Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1098 Mastering Implants with Jamie Oshidar, DMD at MegaGen, Las Vegas: Dentistry Uncensored with Howard Farran

1098 Mastering Implants with Jamie Oshidar, DMD at MegaGen, Las Vegas: Dentistry Uncensored with Howard Farran

10/11/2018 2:42:18 PM   |   Comments: 0   |   Views: 147
I was born on August 8th, 1976 in Manhassett, NY. These are both very important facts to know in order to get to know me. For one, that makes me a Leo and a Leo I am. I am a true competitor in everything I get my hands on – from striving to add the most value into my patient's lives through the dental experience we give them to never giving up on the tennis court to being the best Dad and Husband I can be.

Secondly, I was born with a thick New York "sometimes thuggish sounding" accent that no matter how hard I try I just can't shake. Add my accent to the fact that I do not hesitate to speak my mind (only like a true New Yorker does) and boy, I can get myself in a lot of trouble, especially with my BEAUTIFUL, genius wife Melissa. (If you saw me now, I would be patting myself on the back.) I have held a few nicknames over the years, including Osh in my high school and Air Force days, Dr.O by my patients and staff, and Babo when Melissa is happy with me. Over the past two years, my family has grown from two people to four with our latest addition: my son Julian Jamie Oshidar. We already have our daughter Arianna Layla Oshidar, who absolutely has me whipped. Trust me, if you become a patient here, you will hear all about my babies.

I don't have this overly compelling or wonderful story as to why I became a dentist, but I can truly say I am really happy I did. The truth is my dad wanted all three of his sons to become doctors and in turn, he got two dentists and chiropractor. I love what I do, not because I am the best dentist in the world (which I am close to being) but because my practice gives me the opportunity to help people achieve a better quality of life. I not only do this through my hands-on dentistry, but I love to coach, educate, and advise my patients, staff, and others as well – basically, whoever will appreciate what I have to teach.

I am best known for my drive to succeed and the unique humor I add to pretty much anything I do. Life would be terribly boring if there was a definitive end to what you could accomplish if you couldn't laugh while doing it.

I take pride in knowing how many people we employ in my two practices Roselle Park Dental and Little Smiles of Roselle Park. It is a great feeling and sense of accomplishment that gets reinforced on a daily basis whenever my staff or patients say how much they love being in the practice. Although I've come to realize you cannot please everyone, since my practice is a reflection of me, I take it extremely personally when someone is unsatisfied with the way things are run or with the effort I put into my work. This approach has been extremely instrumental to the happiness all of us in the practice show when we are at work. (Unless, of course, my staff is causing me agita!) I have actually started to consult and teach other dentists about implementing dental implants successfully into their practices.

Deep down, I always give people the benefit of the doubt and I always find myself rooting for the underdog. Maybe that is why I'm such an avid Jets fan. Man, will they ever win a Super Bowl again? Yes, I have Patriots' fans as patients. Here is a quick story for what I'm truly like. One night when I was in high school, right before my chorus recital (for the lucky ones who have been blessed by my singing, it's true I was in the chorus), there was a kid sitting by himself getting made fun of by some other kids. I felt compelled to sit next to this kid named Howie and befriend him. I did this because it was the right thing to do and it makes me furious when people pick on other people that are different from them. If you ever get a chance to see me hit or kick the punching bag while training, you will now understand what predominantly fuels my fire.

AUDIO-DUwHF #1098 Jamie Oshidar, DMD 

VIDEO-DUwHF #1098 Jamie Oshidar, DMD

Howard: It's just a huge honor today to be podcast interviewing Jamie Oshidar thank you so much we're in Las Vegas at the big MegaGen implant symposium there's like 1,200 dentists here today we're both speaking it's a huge honor for you to be speaking of this if I know the owner this company Kari Lyons said that he had a hundred dentists begging him to lecture this symposium, so congratulations on getting in this program that's a huge honor in itself. So Jamie Oshidar graduated from the University of Medicine and Dentistry New Jersey in 2002 with an excellence and endodontics award he went on to join the US Air Force under a health professional scholarship program, he was honorably discharged from the Air Force in 2005. In July of 2009 he purchased his first practice where he began his long continuous journey as established himself as a leader an expert in implant dentistry. I'm a regular guy that happens to love and excel at implant dentistry running a dental practice and teaching others what I've learned through the trials and tribulations of practicing dentistry when I first bought my practice in July 2009 I was headed directly for burnout I had no implant skills leadership skills or business knowledge all I had was determination and ambition to succeed. I am living proof that that is all you need to get what you want life my teaching style comes from a place of humility because of my past experiences I designed this program to help ethical doctors realize their vision while avoiding some pitfalls I experienced in my career. He's got everything behind his name he's got a fellow in them a master and diplomat of international congress of implantology, fellowship from international association implant dentistry, fellowship with implant dentistry from California implant Institute, Association of American implant dentistry, active oral conscious sedation license, over 300 hours of CE's from various implant courses, it is just an honor to have you on the show.

Jamie: It's an honor to be here.

Howard: So what are you here lecturing about what are you passionate about these days?

Jamie: So my lecture was business basics for the implant office and I teach doctors how to successfully implement implants into their office and develop a practice that will sustain growth and so I use a very systemized approach in my office and I'm just kind of share my my tribulations.

Howard: Okay so I know my homies I know what when they're hearing you I know what they're saying they're saying Jamie I graduate then also costs $100,000 a year I just graduated $400,000 in debt and get some of the implants I placed?

Jamie: 0

Howard: 0 so how does she go from that to be like you helped her, how do you do that?

Jamie: Absolutely and it's funny you say that right because the time that you have to invest in yourself is when you're kind of when you need it and the odd thing is in dentistry the guys that I see invest in my type of course or other courses are the guys that do already doing well and they just add to it. So if you're not doing any implants it's probably mostly coming from actually the way that you approach things and your mindset. One of the things I share with everybody that attends my courses is an implant practice is every practice there should be no dental practice in the in the world that is not an implant practice they are the same thing because it's a need that our patients need, it's gives us good results as dentists, it makes us feel good it adds value to our patients lives it's a win win win all the way around.

Howard: Okay but I'm just playing devil's advocate not harassing you what if she saying well well should I just restore him should she place them and restore should she first learn how to restore them place?

Jamie: I think every doctor should go and learn a little bit about the surgery because the restorative doctor. Every dentist within the nation needs to be a restorative implant dentist okay but not everybody needs to place implants in my find. If you're not if you don't enjoy surgery if you have a hard time with extractions then surgery might not be for you but you need to. What often happens is I find that doctors that don't successfully get implants in their offices because they don't control the flow they don't know how to direct the case they don't know how to talk to their specialist they don't have engaged a specialist and make it a team approach, they say oh you need an implant okay just go to the specialist place the implant and maybe come back to me. Then they what happens is those patients usually end up in a guy like my office and you know I can walk them through a case and show them exactly what they need from start to finish and that's what every doctor needs to focus their career on their education if they're gonna if they're gonna successfully implement implants.

Howard: Okay your website is

Jamie: It is.

Howard: What are my homies gonna find if they go to

Jamie: Well it's my continuing education site, I have some of my cases posted I have a very practical approach to implementing implants into your office I don't like you said before I don't think that everybody should be surgically placing them but everybody needs to know how to talk to have that conversation with their patients to get them to the next level. What I find is when I talk to younger doctors they often saying you know people come in and they say I just can't afford the care or and then they walk out into the parking lot and they're driving Mercedes, the reality is it's not that they can't afford the care it's you just haven't made it a priority in their life and you need to know how to talk to that patient so that they can get case acceptance.

Howard: Well my beef is that between age 16 and 76 the average American will buy 13 new cars. Last year the United States we sold 20 million new cars the meeting average rights thirty three thousand five hundred but they don't go up to Jaime and say hey Jaime you got 33 thousand dollars for a car I need it right now I need half down and a half in a month what they do is they go out there and they say on the health history you know like these dentists will have some what's their home address but they don't fill out the credit part they don't say okay have you lived in this home two years and I'll say where do you work and then what's the work address and that have you lived in this work for two years and if the new patient chart and is the same thing as a finance chart then when you go in there and present all the dentistry and then when the the financial coordinator comes in and she says Jamie you got very good credit congratulations on your credit you've been if you want to do everything the doctor talked about it'll be a hundred and sixty dollars a month for 60 months and so when the dentists walk in there and I say you know this is gonna be $7,500 we'll need to have that now well that you 90% of all houses and homes are sold on 90% of cars are sold installment credit 60 month 90% of homes are sold in credit 30 months and then these dentists they they don't use installment credit.

Jamie: I think that's hard for I think that's hard for people to accept that in their offices and I think that's the big problem I don't do just that I do give the patient options but I don't say you need to pay this in full I give them an option that works in my area you know they do have that option of painful they do have a credit application within the office but my approach is unique to me and unique to my vision what I you know how I want to run my practice. So I don't let I like I learn from other people but I make it my own and so that's what I like to teach other doctors that look you can't copy you can copy certain things but you have to make things your own and that's when you find true success.

Howard: So your next hands-on implant immersion weekend is

Jamie: The next one is actually going to be in the spring

Howard: Is the date on this?

Jamie: Not yet.

Howard: Okay but it's gonna be the spring and that's gonna be in Roselle park in New Jersey?

Jamie: That's correct.

Howard: Okay and if you want to follow him on Twitter he's on Twitter he has implants integrated on Twitter but so the next course in the spring what do you teach at that course, how many days is it?

Jamie: It's three days first day is very very intense so what I've done is I've created a course that is basically it's about implementation. So the doctors will be able to place live implants on vets so we give back to the vets I'm a vet as you know yeah in the Air Force so I vets are near and dear to my heart.

Howard: So you went into the Air Force right after dental school?

Jamie: I did I got an HPSP scholarship Health Professions scholarship I was stationed out in San Angelo Texas for three years and it was a it was a great time and I learned a lot.

Howard: and would you recommend that

Jamie: I really would.

Howard: Have you read all the controversy about Arizona the dentist in Arizona?

Jamie:  No what they say?

Howard: Oh he's been out lecturing that he's an anesthesiologist trained in the Air Force and someone looked into and the Air Force says we never trained this guy in anesthesiology and it's a shit show in Arizona crazy but did you but you...

Jamie: I'm not an anesthesiologist.

Howard: but if someone was in dental school freshman do you recommend this program?

Jamie: I think it's fantastic I do and I think you get a good amount of experience you get exposure to a different part of the the nation or maybe even the world and you get training that you wouldn't get in private practice plus they'll pay for your loans and at the end of the day you can say that you put on the colors of the country and and did something good for the country it's very patriotic.

Howard: and so now when they come do this three-day hands-on emergency last they get to work on vets?

Jamie: Yeah

Howard: Now do they need an out-of-state license?

Jamie: They need an active license and they need to have an active malpractice.

Howard: but they don't need to apply for a New Jersey license?

Jamie: No

Howard: Is that because they're working on vets?

Jamie: No that was the State Board of New Jersey.

Howard: So the state so in New Jersey if I have an active license an Arizona and I have my malpractice I can come to a hands-on course?

Jamie: Yes

Howard: That's very good.

Jamie: Yeah

Howard: A lot of states don't allow that.

Jamie: I called the board of dentistry to verify that and she said absolutely.

Howard: Nice

Jamie: Hopefully I got the right rep but...

Howard: So how much is that course and what will they learn?

Jamie: They're gonna learn exactly I mean so I break down everything into a system even presenting cases big cases how to differentiate between the one implant case that walks into your office and the case that is thirty thousand dollars. How do you present treatment to that patient that's gonna need that kind of dentistry and qualify them you know so I don't qualify them necessarily upfront with a credit check but I do want to start having that conversation of what this is gonna cost. So they can start to understand the dentistry is not cheap. The course is surely a practical implant course I've had doctors that have attended my courses that have been placing implants for thirty years that's still call me today and asked me for my advice because I teach it from a very an everyday approach. You know there's failures in implant dentistry I'll get you ahead of the curb and really talk about that talk about real dentistry what you're gonna do on your patients. So if they'll be able to place about four or five live four or five implants on live patients and we're gonna plan each case on models and pictures and they'll be able to simulate the placement of the implants on the models and we're gonna walk through every single step of the way. So what I the reason the way I designed this course was I thought of all the courses that I've ever attended and what were their shortcomings and what were their positives and I tried to put all positives into the course. So when the doctor comes in he's going to get or she's going to get a tremendous amount of value.

Howard: Wheres Roselle Park is that a suburb of bigger city?

Jamie: Roselle Park is a not a bigger city it's a small little city about twenty minutes uh about 15 minutes away from Newark.

Howard: So you'd fly into Newark?

Jamie: Newark yeah Newark New Jersey.

Howard: Which if you fly anywhere you can see Manhattan from the airport.

Jamie: Yeah we're 25 minutes away from Manhattan.

Howard: So are you implant agnostic or you recommend one specific system or?

Jamie: I use MegaGen, MegaGen Anyridge and what you'll see is that I when I when I endorse a product it's from an authentic place I mean they don't pay me to say that I use it for a number of reasons I've used Nobel and I do like Nobel Active as well however what MegaGen offers I don't think another implant really offers all the different things that they do offer. The variety the flexibility the ease of use the initial stability that you get with these implants the majority of the implants that I do are immediate implants about 95 percent of my cases are immediate implants you need an implant with good stability.

Howard: Okay you said there are 95 percent of your implants are immediate what percent do you load?

Jamie: I'm sorry let me rephrase that it's not 95% of my implants are immediate it's immediate implants if I'm taking out a tooth ninety-five percent are getting an immediate the other way around but...

Howard: So if you extracted tooth...

Jamie: First molar forward I don't really do that many second molars.

Howard: Yeah well it's second molar that's an interesting thing when you travel around the world because when you go to many countries advanced countries around the world they consider a second molar kind of like our third molar like we do there's a lot of there's a lot of people.

Jamie: I tend to agree I mean I don't know many people that need...

Howard: I'll tell you this this is this got me in the most trouble with endodontists I mean I have endodontists who just freaking do not like me I wrote a clumsy in my 30 years whenever I pulled a third molar wisdom tooth, I've never ever had a person come back say you know you pull that wisdom tooth and now I have a hard time chewing on that side never had that once. Second molar I always tell him I said well to save this is a $2,500 root canal bill up and crown I said if you pull it I don't think you'll miss it only one patient per decade three and thirty years everytime I said you know I wish I wouldn't pull that and then when placed implant a crown and an endodontist it's their lifeblood is I can't do this root canal and a second molar and then I'm looking at patients and okay well if you pulled that if he only has $2,500 he got seven other cavities I pull the second molar and fix the other seven cavities.

Jamie: 100% agree.

Howard: Oh my god (inaudible 15:42)

Jamie: Well I like you because you don't say the popular things, that's the way I do it.

Howard: It's Dentistry Uncensored in Phoenix is not Beverly Hills Phoenix is the West Florida there's two florida's one on the East Coast and one on the west coast and they're not made of money and I just tell them I said it's like a one in a thousand chance if we pull this second molar you're gonna miss it and you have nine cavities I'd rather do nine hundred and fifty dollar fillings and get you get all your decay fix and have you wipe out your budget on a second molar. So back to you say first molar forward if you extract it to 95 percent time you'll place an implant?

Jamie: Correct

Howard: and what percent of the time would you also load it?

Jamie: I will load it if it's in the aesthetic zone and they absolutely need it but I will test the implant before I load it I use an ISQ that gives us a scientific approach to see if an implant is stable enough to hold a load okay. I don't load I'm unnecessary you know if it's especially if it's in the back we'll just let it heal up you know let it heal up and with MegaGen what I like is that healing caps are so big so as soon as I place the implant the implant goes slightly sub crystal okay goes below the bone and then I put an 8 millimeter wide healing cap on top of that implant and the emergence profile when we in that second stage is just perfect you don't have to do anything the labs absolutely love it it's a it's a walk in the park.

Howard: What's the difference in pricing and a Nobel Biocare Active a nobel active versus a MegaGen Anyridge?

Jamie: That's probably a better question for those reps but I think I think retail for in Any Ridge if you're buying one implant is don't quote me on this but maybe 350 and Noble but it's very inclusive right so Nobel the problem is they have so many little you've got to buy a cover screw when you buy the implants you have to buy yeah they're just pounding it and you and it's complicated even for the experienced guy to keep up with what you need to order if you're doing a larger case if your doing a hybrid case you there's so many different components.

Howard: Have you ever gone to South Korea to Dr. Parks place?

Jamie: No I met Dr. Park, great guy.

Howard: Yeah basically MegaGen is a South Korean by the way I don't get if you're watching this on YouTube these two handsome bald beauties you're probably thinking it's a it's a beauty contest I don't you can't buy us don't no one no one buys me I have enough money on my own I sold both my kidneys and my liver and so I'm fully funded but basically he yeah he started off with like a dental Hospital I mean he went to South Korea he has like this ten story building like the first floors pedo and then fillings and oral surgery and all this kind of stuff and when he started as implant company they would have a design when their own dental hospital that's really what it is it's a Dental Hospital they could have they could go from design to place like 200 at the end of the week and then in like six months know the results and I really think that was that was MegaGen’s core competency because when you go to the European countries they would have an idea then they go to all these university to see if they get some university or under to the research they would they would think about it for six months or a year then they'd finally do a program but it'd be like two years between an idea and a deal. The one thing about Dr. Parks is when like there are literally dentists here at this meeting I would say you know what you ought to try blah blah blah blah blah he make a phone call to his dental hospital make it design it mill had a hundred of them in in in a couple of days and then have them all placed in a couple more days. So he is taking the idea the product cycle R&D; I I would I think the average fry cycle Rd in the United States and Europe is at least two years and I think in MegaGen it's probably two months so they just can they have gone through sales check it out. So you mostly do MegaGen right now?

Jamie: Pretty much exclusively.

Howard: So if they're gonna come to your course you would like them should they when you're saying you're taking photos and all this do use the CBCT?

Jamie: Of course

Howard: Do you use an agnostic CBCT or is their one you like more than the others?

Jamie: I mean that's usually rep based i mean i use a VATECH machine

Howard: Is that South Korean too?

Jamie: That is yeah.

Howard: Yeah

Jamie: It's a good product.

Howard: So what's the chance you're using a Korean CBCT and a Korean implant is that just...

Jamie: I don't know, maybe I have Korean in my blood somewhere

Howard: but were they related or they're just two independent decisions those happen to be Korean, I mean is this VAtech have...

Jamie: You know it's it's all who you mingle with that at a show you know I met Steven from MegaGen a while back and he said you know try this implant try this implant and then finally I tried it and I loved it and I started using it and how did I get the VAtech I don't know but...

Howard: How much was the VAtech?

Jamie: I think they have a range of machines anywhere from I think they start around eighty and ninety to  a hundred.

Howard: So I know she's gonna say Jamie I got $400,000 student loans I just came from an NYU six and a half percent of the graduates last year for me my you and she goes do I really need to spend $100,000 on a CB CT what would you tell her?

Jamie: Do you want to successfully implement implants into your office that's what it comes down to is it an investment it's the best investment I've ever made and

Howard: Plus you won't have to have a hundred thousand they're obviously going to have instalment credit.

Jamie: Yeah no they're gonna do it they're just like what you said.

Howard: 16 months what would the best at a month would you you're...

Jamie: They'll probably give you about a thousand $1,500 a month okay I can tell you right now that when I got us a cat scan my implants doubled easily. When you show a patient how you virtually place an implant on a computer and talk about their Anatomy you just stand out.

Howard: Okay how what software are you talking about patients.

Jamie: No the basics I'm not a I'm not a computer guy I'm not...

Howard: I mean when you're presenting this to the patient this software from the VAtech or is this...

Jamie: Oh yeah it's a VAtech machine

Howard: It's the VAtech software?

Jamie: So all of them have to sit the same software and you can virtually place the implant onto the software and show the patient you can walk them and say look this is your quality a bone this is how wide it is this is how far we are from the anatomy and once you show the patient that you kinda know what you're doing they accept. If you it's when you you lose the patient when you just you have no order you know like the patient walks out and they think of themselves what's next what am I doing here I'm going with specialists and I'm coming back to the dentist they don't it nobody knows what's going on. So when you put that in the CT scan look I mean it's not that you're going to charge I mean I don't even charge I charge $99 per console and a CT scan i don't-nickel-and-dime my patients and the reason why I do that is because I know the return on my investment is gonna be astronomical because piece of paper.

Howard: Describe the view what does Roselle Park measure,is that Richie hoodie toody, is that more middle-class like Ohio?

Jamie: Have you ever been to the Bronx New York?

Howard: Yeah

Jamie: It's like the Bronx.

Howard: Newark doesn't seem very Beverly Hills to me it seems like there's a lot of middle class there.

Jamie: I mean do I seem kind of Beverly Hills, definitely not no Beverly Hills.

Howard: and I love that I love that because there's nothing more annoying to a dentist from Parsons Kansas is listening to some guy lecture from Beverly Hills and all the movie stars use on your psyche dude there's no movie stars in persons Kansas and if you're in Childress, Texas ain't gonna fight but so you're saying you're more in a middle-class Bronx?

Jamie: Middle to lower yeah

Howard: So you're charging $99

Jamie: For CT scan and consultation yeah.

Howard: and how long would appointment is that usually?

Jamie: 10 minutes 10 minutes the close on these cases it's not it's all educating the patient people want teeth if you remove yourself out of that and just educate them and tell them what you're gonna do they accept it's not it's not that hard what happens in dentistry is we make things more complicated than it needs to be

Howard: You think, oh my gosh I always have a running joke that when you go to study club the first dentist anthem says hey I want to tell everybody I'm the best dentist in the room I trim my own dyes and the next dentist says forget you man I like quarry my own stone I pour up my own dyes and then I trim them next and I says forget all you I have my own beehive I grow my own wax I quarry my own stone I trim my own die it takes me 40 days and 40 nights to make a crown and everything like oh my god you're the best it's like the longest distance between two points is what a dentist a physician and a lawyer looks for and the people who come in and just say keep it simple stupid.

Jamie: Keep it simple stupid.

Howard: I have five fingers make it faster easier higher quality lower cost and miniaturize it.

Jamie: Keep it simple stupid I have it on my vision board at home.

Howard: So you recommend the MegaGen Anyridge VAtech CBCT your courses in the spring

Jamie: We're gonna pick a date in this spring and in the spring also I'm gonna come up with a very comprehensive small business workshop.

Howard: You know it'd be the best marketing for your course please please please please please put her online CE course on dentaltown.

Jamie: I would love to

Howard: Really

Jamie: Absolutely what would you like me to cover?

Howard: Whatever you're most passionate about and a lot of people like like Panky has five one week courses so they did an online see on downtown just one hour and a summarizing there one week and it was a very very great marketing thing for them a lot of people the Institute's like you went to that but yeah I would I've been wanting to get a course out of you for a long time. I would I would and then and then after the end of your course you can say you know thanks for listening if you want to come to my three-day hands-on course come here.

Jamie: Absolutely

Howard: and you're out there in Englewood New Jersey you know where Philadelphia where Bethlehem PA is?

Jamie: Pennsylvania 's I do.

Howard: So I'm Howard Farran so im the guy who does online CE is Howard Goldstein in Bethlehem Pennsylvania you know Howard?

Jamie: I do not.

Howard: Yeah email email him ang Howard he does online CE but a lot of these a lot of these I know how they thinks a lot of them are thinking okay well before I got this flyer I'm flying out you know for this 3 day course and they're not sure so the leap between a flyer in three days is and is an hour online CE course because I think you to see you see if they like you have chemistry with you and then then they feel oh yeah I like that guy so then I'll go. It's kind of like when the biggest asset American home is a home so when you're gonna do a reverse mortgage though you can't tell someone to do in 30 seconds on TV so what they do is they try to get a trusted spokesman and say hey just call for the CD they deconstruct the sales process just call and get the CD. So then grandma said oh okay I'll call get CD then the 90 minutes the whole deal is well we can't tell you anything until you call the bank so just call your local bank here and tell them your address so you can tell you what your deal so then finally the CD so a million people see the commercial a thousand get the CD a hundred called the local bank and then ten people do the reverse mortgage. So I really think an article in dental town or an online CE course would really deconstruct the cells for us us to get her hammer her to commit to go spending three days with you in Newark, that's a big commitment.

Jamie: Yeah I think you know I've never had anybody that's come to one of my courses that was disappointed that's reality I don't I'm not Beverly Hills I'm every day dentistry.

Howard: So would that mean that you know I when I talk to Jim Glidewell he says that 96% of the crown and bridge comes in one tooth at a time and when you talk to some of these big implant labs they say they say upwards that 90% of implants replace one at a time is that what you see?

Jamie: What do you mean one at a time?

Howard: So you know one implant place for missing one tooth a lot of these lectures are all on for all these complicated cases these big prosthodontics edges but it seems like the market would you say the market in reality is mostly just single implant single tooth replacement?

Jamie: I would say single implants you know on immediate extractions and then bridges, implant bridges I think implant bridges are huge if you're not a treatment plan you know it's a patient.

Howard: Implant bridge is usually replacing what of missing?

Jamie: 12 to 14 you know instead of a distal extension partial absolutely.

Howard: So 12 to 14 and 3 unit a bridge.

Jamie: 3 unit bridge with the two implants placed properly I think that's bread and butter dentistry.

Howard: and some people would say well if that one implant fail now we lost the case so if you're doing a to implant 3 unit bridge some people think well for just 300 more bucks you could have done 3 single implants what is your thoughts between three implants for 3 single unit bridges?

Jamie: So it's per case it's not a it's I don't say there's a blanket rule for everybody but if the patients that bruxier around want an extra implant I wanna I want those implant crown splinted but the the spread the AP spread of the influence is what really matters you know if the implant is placed place well you know the success rate is very very high. So and yeah I get that I get that point but what are you gonna do if the implant a distal abutment implant fails and you have three splintered implants the case is gonna fail anyway you don't want a distal cantilever you're gonna cause all kinds of problems.

Howard: You couldn't have a three unit bridge off it's...?

Jamie: Tot that you couldn't but what is the ideal it wouldn't be ideal and so when is that implant really when is it gonna fail is it gonna fail after you boated it or is gonna fail in the beginning most of them won't integrate in the therefore you'll know so why would you do that.

Howard: and when you talk about implanting you use the fancy word you said use ISQ explain to what ISQ is?

Jamie: Simple terms basically use sounds to determine the density of bone around an implant.

Howard: and which one did you buy?

Jamie: MegaGen sells one so it comes but it sits there all Ostell.

Howard: Ostell makes all the ISQ's?

Jamie: I don't know if Ostell makes the one that I bought but I know Ostell was the company that came out with them first and so I think I know you can I know you can buy an Ice cube directly through MegaGen and I think it's it's well worth it. In fact I was hesitant to buy it because it was about four thousand dollars in the beginning...

Howard: and what is the intro kit for the MegaGen?

Jamie: It's kind of like a little a little box with a wand and you screw something you with your hands onto the implant and then it shoots sound onto that little attachment

Howard: So your saying the ISQ is four thousand dollars?

Jamie: It is.

Howard: Wow that is an expensive little device.

Jamie: I think it's well worth it you know in fact like I said I was hesitant cuz you know don't want to spend $4,000 on that to test an implant but now when my ice cube broke I felt lost.

Howard: but you said they were made by Ostell

Jamie: Yeah ostell implant stability that should be it

Howard: Okay there Ostell that's another implant company they make implants to don't they?

Jamie: I don't know if they do when I learned when I learned implants basic and Louis Farans course in California it was definitely Ostell unit or us you know.

Howard: So the ISQ is four thousand dollars and you recommend that because if you extract it to 95 percent of time you will place an implant and then when you and then how much longer before you will test that and then test it within ISQ ?

Jamie: I'll test it two to three months afterwards I'll test it immediately so if you want median load case the ISQ will tell you right away scientifically what kind of stability we have with the implant and that's the most important factor in loading an implant okay so it's not it takes a lot of guesswork out right and so but that's I'm not doing it to speed up cases I'm doing it so I have legal proof I have evidence I can can notate it in the chart and I feel more comfortable. You know rather than taking you can always always take the back end of a mirror and that's it.

Howard: When implants fail what I like to top two or three or four reasons why implant cases fail and they felt more immediate there's a horse fall down right out of the gate drop a mile later down the road?

Jamie: I would say the the number one reason is when you're taking out an infected tooth you don't debride the area properly and I've never found the lecture that's done on immediate lectures that really over emphasizes that you have to debride that area if you go on my website implants integrated you'll see some cases that have enormous chronic infections that I debrided thoroughly and you would never think that an

Howard: Are you talking about the one of my mom?

Jamie: Did you mom come in she got us mistaken we saw the bald head it said Howard?

Howard: So with those cases to be on your website about us programs or surgical cases.

Jamie: Surgical cases yeah yeah now if you're from Beverly Hills don't make fun of my work what I mean I'm just a normal guy.

Howard: No I think your work is amazing I really really do it's an honor to have you on the show.

Jamie: Thank you.

Howard: So we're talking about implants filling so you think one of the problems is they don't initially do debride enough?

Jamie: Oh most definitely I think that

Howard: When you do debride is a mostly scraping do you use irrigation? Talk about it for a minute.

Jamie: You have to irrigate in the military they had this saying solution to pollution is dilution.

Howard: Solution to pollution is dilation, that's great.

Jamie: So plenty of irrigation.

Howard: I'm writing that one down.

Jamie: You have to irrigate and you have secured at and you have to be aggressive you have to get to to solid bone before you can place an implant and implant will integrate my rules for placing an implant I mean even in a chronic infection site is is the area to brided it and will a bone graft work right and so if a bone graft is gonna work and you can get initial stability with your implant the implant will take and it will the profile the emergence profile will be beautiful if you know how to place it but we're not here to talk about immediate are we.

Howard: Okay so but here's another question here's a stressful question we see on dentaltown a lot. How would you do so she gets out of dental school she's wearing her mom's a dentist she's working with her mom her mom's placing implants and she sees all these five to ten year old implants with peri-implantitis and her mom says well doesn't hurt they're fine and then she gets on she reads about you know these the oral systemic Rask and you know it's very confusing and it's hard to say to your daddy says I'm a diplomat the International Congress of oral implantology and she's her dad's like twenty years older than her and she's like looking all these peri-implantitis. So some people are saying that at five years up to 20% implants out peri-implantitis some are saying at a decade it's up to 40% so what is peri-implantitis what do you do about it how how do you...?

Jamie: That's tough it is tough there is no definitive answer for peri-implantitis. I invested in a laser from millennium it's an nd YAG and they have a peri-implantitis treatment called LAPIP.

Howard: How much was that laser?

Jamie: It's pricey

Howard: Okay

Jamie: Jeah 100K

Howard: Is that a return on investment, are you glad you spent 100k a Millennium Lanap?

Jamie: At this point in my career a return on investment for me looks like makes my life easier not necessarily monetarily it has paid for itself that's for sure maybe not the entire because we just bought it to long ago.

Howard: Okay talk about it, it wasn't Lanap it was Lapap

Jamie: Well Lapap is perio.

Howard: Lanap which stands for laser assisted new attachment procedure.

Jamie: Right

Howard: and then for the

Jamie: Lapip is laser assisted peri-implantitis procedure

Howard: So and it's a hundred and thirty five thousand with training right?

Jamie: Yes I guess.

Howard: Or was your cheaper?

Jamie: I think I mean look some of these companies are somewhat negotiable, right so

Howard: So you thought oh and that's a made by millennium millennium, so you recommend my Bob Gregg and that's what to G's in it so you recommend that we'll talk about that. That's a big decision when you're spending that kind of money.

Jamie: It's a tough decision I mean if you're in the if you're kind of in between you don't you not come you're not doing a lot of perio within your office phase two perio or you have peri-implantitis cases you know i think it's very valuable, there's other things that it also does to that we can't do with the scalpel. Do i think it's the best return on investment no I don't if I was doing the LANAP procedure on a regular basis and not just my associate so because I'm putting him and pumping him up we trained him to do it I think it would have been a better monetary return on investment I don't think it's as good of a return on investment in terms of money as a CBCT I really do not I think that is by far if you're going to be in implantology or an implant practice but do I think it's up there yeah I think it offers you things that that make your life a lot easier and better.

Howard: Now I'm gonna go back to the little girl working with her mom or dad because it's just tough it's easy to tell...

Jamie: You know what the answer is what it comes out to this it comes down to other older doctors that have done well to start mentoring them and that's why I design my program that's the reality. I mean I I saw it I when I bought my practice the guy who he said he was gonna be my mentor he said he'd do anything for me he just left me to rot he didn't teach me. So I had to learn the hard way and I don't mind giving back you know to the general I don't want corporate dentistry to take over I really don't.

Howard: Here's your other problem, she goes and hangs out with her dad and all those old men say that surgical guides is like putting on training wheels you want to be a surgeon grow up take the training wheels off learn how to ride your bike.

Jamie: Amen little girl, amen.

Howard: Amen what so you're saying you don't need a surgical guide?

Jamie: No no I didn't say that I think surgical guides have a very good place in the implant dentistry but the paradigm shift that we think we can take that person who has no surgical skill and make a surgical guide that's not always accurate you always hear of problems people having problems. If you're an experienced guy that knows how to get out of trouble by all means why wouldn't use a surgical guide when it's right at your fingertips but if you're trying to do take on surgery and place an implant through a plastic device and now it goes wrong nobody wins it's a scarcity mindset it all goes back to the mindset why would you do that you're not you're not doing a good service.

Howard: So you're saying you you got to learn how to be a surgeon

Jamie: You have to be a good surgeon if you're gonna do it listen the specialists don't have a problem with me when they see my work because they know I know what I'm doing, they have a problem with the idea of people taking on an advanced aspect of Dentistry without training and it's not right. I mean I hear you talk to the reps all day long these guys go to the different offices and they say guys are using surgical guides without any training he says I mean I don't know if I bring my dog to that guy you need to be trained if you're gonna do surgery. Restorative dentistry is a is a different whole different ball game and implementing implants in general is completely different but I don't mean that everybody should be placing implants no that's definitely not the truth but...

Howard: Well I'll just end on this, it blows my mind when someone walks out of dental school after eight years and says well I don't like blood it's like you're a doctor did you did you sign up for dental electrical engineering school and you thought it was Intel Inside a lot of it I think is just fear and then they ride that fear and it makes a light like they'll come out school and say oh I don't like molar endo well you know what endodontists makes 350 thousand dollars a year you know if you have to sell veneers bleaching bonding but when they come with a toothache and say Jamie will you please get me out of pain they're begging you to do it I mean imagine going to a hospital saying I'm having a heart attack you might say you know we don't do hearts you know we just don't like hearts we just decided we don't like hearts and now drop dead of a heart attack. So much is your attitude and your attitude determines your altitude don't tell yourself that you hate molar endo that you're not a good surgeon because you know. I don't care if you lie to everybody in the other room don't lie to yourself why are you telling yourself you don't like molar endo you don't like surgery you don't like blood when you're 25 years old from 25 to 65 that is like a five million dollar decision. I mean you just through five million dollars out the window because you just all of a sudden decided that you're the doctor who doesn't like blood I would understand it an electrical engineer said I don't like blood I'd understand of an architect said they don't like what you're a doctor get over it. You know why you don't like Muller endo because you haven't done a hundred you know why you're afraid of implants because you haven't placed 100 just go do it.

Jamie: I agree with you I do want to leave them one thing though you know you have to if you focus on the patient why they're going to the dentist I think we've lost sight of that. You know I hate that argument that we can't tell patients what they need in their mouths to keep their mouths healthy why did they come to the dentist they didn't come to the dentist for insurance they came to the dentist because they're trusting you to advise them to keep their mouth in there healthy and in their mouth in there head.  So advise them like that hey you need this because that's gonna help you keep you healthy I mean it's a very simple concept.

Howard: and they've proven so many ways they trust you mean last year the United States has spent a hundred twenty nine billion dollars at just American dentist he spent five hundred billion globally that's half a trillion globally there's two million dentists only 5% of Americans went to the chiropractor last year over half went to the dentist this is a very serious occupation and go ask your mom, your sister, your wife how much one of you you'd have to give her to pull her front tooth and never replace it? She wouldn't do it for anything if she lost her front tooth she give you her car to get it back it's a very serious deal and what we need is you to say that when the public health there's nine specialties one of them's public health and the public health dentist in origin, oh just because half the dentists when you went in there the toothache they said oh you don't do molar endo here's here's a scrip, go find it you'll go find someone else and then that night later that night at 10 o'clock there in emergency room. So life is an attitude implants aren't covered by insurance so you get a set amount of premium profitable price and with Invisalign if you're not doing Invisalign and implants and all you're doing is signing up for PPO is doing cleaning exams actually XANA fillings your overheads going up and up and up and up and your net income is going down and down the procedures that aren't covered by insurance around the world are Invisalign and implants and they're just I mean when you charge $6,500 for Invisalign case and you can charge you know $1,500 for an implant I mean and another, it's a profitable it's a good service Jamie it's an honor that you came on the show.

Jamie: It's an honor being here.

Howard: I hope you do an online CE course with us.

Jame: I would love to.

Howard: It would be a big honor for us at dentaltown.

Jamie: I think I know what I'm gonna do

Howard: Aright buddy thank you so much.

Jamie: Thanks a lot thanks for having me 


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