, eventually, they got the natural, life-like restoration from us. That's our company goal. So, that's a different concept, meaning I trained my technician, we've got to be right if doctors send a good color with the photo. We trying to match it. But otherwise, you know, Dr. Farran, what is the difference? Other lab already made it, A1, chop-chop, crown cookie cutter, right. So, what is difference? That's the difference - longevity and color and opacity and depends on what patient grind or not, that one has led to ... I just want to talk to the young dentists, so young dentists can do the better job.
Howard: And when you're doing zirconia, what percent of the zirconian single unit crowns for a first molar, are you making ... doing CAD/CAM?
Luke: Probably seventy percent.
Howard: Seventy percent. And what are the other thirty percent?
Luke: Thirty percent E-Max. I'm sorry. I'm sorry. Let's put it this way, probably sixty percent, I would say fifty percent zirconia and thirty percent E-Max, twenty percent [00:51:20] PFM. [0.4] Still they love PFM. I don't know. I do a lot of PFM.
Howard: I know why.
Luke: Why?
Howard: Because there's a lot of people that say, okay, you bite down on something, you hit a piece of grit. Well, if the ... on a PFM the porcelain chips off, that's the weakest point. When you go to zirconia, and that zirconia is not going to chip, there's a lot of endodontists that think what's going to give is the root canal is going to crack.
Luke: Okay.
Howard: So, a lot of endodontists are talking that they like PFMs because they don't want the weakest point to be the endodontically treated tooth.
Luke: Yes.
Howard: And so, the real question is, are we seeing more failed root canals that are fracturing and having to be extracted because they had a zirconian crown versus something a little softer, like E-Max or a lot softer like a PFM or what I chose in my mouth, is all gold. I like gold because the only restorations I did thirty years ago that looked better today are gold.
Luke: I agree.
Howard: Because it's soft and malleable. And I remember some of these patients exactly where, you know, I was almost not wondering if there was a good enough fit or this or that. And now you see it thirty years later and it looks like somebody welded it to the tooth. I mean, it's soft, it's malleable, and every time they chew on it, it just gets better and better and better. That's why. And it's sad because, you know, Caucasian, European women in America don't like gold. I have no problem selling it in Arizona to my Native American Indians, my Hispanics from Guadalupe, my African-Americans from South Phoenix and Ahwatukee. They love gold.
Luke: I see.
Howard: They love it. But it's just, I mean, this is Dentistry Uncensored, and I know this sounds racist, but the problem is, it's just white women. White women don't like gold. And they tell you they don't like gold when they have seven gold earrings, a gold bar through their nose, a gold bracelet, a gold wedding ring, they have gold all over their body. So, I think gold is the best. But the ... I think what will be interesting over the years is finding out if the zirconia is too hard for root canal endodontistry. So, my question to you is, are you seeing more of these PFMs on endodontically treated teeth?
Luke: Yes. Some, some. But I'm not [00:53:52] seriously [2.1] notice it, but I notice it we got a lot of PFM. And probably five percent, three percent, is full gold crown. Yes. Well, maybe that's one reason about behind a story, like you said, which is I just heard about you because I'm not a dentist. I'm not clinical guy.
Howard: But, you know, when you go to other countries, like, when you go to Africa and Asia, beautiful women, sometimes on an incisor, will go with a full gold crown, and they're just rocking it, and they look beautiful and they're gorgeous women and they have no ... and sometimes they just put gold dots in their teeth, the gold foils. I know a lot of dentists that the only reason they learned how to do a gold foil is because girls in Cambodia and Indonesia and Malaysia and Johannesburg and Soweto, they come in and they just say, I want three little gold spots, you know. So, yeah, gold is [00:54:46] sad. [0.6] So, what else do you think ... I know a lot of the young kids are driving to work right now listening to you thinking. Well, what kind of prep do you like? What is your favorite prep?
Luke: I like deep chamfer.
Howard: Deep chamfer. And it doesn't matter if that's for zirconia, E-Max, PFM or gold?
Luke: Yeah, everything, yeah. Gold is ... you can do the [00:55:08] fatters, fatters not [2.7] a problem.
Howard: Let's call this podcast 'Fatter's not a problem'. I just like that. I mean, when you're short, fat and bald do you ... I think we should just name this full podcast, 'Fatter is not a problem'. So, you like a deep chamfer...
Luke: Yeah.
Howard: And let's take that zirconia, E-Max, PFM and gold and arrange those from the one that needs the most reduction to the least reduction. Which one do you as a lab man need the most reduction for: gold, PFM, E-Max, zirconium, to the least reduction?
Luke: Most reduction for E-Max.
Howard: E-Max would be the most.
Luke: Yes.
Howard: What would be second?
Luke: Zirconia.
Howard: Really? Zirconia over PFM?
Luke: Yes, zirconia, I need more reduction is better because sometimes most of doctors say it won't break but it will break, because [00:56:02] [...] [0.3] break the teeth and they will break. So, I need a little bit more reduction, occlusion, one millimeter, that would be great too.
Howard: So, how much reduction do you need on the occlusal for E-Max versus zirconia versus PFM versus gold? How much reduction?
Luke: E-Max I'm comfortable to about 1.5 millimeter.
Howard: 1.5. Zirconia?
Luke: Yeah. Zirconia, probably 1 millimeter.
Howard: One. PFM?
Luke: PFM is 1.5 at least. 2 millimeter is best because...
Howard: So, for PFM, 2 millimeters?
Luke: Yes, metal or pack. I'm talking about, in order to make life-like restorations, a good-looking crown. You know, if I make the bad opacity crown, yeah, I can get a 1 millimeter, but they will get the bad B1 color, which is not attractive. That's why young dentists think, “Why do I have to using the LSK?” Same thing, just like that. So, I need the more reduction for a PFM, that would be great.
Howard: Nice, nice, nice. I only got you for three more minutes. I can't believe this has already gone fifty-seven minutes. Any other advice you can give these young dentists. You get to see incoming work from five hundred dentists, sixty percent of which is in America, or sixty five percent.
Luke: Out of State.
Howard: What else would you recommend that she does? What other better practices do you see?
Luke: Well, you know, I'm getting old too. So, if I...
Howard: How old are you?
Luke: I'm fifty-one.
Howard: Oh, I'm even older than you.
Luke: I know. But I've been dedicating my life about this here. I felt like more old ... but I'm sorry, but what I'm saying, I ... the all they can do, they have to set up the more highest career, highest expectation. I want them to do better work every day. Then eventually, when they're forty, turning fifty, they will going to do the high-end work, for sure. So, we can make a better United States and they will help make the better restoration than anywhere. That's my message to them. So, we can make the natural, life-like restoration. We have technician and dentist knows more better than European, you know, dental industry people. So, that's my highly recommend to the all young dentist. That you have a dream. I know they cannot pay right now, but they can set up the goal, about ten years later, they took the lot of journey for the high-end course and then they can do the better their work. So, instead of see the thirty patient a day, I want them to see them five to seven patients a day. So, that's my recommendation. Appreciate your time, Dr. Farran.
Howard: And, if they're coming to the Chicago area, you don't care if they come by your lab and look around and learn something?
Luke: No problem. I have [00:59:02] [...], [0.1] I do have a lot of staff.
Howard: Your website is LSK121.com.
Luke: Correct.
Howard: And the name of your lab is LSK121 Oral Prosthetics. I want to ask you one last question, a political question. They say you should never talk about religion, politics, sex or violence. So, let's start with ... let's just have one on politics and that is, in the last thirty years, these dental schools have all closed down their CDT programs.
Luke: Right.
Luke: Now, if all these dental schools would have closed down their registered dental hygiene programs, dentists wouldn't have hygienists. And when I go around the world, you know, I've lectured a thousand times in six continents, like Hong Kong, their dental school has a larger class of CDT students than they do dental students. Germany, it seems like Germany is one of the only countries serious about training certified dental laboratory technicians and their status and the years of training and they get Mastership, and it's like the Germans ... and think of the Germans, they make Mercedes Benz and Porsche and Volvo. What does America make? Chevy, Ford, Chrysler, I mean ... and the difference is, Germans are serious about training dental laboratory techs and Americans closed them all down. I think there's only three programs left in the United States. So, my question is, do you think that dental school deans should go back and revisit that decision to close down CDT schools? Do you think your laboratory would be well-served if you had a supply of people coming out of dental schools that, you know, the dental schools, they graduate dentists, they graduate hygienists, but do you think they should graduate certified dental technicians?
Luke: Yes, I, you know, completely agree. But the sad part, even though they do have a two-year college degree, the problem is the college don't have any highest technology than we have. So, the problem is they only knows about terminology, how to do here and there. So, was my thinking is pros and cons. So, it depends on the laboratory require, depends on laboratory need it. So, if dental laboratory school will revival, that'll be great, but they have to teaching more future dentistry, more high-tech, then laboratory owner can get a lot of employee, then we are win-win situations. That was all, yeah, I completely agree what you're saying, but we have to make some good program for dental technicians.
Howard: Okay, well, you're the ... an amazing high-end laboratory technician. I know you're busy, I mean, my gosh, you're one of the largest high-end labs in America, and, Luke, I just want to thank you so much for coming on the show today and talking to my homies about how they can do dentistry better.
Luke: Thank you, sir.
Howard: All right, have a great day.
Luke: Thank you, you too.
Howard: And go see ... go have lunch with Byoung Suh.
Luke: All right.
Howard: I guess you'd have so much talk about. You were both born in Seoul, Korea. You're both in dentistry. He's one of the most amazing people I've ever met in my life. Gosh, that guy, he is so smart. You and him should be best buddies.
Luke: Okay. Thank you very much.
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