Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

Blog By:
howard

Websites, Emails, Phone Numbers and Products Mentioned:

                        
• 3M ESPE Permadyne - http://www.3m.com/product/information/ESPE-Permadyne-Penta-H-Impression-Material.html
                        
• Hint-Els 
                        
• Uwe Mohr email address - Uwe@Smartceramics.com. 

Howard Farran: 

It is a huge honor to be interviewing today one of my all time idols in Dentaltown. Uwe Mohr is born and raised in Germany. Uwe is a master dental technician, MDT, did I say that right? 

Uwe Mohr: Correct.

Howard Farran: And for the American audience, I just want to tell you why Uwe makes me so excited. In America we have hygienists because the universities got involved and created a curriculum for dental hygiene and they have two years of undergrad prerequisites and they go to two years of hygiene school, it’s a four year program. It’s like a registered nurse and America basically got out of the laboratory education 30, 40 years ago. All these schools closed down all these programs and I’ll never forget, Uwe, this is embarrassing to say as an American, when I opened up my practice there was a lab man and I was over at his lab and we were talking to him and I wanted to see his set up and all this and he was mixing up the stone and he spit in it. 

When he spit in it, first I thought I didn’t see it and then I said did you just spit in the stone? And he goes yeah. And I go why did you spit in the stone? He goes there’s something in saliva that makes it so when you pour it up it doesn’t have bubbles. And I thought oh my God, and this is what happens when you don’t have formal education and in Germany, America- and I’m sorry if this offends all the Americans, but it’s how I feel and I always want to be honest with how I feel, there’s too many people lying to you and there’s political leaders to have another person lying, I’d rather have someone tell me something I don’t want to hear and know that at least they’re telling me what they really feel than wearing a suit and tie and lying to me- and I believe that the only two countries that have mastered manufacturing are Germany and Japan. 

They make the best cars, they make the best dentistry, they make the best everything and so you’re a master dental technician and you had to do four years of an apprenticeship. Explain the process of what it took, because it took you basically 12 years. You could have been a periodontist or an oral surgeon in the time it took you to learn how to make crown and bridge. Tell them your curriculum from Germany.

Uwe Mohr: Well it’s actually very true. The master’s degree is there so that the technician can be on an educational level with the practicing dentists or prosthodontist. That’s why we have to go through what we go through. To be from the beginning, first of all Howard thanks so much for letting me be here. I mean it’s nice to see you again. Last time I saw you was when you were here in Toronto. I enjoyed that very much. 

The dental technician’s program in Germany, as an apprentice, you have to apply to a dental laboratory. Then you go through a selection process in the laboratory that will vet your basic skills. You then get accepted and it’s a government sponsored contract and you do what’s called dual education. You spend three weeks in the lab and then one week at college so your education in theory teaching is the same as in practical learning. They’re supposed to match. So when you’re in the denture department, you do dentures at the college too so that’s four years. You have to graduate and you graduate with what is the equivalent of a CDT in the States. 

Then you have to do eight years of post graduate studies, you’re supposed to, to learn specified techniques. You have to learn for example milling technique, you have to learn telescope techniques, you have to learn implants, you have to learn ortho on a master level and you have to learn dentures on a master level and the way you do that is go study with the best master technicians out there giving the courses and if you’re lucky like I was you have a master technician who is an expert in one and he was an expert in pathology, so then you apply to master school. 

Applicants- 99% are set to fail. That’s the government standard that is set. They want the top 1% enrolling in master schools. So you have to do a theory exam and a practical exam to be permitted into master school. Then you do your training in master school, again with the top lecturers in the world and learn further skills, and they update these techniques all the time. Like back then, laser welding came in. Now we have digital printing, we have CAD/CAM printing, CAD/CAM milling, all these things now you have to have at a master level in Germany. 

So then you do your final exam which is a two week exam and before you do that you do your theory exam which is two week’s written exam. Not multiple choice, written. So you have to actually know the answers and explain them. Then you do your practical which is every possible appliance on the planet you can think of, ortho appliance, I had to do a Bimler appliance, you have to do full dentures, you have to do absolutely everything on a master level and the failure rate there is set at 90% so the top 10% graduate. 

Howard Farran: It’s just amazing and you know American always want to say we’re the largest economy in the world and I want to say that in 2014 when the numbers rolled in at the end of the year, the IMF said China eked out ahead of the United States are now 17.6 trillion and the United States is number two at 17.4 trillion but when I go, when I live in the United States and I’ve been to 50 counties, so much of our economy is just repeat because it’s all garbage. 

Do you know how many times in my 52 years life we’ve had a plumber come out to fix a toilet and they don’t even get down the street and it’s broke again. So much of the American economy, I suspect that if that 17 trillion, probably three trillion is just rebuying junk because it didn’t last the first time and I had American cars my whole life and basically each car should come with a full time mechanic just tied up in the trunk. 

I bought a Lexus and now my Lexus is 10 years old, has 100 000 miles on it and it hasn’t blinked yet and I’ll probably get 250 000 miles out of this Lexus and the only thing that I don’t like about it is now 10 years later the stereo system isn’t up to date but I just had some guy plug, hang a wire out there so I can plug my iPhone into my stereo system but what I love about Germany is I’ve been in dental companies all around the globe and when you walk into a German dental company, I want to tell you the difference between a German and American company. 

When you walk into an American company, many of them, especially in the one million to hundred million range, you say well where is your Ph.D., engineer, scientist developers? Oh we don’t have any. And then they have a call center with 60 people dialing for dollars.  

Then you go into Germany and a small company that only does like maybe say 10 to 15 million a year, has five to ten Ph.D.’s in white lab coats working on the product and then they don’t even have a telemarketing center and they don’t even really understand advertising. They’re mindset is a product speaks for itself and in the German factories you can eat off the floor. I mean and they have lines on the floor like this line goes to the boy’s room, this line goes to the front desk, this line goes to the office. Every light switch has markings on the side. 

I remember a long time ago, like 30 years ago, they rolled out the space shuttle Columbia, and here’s the space shuttle Columbia and there’s this big words on the side fuel here, with an arrow. And when I first saw that, I said are you kidding me? I don’t have that sign on my car and I gas up my car. Why would NASA need a sign with an arrow for the top of the space- what are these guys crazy? And they go no, NASA was built with Germans and Germans, everything is a system, everything is explained, there’s only one way, it’s all that quality control, it’s all that redundancy and so I always joke that there’s basically three camps, the Germans, the Americans and the Chinese. 

The Chinese is we’ll make it so cheap, you’ll have to buy it. The Germans are we’ll make it so good, you’ll have to buy it. The Americans are I don’t care what we sell, we’re so good at advertising and marketing, we could sell shit to anyone, all day long. 

They all need to learn from each other. The Americans need to learn more about Ph.D. and education, the Germans need to learn more about marketing and advertising- and I also want to ask you a question, on your program that you studied, is there anything like that in the United States or Canada? 

Uwe Mohr: Well Canada, let’s go one step back into qualify this. In Germany, everybody working in a dental laboratory has to be a CDT. The only people that don’t have to be qualified by a degree, the office staff and the cleaning staff and the rest have to be trained dental technicians that have completed an apprenticeship. So even the person in the plaster room will be a CDT and more importantly in the larger labs in Germany they will have a master technician to run each department so there will be a master technician overseeing the plaster department, there will be a master technician overseeing the clasp partial department. 

That’s not unique to dental technology. My hometown is Stuttgart where the Mercedes factory is. All my friends growing up worked in the Mercedes factory. You hang out with these people, you find out what anally retentive German mean. Literally you could eat off the floor. 

Howard Farran: Absolutely and you can tell by driving their product. You can tell by driving a Mercedes or a Porsche. Is it pronounced Porsche or Porsch-a? 

Uwe Mohr: Porsche. 

Howard Farran: Is there anything like that in the United States or Canada? 

Uwe Mohr: Canada has a program and it’s a little bit different by provinces. I wish they would federate it. In Canada if you want to own a dental laboratory you have to employ or be an RDT, registered dental technologist. That’s a two and a half year program at George Brown College. The problem with that program is it is about 50 years old. The technology they teach is outdated 30 years ago and you don’t qualify with a degree. 

You have to then spend another two years in a commercial dental laboratory under a RDT and then you have to do your exam separately. Most people choose not to do the RDT exam because by that time they either left the industry or they’re bored. 

The United States has some programs but as you mentioned earlier, they’re just shrinking away. They’re getting put out of existence because mass production is what’s being done. There’s very few high quality laboratories and you will find these are all small guys like me, one man shows, two man shows. 

Howard Farran: I also want to say that I thought there was a massive lesson lost. When I got out of school in ’87 there were 15 000 laboratories in the United States that had a mailing address that people like LMT were mailing a magazine to and now, 25 years later, there’s only 7 500 so we’ve lost half the labs. A lot of this moved to China and a lot of people say well China- because it was labor intensive and it was just cheap, but I’ve got to ask you something, does that make sense to you dentists out there? 

My take on it going to China is that their only dental school in Hong Kong has more students in their crown and bridge laboratory than they do in dentistry. It was the minds rolling out of that lab that set up all those laboratories like Modern Dental Lab and you just can’t go into a village in China and the next thing you know they’re making crown and bridge. It starts with government infrastructure and a lot of Americans, I think one thing about Americans: they all don’t like government. They all want less government, they don’t want any government, they don’t want to pay any taxes, they just believe this liberal laissez faire but it’s a partnership working together. It’s the government, it’s the people, it’s business, it’s the family, it’s the individual and China got behind crown and bridge laboratory at the dental school level, rolled out some highly educated young men and women and they went out there and built some amazing labs and when I went to Modern Dental Lab in Shenzhen which has about 4000 employees I was amazed at the order and the sophistication and they take every step as serious as a heart attack and they’re just trying their hardest. 

What is that guys name out there- Patrick- there’s another one, it starts with a G- anyway, Godfrey! Do you remember Godfrey? 

Uwe Mohr: Sorry somebody just walked in on me. No, just give me one tiny second, sorry I hate to do this. 

Howard Farran: Sure, take your time. 

Uwe Mohr: Okay first of all, China started because the need was created by the United States because big laboratories, mega laboratories that had up to 3000 people on the floor started pumping out cheap quality work and cheap work which people decided if it’s going to be that cheap, China can do it cheaper so China filled the void that was there but it was in my opinion created by the big US laboratories that wanted to capture all of the market by making it cheap and putting it beyond the production cost of the average laboratory in the US. 

If you look at some of the super skilled people we have on Dentaltown, there is no way in the world they can produce a crown for $100. They’d be losing $200 if they did. So China filled the void. 

I trained a lot of people in Asia, I was in Singapore 1987, 1988 and we were setting up the biggest outsourcing laboratory in the world at the time, long before Glidewell came along. We had at the top of the line 500 people per shift but that was gigantic back then. Now you go to Shenzhen and you have building after building after building where they have 5000 technicians in there and the products are not all bad. 

I always have this argument on Dentaltown. The quality coming out of China is as good or can be as good or better than what mass production laboratories in the States produce and vice versa. There’s laboratories in the States that produce world class quality. If you look at the concept in China, like the big laboratories, you will find a lot of German master technicians there running shifts and running departments and running whole floors and that’s what the concept is built on, because if you’re doing 2000 crowns a day you have to have a system in place and the best systems and the most organized systems come from Germany. 

They have the model systems, they have the workload systems and if you train by department and compartmentalize the product you end up with a much better product in the end. 

Howard Farran: So first of all, I’ve got two questions for you. The first question is, you were born and raised where they made Mercedes Benz? 

Uwe Mohr: Yes and I’m third generation dental. My grandfather was a dentist, my father was a dental technician. At age nine I was making custom trays in his laboratory. So I’m damaged. 

Howard Farran: When you look at the history of humanity, most last names are associated with your occupation, like a Smith was a blacksmith and when I grew up in Kansas most everyone goes into the family business. If your dad was a wheat farmer, dairy farmer or a corn farmer, whatever, family businesses, that’s still romantic to hear. I’ve heard stats that one third of all dentists in the United States have another dentist in their family. 

When you look at- I don’t know the exact example for Mercedes but like for GM, they have a low cost Chevy, then a Pontiac, then an Olds, then a Buick, then a Cadillac. So do you see market segmentation in dentistry in crown and bridge laboratories where there’s a market for a Mercedes Benz but there’s a market for a Chevy and a used car? How do you summarize that in your mind? 

Uwe Mohr: There absolutely is and it’s a necessity what you have to in today’s market, I do most of my work for clients in the US so I know the market fairly well. There are people that provide very good dentistry but they are in areas where they simply cannot ask more or where HMO’s and other insurance companies pushed them down into a price that they simply cannot afford to get a $300 crown so as most laboratories, small laboratories like me cannot compete in that market. We have a certain cost for producing our products that we cannot match the big laboratories. That’s where the Glidewell’s and the Burbank’s and all those big laboratories come in, they can service these markets- they can make a profit on $100 crown. 

Is it the same quality as a $300 crown? I dispute that but there is a market that needs to be serviced and you can’t punish the patients for only being able to afford a certain amount of money so you have to provide a product at that price to them. 

Howard Farran: I like the way you said it, you can’t punish the patient for not having the fees for a given market. So you said you’re a two man operation, you and one other person? 

Uwe Mohr: Yeah I have a friend come in every now and then. He’s an expert implant technician and metal technician, he helps me out when the load gets too high he does the smaller cases. I’m sitting here, I’m pretty much doing full arch cases most of the week. That ended up being there because I don’t know, misbehaved on Dentaltown or whatever but it worked. 

Howard Farran: So I’m a huge fan of yours. You have 10 000 posts on Dentaltown. You’ve been a Townie forever. How long have you been a Townie? 

Uwe Mohr: It’s got to be at least seven or eight years. 

Howard Farran: Seven or eight years, so you said most of your clients were from the United States. Did you find a lot of them on Dentaltown? 

Uwe Mohr: I do get frequently get clients through Dentaltown. Also because I spend some time in US laboratories I had certain people following me, calling me up if I wanted to do their work now that I’m back in Canada so it works both ways. I do some other publications and it seems like every time I publish a case either on Dentaltown or on somewhere else on the internet that the phone starts ringing because it’s a type of work that’s not done very often and that’s not because I’m special or whatever, that’s just a master education, that’s what we do. You get trained basically, the master technician is the prosthodontic degree in the dental technician field. 

Howard Farran: I pushed out a case of yours a week or two ago didn’t I? 

Uwe Mohr: Yeah. 

Howard Farran: Did that generate any phone calls? 

Uwe Mohr: Actually it did, it’s nice to hear it and I always love it when Townies call. Even, like the majority of calls are enquiries and it may or may not lead to me getting the case but it’s nice and I’m always happy to discuss cases and this is one of the reasons why I email a lot of pictures back and forth and any which way it goes. In doing that we can get to a different level of discussion. 

Howard Farran: Well if you ever post a case on Dentaltown that you want me to push out, email me, send me an email howard@dentaltown.com and say here’s a great teaching case. If you think you’ve got a case where you’re teaching something and it will be great to push out, I would love to. 

Uwe Mohr: I would love to. I’m doing a few, I’m very fortunate, Dr. Aaron Garg, his office sends me a few cases and he requires me to document everything from beginning to the end so I actually do get patient pictures from stage on all the way to insertion pictures so that’s probably something that would definitely be worthwhile and with the quality of teaching that he does on the surgical side, it’s nice to be associated with that and show cases like that because you get a completely different quality of work out there. 

Howard Farran: Aaron Garg, the implant teacher out of Florida? 

Uwe Mohr: Yeah. 

Howard Farran: Yeah amazing guy and he’s got the hands-on, surgical implant deal in Dominican Republic is it? 

Uwe Mohr: Yeah he just opened his own institute over there. It’s finally finished and they did the first couple of hands on courses over there. It’s amazing what this guy does. 

Howard Farran: Yeah, a go getter. So first of all I want you to explain to our listeners, you have a $300 crowns, you’re a one man show. What is it that you mostly specialize in? Is it mostly- do you do single unit crowns or is it mostly full arches? Tell them what you do. 

Uwe Mohr: I do everything and literally I will be sitting here doing bite splints or doing dentures or single crowns. A laboratory, a German trained technician has to be able to do everything. You can’t just say I only do crowns, or I only do dentures. There is no specialization. In Germany when the phone rings and there’s a pickup, you don’t know what it is until it comes to the lab. It could be a denture repair or it could be a fourteen unit implant case. You have to be able to do it. So we don’t specialize, not like the laboratories in the United States that want to do just crown and bridge or just ortho. 

So we have to do everything. I do a lot of single crowns, I do a lot of regular crown and bridge but predominantly full, complex cases. Somehow I ended up with that, I don’t mind it. It’s nice. 

Howard Farran: Let’s focus on the dentist listening. I love these podcasts because they’re exploding on iTunes. I think the reason podcasts are a big hit is because I think most humans are too ADD to sit in a chair and read a black and white book. They like listening, the biggest feedback I get is people that say I listen to the podcast when I’m an hour on the treadmill, on Saturday mornings it takes me four hours to do the dishes and do the laundry and sweep out the garage and I’ll listen to four of them, in fact the biggest complaint I have about the podcast is I don’t do enough of them. They want at least four hours a week. 

So talk to this dentist sitting on his treadmill. What could dentists do better to make your job- I have a feeling that at your level of training you’re probably not getting stuff sent to you good enough? When do you need full mouth? When do you need upper and lower impressions versus a quadrant tray? What impression materials do you like? Do you like receiving optical scanning impressions better than physical polyvinyl siloxane or polyether? Educate the dentist on how he or she could send you what you need to do the type of level work that you can do? What’s the low hanging fruit lessons on that? 

Uwe Mohr: Actually some of my best clients that I work with now started out sending single crowns and like you mentioned is the impression good enough or not, and they send it to me to see if it was good enough and we ended up discussing exactly what you mentioned. A change maybe in impression technique or impression material or optimizing the impression material with a material that I know is good. So I’ve been with a number of my client, I’ve been working with them for many years and seeing the level that they’re at now and what they’re putting out now and the confidence that they have developed and also accepted advice from me which training course to go to in the States, which lecturer to see. 

I know you’re a big fan of John Nosti, everybody that ask me questions I send over to John. If they want to go to the lecture, if they really want to learn how it’s done properly. For me if a dentist contacts me to learn or to listen to certain techniques, I may not end up doing a lot of work with them because sending to Canada is a bit of a pain in the neck, but I’ve got a good procedure in place, but I don’t get all the work that I talk about. I don’t get all the work from all the clients I talk to and speak with on Dentaltown or private phone calls. 

I like the fact that the ones that call me want to learn and want to improve and I’ve been doing this, this is my 43^rd year this year. 

Howard Farran: Wow. 

Uwe Mohr: Yeah!

Howard Farran: Did you start when you were 12, because you look great buddy. 

Uwe Mohr: Thank you, it’s my 59^th in a couple of weeks. 

Howard Farran: Well happy birthday!

Uwe Mohr: But it’s the German beer that keeps the face young. 

Howard Farran: So do you drink it warm or out of the refrigerator? 

Uwe Mohr: No, cold, cold, cold. 

Howard Farran: Really? I thought in Germany they like it warm? 

Uwe Mohr: No that’s England. 

Howard Farran: So England is room temperature but Germany is cold? 

Uwe Mohr: Yeah England especially, the Guinness room temperature, other than that no Germany, beer, cold. If you serve warm beer in Germany that’s reason for being kicked out of the country. 

Howard Farran: So what’s your favorite German beer? 

Uwe Mohr: Hacker-Pschorr. I know it’s impossible to pronounce. 

Howard Farran: Okay but let’s get specific and name names, like if I was going to send you my first, just a standard, single unit crown on an upper first molar, let’s say number three. Would you want polyvinyl, polyether or would you want an optical scan and what brand would you use? Is there a difference? Is all polyether, polyether? Is all polyvinyl? Are they all the same? 

Uwe Mohr: No there are reasons why some are cheap and some are expensive and if you look at the manufacturers you can see why. Personally my absolute favorite of all is 3M ESPE Permadyne, the heavy body and Permadyne which is basically Impregum but modified in viscosity. 

Howard Farran: So it’s a polyether? 

Uwe Mohr: It’s a polyether. What you get with the heavy base of the polyether and then the light body, the hydraulic compression during the impression taking presses the light body substantially better into the sulcus and into the margins. A lot of cases where these days we prep equigingival, no need for retraction cord. A lot of no prep veneer and veneer cases can be done without cord. The detail I get and I can see because I’m looking at my work under sterile microscope, I trim my margins under 20x magnification. If it’s there, it’s there. If it’s not there then sometimes you can play with it and sometimes you have to pick up the phone and say we’re going to try this again. 

Howard Farran: Okay now are you talking about laying- you said 3M ESPE Polyether Permadyne, is that the purple? 

Uwe Mohr: It’s pink. Purple is the Impregum. 

Howard Farran: Okay purple is the Impregum. 

Uwe Mohr: The Permadyne is pinkish and then the heavy body to that, sorry the light body to that is blue and that comes in an cartridge. A lot of people buy the machine because polyether is a bit of a pain in the butt to mix and your assistant will break a wrist if you do that all day long. 

Howard Farran: Yeah I use the 3M ESPE Impregum in the machine. 

Uwe Mohr: And that’s perfect and you will find the Permadyne itself is a tad lighter in viscosity than the Impregum. It’s the same material, it’s a tad lighter. 

Howard Farran: Now when you said hydraulic, now do you want them to take a heavy body impression and then take that out and then push the light body and use the hydraulic? 

Uwe Mohr: No, it’s all in one impression and the positive result that you’re getting, because you inject the light body around the prep and on the occlusals everywhere you want it to be. Then the heavy body of the Permadyne is so dense, it compresses very much and you do get a hydraulic effect without doing two stage impression. 

Howard Farran: Okay and some dentists when they lay the light body down, I know Gordon Christensen was a big fan of air spraying it down because he said if it sprays off the tooth, it was wet, you need to put more or whatever, do you like that or do you just think laying the light body down and then setting the tray with heavy body is best? 

Uwe Mohr: Well today with the auxiliary equipment that you get like OptraGate and all these where you can keep the work field very dry, it’s substantially better impressions than if you work in a moist environment. Some polyvinyls claim hydrophilic impression, I haven’t seen them work as well although I have seen some people getting extraordinary impressions. If you’re talking about the real hydraulic impressions like the blue mousse technique, Howard Goldstein was amazing with those impressions. He got really, really good impressions and now he’s working for you. You took him away from dentistry.

Howard Farran: When he hit 30 000 posts I said no, it’s so much finer to find a person to join your team who already had the behavior naturally. 

Uwe Mohr: I mean you’re a genius for hiring him. He’s one of the nicest people, I’ve had the pleasure of meeting him. I consider him a good friend of mine. He’s keeping me in the straight and narrows on Dentaltown. I used to misbehave in the past. 

Howard Farran: Have you noticed all the best guys in dentistry are named Howard? 

Uwe Mohr: Apparently so. There’s another guy down in Florida, Howard Chaslin, who’s one of the best practitioners you’ll ever see in your life. 

Howard Farran: Yes. Big time Townie poster. So some people are saying that the optical impression are far more accurate and that when I mail you an impression, say I mail you an impression and it goes into a UPS truck in Phoenix, Arizona and it’s 110 degrees outside. They’re saying, and then it goes to Canada where it’s 10 below zero. Is that affecting the impression? Are you receiving any optical scans? What are your thoughts on that? 

Uwe Mohr: I like optical as much as I like polyether. I mean it’s a very good system. It’s definitely here to stay. The technology is, let’s put it this way, more accurately, there is more technology coming over from Germany and Japan in particular now that make this a much better system. I installed a system 12 years ago in England, I set up a head office for a chain of dental laboratories and the first things we bought were two $250 000 milling machines that could pump out 150 crowns each a day. Optical scanning or scanning impressions or things like that, that’s 12 years ago in Germany. They’re finally coming around. There’s a number of laboratories in the States that are bringing machines of that level in. 

There’s a lot of milling machines in the States but not at that level. With these machines I can mill a complete implant bar including the interfaces and the denture base and the retention pins for a denture all in one block. That technology has been there for 15 years. A lot of the products don’t come to the States because the suppliers don’t want to bring them in because it costs them a lot of money to register each product with the FDA. 

So a lot of the products that is common use in Europe is not being used in the States because the suppliers don’t bring it in. You literally have to go out yourself and find it. There is some great technicians and laboratories in the States that brought in a lot of systems at a very high cost, sometimes more than double the cost of what the system costs in Germany because there’s no distributor or supplier there. 

So it’s considerably more expensive to do that in the States whereas in Germany it’s commonplace. Even a two man lab in Germany would have their own milling system worth $150 000 or $200 000. 

Howard Farran: Is this one system you’re talking about? What is the name of this one system or are there several of them? 

Uwe Mohr: There is now several. Back then there was one, the company is called Hint-Els. They are represented in the States now, I believe Dave Lesch has at least one machine, there’s a couple of more out there. 

Howard Farran: David Lesch in Texas? 

Uwe Mohr: Yeah and there is the scope of that system is tremendous. Now Germany, the health fund, and many other countries in Europe, the health fund will pay you a PFM crown up to the first premolar on non-precious. That’s paid in full by the health fund. If you want to change to alloy you pay the difference out of your pocket. They will pay you for a full metal crown from the second premolar back, if you want to change that you pay the difference but the cost and everything is covered, you just pay for the material. So in England where we set up this system, NHS in England pays non-precious only and back then we were milling titanium. We were milling close to 200 copings a day in titanium and there’s porcelains that can give good results. I’m not happy with the long term results because of the way the titanium is treated. There’s better systems but that’s what we were doing at the time. British health fund is non-precious. 

Now a CAD/CAM milled titanium coping or non-precious coping you can get a puck for any milling machine out of any material in Germany, you can even have high gold or 24 carat gold, it makes no difference. You pay for the material yourself. I can do a 10 unit titanium bridge or non-precious bridge as a PFM bridge. The fit of those and the material properties of that is far superior that a cast product because with casting you introduce gases in the case of titanium, quite volatile gases into the system whereas when you have milling from a pure titanium puck, you don’t have those contaminations. 

So CAD/CAM milled titanium or CAD/CAM milled chrome cobalt crown will be better than a cast alternative. 

Howard Farran: Now as far as porcelain bonding strength, well first of all tell me this, what are your thoughts, so there’s 5000 graduates a year in the United States and they’re coming out and they’re writing their first lab script. What should they be thinking when they’re checking that lab box of porcelain to full gold, porcelain to semi-precious, porcelain to non-precious? Help this 25 year old kid, what should they be thinking about those three different types of crowns? What are the pros and cons, price, quality, aesthetics, what’s going through your mind Uwe? 

Uwe Mohr: First of all they should be calling up the lab and having a good chat with the lab owner. Not a customer service rep like you mentioned earlier, you know having 20 people answering phones all day and reading off a script isn’t going to do anything for the quality of your work of helping you make up your mind. You want to talk to a qualified technician who deals with you. We’ve got a number of really, really good guys on Dentaltown that will be able to help any young graduate in the right direction. What you want to know and what’s missing in most university teachings here is material properties. Nobody ever talks about material properties. They talk about E.Max is going to cost you this much or PFM is going to cost you this much, and then they workout their scope. If they’re working as an associate they may get some help. They don’t really know the material properties of each crown. 

If you’re looking at a standard PFM crown, you have a MPA of anywhere between 140 and 170 for the finished porcelain. The gold may be 700. That doesn’t do you any favors if you design the crown wrong or if you under prep or if the laboratory makes mistakes and doesn’t apply metal support then that crown will fail, no matter how good the gold is. It’s the way the porcelain is designed. That’s the standard PFM porcelain. Then you’re looking at something by comparison like E.Max as a pressed- milled is 370 MPA’s, pressed is 400 MPA’s. I can put that, and I do, I haven’t done a PFM crown in I don’t know how many weeks because everything is E.Max these days. 

When you’re working with those compressive strings you can help an inexperienced operator achieve a very good result by choosing a material that’s better suited to the purpose and that’s what you need to talk to the laboratory about before you pack up that case and try to work out the script, call them up. Guys like me, you have Rick over there and you have Bryan and all the great technicians on Dentaltown, they’d be happy to answer a phone call even if you don’t send the work there, they’ll still talk about material properties. What’s your favorite crown? 

Howard Farran: And sometimes I throw my colleagues under a bus saying a lot of dentists are very book smart, but a lot of them aren’t street smart and I think when you’re street smart and book smart you go crazy. Like for instance so many of them think that to learn just a little bit of information, they have to pay $5000, fly to another city and take a three day course in some big brand name and when I got out of school, there was a German lab out here, Wolfgang, do you know Wolfgang? 

Uwe Mohr: It’s a very common name. I don’t know it personally. 

Howard Farran: There was this older German guy with the same accent as you and I called him up and he said you know it would be a lot easier if I could show you, would you come down here? And I went down there, I swear to God he spent half the day with me and he was showing me all this, and then every time I had a question, I’d just say can I come down there and that, sometimes it was an hour, sometimes it was two hours, someday I observed half a day and it was free and he was my friend and he was in town and I didn’t have to buy airplane tickets and so street smart- you’re right. 

Log onto Dentaltown. I mean even the online CE courses for 18 bucks, and the dentists won’t do that. Then they’ll spend $5000 on a three day weekend and they didn’t even fund their 401K this year. I mean you could learn so much high quality information for a low cost. 

So is going from PFM to E.Max, do you think that’s a good thing for our industry? 

Uwe Mohr: Oh it’s perfect and CEREC in particular helped us with that for laboratories because so many dentists have bought into the CEREC system and they’re doing their single crowns in the operatory and the material itself is a really good product. I’d put them on second molars without problems if everything else is correct but it helped pave the market for E.Max. E.Max itself is a fantastic product. I don’t know how many thousands I do a year but it’s my main product. I have four pressing furnaces here for E.Max. When it rolls, it rolls. 

Howard Farran: Uwe, you might not know how smart you are compared to how we started when we rolled out of dental school but you’re throwing around the term MPA and 300 MPA, explain what the MPA is and what that meant for the kids who that flew over their head? 

Uwe Mohr: Alright, dental materials for crown and bridge in general get measured in two levels. One is the hardness of the material which is generally measures in Vickers and then you have the compressive strength which is MPA. For example, as a material when you go back to Procera Alumina and you go back to VITA Alpha you have a compressive strength of 140. That’s why you saw a lot of fractures in those materials because in a challenging environment if the excursion and crossover isn’t adjusted properly, you will see fractures on those in no time whatsoever. The crown will split down the middle. 

In PFM’s where you have the older type porcelains, when you’re looking at Ceramco, it was very, very widely used in the US. Nowhere else in the world but in the US. VITA VMK 68 came out in ’68 and that had far better material properties but it was too expensive for the American market and it wasn’t distributed very wisely because the guy who owns the company is particular, shall we say. Much better porcelain and compressive strength and material properties. Ceramco for example would sheer off and it would sheer off because the technician made a mistake, not designing the metal support properly. Compound that with a porcelain that had very poor sheer resistance with 148 MPA, any time you have somebody bruxing horizontal or vertical clenchure that would destroy that crown in no time and then you had to start all over again. 

Ray Bertolotti invented the crown because there was so many bridge failures that you had to invent a crown to slip over the top of an existing bridge in order to stop remaking the bridge. That’s how bad the properties of the material were but that was the best porcelain available in the day. So now we have even regular VMK porcelains that come up to 190, 200 MPA’s. They are much better and much more durable. 

Also the educational level of the general dentist has gone up and we have to blame you for part of that because it’s really dentists now know that you can’t put a crown into a anterior case or posterior case that’s not suited to it and you have not calibrated the bite or you have not taken the patient into consideration, you have not analyzed the case. Does he need a MTI or a night guard after he’s received a crown and one of Howard Chaslin’s favorite saying: it’s no point putting something in there if you don’t address the circumstances. It’s going to break like the natural teeth did. 

Howard Farran: Since you’ve mentioned Howard Chaslin twice, can you do me a favor, when we’re done call him and tell him that I want to do a podcast with him? That would be a great follow up. 

Uwe Mohr: He’d be very open to that. He’s a nice guy, one of the nicest down to Earth guys out there. Amazing clinician. 

Howard Farran: You mentioned John Nosti and he’s the one before you and then you, and you mentioned Howard Chaslin so I think for our viewers, if you called him and he was the next that would be a great flow. So this kid coming out of school, opening up their office and on Dentaltown you hear E.Max, you hear Bruxzir, what would you tell that kid? What’s the difference between E.Max, Bruxzir? 

Uwe Mohr: Well I would tell them to do exactly what you did. If you really want to know the materials, go and spend a day or two in the laboratory and see what a laboratory has to do to get a good result out of one of those. You can put a Bruxzir on anything, whether or not it will stay there is a different matter. Whether or not it destroys the opposing dentition because you didn’t adjust it right, that’s for the dentist to learn, but the material properties and the applications, you cannot do better than go and spend a couple of days in a lab somewhere. That’ll teach you more than any course because if you see what a technician has to do to get that result that a dentist wants- I’m fortunate I work with some amazing dentists, I’ve also worked in big commercial laboratories where you get 500 impressions a day and you’d want to send back 250 of them because that’s the reality out there. 

There is still a lot of impressions that are taken poorly, either with the wrong material or the wrong technique and the big commercial labs have to push those through otherwise they lose half their turnover. So in laboratories like that, you need to have an education department or somebody responsible to teach the dentists the steps they want to take. Most of the dentists are quite happy if they get advice on how to be a better dentist and how to get more out of a certain product. 

Howard Farran: And tell our viewers about your Dentaltown continued education course you put up. 

Uwe Mohr: The crown and bridge is not quite complete yet. Howard is pushing me, Hogo is pushing me to do that. It’ll be done very soon. 

Howard Farran: And what is that going to be like? What is that course going to be on? 

Uwe Mohr: I wanted to focus on standard laboratory procedures for implant work because there is a few steps in the laboratory that can make it a lot easier for the dentist along the lines of what I do with Dr. Garg, starting a case with the final outcome in mind, what Misch postulated, you have to go back from the functional aspect of the case that you want to finish with and work your way back from there. It means you have to start with a denture set up or a diagnostic wax up. We do these with the flanges removed so the dentist can visualize where the bone is missing and it shows you from the tooth position where the implant should be and then the dentist has to go and work out how to get the bone there or go with an alternate route and that’s the main focus of my work really, is these types of cases where we have cases- most dentists inherit a case. 

The patient walks in with an implant, what do you do now? That’s the situations I get a lot of phone calls from where he suddenly goes okay, this is what I’m stuck with. So we want to go back and show dentist simple steps that every GP can do even if they don’t place the implants themselves, to visualize first and analyze the case to see how complex the restoration will be. Placing single implants or three, four implants is okay but when you go in a situation where there is major bone loss and several grafts have been applied and failed and you’ve got to go back into that scenario- the patient still wants fixed teeth. Nobody wants removable teeth anymore as such so you’ve got to be able to, as a laboratory, you have to be able to supply the dentist with all the information he needs to make up the decision which way he can go so he can present this to the patient and say you have three options, you have option A which is the cheapest, you have option B which will get you by, option C is the Mercedes and that will get you for the rest of your life. 

So the complexity of that isn’t very well known and the treatment planning is the part that’s lacking. 

Howard Farran: You know the first thing Carl Misch told me, like I think it was 25 years ago, I got my fellowship in the Misch institute a quarter of a century ago and he said the reason he thought he was so successful in implantology was because first he mastered dentures, removable dentures, long before he ever did an implant and he said he started noticing that these dentures on implants that other people were doing, the dentists were complaining that the implants were cheap because they were snapping, and Carl is looking at the denture saying the denture and the occlusal and the bite is so bad, that’s why they’re breaking and what you just said, start with the restoration and work backwards. 

If you can’t visualize the finished case, the bite, the occlusion, the aesthetics before you go and start placing implants it’s kind of backwards. 

I want to get back to the optical scanning. So dentists are hearing all these companies, you can’t go to a convention and throw a cat without hitting three different scanning companies. 

Uwe Mohr: And they’re getting better, that’s the good news. 

Howard Farran: But walk us through because Uwe, they get stressful when the decision is going to cost them like $100 000, to upgrade from a two dimensional pano to a three dimensional, that’s 100 grand. To get into CAD/CAM, E4D or CEREC SIRONA, that’s 100 grand. Some of these lasers are 50 grand. These optical scanners, can you help this dentist make a decision? There’s different companies, there’s different prices, I’ve heard some of them will put the machine in and just charge you per scan- help this dentist because I look at the search data on Dentaltown and the highest searches are usually associated with the highest amount of money to solve the problem. The mission of Dentaltown, all I wanted on Dentaltown is a place where anybody who works in dentistry doesn’t have to be alone. 

So if you’re sitting in your one man lab or you’re sitting in your one man dental office and you’re pulling your hair out, you can go to a place and find other people like you. So help this dentist wrap around. So let’s say they’re out of school five years, they’ve got $300 000 in student loans, they bought a practice for $400 000, they’ve got a house for $250 000, help them make a decision, should I buy an optical scanner and pros and cons, help them with that decision. 

Uwe Mohr: Well the market for optical scanners is much better now. We get much better scanners, different systems, even some of the older systems they have now updated and you can compare the difference in quality level, the upgrade Redcam Bluecam with CEREC. Substantial difference. What I would do the same as a young dentist or as a new dentist into that particular market, get whoever is willing to come and demonstrate the machine in your office or get invited which I recommend a lot of dentists to do, call somebody you know who has the system or call a friend who knows somebody, go there and spend a couple of hours or a day with that product to see how it works and if it suits your work style, your work flow. Even the best system in the world may not work for you because you work differently. You have different requirements at what you do. 

What you perceive as quality may not be what the next guy will perceive as quality. It may not suit their purpose and style of what they want to do. There is way too any systems out there, you have iTero for example which has come a long way, the CEREC scanners themselves have become substantially better and if what I hear is right the architecture will soon be opened up to more centers so you can go on more systems. 

The limitation of the CEREC is the size of the blocks. In Germany milling centers work with hockey size pucks. The CEREC takes a very small block. We mill on completely different systems and that’s what I get into- one, two man shows, even five man shows, we can’t afford $30 000 for a scanner and software, we can’t afford $150 000 for a milling system, that’s just out of our purchasing range but I can receive scans, I can manipulate scans, I can design everything and then send it off to a milling center that mills it to my specifications and by doing that I’m actually getting the best possible product. I can send it to BIOCAD for example from my implant bars. 

I can send it to a milling center like Lesch or other people that will mill the block out of the material that I require without me having to have a capital outlay of $200 000. 

So for small labs it’s actually easier, I believe, to get a better product into the market because look at the big labs, they have 300, 400, 500 thousand dollars of equipment invested, the software is out of date by the time the system gets installed. You know how software improves all the time. Most of the software sold in the States doesn’t include the rights to the implant bodies, the scan bodies. If you look at the Preto system for example, it’s my favorite zirconia milling system. The guy is amazing. Enrico Steger who founded the company is an amazing dental technician, he was an amazing dental technician long before he got into this work. He used to lecture all over Europe on his system. I was fortunate to study with the same master that he studied with so I followed him for a long time. 

The systems that he has out are technician focused, they’re not dentist focused. They’re solution focused to give the technician the best possible product to give to the dentist. If you look at others, CEREC to me is an extremely limited system because I can only do a three unit bridge, that may be good but for a laboratory to buy a CEREC to have in the lab, the same amount of money you get a Roland or other digital mill that can do you 100 crowns a day instead of eight. So you’re looking at it differently from a dentist point of view than from a technician’s point of view. 

What you scan, a lot of the systems now are open architecture, means the file can be emailed to the laboratory and the file can be manipulated in the laboratory and either milled in house or sent out. That’s what we want. We don’t want closed technology so as a laboratory we want open architecture files. We don’t want to be having to purchase for example $4000 SIRONA software so that we can manipulate the file and then send it off somewhere. 

Chairside scanners, you mentioned there’s people offering them for free as long as you send to them, that’s a viable route if somebody really does a lot of dentistry. If it’s just an odd crown here and there you’re losing money. So for the dentist, find a friend who has the system or go on Dentaltown, ask if you can sit in and go to somebody for a day and learn a different system and you will find the one that’s good for you and that’s gives you the results that you want. 

Howard Farran: Now be careful how you answer, so I’ll give you a moment to think of the answer, what if one of my listeners wanted to ask you? Can they contact you or email you? 

Uwe Mohr: Any time. My phone and my email box, I get a lot of contacts from Townie, I’m very happy to answer any enquiry. I’ve been doing it for years. I’m not the only one, there’s many other labs out there who are happy to do it. The good thing is with Townies, you know that somebody is calling you because they really want to have an answer or want to learn something and vice versa, they know that you’d be happy to answer the question. I’ve been doing it online for I don’t know how many thousands of pictures I’ve got out there, it’s got to be at least four or five. 

Howard Farran: Are you willing to give that number or email address now? 

Uwe Mohr: Absolutely. It’s Uwe@Smartceramics.com or my toll free number 1888-

Howard Farran: No, don’t give them a telephone number, God if they’re asking you, don’t be paying for their phone call. It’s alright okay what’s that number? 

Uwe Mohr: 1 888 264 0787. It’s also in my signature on Dentaltown, everything’s been there for years. 

Howard Farran: People always ask me what my toll free number is, I’m like really dude? I have to stop my day, answer your question and you want me to pay for it? Really? 

Uwe Mohr: But that’s how we get business. This is part of the price you pay. Literally 90% don’t eventuate in anything of the calls that I get but 10% that come through are nice and interesting cases. Some of them are very challenging and I love that stuff so for me this is part of the business. I’m always happy to give advice even if the case doesn’t come to me. 

Howard Farran: What I want to remind people all the time is the 80/20 role, 80% of dentists when they get home at the end of the day, they’re done, they’re spent, they check out, they want to open up a German beer and watch football or check out and I look at those dentists who go home from work and they log onto Dentaltown and they’re there for hours and it’s the cream of the crop. It’s people who want to be a better dentist so if you’re a listener out there and you’re all alone, the German masters, that’s the type of quality on Dentaltown and people are just absolutely going for it. 

So Uwe I’ve only got you for three more minutes. I want to ask you a philosophical question. You said you’re turning 59 in a couple of weeks? 

Uwe Mohr: Yup. 

Howard Farran: And you’re third generation dentistry, I just want to ask a big macro economic question: in your whole life that you’ve spent in dentistry, is the dental profession, the dental laboratory business, is it getting better now? Is the playground better now than when you started a long time ago or it is going the wrong way, is it going the right way and where do you think it’s going in the next generation? 

Uwe Mohr: That question you’d have to really make country or continent specific because there is a disparity between areas. Germany in the 70’s I got into in my apprenticeship, the materials and equipment were only just about emerging. Like VMK 68 had just come on the market and the techniques, we did the first platinum foil crowns and things like that to experiment with that. Now you have everything computerized, you have CAD/CAM milling systems, you have light cure materials so you don’t have to cut and solder your bridge three times, you get something that casts that fits. The materials as such have improved. 

As a side effect the technology and the products have improved. Training in the States has decreased substantially for dental technicians. It’s literally falling away, within five years it may be gone completely. There’s a couple of big laboratories that are to blame for the demise of the small one man shows, you mentioned a number of labs that existed way back then, if you go on to NADL website you see literally there’s 30% left and a lot of the guys out there that are really good are in my age range so what’s the next generation of technicians going to be doing? Nothing but CAD/CAM and have people who never waxed up a crown design a crown on the computer screen. That’s the big problem. 

You mentioned customer service. They will have 50 customer service reps on the phone but only one CDT out of 500 employees. There’s only one person there who has actually done formal training. Again the law is the same in Germany and most of Europe, everybody working at the bench has to be a registered certified dental technician. You go to Japan, look at the ceramists that Japan brings onto the market because they way back then brought a couple of German technicians over there to teach the Japanese, the Japanese masters became world teachers on their own. They’re putting out quality now that most ceramists can’t even touch let alone think repeating. 

I’ve lived in Australia for 12 years before I came to Canada. The technicians in Australia are amazing but again you have to be a RDT. I worked in England, the best technicians we had available in England were South African dental technicians, certified South African technicians, the training program in South Africa is absolutely amazing. They’re putting out technicians that are really, really on a world level. 

You do have an awful lot of very talented and skilled technicians in the States but they’re all specialists. You will have a top ceramist, you will have a top denture guy, we have a lot of them on Dentaltown, but you do not have the overall specialists and specifications that Europe has so there is a disparity in terms of overall training in particular because there’s nobody out there willing to train these people. There’s not enough money in there. If you can get a guy walk over the border from Mexico in the morning to do your ten gold crowns a day you’re not going to hire somebody that costs you $100 000 a year. 

Howard Farran: So what would be the solution? For dentists that are involved. Yesterday on the podcast was the current president of the American Dental Association and the president elect coming in Carol, a friend of mine for 25 years, do you think that the dentists out here listening in the States should get involved with their dental schools and try to get dental laboratory programs back up? What I hear is we’re down to three programs and you’re thinking those will probably be gone in five years, can we really be a great country without any crown and bridge laboratory programs at the university level? 

Uwe Mohr: Well it requires a change in attitude because right now the predominant question you hear is how much is a crown, it’s not how good is a crown, it’s not what do you require me to do that crown, even I’ve had one of my best clients in the States told me one day you’re going to have to cut our prices by 20% so you can keep doing my work and price is the determining factor more than ever in the United States. It’s not just in dentistry and until the attitude changes that you are prepared to pay for higher quality when you can, like I said earlier, not everybody can. You have to force training to exist and there is no interest at the present moment. There’s only laboratory interest to keep training going, there’s no interest from the dental sector in general to get more schools get better programs. That costs money and you have to hire some of the top teachers to teach the top technology and that’s not being done. 

Howard Farran: And what’s also sad is in my half century on Earth, it seems like to sum up the American government in one slogan would be money is the answer, that’s the question? 

Uwe Mohr: Yeah exactly. If we throw enough money at it, it will go away. 

Howard Farran: Well I’m telling you our hour is up. I knew it would be the fastest hour. Uwe, I love you so much. I adore you, you’re amazing, huge fan of your 10 000 posts. I can’t believe you were crazy enough to give out a toll free number on your podcast and your email. Thank you for all that you’ve done for dentistry. Thank you for all that you’ve done for Dentaltown. Thank you for literally answering 10 000 dental questions on Dentaltown. You’re just my idol buddy. Thank you so much. 

Uwe Mohr: Thank you so much. Thank you Howard it’s a pleasure being here. Keep it up. 

Howard Farran: Alright thank you very much I look forward to your online course. 

Uwe Mohr: Alright man. 

Howard Farran: Bye-bye.