Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1168 Lane M. Ochi DDS, FACD, FICD on the Fundamentals of Fixed Prosthodontics : Dentistry Uncensored with Howard Farran

1168 Lane M. Ochi DDS, FACD, FICD on the Fundamentals of Fixed Prosthodontics : Dentistry Uncensored with Howard Farran

4/5/2019 6:07:35 PM   |   Comments: 1   |   Views: 385

Recorded live at Townie Meeting 2019.

VIDEO - DUwHF #1168 - Lane Ochi

AUDIO - DUwHF #1168 - Lane Ochi

Lane M. Ochi, DDS, FACD, FICD, graduated with honors from the University of Southern California in 1981, where he received the Robert W. Mc Nulty Memorial Award for the highest scholastic achievement. He has been elected to membership in Alpha Tau Epsilon - USC Dental School Honor Society, Phi Kappa Phi - National Society of Scholars, Omicron Kappa Upsilon - National Dental Honor Society, the Pierre Fauchard Academy - International Honor Dental Society, and he is a Fellow in the American College of Dentists and the International College of Dentists. He is currently an Associate Clinical Professor in the Department of Restorative Dentistry, and was the Co-director of Occlusion at USC School of Dentistry. He is also an Assistant Director in the Advanced Restorative Institute Dental Education Center, on the faculty of the Esthetic Professionals Education Center, and serves as a specialist consultant to the Graduate Prosthodontic Program at the Veterans Affairs Hospital in West Los Angeles. Dr. Ochi maintains a full time private practice in Beverly Hills with an emphasis on physiologic and aesthetic reconstructive dentistry. His patients include Academy Award winners, and some of the most recognized names in the entertainment business.

Howard: It is just a huge honor to be with the most requested podcast the biggest legend on dentaltown Lane Ochi,

Labe: Pleasure to meet you.

Howard: Oh it's an honor to meet you I mean I can't Middletown was 20 years old this last week 1999 and you're you're the number one authority on dentaltown.

Lane: I'm nothing actually.

Howard: How did you how did you gain that respect?

Lane: You know I think we need to step back a little bit to how I came to dentaltown and I don't know if you've ever seen me write about this but it's kind of interesting I got a copy of dentaltown magazine I read something that I so disagreed with that I had to log on the dentaltown to say I don't believe this and all of a sudden I started engaging was just incredibly passionate human beings just dentists who really wanted to learn wanted to hear different sides of the story and you know what I'll tell you one thing you are looking at the ultimate beneficiary of mentorship and what dentaltown offered me was an opportunity to return mentorship to people who wanted like me to learn so I got there and that's why you have me.

Howard: Well it was such a so different because I'm sure Millennials don't realize that it used to be all the magazines and newspapers just came at you and you couldn't return the ball.

Lane: Right

Howard: and that was what was so cool about dentaltown is you could say something a magazine and a guy like you can log on and say no I disagree completely but that's really the magic that it's interactive.

Lane: Absolutely and you know what's really interesting I've heard about the Wild West days and I've gone back being an occlusion junkie and looked at some of those interactions and while engaging and knowledgeable weren't very favorable to again bring the outside people in to join the party to join the conversation. So you know kudos to the whole process of making this community where everyone's welcome not just to listen but sayings ask a question, boy this may not seem like I know what I'm talking about but can I ask it anyways and people don't have any fear and to me that's just wonderful I mean you just can't ask for better interaction than that.

Howard: So what are you sorry about is what was my biggest mistake on that dentaltown is being a libertarian I just don't like regulation I mean when you grew up in Kansas if you want to plant wheat or soybean I don't know why you need a Department of Agriculture like we don't have a department of cell phones everybody's staring at through cell phones so why do you have a Department of Agriculture. So I was a libertarian and just said free-for-all because I didn't understand what social bullying was what toxic people are what trolls are I thought it would sell place and it took me a long time to realize there's just really toxic negative painful people so that was when we brought in Hogo and we brought in her Goldstein and we just said um and people were just shocked right you can't ban me I have 10,000 posts you're an asshole and I'm and we're banning you because it because and then people would say well I have freedom of speech no the Constitution's between you and the government you don't have free speech in my house, you come in my house I can shoot you.

Lane: Yeah you're my guest, please respect my rules.

Howard: All we ask it that we're at a party it's private property it's my house just be nice how hard is it to be nice.

Lane: and again if you want to learn something if you want to engage then you know you have to play nice. Look I've engaged in and had to actually I actually gave myself a couple timeouts over the time I think downtown because I just got sucked into the vortex of negative people and negativity and I just hated myself for doing that and so you know it's just it's kind of fun to to work in the internet right like you're describing. To me I treat dentaltown like a case presentation resident case presentation you know look you get to you get to say what you're thinking you get to show me or what you want to do you present your rationale and then people go around the room and either agree or disagree and it's a learning experience to share that kind of knowledge disagree or not agree and come away with everyone going you know what I have a couple of other options I didn't consider or as I always say Howard look the hardest part of the most important part of being an educator is knowing when to take off that educator cap and putting on your student cap and that's why I love dentaltown.

Howard: I know you're shy and tell these people who you are.

Lane: No no

Howard: You don't want to tell them your resume?

Lane: No I do not.

Howard: This is an amazing man.

Lane: I'll tell you what one of the proudest things just we talked about social media right my daughter's a social media expert and she goes dad why don't you have a website I go what honey what do I need a website for, well don't you want to be busier I go no not really but she goes well you don't understand you know how important you know connections are in social media what influencers are and the funniest thing happened and I consider this one of my greatest honors a recent that you and I are both in the same book the Titans of Dentistry.

Howard: Yes

Lane: and I thought this is really cool because I consider myself a Mr. Magoo I'm a dinosaur I'm an analog guy in a digital world so it's so exciting you know to be part of interactions and teaching you know that is so broad-based that is involving social media you know it just feels good to be I guess relevant again you know and and and that's what I'm really digging that's what I really started digging dentaltown and it's nice because it stays so damn focused I mean there are plenty of dental Facebook groups out there I'm the moderator of a couple of them and the interactions can just kind of go so far off the trail that there's no to bring it back and so this is the beauty of having a family and I dig it, I really love it.

Howard: So what do you think dentists have the hard time like I only start with oclusion. When whenever I talk to young people that are still in dental school or just come out they like you know they always told me they don't see a lot of controversy endow the pediatric dentist the only thing you really argue about a silver diamine fluoride but there she's got $350,000 of that and she doesn't know she should learn neuro lingual muscular occlusion or Panky, Dawson, why are there different camps and occlusion and what guidance would you give her to pick one direction or another?

Lane: Well the problem is with occlusion confusion Im going to be talking about this tomorrow I have a favorite saying from one of my predoctoral dental students occlusion is the science of useless gestures for pretended accuracies, occlusions the science of useless gestures for pretended accuracies. Here's the problem right it's the problem is our educational system when do we learn occlusion we our first year second semester right preclinical doctors by the time we hit clinic by the time we actually have to make a restoration or carve an occlusal you know direct restoration you know all that all that got pushed out of our heads and fell out and we had to replace it with something else and so we're so busy trying to learn for the moment we're so busy trying to earn our credits we're so busy trying to just get out that we never have time to revisit what we learned and you know if you look at the underlying message and in by d-t lectures both of them is that there is a continuity that we have to keep coming back on what we've learned and apply it to what we are trying to learn more about and so when it comes to occlusion there is no right or wrong answer okay like all like this that pesky little bell curve that Gaussian distribution all of us are different and that makes you know makes it wonderful thank god there's physiologic tolerance can you imagine if everybody was occlusally aware we never walk out of the room right Howard we wouldn't. So my comment to anyone who wants to learn inclusion is learn as much from as many schools as you can because not every shoe fits okay there's nothing really wrong but that said there are some really basic rules guess what I'm gonna be talking about tomorrow?

Howard: The basic?

Labe: The basic rules because they're real simple

Howard: Can you tell us what they are now?

Lane: Well in a nutshell there's two traditional types of treatment planning right when you and I went to school it was all about learning things about the joint and treatment planning from the joint forward you know today Cosmetics drives train doesn't it right so all treatment planning today is from the front backwards and the reality is that we have two treatment plan for both both forward and backwards. There are some anatomical information that the jaw joints give us that we can apply to how the front teeth look how long they are and whether they're gonna run into each other and hurt themselves so basically it's just a melding of understanding what's here and how this has to be in harmony with this so we talked about occlusal design it's nothing more than occlusal harmony the front has to be in harmony with the back that's all there is to it. This whole concept of envelope of function I have no idea what that means I think it's a made of term and so it complicated occlusion tremendously just like centric relation complicated terms you know complicated occlusion tremendously now it's much simpler than that.

Howard: What terms do you like?

Lane: How about if I were king of the world to call it the position of orthopedic stability just it's that simple, it's not a position we force people into it's not a position that we electrocute their muscles with to find, is a place that they can comfortably function to and from that's it harmonious.

Howard: So when you go to any dental laboratory probably 95% of the crowns are coming in 1 tooth at a time it's usually a six your molar when does someone have to step up their occlusion game and go to full mouth impressions and a bite or particular later?

Lane: Wow did you write my lecture for tomorrow... so it's really you know 99% of our work is gonna be done in MIP the patients are just the way they present to us right?

Howard: and MIP is?

Lane: Maximum intercuspal position so the question is when don't we use MIP and that's when it's unhealthy it's not reliable or stable are you gonna alter the vertical dimension of occlusion. You know those are you know pretty broken down dentition when you get to that point right so when you want to advance into more sophisticated occlusal concepts to do more sophisticated dentistry that's when you have to start learning more and more about occlusion. Just an observation and of course this is a simple generalization right what's the problem with being an old dentist our patients have gotten old with us haven't they now we're seeing warned dentition, mutilated dentition. So I don't think the younger dentist is going to see as many older patients that's typically how it doesn't work right it works with our demographics follow us within 10 years of our own age. So for a new practitioner occlusion really is not a big deal to learn the only thing you need to know about of occlusion as a young doctor is when to refer her as you become a more middle-aged a more experienced doctor and you start seeing wait a minute I'm seeing wear and breakdown in my cases in my patients things don't last as long as I thought they would that's when you start learning. When I you know I used to run just private workshops and I found interesting we got the demographics was the 50 year old dentist you the guy who loves our profession loves doing dentistry and helping people but it took him you know half a lifetime of observation to see hey I need to know something else because something else something is missing. So I guess if to go all the way full circle back to your question you know when do people need to start really learning occlusion I would say be aware of it in the early part of your professional journey but make sure you put it on the shelf in the middle part of your journey because back end the final part of your journey is going to be so much more rewarding.

Howard: Why do you and I have gold and why is the market all gone to zirconium and you think that's a big deal?

Lane: Well it's it's it's kind of our own doing unfortunately right let me just play it this way so in Beverly Hills...

Howard: Is that where you practice?

Lane: I practice Beverly Hills ground zero for Aesthetic

Howard: 90211?

Lane: 90211, so basically 50% of my single tooth operative is still gold I still do gold in my patients I'm a doctor's doctor you know I treat a lot of our colleagues none of them offer gold in their own practices. You know they're perfectly capable of it they just don't want to be bothered explaining to patients and pros and cons but guess what they want me to put in their mouth you know gold and you know what patients ask me well won't it show and I go have you know ever noticed my gold crowns and I've got you know two full gold crowns on my lower first molar so my lower sixes I mean come on then it shows if you look for it but most people aren't looking for and I tell them the story about other dentists they go well why do dentists want to put gold in their mouth they go guess what we don't like sitting in that chair any more than you do so what we do is we put in in our mouths the thing that lasts the longest what would you like me to put in your mouth?

Howard: The thing that last longest all gold.

Lane: All gold yep it works really well. Now that said let's face it the evolution of our of our profession with the simultaneous evolution of lab has changed you know the small lab is gone the individual single lab technician what my father was is gone.

Howard: Your father was that?

Lane: My father I'm on the dental radar blip and I'm like I'm a valley my father was one of the premier laboratory technicians in the world at the time he helped Peter Kay Thomas teaches waxing courses around the world so that's that was my into dentistry.

 Howard: and Peter where did Peter Kay Thomas live was he...

Lane: No no Beverly Hills also

Howard: He was Beverly Hills

Lane: Beverly Hills also Wow that's that's my into dentistry and so what's happened and he's okay so so of all things in let's see 19 in this nineteen late 70s there was a dental technology school and again just as the wave is going that dental technology schools are disappearing because handcrafted restorations are disappearing but at the time there was a very good dental school at orange county University Orange Coast University and there were two lab techs on the board one of them was my father the other one was Jim Glidewell and so my dad always thought...

Howard: Is your father still alive?

Lane: No he passed but he always

Howard: How old would he be now?

Lane: Oh geez

Howard: Jim's about what 70 something...

Lane: Yeah he my dad would be in his eighties early eighties

Howard: Okay so he's a little 10 years older than Jim.

Lane: Yeah so anyways you know my dad because I you know his work isn't as good as mine but I got a funny feeling he's gonna do better than I will and and so as the as the market changed you know as our reimbursements changed and this is why you know becoming a fee-for-service dentists is critical you know that you have to do this because if you're gonna be stuck with the whims of what you're going to be compensated you have to find lower-cost alternatives and unfortunately what filled the niche of the lower-cost alternative something not made by you and me by hand something that was made by a machine where the skill the technician is simply can you play Nintendo and program a computer. So we've kind of screwed ourselves because we weren't careful and we weren't seeing the big picture and now the price to be paid with these restorations is we have restorations that while they cost less they're easier to manufacture don't last as long for a number of reasons.

Howard: The zirconia?

Lane: Zirconia

Howard: Okay so Glidewell is doing 12,000 cases a day...

Lane: Yeah

Howard: Why circle around the question do you think the zirconium does is not lasting as long as a gold?

Lane: No

Howard: Okay but explain that one.

Lane: Well the problem...

Howard: A Lot of the young kids say no no it's harder than gold.

Lane: Well yeah but see that's just one one part of the whole picture right so at the end of the day we have to understand something about zirconia ok it's made with subtractive milling and so we're taking away we're carving the internal the dettaglio of a piece of material to get it to fit as intimately as possible to the tooth. Now it's not just the fit it's how well you adapt to the internal features as well as how well you manage the thickness of the looting agent every thing interacts with everything else. Nothing to date it's better than wax and cast metal on the internal of the crown where it's the most important that the cement not fail there. Now marginal fit almost identical between subtractive milled and waxed and cast but internal fit still a significant difference and I actually again I'm going to speak to that great detail as well because your question is the question I get the most from younger doctors why do we have to be so anal about all the details it's just a crown for goodness grashes yeah it's just a crown but what happens when it fails what happens if it gets secondary decay. You know what I don't enjoy cutting those things off I don't know about you but I just don't enjoy doing it and yet we're having to take away more and replace more and more of them because of decay yet how long have they actually been on the market Howard right 2008 Glidewell was making zero zirconia crowds here we are just barely a decade later why are we replacing so many of these things, there's a problem isn't there.

Howard: and what do you think the problem is?

Lane: Well again I think it's just it's just a manufacturing methodology because it's milled.

Howard: Yeah what I what blows my mind away is how girls resist gold dentistry but they have it on their ears or nose your bellybutton their ankle you know why is it that gold is the coolest thing anywhere on their entire body but their teeth?

Lane: Right you know it's a it's a question I always ask it I you know what I have those really stubborn ones that just don't no gold like a but yes I know it's here it's here it's here it's here I just don't want it now this is this may just be a demographic thing right in Beverly Hills they all have they all grew up with nannies and housekeepers from third world countries that have open open-face gold crowns on their anterior to you so it may be just you know

Howard: Status

Lane: Yeah my unique my unique you know geography that it's just not it's not associated with you know the US

Howard: I have to make a confession on the tape that at least at least once every five years you know she refused gold it's a second molar that prep was so short I'm looking at the deal the laments there's not enough for him and I just say just do it gold she'll never know and no one's I've never I've done that at least every five years for 30 years and not one woman ever came back to me and said hey you put gold but it's a maxillary second molar.

Lane: Right

Howard: Only me and your ENT are ever gonna see this thing no one else.

Lane: Yeah if their looking that close man it doesn't matter right their into your personal life. This is a deal I make with patients right if they're other pardon the pine if they're on the cusp okay look I'll tell you what...

Howard: No pun intended

Lane: No pun intended, all puns intended look this is what I believe and I have to put my money where my mouth is because I make my money doing procedures Mrs. Smith okay I truly believe that the best thing I can do for you is a partial veneer gold crown in this situation I'll tell you what if you after living with it for two weeks do not like the aesthetics of it just tell me I will change it to a porcelain crown I will not charge you to do it but if I have to put my money where my mouth is because if I value your tooth that much and I don't want to take more away this is the best thing for it. All I have to do to convert it to a porcelain crown is just cut off the gold and cut more tooth away it's no big deal to me it's not my tooth you know what's surprisingly a lot of people look at you just go oh okay let me try and I've had one person in my entire career make me change that restoration.

Howard: and how old is your career, when did you get a start?

Lane: I started I graduated in 1981 the very beginning of the all ceramic restoration the first castable disilicate.

Howard: Dicor?

Lane: Dicor

Howard: You graduated in 81?

Lane: Yes

Howard: You look damn good man I thought you're.

Lane: You know that's cuz I divorced my wife soon enough.

Howard: I got to tell a Dicor story because remember don't listen to manufacturers and when I was at a school they said if she's beautiful do all Dicor glass grounds and cement them with duraline guess how many of those failed that I had to redo for free.

Lane: I'd say about 90% of them.

Howard: All of them, then there was a targets vectors I don't know what Turkish means and I don't know what vectors means where they hated each other and came apart there was another one all right glass hey my various calls her and I'll blast and I have to tell you what old people do is when they see all this new stuff come out I mean I let all the babies I know everybody who hasn't sucked their tongue in a light socket will try it and then five years later they're gonna get on dentaltown and tell you it was a really bad idea so old people they've done that so many times don't be bleeding edge. The most recent one was when I'm Megagen came out with that pulverizer where you take the extracted tooth you pulverize and you make your implant you know so you have a...

Lane: Tooth Cuisinart

Howard: Yeah and it's like you know that just sounded so obvious and so everything was saying you know I don't know if they yeah I don't know who grounded up enamel and cementum I just don't know but I don't want to be the guy who placed 1,000 implants to find out three years later that it wasn't a good idea.

Lane: Look we love early adopters as long as it's not us.

Howard: Right

Lane: So again understand something right Emaxs, Emax was reintroduced disilicate in what 2005 so 1981 Dicor fails miserably we all hated it I still have a Dicor machine in my garage to remind me not to be an early adopter I bought one I had to set up my lab around it then was reintroduced as Empress 2 Empress 2 went the way of the dodo let's see if you remember this one Howard he was reintroduced as Aris do you even remember Aris, it was around for less than a year.

Howard: How do you spell that?

Lane: Aris

Howard: No I don't remember that one.

Lane: Quickly disappeared just I mean it's like where'd you go so then that was replaced with where we are today Emaxs. So Emaxs is looking pretty good you know I mean 2005 I waited I waited honestly about seven years before I jumped on the Emax you know bandwagon so but at least I feel comfortable with it that said at lab Day 2019 this year in Chicago Ivoclar was giving a lecture on guess what how to remove cement from a deep bond in Emaxs restoration it happens. So we still have a long way to go with understanding all interactions right you know, hold old are your gold crowns can I ask?

Howard: 20 years old

LAne: 20 years cemented with water based looting agents

Howard: It was all zinc phosphate on a glass slab yeah there's really say what that...

Lane: Chilled glass slab yeah but because we understood preparation concepts it got hammered into our heads. May I ask you how many how many cast restorations did you have to prep wax and submit yourself and your dental student?

Howard: On a live patient?

Lane: On a patient

Howard: None

Lane: None?

Howard: On the lab I think in the lab four or five.

Lane: Okay

Howard: I don't think we had to do any...

Lane: Really

Howard: On a patient

Lane: Wow in dental school.

Howard: I mean we might at was 31 years ago.

Lane: Out of sight out of mind.

Howard: Yeah that's a long time ago.

Lane: Yeah see you know it went when I went I was like in the glory days of USC our clinical requirements like 30 single units you know it's a lot of things as 3FPD's so you know just quite a bit of dentistry. I think most young ones would be pleased to do that much dentistry in a graduate residency program you know so back in the days again the education system was different right. You know it was it was just the most amazing thing in the world I could get an instructor to convince a patient they needed a class two foil on an insiphian lesions the greatest thing in the world it's but you know we just don't seem to have the you know the base of patients as well that come to dental schools.

Howard: Do you think a dental schools the dental school that also are do you think USC is significantly above? There's 56 dental schools and some are private some republics somewhere how old USC?

Lane: I have no idea.

Howard: A century

Lane: It's past a century I was

Howard: How is USC doing is it a legend

Lane: It is it was a legend when I left which you're what I graduated that's that was like the pinnacle you know all things go through cycles right you know dentistry ER restorations are great through cycles education goes through cycle. You know in the 90s USC took a huge leap of faith and they went to problem-based learning which is the Harvard Medical School protocol for education so rather than sitting in didactic classes memorizing and regurgitating information you would be given a problem you and a group of other students and you would research the solutions to those problems create your own algorithm which makes you a better thinker a bit better applier a better listener which is perfect to figure to be a physician. So this education system needed a facilitator who didn't have to be a physician or a dentist that would guide these students in their journey of learning and if they're doing a good job yes good job if they're going in the wrong direction whistle back you don't come back this way so it proved really effective incredibly effective in creating an empathetic physician well no well well-balanced well our position so USC implemented the problem-based this is very simplified by the way from our highly simplified us see implemented problem-based learning in the med school and guess what happened for the first time in the history of the med school that was profitable because facilitators didn't need to be physicians. So they implemented in the pharmacy school and guess what happened for the first time in the history of the pharmacy school it was profitable so what was the next logical move for the Regents do it to the dental school house laugh can you know what just what a one of you know the most incredible deans with a great mind and you know once was the head of the NIH was tasked with putting implementing problem-based learning at USC dental school and unfortunately it failed miserably but by the time they got a full four years of classes through the univer the dental school they changed the physic facility they changed the curriculum so much they changed the instructors that we went from being one of the top dental schools in the country to just a dental school and I think what's happening to a lot of dental schools they're having the same problem there's no one best right now because there's just too much information to teach now than when you and I were students. I mean what did we have to know when we were a dental school how to do an amalgam they come enamel etching barely came into being you know we just played with chemical composites that we had to know how to do a casting or that's where we're implants the implants didn't occur to what three years after I graduated. So that's the that's the problem we've got too much information and not enough time and dental schools are still struggling with that balance.

Howard: Every time you do a hands-on course over the shoulder that's sold out in an instant.

Lane: Pretty much

Howard: Talk more about your over the shoulders.

Lane: Their hands they're more hands-on so you know I'd been doing those for quite a while on my own.

Howard: and where do you do those at?

Lane: Well I did those on my own in Los Angeles and then I got tired of doing them because their tremendous amount of work and then another mentor influencer that I meant through dentaltown Mike Melkers you know lit a fire under my ass and said you know what I do this let's do it together and so we've been doing those together and we take the show on the road we've done one in Los Angeles our second one in Denver is coming up next month we have one scheduled next year in Chicago and basically Mike and I bring a couple of our cases to the participants and they are forced to go through the thought process the workup the treatment planning so that they have a roadmap on how we would address a full comprehensive case. You know to going back to the occlusion thing of learning learning where it was critical in the time of your career once you understand dentistry in itself once you have the confidence to do onesie twosie crowns right big cases really are not that much harder but where they're harder is planning them so that you can execute them like onesie twosie. So that's where you know we come in we take these cases that look just like insurmountable at their face but when you start breaking it out and working it up on your own then you get a hopefully the light bulb goes on and so that's the goal these hands-on courses.

Howard: Michael Melkers is an amazing man love that guy got out to him and his wife and they left Spokane and now they're on the East Coast.

Lane: Right right

Howard: There on West Coast with you.

Lane: Yeah

Howard: and now their on the East Coast.

Lane: Yep

Howard: One of the problems, she's young she's at high school she's been there two or three years it's just a six year molar it's broken down.

Lane: Right the money tooth

Howard: The money tooth but it's just severely worn down dentition, how does she's supposed to think about do I just treat this one tooth and keep it in the severely worn dentition where do you where do you cross the line and say...

Lane: There's yes when is that tipping point going to go.

Howard: Where is that tipping point?

Lane: We talked about treatment planning front to back, back to front and my real belief is that tipping point occurs when the front teeth can no longer do what they were designed to do and that's to reduce the bite forces the pair of functional forces that are occurring on the back tooth okay and we can evaluate that quite easily by looking at the dentition we can do it quite easily by taking mounted casts and once they hit that tipping point you need to move forward. Now when it's not going to happen in a worn dentition I don't know but I'm also gonna say something else, one the problems with a worn dentition is the patient's biggest complaint isn't their war and molar is it the biggest complaint is they wore their front teeth down and they don't show them. So the strategy is if you're gonna rejuvenate their worn dentition you're gonna have to lengthen their front teeth too in order to lengthen their front teeth without having the same pair of functional attack angle that wore out their teeth in the first place now this is where we have to start getting into opening the vertical dimension of occlusion. So that decision point comes when you've lost and you're about to lose all the information that the front teeth give you and that's the simplest way I can put it.

Howard: That's the simplest way you could put it.

Lane: Yeah

Howard: I want to hear the most complicated way.

Lane: No you dont want too.

Howard: because that is a it's scary because now she has to do you know full arch dentistry.

Lane: Right right and sometimes you can do a partial arch you know sometimes you know John Nosty another townie that I just consider a huge mentor and influencer you know John and I reach out I reach out to John all the time and have questions for the guy. I mean you know you Howard the gift that you brought to this profession just astounds me that I can count probably Arty Volker who's sitting over there laughing already another huge influencer.

Howard: Arty is one of the first podcasts as I ever did.

Lane: Really?

Howard: Yeah he was lecturing in New York City I nabbed him right off the stage and said sit down I'm podcasting you and I think he said what is the podcast.

Arthur: Pretty much, yeah.

Howard: Pretty much, so what would your what's your question for Lane?

Arthur: You know you've influenced so many townies, so many people throughout the years what keeps you fresh is it just relaying information because I mean you know you've said I was listening to you guys lurking as I usually do on dentaltown over there being a lurker this is my historical history with Lanes I've always lurked his posts and just try to soak up as much as I can how do you stay motivated like you know you keep contributing and you're still running high on energy I'm just curious what keeps you going?

Lane: Well that's easy Arty, it's like you if you know what so the more we invest right in our abilities the more we love what we do it's such a simple formula you know getting people excited about doing quality dentistry taking it to the next level. You know I just like just what was your most recent post using printed bottles to help you guide your to work. I mean just the fact that look I want another tool in the toolbox doesn't that make what we do so much more fun and so exciting.

Arthur: I'm sure it's pushing but I mean you know you also take you don't have to do this I'll tell you a sorry about Lane when I went to go visit him in Beverly Hills I know he came and he made time for me and I said you know I just want to say hi that's all I wanted to do just to say hello and he says look Arty we'll go let's talk a little bit but I have somebody in the chair and he took the time just to see you know to make people feel welcome and as a dentist who was following you for years and years like that was just you know it's that extra thing it's like I don't mean to say I'm a fanboy but you know I'm a big fan why don't make a secret of it both you guys and just to have you take the time to inspire, I'm like that's that's that's incredible so thank you for that and thank you for that.

Lane: Well thank you and I'm gonna jump with Arty's point like attracts like right this is right you created a world of guys who are like minded but it's like oh and why didn't I think about you know that I'm gonna implement that in my next case and you get excited about the littlest thing.

Hogo: You know there's so many things I want to ask you.

Lane: Like about my watch?

Hogo: That's a good one, yeah very nice watch.

Lane: Vintage

Hogo: You are probably the number one clinical person on dentaltown message board of people ask for advice from.

Lane: Well that's that's only because Chazillan you know just like being really lazy you're not coming on very much anymore.

Hogo: No comment but anyway I'm gonna criticize no I'm not I have a question about what she said earlier about milling.

Lane: Yes

Hogo: Being less accurate because of the internal surface.

Lane: Correct

Hogo: and he said but the margins are fine so why wouldn't you just take a get a milled take a burnt scratch out the inside except for the margin and the guy would sit down perfectly?

Lane: No it's the other way around it's it's too loose internally.

Hogo: but if you have risk but isn't resistance more important than retention?

Lane: No it's a combined effort of both resistance retention and it turns out the film thickness of our looting agents is also a critical part of the equation so if a restoration is over milled internally right you drop you drop the shear strength of our looting agent significantly, so that's a huge you know part of the total picture.

Hogo: I just found there's no scientific study that if I had no resistance the crown came off of course if I had no retention...

Lane: The crown came off?

Hogo: No the ground if I and I bonded it yeah it stayed on but resistance was always more important to me then retention.

Lane: You're absolutely right you're absolutely right.

Hogo: So it was throwing me off when I heard you say that earlier.

Howard: Well I'll tell you what my biggest mistake in dentaltown libertarian it's insulting for me to edit your post or tell you what you can't say I just did not understand the toxic troller of the time and then 10 years later it's common knowledge that in school there's bullies or bully and all the schools are looking for it and everything for but when we started dentaltown in 98 bullying wasn't even a concept of him all right well but you were the one who kept telling us for years this has got to change.

Hogo: You gave you permission to do that now so kudos to you for like for saying yes that's the direction we want to go.

Howard: and then when you find great people you get out of their way so I ever micromanager overall your decisions?

Hogo: You do not and I appreciate that.

Lane: When we play nice we learn more you know I like a hearty disagreement you know I really do.

Howard: Well what's funny is I think almost of every person we've ever banned on dentaltown is one of my friends. Something wrong with my personally because we have we've had to fire a patient about every five years because he's over-the-top crazy nuts, half of them were my drinking friends and one of them I actually didn't say his name but anyway John I mean he's like one of my favorite friends in the world but when he comes in the dental offices he he uses you know over-the-top language because he's scared he doesn't like that but anyway long story short my just might just have said you know we just we just can't stand him so I had to call them and I said I love you I'll go have a beer with you tonight but you can't come in here anymore. It's the same thing with dentaltown some of these people post stuff that I think is hilarious but you delete and say I get it I get it's toxic and some people some people doesn't bother somebody but thanks for changing the entire culture of dentaltown and now the president of the Academy of General Dentistry are you not the president of they care you gotta come over here now so question you're the president of the most...

Lane: By the way the only reason I'm here today is because of that man Hogo.

Howard: So this is the president of the Academy General Dentistry I just wanna say one thing that in my journey the looking back of all this is I made that best decision I ever made was to get my fellowship in the AGD and the reasoning and then my master's in AGD because what I learned as a little 24 year old kid is that when I went to those courses the people had their FAGD they were there with another level of the non ones and and and I said how did you get like that and they go well I took five hundred hours a see and I did all sub but that's what I cut my teeth getting my FAGD and the other thing is we had a study and I know you guys are looking for we had on dentaltown but there was a big-time major consultant and I forgot he was but he didn't just all of his dental CPA clients of the DDS degree versus an FAGD versus MAGD and the net income just went straight after you just can't take a hundred and fifty hours to see a year and not learn.

Lane: Well we're going full circle here Howard right passions right Arty passion passion raises the bar raises your ability and guess what happens patients pick up on it patients want that patients refer their friends I want that to you I mean this is just the coolest self-fulfilling prophecy right education.

John: Absolutely and I just want to echo what Howard said earlier you know it's a town dentaltown is a community and there's enough room in the sandbox for everybody to play and as a specialist I'm sure you appreciate generalists to do certain procedures and certain things and as well to refer to you those things that are outside your scope or outside what they feel comfortable doing. There's too many people out there that protect their specialties and don't want general dentists to do anything that should be in there specialty. It's like the whole discussion about implants it's a root so an endodontist should be doing it, it's surgery so the surgeons are in it's in the gums in the periodontist think they're the experts well and it's prosthetic limb driven so the prosthodontics thinks that they should be doing it so who should be doing it, you know.

Lane: Well for the first and foremost you know I've said this on dentaltown.

Howard: You haven't even told them your a prosthodontist.

Lane: No I'm not a prosthodontist I'm a generalist I started a prosthetic residency and this is why I into you know all the things that that poor prosthodontist the residents have to go through writing literature review case review I never made past my first year because I was offered the most incredible mentorship opportunity of a lifetime and I went to my director and said so-and-so just offered me a position is practice he goes later I think what do you mean later am I not that good because no I want you as a resident but I can't give you what he's gonna give you and so and he knows that.

Howard: and who's that?

Lane: Albert seulement who is one of the premier doctors and occlusion has wrote one of the ultimate textbooks on occlusal correction yeah just a tremendous opportunity and you know he just this talk about a man whose passion was dentistry both his sons are world respected dentists as well his youngest son Gary's a prosthodontist in Beverly Hills hugely successful big time lecture and his other son Jay went the endo route he's an endodontist at Beverly Hills. So you know there's a son's legacy.

Howard: So I got to toot my own horn my boy just got his ankle bracelet taken off the other day I think and now fly again but I think we all can agree on one thing is that we when you look at them success I mean you don't measure success in dollars and cents on its do they have a fun and rewarding and fulfilling career so what lines up with the long rewarding fulfilling career the obvious most low-hanging fruit is a hundred hours of CE a year.

Lane: Right

Howard: Those guys always stayed in the game they always loved it you talk about burnout well yeah they haven't learned anything for five years I mean I mean you and even if you're going to a CE course on inclusion and you were suffering burnout well what better five days at dinner to talk about burnout I always thought it was funny that half the course ever went to half the stuff I learned was just from the group nothing to do with the lecture.

Lane: Right no no it's late and that's what dentaltown is I mean you know Arty and I chat offline all the time you know like that Hogo guy you know I even talked to him a little bit about some laminer techniques that I tried didn't work at all of my hands but I enjoyed trying it and I you know I figured with enough practice it really made a lot of sense but you know it's the guys it's it's you're saying right like attracts like.

John: and the other thing you said is when you're in a group together it's good to know that the same shit happens in everybody's practice.

Lane: Yeah

John: Then you feel like you know what it's not something I'm doing wrong or I'm incompetent it's sometimes the things just don't work out.

Lane: Right

John: and maybe you learned from somebody it's just oh you know what you have to use a thinner layer of cement you have to use a different material or whatever it may be that the two don't mix and match like your last article that we were talking about so you know these are the small things that you pick up on that will literally change your life and your practice.

Howard: So somehow I got into the dentistry uncensored part the politically incorrect stuff that people don't want to talk about she's been out of school three or four years she thinks in order to be a good dentist like you this means to spend a hundred and fifty thousand dollars on a cad/cam machine...

Lane: You want to know something

Howard: True or false

Lane: False, patients are not impressed by technology but not they're impressed with you period. Are you honest you know do you take the time to listen do you not hurt them these are the critical things patients are looking for. God I still shoot film in my office you know I've got a dip tank for God's sakes I mean I have a processor but I still shoot film I have no modern technology whatsoever, well okay I have a three shaped scanner I do take impressions I scan my I scan my models but from what the patient sees I have nothing new. I don't think technology is necessary and in fact you know what's interesting there was a survey interesting survey just published this year by inside dentistry do you know how many of us actually use digital capture for crown and bridge?

Howard: How many?

Lane: 17% that's you know that's minimal right that's nothing so.

Howard: and how many use CAD CAM?

Lane: 25

Howard: 25

Lane: 25 and that market bet number hasn't changed very much at all you mean in-house CAD CAM yeah.

Howard: Yeah chair side milling.

Lane: Chair side milling, yes.

Howard: So when you were talking when Hogo asked you about the internal fit you know that was a reduction milling where you started the, are you sound now they're doing the opposite they're printing right does any of that excite you?

Lane: Personally not yet not yet.

Howard: So it's still bleeding edge.

Lane: Yeah it's still you know what it's gonna be here it's probably not gonna be here in my career lifetime but it's definitely gonna be here.

Howard: and so what so what is your wheelhouse what are you mostly doing in your practice is it mostly crown and bridge?

Lane: It's all crown and bridge.

Howard: It's all crown and bridge and what percent of it is gold versus other?

Lane: Well goals do you know if you what because you know crown and bridge sometimes I told you I operated numbers but in terms of my full numbers I would say a good twenty percent my practice is still gold is gold.

Howard: and what is the other 80 percent?

Lane: It's metal ceramic and all ceramic so it's metal ceramic plus all ceramic so all ceramic is beginning to increase in numbers you know the ability to do a partial linear restoration tooth colored restoration or bicuspid and rather than cut the whole thing down into a nub for a metal ceramic crown is a game-changer you know just to preserve tooth. You know where the interesting things about the evolution of a dentist there at least me as a dentist the the most humbling moment came you know when I realized that my best work failed that is like the most humbling moment in your professional career that you can do the best technical work possible and it still fails and it made me search out and start thinking about some of what Bob Barkeley taught right and one of the most powerful statements he made right is our job is to help our patients get worse at the slowest rate possible so when you asked me about when did when do I how long do I watch and where patient before I do a reconstruction part of what you have to ask yourself at the big pictures well if they wore out their own dentition what's gonna keep them from wearing out what I do and how old is this patient you know am I so quick to do a rehab on somebody in their 40s when I graduated from dental school damn straight I wanted one I'd do it all the time today I'd be horrified if I did it. So you know that's kind of kind of where you know I've evolved too so my dentistry has become a lot more conservative it really has you know.

Howard: I remember one time I met a 92 year old dentist in the St. Joe Missouri and his name was George Ruie and his son George Ruie jr. is that a said George Ruie the third was a dentist and I asked his 92 year old I said which teeth lasts the longest and he said the one that dentist never touched.

Lane: Exactly

Howard: It's the one you never touch right and when we touch the teeth and reduce that we committed to a life of retreatment.

Lane: Right dentistry begats dentistry begats dentistry and the dirt in the sad part is and I see this in my community it drives me nuts that I see 20-somethings I want veneers and I say no just not gonna do it you know you can go get ortho you get bleaching we can reshape but you're not gonna do veneers well why not I doctors so and so I consulted with the doctor so-and-so and they said don't start tomorrow I said well did they also tell you how long they're gonna last well if they're gonna last forever aren't they.. no. They well how long will they last I said well a really really good set of 'dearest my last 20 years ha let's say you'll be 40 then boom the next set will only last half as long as the first set now of course I'm exaggerating a little bit so let's see that takes you to 60 and this third set are probably gonna be crowned so we're gonna cut down your teeth two little stubs you may get another 10 years before one or two snaps off by the way did you see that Instagram post of Demi Moore that because she's had her front teeth veneered so many times she snapped off her two front teeth.

Howard: I did not know that.

Lane: Yeah and so patients...

Howard: Did you post that on dentaltown?

Lane: I did not but it's it's out there in our community Beverly Hills you know cuz everyone knows her and people go that's because she had veneers done and I go yep multiple times so.

Howard: So how do you combat that cuz Dennis aren't dated you're I mean you still have dentists that believe that they're composites lasts as long as amalgams. Whenever I see big studies that did not last twice as long as composites and you have big footprints and dentistry saying that they're veneers are permanent and then if you say no they only last 20 years and they're like well maybe yours only last 20.

Lane: My response is I'm not that good

Howard: How do you counteract data-driven?

Lane: Whose data and that's always the thing you know it's like anything right and and when this is what we talked about who do what do patients really want from you they want honesty and the most honest answer you can give them is that nothing we do is as good as your own tooth period. I don't know how you know everything in anything original equipment is usually the best unless it's a lemon right from the get-go but people respect that attitude they really and truly do.

Howard: Yeah and I'm including kudos to me for turning down so many cosmetic cases where I just tell the kids look if you're my daughter you're gonna get braces and bleaching.

Lane: and guess what honestly yeah you know some will be boneheads and do what they want to do but most will listen you know especially if they drag their parents in who are paying for this.

Howard: So or there's another question I'm when I asked dentists why are you stressed out why are you burned out and a lot of times its managing patients and so that good old boy in Parsons Kansas his patients are nearly as a pain in the butt as yours and Beverly Hills. I mean so what it would advice would you give to kids what we call them high maintenance patients. I mean Beverly Hills I mean that's a lot of harder person to handle than a corn farmer from Iowa so how do you handle these big egos major.

Lane: Well probably because I have a bigger ego than most of them you know boy it's the old saying right unfortunately this is our own creation we get paid for procedures right we don't get paid for degrees of difficulties and that's that's our own fault and so one of the key things is is you have to always ask yourself you know is the juice gonna be worth the squeeze you know am I really going to enjoy doing this case is this case could have caused me an ulcer in my stomach line and if it is you know can I charge enough to rationalize this oh I'll be happy and so when you go back to what you asked me quickly jumping into cases you know comprehensive a set of cases I ain't quick to jump into any of them I need to get to know the patient you know you've seen me jokingly referred to some of these cases in patients in dentaltown well put him in the perio penalty box first you know see how they do with their their recalls you know are they behaving show me what you're about. You know lose them in repositioning come whatever you want to call it but just don't start right away. You know what they'll either get really frustrated and their true persona may show or they will go WOW no one's ever done this you know I really like that you know listen carefully you know learn how to communicate by listening but until you get to know patients yeah and I bet you know Arty's the same way you know that he really wants to make sure he knows his patient before he commits them to any kind of dentist at the cosmetic dentistry be it adhesive or purely direct bonding or having to prepare teeth.

Howard: Yeah so the hour went by we already did our arty what question was I not smart enough to ask, did I get them all? Was there any anything that you wished I would have talked about it or a subject I didn't bring up?

Lane: No we went around the block pretty good there I think yeah

Howard: Well really Arty, you guys I mean that dentaltown was nothing without you guys I mean it was just I mean you guys are what made dentaltown.

Lane: Well you still need a vision you know you'll still need somebody in charge she's got a passion so

Howard: but what you know what I love about you the most and sometimes you would just post this light like this little drawing it was like two lines but it completely I mean here's a master educator you take the very complex you make it very simple and some of the most profound things that you did on me I bet you made that slide in two minutes I may be you know just a little deal and you could just tell what we weren't seeing right and then you'd make a little image and you'd see it you know I mean so kudos to you. I mean the doctor comes from the Latin word dosar meaning to teach and my god if there's a doctor it should be you.

Lane: That's the ultimate compliment thank you my friend

Howard: Thank you

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