Speaker 2: You can hear my dog, apologies!
Speaker 1: No, the dog just said that he loves it. I can speak dog.
Speaker 2: Okay. As you say, I'm from the UK and back in 2003, 2004 when we were doing a lot of Veneers and stuff, I had a different way of restoring teeth. I was using bonding and [inaudible 00:01:31] as well. I wrote about the aligner, actually in the AACD Journal and also in the Orthodontic Journal as well. I thought this is quite an interesting things, so I contacted Don Inman, [inaudible 00:01:49] some cases to him. I was just amazed with the results. In fact, the kind of cases that I was doing, Don didn't think worked and pushed the boundaries a little bit and [inaudible 00:02:04] all the protocol, and I think probably not being an orthodontist, this gave me a slightly different perspective on how we could use it.
We were looking at things in a very analytical way in millimeter measurements and the whole dynamics of it, and we started to realize what it could do and what it couldn't do. Eventually, a couple of years later, I kind of revealed it to a lot of my colleagues at the BATD, and for many of them, a lot of them were still prepping a lot of veneers at the time, I think it was quite a jaw dropping moment to see what I was doing with this little appliance, and so from there this course just started, almost like a bit of a hobby, and a joke really, and eventually it has grown into what it has, so that's pretty much where it has come from.
Speaker 1: So, so the Inman aligner was named after Don Inman?
Speaker 2: Yeah.
Speaker 1: And he's an orthodontist?
Speaker 2: No Don Inman is a technician in Coral Springs, Florida. He is a very humble guy, an American who actually I call one of the unsung heroes in cosmetic dentistry and people need to know who he is and know his name because he invented the Inman aligner, and you know, I just took the alinger and I developed it and made it work in situations that I didn't realize would work.
Speaker 1: Now does he still work in a lab? Does he still make Inman aligners?
Speaker 2: Yeah he builds most of the Inman aligners in the USA. There are only several labs that are educated to do it and Don's lab probably does most of them.
Speaker 1: So will you send him an invite after this one and we will follow your pod-cast with one from him?
Speaker 2: I think that would be a great idea because you will hear his side of the story and you will hear, you know how a technician has been involved in the whole process, and Don has really helped, especially with the whole digital work flow and our interpretation of digital work flow. Actually I would argue that the stuff that Don and I have been doing with digital interpretations has been leading the way in aesthetic orthodontics.
Speaker 1: Okay, before you get into that, I want to stop you. I'm trying to guesstimate, on our first 75 podcasts we went over 170,000 views, most people listen to these on sound only, in their car while they are on a treadmill, driving to work or whatever. I always try to guess their questions. The first question everyone is going to have is "what the heck is an Inman aligner."
Speaker 2: What is it? Its a removable appliance which is designed to straighten the front six teeth. Its driven by [inaudible 00:04:44] Coral Springs. It works within a very restricted area so its extremely safe and very predictable so you know where the teeth are going. It doesn't work for every patient. Its not going to work for every case. Its not a comprehensive treatment in any way. But, in cosmetic dentistry for those kind of cases where you have that slight anterior misalignment, it works like magic. It works quickly, effectively and you know, patients love it. Its as simple as that. Its made a huge difference in the world really.
Speaker 1: Okay now what is the IASORTHO.COM? What does AIAS stand for? Intelligent Alignment System Academy?
Speaker 2: Intelligent Alignment Systems. That's correct. Now in the UK we have, I mean obviously there is a lot of ortho in the US, but in the UK our market, I'm not saying its more mature, but I think the number of dentists per head doing ortho, doing general dentistry ortho, I think is higher, so we really have gone a long way very, very quickly. As a result, you know there's a lot of systems out there pushing applicances, pushing buy 5 cases getting 3 free kind of thing.
What we are trying to do at IAS Academy is to provide an ethical staged learning approach for dentists. So we're not going to drop dentists into full mouth fixed ortho. Its also very much about teaching the dentists what they are doing, its fundamentally based on diagnosis and the correct assessment. So you can't just take an impression, throw it to the lab and expect the lab to do everything for you. Of course they can, but medically and legally, you are going to be in deep trouble if your case gets picked up and all it says is, I took an impression and sent it to the lab. The dentist needs to be in control of his cases and understand why they are doing what they are doing. So the whole basis of IAS also is to actually provide that pathway of learning.
Speaker 1: So he's saying IASORTHO.COM for Intelligent Alignment Systems Academy. And so, this lady is driving work right now, you know, and if she goes to that website, what is going to be on there? Do you have on-line courses that teach how to diagnosis and make a treatment plan for ortho?
Speaker 2: Yes, that's actually correct. I mean there's several ...
Speaker 1: Does it cost money to joint this site or does the CD cost money, or how does this work?
Speaker 2: Yeah of course, the Inman Aligner is often considered the first place most dentists will look when they are getting involved in ortho because its such a simple, safe technique. Not a lot can go wrong. So Inman Aligner is also part of IAS, and then there's also clear alginers and there's also fixed braces, and also there's a very high level advanced course which has been wrote on by a professor of orthodontics in the UK.
Speaker 1: What's his name?
Speaker 2: His name is Professor Ross Hobson. He's one of the leading orthodontists in the UK?
Speaker 1: So can you deliver him to me on a podcast?
Speaker 2: I think we definitely can.
Speaker 1: Right on! This podcast has already turned into three. I mean I hit the bulls eye this morning!
Speaker 2: Ross is a crazy guy. He's an accomplished sailor and pedal-head as well so I'm sure he will be an entertaining speaker.
Speaker 1: What's his name? Ross?
Speaker 2: Ross Hobson.
Speaker 1: HOBSON?
Speaker 2: Yes.
Speaker 1: And he's an orthodontist?
Speaker 2: He's a specialist consultant orthodontist, yeah.
Speaker 1: And he's a sailor?
Speaker 2: He's a huge sailor.
Speaker 1: And it was a British Sailor that made the first medicine on earth who discovered that if you had a lime you wouldn't get scurvy. He noticed the British Navy came back, and every time the British Navy came back, about a quarter of the sailors were really dying from scurvy, and he noticed one time that one boat came back and nobody had scurvy on it and he absolutely knew something happened, and he wrote down every detail on the ship. It took him about a month looking at the list, and he couldn't find it. Finally he said to himself "I can't find it, the only thing different between this ship and all the others was one barrel of limes."
Speaker 2: That's right.
Speaker 1: And he had to think about that too. That should be 100 million dollar blockbuster movie and you should play the British sailor. No we will get Ross Hobson to play the British sailor. Yeah and the British Navy still calls them Limies to this day, don't they?
Speaker 2: That's absolutely right. Limies.
Speaker 1: Okay, so let me, I'm trying to guesstimate questions from these people driving. So if I go to your web site, ISOORTHO.COM, I can learn how to do, start with Inman aligners, go to clear, would you call it clear, what?
Speaker 2: It would be Clear Smile Aligner, basically like clear aligners but they use the protocols of planning Inman Aligner uses, meaning we have digital arch evaluation.
Speaker 1: And then you go to advanced ortho with Ross Hobson?
Speaker 2: Yeah, well then the next step would be simple anterior fixed ortho, just of the anterior front teeth with sectional digitally pan fixed and then beyond that, for those dentists who want to go further to a level of comprehensive ortho, then its a completely non-system based course where Ross will teach you a level of ortho which is close to that of being an orthodontist. That's a year and a half course so, its a big commitment.
Speaker 1: How many hours and what's the pricing for like learning Inman Alinger versus the clear liners, versus anterior?
Speaker 2: Yeah sure. Inman aligner itself is a day course, but it is actually a continuum because to be certified now and to maintain your certification, you need to actually submit two cases on-line and we actually assess and reevaluate, which we have been looking to increase the quality assurance. That's one reason why Ross got involved. He only got involved to make sure that the quality assurance as there so, so with Inman Aligner you've got to submit two cases on-line. Truly the course probably takes six months because we follow your cases right from the beginning until they are complete. So Inman Aligner course in the US is probably around $800 to $900 and all then all on-line support is free. The clear aligner course that comes with that is free for Inman Aligner users. The fixed brace course would probably be the equivalent of $1,500, and again, very similar, its a continuum of education, its not just a two day course, you actually get your hand held right through the whole process.
Speaker 1: So, clear aligners, would a similar brand be Invisalign? Is that kind of similar or is this very different process?
Speaker 2: Its different in that it is very much dentist led, so we have something very unique that starts with Inman Aligner, a piece of software called Spacewize, and Spacewize is basically .... my dog!
Speaker 1: We love dogs!
Speaker 2: Spacewize is basically a digital arch evaluation tech software. The idea of this software is that the dentist can: a) Work out if the case is suitable. b) The dentist can actually then provide the lab with an occlussal trace to tell the lab where the teeth need to go. This is actually very important because it has started to be quite a valuable part of your medical legal consent. A lot of doctors have this now and they can show that they had a plan from the start, not just to say I took an image and sent it to the lab. Spacewize works all the way through one of our systems, through Inman aligner, Clear Smile Aligners and also through clear braces and the fixed braces as well. Once doctors understand how to use it, its very, very useful.
Speaker 1: Okay Tiff, how many countries are on this website? I mean, how many countries have you worked with, general dentists from around the world. Is this a handful of countries or is this an international phenomenon?
Speaker 2: Its definitely international. I think we have probably given courses in about probably 20 countries at least I would say, probably more than that actually. Europe, Australia, the Middle East. Obviously we get invited to lots of places but we can only go where we know its going to work. So it is a large international group of leading dentists, all who are trainers and becoming trainers in these systems. The great thing about these people, these are all people that came onto my Inman Aligner course and enjoyed, became great at it and learned how to teach. So we've got some great people involved, and some very talented people involved in the whole process.
Speaker 1: So are you mostly teaching on the other side of the pond or are you yourself lecturing much in the United States and how has the United States been as part of your business? I mean, has that been a significant part of it?
Speaker 2: Definitely. I mean we have done a lot of training in the USA. Myself and one of my business partners, James Russell, we've probably done maybe 15 to 20 courses in the US and I've been over there nine or 10 times over the past few years. We are putting a newer version of our course into a more on-line version to make it more accessible in the US, but equally we are currently talking to a couple of trainers now over there to take over the courses. Because you can imagine, its difficult travelling all the time. At one point I was flying away virtually every weekend. I don't want to get divorced or leave my children so I am going make sure that I reduce the amount of flying I do. So yeah, we are planning with Don to launch more hands on courses and we are pretty sure that Dr. Ross Nash is actually going to be running these courses with us. He's already a big Inman aligner user, in fact one of the biggest in the US. So, that's what we are hoping to happen very soon.
Speaker 1: Ross Nash, is he North Carolina or South?
Speaker 2: Yeah, Ross Nash is from North Carolina, that's correct.
Speaker 1: Yeah, I love his wife, Deborah Englahart Nash, I mean what a lovely lady. I love Ross. Have you noticed that all the great American dentists are all short, fat and bald like me and Ross? Have you noticed that? I think if you shaved your head you would just do better in American. They would say "hey you look like Howard and Ross Nash." And then you would need to gain about 50 pounds of weight. Ah, but ah! So, okay so, now the clear aligners, if a dentist is sitting there thinking "Okay should I learn clear aligners or Invisilign", what would you say to that question?
Speaker 2: You know what?
Speaker 1: Is there a difference in cost? Because when a lot of dentist thing about Invisilign, they are usually thinking about a thousand dollar lab bill, now is that right or is that wrong?
Speaker 2: No I mean, there's no doubt that the laboratory fees for Clear Smile are not as expensive, but you know what we are doing...
Speaker 1: How much less expensive? 10%, 20%, half? I mean?
Speaker 2: I would say more than 50%. Yeah, more than 50%. I mean, I can only talk about the UK here and comparatively, but then equally, Clear Smile, we are focusing on the anterior region. We are not allowing general dentists to do full mouth ortho under a technician's prescriptions. You know, if that's the way Invisalign operates, that's perfectly okay with me. Our protocols are to make sure the dentists are doing appropriate treatment that is appropriate to their skill level and that they are responsible for the treatment. We won't be moving molar teeth with Clear Smile aligners. In our opinion that is something that either an orthodontist should do or a very well trained general dentist.
General dentists, there is enough work in the anterior region, especially if you expand the concept of [inaudible 00:17:24] studies that actually general dentists can deal with anterior teeth, removing molars, and that pretty much is all you can do. So our system Clear Smile Aligner is different, its much dentist [inaudible 00:17:40] assessment but also we have dentists actually giving you on-line assistance as well, not lab technicians or anything like that.
Speaker 1: So my model for me was, you know, it was in 1998 and you know I would come home from work and it was so professionally lonely when you had questions and thoughts. I saw on the Internet as a thing that I could talk to other dentists like you and how interesting this is, now its 2015 and I'm talking and seeing a great dentist from the UK. This is so damn cool, so our motto was "with DentalTown.com, no dentist would ever have to practice solo again. I'm always trying to predict, what does this individual solo dentist, what is she thinking when she is driving to work? I think one of the questions, maybe several hundred of you thinking, I'm seeing this Inman alinger, Clear liner course, and everybody has heard of the Inman Aligner.
In fact, some of my friends that knew I was doing interview with you, last night at the bar, three dentist said "You know I've heard of the Inman aligner but what is it?" They are also hearing Powerprox 6 month braces with Rick Napal. They are also hearing Six Month Smiles which was started by [inaudible 00:18:59] Ryan Swain, but he sold if off. So as an individual dentist, what's the difference between these three systems and why should I learn Inman aligners and clear aligners versus like Six month Smiles or Powerprox six month braces, what would be the unique selling proposition because this dentist in the car doesn't know anything about all three. We just hear these brand names all the time.
Speaker 2: Yeah, I totally get what you are saying. I think there is a slightly different realm patient. I would say that treatments like Six Month brace and Six Month Smiles are probably for more advanced crowding cases, as simple as that. So if you have more crowding and large canine movements, then actually those sorts of treatments are probably more suitable. The Inman Aligner is definitely more for incisor movement with some mild canine movements. Also typically for patients who have hygiene issues because of their minimal crowding, they don't want to have brackets on their teeth. So to say its an alternative option, the truth is I think every dentist needs to offer as many options as possible. The difference with what we are doing is as I say, we have a common thread of diagnosis and assessment that start with Inman Aligner, digital space evaluation, form support. All the doctors know that when they start with Inman then go to clears and then go to the fixed braces, everything is done in the same [inaudible 00:20:25] and they are dealing with the same people. I think the other systems are great though.
Speaker 1: Okay you were comparing Six Month Smiles and Powerproxy with Smiles to more movement than an Inman aligner, you are saying the more mild movement, but what about those versus clear aligners. Is clear aligners more movement than the Inman aligner?
Speaker 1: Not hugely. Maybe yes. You probably can move canines a little bit more and maybe the first [inaudible 00:20:51] molar a little bit, but then there may often be places where we will do a whole case with one arch with an Inman alinger and the other arch clear aligners. The nice this is that that case can be planned digitally on one set up and produced by one lab and the whole lot will come out to you and be fitted on the same day. You know, you've seen an Inman Aligner. You wouldn't want one at the top and one at the bottom in the same mouth. There are patients who do that but they are usually [inaudible 00:21:18] or they are nuts. Its usually one of the two. But, quite commonly we will combine those treatments. Yeah I mean I think that [inaudible 00:21:27] liners, they do [inaudible 00:21:31]slower, they are more expensive, but there are always certain situations where they work better. And some patients just prefer them. Some patients want the speed of the Inman aligner.
Speaker 1: Okay, I'm with you. One of the things that I admire and respect about you, and I love your message so much, you know, I've been a dentist for 28 years, and when you start pealing off all the enamel on the upper front 10 teeth to do veneers, that's aggressive. And those teeth, when you strip all the enamel off them, they walk out of there it looks gorgeous. But 10 years later, 20 years later, what percent of those 10 teeth do you think had died at that time and need a root canal, because you stripped all the enamel off and did veneers? I mean, yeah, what percent of these cases would you say would die and have needed endodontic treatment?
Speaker 1: I'm not sure what the figures are but I know, you know what Howard, I did that years ago and I did that 10 or 15 years ago and that's why I changed. Patients would come back, and you had patients with fracturing (let me just switch that off.)
Speaker 2: Is that your girlfriend or your barker?
Speaker 1: I have no idea but I'm switching it off.
Speaker 2: But you had patients with fracturing veneers, and you had patients who then needed a crown. The patients from 10 or 15 years ago who I told them it would be a good idea to have the veneers, I just feel terrible guilt now that I did it, and you know, I often do bits and pieces of them for free because I feel bad. Back then you know we were using digital [inaudible 00:23:06] to try basically tell people that they needed to have this done and I realized very quickly once I started to align teeth that actually, the psychology of the patient changes as soon as they see their teeth improve their mouth. Now I've had, and this is a fact, I've had over 100 patients in my practice who have come to me wanting 10 veneers, who as soon as I started to align and bleach their teeth, they change their mind completely.
I'm not a big fan of the concept of smile design, because I believe that actually patients should be able to see their teeth improve progressively through progressive smile design. So I'm not anti-veneer, I just think with veneers, people jump straight into veneers as if its the be all and end all of cosmetic dentistry. The truth is that so many patients who started off wanting veneers wanted wider buckle corridors, wanted you know longer looking teeth, and the minute I started straightening and whitening their teeth, they didn't give two hoots about all of those things. They just want their own teeth to look more beautiful.
Speaker 1: Well there's no doubt about it that when a human doesn't like something, they don't pay any attention to it or take care of it.
Speaker 2: That's correct.
Speaker 1: And as soon as you start making them feel better about their teeth, their brushing and flossing jumps through the roof, they start coming in for their regular cleanings, and you just, if someone is covering their smile and hates their teeth, they are not going to brush them and floss them every morning and brush them and floss them every night and get their teeth cleaned every three to six months. So, yeah, with humans everything is psychological, motivational, inspiration, and the hygienist and the dentist that are sitting there making people feel bad by "Tiff, your missing your plaque, and your not brushing, and you were due six months ago." Yeah, just make them feel all bad and then they don't come back. Its the coaches who motivate your kids, or the kids just want to do good because they want to make the coach proud. Those are the ones brushing and flossing in the morning and doing all that stuff. So yeah so beauty is everything.
You dentist expect that, since we're all dentists, we gotta, you know, say all the proper things in the country club, and you know I've always been the opposite instead of, just the first to call the 4000 pound elephant in the room, and that is, they don't strip the enamel off their own daughters, their own daughters they send to the orthodontist and get braces and bleaching, and then since they can't do that, they strip the enamel off and do veneers.
And then when dentists come along like Bob [inaudible 00:25:39] saying "well just put veneers over the teeth. Don't do preparation. And then they call no prep veneers." And then the dentist would say "Yeah but it thickens the tooth and makes is bulky." I'm like "what about woman beauty is natural. Does anybody think their plastic anti-gravity boob jobs are natural, their thick red lipstick, their eye shadow." I mean half of them are dressed up like a clown with anti-gravity boobs and your telling me your not going to thicken their tooth a millimeter? I mean what part of a woman looks natural? Her four inch heals? I mean the whole beauty look is silly looking.
Speaker 2: I agree.
Speaker 1: So why not prepless veneers? I mean, you know. You know what the number one complaint of a boob job is in America? The number one complaint? Its too small. And yet the dentists are filing off a millimeter and a half of enamel because they don't want to bulk up the tooth? When they're bulking everything else. Now they're doing butt implants. You know the big rage in American now is some Hollywood movie star, I guess, has a butt the size of, she's married to Kanye West or some person I guess.
Speaker 2: Yeah I know who you mean.
Speaker 1: So, so, what do you think about prepless veneers? I love your conservatism, but what do you think of prep-less veneers? Because you're a high, I mean you're the past president of the British Academy of Cosmetic Dntistry. Would you do a prep-less veneer? Would Ross Nash do a prep-less veneer? Or is that a ....
Speaker 2: Yeah, I mean I have done prepless veneers. I think there is definitely, definitely a place for them. But, I think unless the dentists have the ability to actually improve the teeth with just direct bonding, you know, why would you do a prepless veneer? And you know what? Listen, this statement, listen to it carefully, okay and tell me if you think it is okay. But I have heard many dentists say in lecturing, I've heard many dentists say in a lecture "I did veneers on this patient because I'm not very good at bonding." Okay. Now that statement gets said so often. If you think about it, its gotta be one of the most immoral statements in dentistry.
Now the answer to that question is, if you are not very good at bonding, you gotta learn how to do some bloody bonding, okay! You don't stick veneers on patients just because that's all your good at. There's a psychology in dentistry where I can hear someone say that in a lecture and no one even bats an eyelid. The fact of the matter is, yeah prepless veneers can be great, but there are so many cases that I've seen posted up that actually the patient could have just had some bonding, just a composite edge bonding added to edge bonding. The truth is, unless you actually try that in the patient's mouth, how do you actually probably properly consented to them? How do they know what that bonding would have looked like? Its the same with ortho, patient's who don't have ortho, how do they know until they've had a little bit of ortho.
So I've got nothing against prepless veneers, but I think this kind of progressive approach smile design should be that you try everything you can, bleaching, contouring, edge bonding, to see if the patient is happy with that improvement before you start doing treatments that are irreversible. And lets face it, prepless veneers, I'm sure there are people who say they are reversible, but from my understanding, its relatively irreversible. Its not an easy thing to remove.
Speaker 1: So how does this dentist listening in the car learn how to do direct composite veneers?
Speaker 2: Well I think this [inaudible 00:29:05] serial selection, I think [inaudible 00:29:06] out there that [inaudible 00:29:10] of composite and I don't use [inaudible 00:29:17] but there are people out there who teach it in a very, very simple way. You have people like the world famous DDADH, he I think is one of the best dentists in the world.
Speaker 1: Who's this?
Speaker 2: DDADH, his name is. DDADH.
Speaker 1: DD..
Speaker 2: DIER DIETCHE, I think.
Speaker 1: His name is Dier Dietche?
Speaker 1: And where does this person practice?
Speaker 2: He practices in Geneva. Actually he runs an amazing course in Geneva. He is one person who teaches composite and bonding in a very simple way. Another great guy is Corky Wilhite, your own Corky Wilhite, who I saw speak in Georgia who also teaches bonding in a very simple but beautiful manner. He is an excellent speaker.
You've also got world famous Jason Smithson as well who posts a hell of a oral on dental tact.
Speaker 1: Oh my God he is amazing. He's got 5 or 6 thousand posts. You've only got 600 dude. You gotta Jason-up on those boards.
Speaker 2: I know, I know. I need to post up more. But I mean Jason is a real inspiration. He's a very, very good dentist. But I think the key is with these guys, with DDA, with Corky, with Jason, and even, hopefully what I show, people should realize that the composite bond is not magic, you know. The materials are there now to make it so much more simple than it was 5 or 10 years ago. And it can be predictable. Its not for every patient, and sometimes veneers are definitely a better solution. But I think too many cases end up with veneers and not enough cases end up with bonding. That's my feeling.
Speaker 1: So on your assigment, can you deliver Dier Dietche for a broadcast too.
Speaker 2: I think I can, I know him pretty well. I think he will.
Speaker 1: Your gonna have more time to spend after our podcast than during our podcast. So this individual driving wants to know, like, okay lets not be politically correct. They want to know what composite do you use. I know you guys don't like to do that but I gotta throw you under the bus and ask this, they're sitting there thinking, I mean there's probably, at the IDS Conference, seriously, there were what, 240 different implant companies selling a titanium implant? And how many composites are there from around the world? I mean, can you even count them?
Speaker 2: Yeah, no.
Speaker 1: So dude, what are you using, come on, what are you using? You're the past president of the British Academy of Cosmetic Dentistry. This lady driving her car wants to know "what the hell are you using?"
Speaker 2: Honestly when I am using mostly right now is Venus Diamond from Haraeus, that's what I use.
Speaker 1: Venus Diamond from Haraeus Kulzer.
Speaker 2: And they also have another one called Venus Pearl as well.
Speaker 1: Venus Diamond and Venus Pearl.
Speaker 2: That's a great material, but there's a couple of other materials that I would rate very highly. Another one that I rate very highly is Renamel by Cosmedent.
Speaker 1: My buddy, Buddy Maupert in Chicago, right across from the Rigley. He is such a neat guy.
Speaker 2: And also I've been trying out some material that actually Dier Dietche is using himself is called Inspiro.
Speaker 1: Is that Inspiro? INSPIRO.
Speaker 2: Yes.
Speaker 1: And is that a product out of Geneva, Switzerland?
Speaker 2: Yeah, yeah. I think they are only selling it but I might be wrong. But I've been trying it on a few cases. Quite a few of my Dahl cases, do you know what Dahl means? My Dahl principle cases? I've been using it on quite a few of those recently.
Speaker 1: When tell your buddy in Geneva, Switzerland that if they are going to sell anything in America from Switzerland they gotta call it the Matterhorn composite.
Speaker 2: I think [inaudible 00:33:32]
Speaker 1: They gotta call it the Matterhorn composite because all American's first brush with Sweden is when they got to Disney and ride the Matterhorn roller coaster, named after the big mountain that you can see.
Speaker 2: Gotcha.
Speaker 1: So [inaudible 00:33:46] that's out of Germany?
Speaker 2: Yeah.
Speaker 1: Now are all these 3 composites, would you say they are all the same as far as they are all a MicroFil? I mean, they're all MicroFil and not hybrids for your polishing luster?
Speaker 2: No. I mean ...
Speaker 1: Talk us through this Venus Diamond and Venus Pearl. That was your first choice when you were asked. Is it a MicroFil or a NanoFil or what is it?
Speaker 2: Its a NanoFil, its a Nano hybrid. Explain that, because ... Well I'm probably not the person ...
Speaker 1: If we're on eight generations of bonding, first there was MicroFil, then there was hybrid, now there's Nanohybrid.
Speaker 2: My understanding is that it has strength but it also has high polish-ability. Polish-ability is not going to be a good a MicroFil, but as far as I am concerned, its actually good enough for most cases. What I like most about Venus Diamond is that it is actually very strong [inaudible 00:34:38] I mean I'm building up [inaudible 00:34:46] because I'm just putting little edges on the teeth. I've been using it for maybe 5 or 6 years now and my [inaudible 00:34:51] is very, very low.
So, the other think I like about Nanohybrids like Venus Diamond and Inspiro, is it actually, the denting shade is quite opaque so its very easy to actually block out the join line, so most of my cases, I don't do any beveling which some people might think is crazy. But I don't do any beveling. I literally just put the composite at the end of the tooth and I use a denting shade to block out the light and then the enamel shade to create the blend, what I call is a reverse triangle technique. But, I just just to do it as simply as I can and to make it affordable for my patients and to make it look good and to last, and it does, it does! So that's what I'm using.
Speaker 1: Well when you said that people will think you're crazy, I just want to say for the record that the worlds two million dentists are all crazy, so since you're a dentist you're automatically crazy. Our 7 billion patients are crazy with a Capital K. The dentists are just crazy with a small c.
Well good at you for saying, well God, your are so awesome. You talk about you, you don't want to peal off their enamel, you want to be more conservative, and you said you want to make it more affordable. You know the biggest companies in the world, like out of Europe, probably one of the biggest companies every, is Ikea because he focused on cost. He said lets make furniture at a lower cost. In American its Wal-Mart, its Delta Airline, its Home Depot. Its people who bring down the costs always do the best, so good at you mate on that one. But I want to ask you, got listeners who are thinking, what's the difference between Venus Diamond and Venus Pearl? You said you kind of just want to keep it just to a couple of shades, is Pearl a deadened stump shade and Diamond an enamel shade, or what? What's the difference between Diamond and Pearl?
Speaker 2: The only real difference between Diamond and Pearl is that Pearl is a little softer and easier to handle, but the shades ranges are exactly the same. The reason I like Diamond is because I'm building up an edge when I put it into the correct position, there will be no slouching, it will just hold the position so I can take as long as I want just to get the shaping and I know its going to stay put. Now some dentists find Diamond a little bit hard, but for me it has the same effect basically. I think mos doctors are using Pearl, but the actual visual property is identical.
Speaker 1: Are a lot of these cases you are doing, like direct bonding veneers on the upper maxillary 6, 8, or 10 teeth at one time? I mean are you doing a lot of those or not really?
Speaker 2: Yeah, I do but the thing is probably not so much now because nowadays, once you straighten the teeth, and once you have whitened the teeth, you just don't need to do an Veneer. You just need to do an edge. That's it. Actually an edge is so much simpler than a veneer. So the key is to .....
Speaker 1: What do you mean by an edge?
Speaker 2: I mean literally just adding to the tip of the tooth. I'm no doing a veneer. I mean maybe you call it a partial veneer, so say for example, the tip of the tooth, we are adding 2 millimeter of length, I will build that 2 millimeter tip up and only take the composite bond, maybe 2 millimeters down the facial surface. So I don't take it right to the neck of the teeth.
Speaker 1: So your ground to root ratio on that would be 1 to 1. If you're going to add 2 millimeters of edge, you only overlap 2 millimeters of teeth.
Speaker 2: Exactly, yeah.
Speaker 1: Wow.
Speaker 2: I'm not covering the whole tooth. If you look a my cases on line and on Dental Town, All of these cases are pretty much just edge bonding, they are not veneers. They are just edge bonding. And the really important thing, If you're gonna do edge bonding, is that you have to polish that margin super hard. You have to really polish it well, and I'll get patient back twice, maybe three times to make sure that I have polished that margin to infinity. You know, if you are more comfortable then a bevel will be fine, but I just tend not to like that, I'm not a big fan of bevels really. I just don't want to cut the tooth if I don't have to.
Speaker 1: So this person with their headphones right now on the treadmill right now thinking "Dude how many years out have you seen these cases? I mean you're adding 2 millimeters of length, 2 millimeters of bond." First of all, tell us how many years have you been a dentist?
Speaker 2: Uh, 23 years maybe.
Speaker 1: Okay, so how many year follow ups have you seen on the edge and their still there?
Speaker 2: Oh 16, 16 years easy.
Speaker 1: And are you avoiding these if they have any grinding or bruxing, or do these people have to wear a night guard, or?
Speaker 2: Well see now we're into a different subject. You see because we use this concept over here call the DAHL principle.
Speaker 1: Your kind of theme is for the DAHL principle.
Speaker 2: Well, it actually should be called the Anderson principle. The Anderson Dahl because the concept was originally invented by a teacher in the UK dental hospital called [inaudible 00:39:54] but Dahl kind of pioneered the concept more, but I have been doing Dahl cases for 15 to 16 year and I still got cases that are that old. And you know what? When I go in so many courses on occlusion, and I watch some amazing speakers speak, and as amazing as their cases are, I always think one thing, these guys don't know the Dahl principle and they need to know how to do it. Actually its great, I commented to somebody Dr. Terry, one dentist has been posting cases on the cosmetic dentistry because the first time I have seen the US doctors talking about it, because its actually hugely used in the UK and not anywhere else. Yeah a lot of my bonding started off with the Dahl principle so [inaudible 00:40:45] I am confident to then just do prosthetic edge bonding and not worry so much about it they way guys worry a lot.
Speaker 1: Okay we're 40 minutes down and only have 20 minutes left. So, she's driving to work and she's saying "Okay, what is the Dahl principle." What, what is this? She is a Yankee and she's never heard of this concept.
Speaker 2: Okay, well if you have a patient who is starting to develop anterior wear, but no posterior wear yet, so the anterior bite is starting to collapse a little bit. Its a great way of intercepting this problem, and actually opening the anterior bite. What happens is you open the anterior bite, the anteriors sloppily intrude and the posteriors passively erupt into contact. Everything comes. The teeth actually, the bone comes down, everything comes together. So you don't actually make longer teeth. Everything comes together.
There are limitations in its usage, but its a great way of picking up patients. Now the real magic in this is if you combine Dahl and [inaudible 00:41:52]. So, so many dentists out there us splints. I use splints sometimes but my splint is actually my Dahl appliance. Its the bonding that I have put in the patient's mouth. Its a splint they can't take out. So I'm using Dahl appliance here, actually and combining with CR to basically give the patient an in-built splint that is opening their bite that is actually restoring their teeth at the same time. You know I do, unfortunately I teach Inman alinger a lot, but actually do a lot of teaching on Dahl as well and when I get the chance to lecture, its quite an eye opening subject.
Speaker 1: Well what of all this is covered on you dental time course? You put up course, Wrapping Anterior Orthodontics Simplified. Explain that course to the listener and what ....
Speaker 2: That really is only a brief introduction to the Inman Aligner, and probably the concept....
Speaker 1: What year was that put up?
Speaker 2: I think we did that about four years ago, didn't we? Maybe we need to do another one.
Speaker 1: Oh you have to. Can I get you to commit to an Inman alinger and a Dahl course? Because you lecture so much you can do this in an hour.
Speaker 2: I know I've had a number of people who have asked me to do more Dahl lectures and when am I going to do my next Dahl lectures. Because I know its a subject that so many doctors want to learn about. Its difficult to see because there's not enough people who have long term case photographs and follow ups, but I've got plenty. I think if you do it the right way, its very, very powerful. But some people have used it the wrong way and then it hasn't worked. So its just about using it the right way.
But yeah, I will do, I have a lecture up kind of already, like a three hour lecture done on it already done, and I gave it to the BACD last year, not for the first time, and I've been thinking about maybe giving a online version to kind of help people understand how it all works.
Speaker 1: I've lectured around the world and I know you are a legend. I'm begging. The only thing I can kind of sell you on, is we are coming up to 200,000 members, and the Dental Town app has exploded too so we can definitely deliver you message to the most people. ou know, we can definitely get the word out because I'll bet you, 95% of dentists have never heard of the Dahl in the United States? Would You agree with that?
Speaker 2: Sure. Yeah I'm sure they would. Lets put it this way. Here's an example of what Dahl is used for. You know when doctors have cases where the patient is biting against the upper teeth, and what do they do, they just give the patient an upper Essix retainer because they can't fit the wire up. So actually what we do with Dahl is, we have the patient open to accommodate the wire, that's what we do, using the exact same way as in restorative dentistry. So, you know, if you ever want to know how to put an upper wire on [inaudible 00:44:57] is the way to do it.
Speaker 1: And so all the labs making the Inman alingers are making the Dahl appliance too?
Speaker 2: No, maybe you misunderstood me there, Howard. The Dahl appliance is something that is actually direct bonding onto the teeth so you use the Dahl principle and you build the Dahl appliance in the patients mouth by actually putting the composite on their teeth. Okay. So, technically a lab could make a Dahl stent for a doctor, but Dahl is something that I do and I teach that the dentists can do free-hand, completely free-hand. You know I've probably done an excess of 500 Dahl cases over the years, never had to take a single one off the patient. Never had a case that caused any discomfort. So its quite an interesting sort of potential treatment for many doctors.
Speaker 1: So I guess when you use the word appliance, I basically think of something that goes in and out of the mouth. You're saying, you use the term that you will build an appliance directly in the mouth with bonding.
Speaker 2: Absolutely. And I think that if anyone listens to this podcast and wants to see it exactly, go on Dr. Terry's thread on the cosmetic dentistry forum. Maybe you can post on it, or mark it Howard and go to the top of the pile and on that forum, Dr. Terry has posted a couple of great cases. I have posted up two or three cases, Dahl cases. One of them is a fifteen year followup case, and they can then see what a Dahl appliance is in the sense of it being direct composite bonding.
Speaker 1: And you know how to spell his last name?
Speaker 2: I'm sorry what is the question?
Speaker 1: Do you know how to spell Dr. Terry's last name?
Speaker 2: I don't know what Dr. Terry's last name is, all I know is its .....
Speaker 1: He goes by Dr. Terry?
Speaker 2: Yeah, his Dental Town name is Doc Terry.
Speaker 1: And we have a member search so you can type in Doc Terry and boom and it shows all of his posts. Yeah, I love that guy. He is an amazing man.
Speaker 2: He's a great guy.
Speaker 1: So I'm down to only 13 minutes. My next question is, how many dentists are in the, I'm going to switch complete subjects. How many dentists are in the UK right and right now, a lot of dentists talk about that the British had the National Heath Service, the NHS, and we have been told that over the years, the number of dentists for that has been going down, and the number of dentist that are breaking out and just going independent fee per service is going up. Can you tell the Americans what the scene is? How many dentists are there? There's like 60 million British people in the UK? How many dentists would service 60 million people?
Speaker 2: I think we only have about 30,000 maximum.
Speaker 1: So you've got 30,000 dentists for 60 million people. So tell me what your opinion is of, the NHS, the Nation Health Service, their dental delivery and is that model changing over your career of the last 25 years?
Speaker 2: Yeah absolutely. I mean I have to say, I don't think the model has every been a hefty model in the sense that its never stayed the same for long. When I qualified it 23 or 24 years ago, it was changing and there were pilots for new ways of doing it and its always changing. I think a lot of dentists just get frustrated with it because they are restricted in what they can do. Some dentists make it work very well, some dentists provide excellent National Health Service treatments.
I took the decision to leave because I couldn't do what I wanted to do and I wasn't willing to compromise at that time, but you know what, it works for some people. We have a very, very healthy private market. One thing we don't have much, like you guys do, but we don't have much insurance. So people are either National Health or they are completely private, they pay for everything. There is insurance but I would say maybe only 5% of people have some kind of dental insurance. So its quite a different system here, actually. The NHS, you know the truth is Howard, I'm not allowed to criticize the NHS. I don't know if you know that, but I can't say anything bad on it, so you're not going to get anything bad out of me.
Speaker 1: Because they will take your licence away if you criticize them?
Speaker 2: Yeah. If I criticize the NHS I could be in big trouble, so we can't. All I'm allowed to a say is that the NHS can get you to a state of oral health, and in truth it an, and in truth there is a lot of good that comes out of NHS, but unfortunetely dentists aren't allowed to say exactly what they think about it in the UK.
Speaker 1: Huh, that seems crazy in an ancient old democracy like the United Kingdom.
Speaker 2: It does seem a bit strange, doesn't it, but I can tell you I've already come close to being in trouble once by being misquoted in the newspaper. So I don't want to go there again.
Speaker 1: So, so let me ask you this. What percent of the dentists are not in the NHS and would be cash only patients? Would that be 1%, 2%, 10%.
Speaker 2: I don't know. I think maybe 20% are private and maybe 10% are completely. So I think there about maybe 25% who are mixed. They have private and NHS.
Speaker 1: So 1 in 5 dentists have a cash practice?
Speaker 2: Yeah.
Speaker 1: And how is that, so of your practice, what percent of your patients just write a check or give you a credit card?
Speaker 2: Everybody. Everybody writes a check or credit card.
Speaker 1: And its so funny how people don't realize how, you know they are born into their language, my two older sisters are Catholic nuns and they have no belief that if they had been born in Saudi Arabia they would be Muslin or they would have been born Indian or they would be Hindu. Its so funny because when you go to Brazil and China, there's no dental insurance and the industry is perfectly fine. In American, these Americans, they take care of their house in cash, their car in cash, their entertainment in cash, and they walk into a dental office, both the patient and the dentist believes, that the employer is the one responsible for this bill, and they spend all their time trying to get the employers insurance to pay, and its ridiculous. Its literally ridiculous.
Speaker 2: Yeah.
Speaker 1: I mean they pull up to your dental office in a $30,000 car, its like the joke of where, this is actually a true story, someone actually told me this today, that someone was locked out of their car, the clicker wasn't working or the battery went dead of whatever, and it didn't even dawn on them that they could stick the key in the car door and just unlock the car. It makes me, so. Americans need to hear this, that when you go to China and Brazil, and Russia and India, people just get out their credit card and they pay for dentistry.
Speaker 2: Yeah they do here. Obviously the health service is paying, and even the health service doesn't pay everything, it only pays a certain amount. The patient still has to pay a fee. And you know what, the National Health Service is a funny thing, its difficult to understand if you're from the US. Dental service, I think it needs a lot of help. Its got a long way to go to be a good working model. I think the medical health service in certain areas, is just unbelievable world class. In some areas not so good. But, I think we are very lucky to have that system here where our health delivery is free and you know, its at good thing to have, I think.
Speaker 1: I think the future of politics for at least the next 1000 years is going to be the same game everywhere. None of them want to pay taxes and they want to get everything for free. So it just gained here, gained there, but at the end of the day your gonna have to buy your house, your car, your gas, your food, your dog.
Hey I hope this doesn't come off rude or personal because I'm American and your British, I have prejudice but, how come in culture in comedy people always make fun of British teeth? My favorite cartoon is Family Guy. Do they have Family Guy in the UK?
Speaker 2: Yep, yep, yep?
Speaker 1: Whenever the British guy comes over he's got 25 narly teeth, they're all going the wrong way. I swear to god, I don't know if its just jokes in America and I don't know if this is true in Europe, but in American, British are associated with crowded bad teeth. Are you aware of that stereotype?
Speaker 2: Yeah, we're definitely aware of that. I've seen the Simpsons book of smiles, you know, its well known. I think people are aware of it.
Speaker 1: But do other countries make fun of British people. Like do Germans, and Russians and Japanese and Polish, or is this just an American?
Speaker 2: Its an American thing, believe me. Have you been to Japan? Have you been to France? Have a look around there. We think French people have bad teeth. Okay!
Speaker 1: So that stereotype is just an American stereotype?
Speaker 2: I think it is an American one. Yeah, I think its an American one.
Speaker 1: Where do you think that is coming from? Where do you think that is coming from? Because British was our mother country or?
Speaker 2: Probably because in the 80s and 90s, everybody that you saw on TV and all the actors and all these [inaudible 00:54:41] you know the guy From Top Gear, you know look at his teeth. It is, its bad. But its changing quite a bit now. I think people are becoming much more conscious about their teeth. Great Britain has the biggest market in private dentistry and cosmetic dentistry in Europe, easily. Everyone knows that. And that's with only 25% private health market. So, its changing a lot.
Speaker 1: I think you and I need to write a joint letter to Seth McFarland and tell him that the British has the highest market of private pay in cosmetic dentistry and Family Guy gets to rewrite the British guy.
Speaker 2: Yes they do. And also you can tell him that Great Britain has a got lot of great speakers as well. We got a lot of good teachers so.
Speaker 1: Oh yeah, yeah.
Speaker 2: I'm talking about people like Justin and [inaudible 00:55:33]. There's a lot of great guys coming from the UK now, so.
Speaker 1: And Jason is a legend on Dental Town. I think his thread, there are 10s of thousands of views that Jason mentioned disciples there. I mean he has his own disciples around the world. He's a big fan of Buddy Maupert's Cosmedent in Chicago. He really likes the re-enamel, right.
Speaker 2: Yeah.
Speaker 1: And that was one of your choices. Jason uses all sorts of material, literally. And you also mentioned another one, Inspiro, and you'll deliver that guy on a podcast and he can tell us about Inspiro from Geneva,
Speaker 2: DDA.
Speaker 1: And by the end of the podcast I will have it changed to the Matterhorn. I'm going to ask you one more sensitive question, I hope this doesn't offend you but, as an American, Lady Di was a legend. In fact when she died it was front page news for a year and when my hero, when I was little, I have I grown up Catholic, was Mother Teresa of Calcutta. When she died, it was about the same time period that they both died, and I sort of thought Mother Teresa was on page six, and Lady Di was front. It looked like she had 4 bicuspid extractions. It looked like she had a narrowed arch. I've never seen her dental records or models but you're a Britt. Did she have four bicuspid extractions, or what was your assessment of her cosmetic work?
Speaker 2: Lady Di, I would expect that she probably did. There was a time when that was very common over here. Again ...
Speaker 1: Did you ever have those thoughts when you were looking at her? That she was a 4 bi extraction?
Speaker 2: I think at that age I probably wasn't even doing dentistry to be quite honest with you so it didn't really occur to me, you know when she was around and when she was famous and stuff. I think I was doing dentistry, obviously, but yeah, she definite had quite a recess. You know its quite a common thing, you see it, that kind of post extraction look, its quite common. But certainly this is changing quite a bit. You know, a lot more orthodontists are doing non-extraction based work over here now. So I think you're going to start seeing a lot more Britts looking like Americans.
Speaker 1: My God, the orthodontists actually forced the general dentists into ortho back when I was going to school in 87. I mean the orthodontist sent them back [inaudible 00:57:48] literally spacing on almost all the teeth and tell you to pull the first four BI's. I mean you would just look at this and say "what the hell". I mean it was just crazy. And then some of the four BI's, your right, the four BI's plummeted. In my backyard is probably not even 1 in 4 cases.
And the other thing that I still kring on, back in 2013, is how they want 4 BI's removed because they want to pick up, you know, 3 or 4 millimeters and all these teeth have MODs in them. Its like dude, you could replace all these MODs that are all old and ugly and you could replace them all and just have open contacts and have your space right there, you know what I mean?
Or they will have big over-contoured crowns on their first molar, its like, do you not realize that restoratively we could almost get all of this spaced?
So I only got you for a minute and a half. So I want you to go into your minute and a half big close on why, when this little lady gets to work, she should log onto IASORTHO.COM and learn how to do her Inman liner, and your going to tell her all day today what case should she be looking for? She's going to see eight patients on hygiene, she's got patients that are [inaudible 00:59:00], what would be the low hanging fruit, cherry picked case, for me to do my first case with. What would it be? Would it be a man, a woman? Class I? I mean, cherry pick me a case?
Speaker 2: It could be any, it could be man or a woman. You know what it is, its a patient who has mild or moderate crowding, but what you need to tell that patient that they don't realize, is that that crowding is going to get worse. The studies, the evidence shows that anybody with mild to moderate crowding, their teeth are going to get worse. The canine width could potentially collapse, the guidance could change, the perio could get worse, the staining will get worse, the edges of their teeth are going to deferentially wear, they are going to absorb color. I think as dentists we don't think of the long term so much. The minute you start to tell your patients this, and you can show them photographs and you can take photographs of patients teeth for fifteen years, when patients are treated, their teeth age.
Its an anti-age treatment. We are trying to stop teeth from aging. So if you go in, you align teeth, you retain them, you can actually keep the teeth, not just looking better but functioning better for a long period of time. When I started getting ortho for cosmetic reasons, I didn't realize that actually fixing and straightening and fixing that canine width was actually going to provide a huge functional benefit. That's where this is all going long term. I hate the term cosmetic ortho because actually what we are doing is interceptive restorative ortho, that is actually what we are doing.
Speaker 1: If she logs onto IAS.ORTHO.COM, you have an on-line CD there to actually teach me how to do these intro Inman Alinger cases?
Speaker 2: Yeah we do.
Speaker 1: And how many hours is that and how much money is that to learn the basics of Inman?
Speaker 2: I think the Inman alinger CD is about $299.00, but there is a brand new super-duper version coming up very soon, so I would say hold off for maybe a couple of months so or a month or so. We have a brand new version coming out which I have just finished recording now. The Inman will be about four hours or three hours, and then the clear aligner course is around about two hours a CD. But the key, its a course of what you really learn by using these forums. We have thousands of users on these forums and we have about 6,000 cases on one forum alone. They are just a massive learning resource for so many dentists. That's really the key.
Speaker 1: That is awesome. And when can we expect new courses from you on Dental Town?
Speaker 2: I'm working on it and I think I will kind of do an updated kind of Inman alinger and clear aligner type course [inaudible 01:01:42] titles. And I am going to definitely work on a Dahl principle course because I think the need for that I think is just huge. I think every dentist in the world could benefit from understanding the Dahl principle. So I want to do a little bit of a intro lecture on that and maybe develop some courses beyond that long term.
Speaker 1: Well Tiff Kareshi, you are an amazing man. I heard about you from dentists in countries, I've lectured all around. I was so excited when you accepted my offer to come on today and I just want to thank you for all that you do for Dental Town, all that you do for dentistry, and dude I just think you are a rock star. Thank you so much for coming on my podcast.
Speaker 2: Thanks very much for having me. I wish you would have told me you were going to put me on a video and I would have had a shave and put a shirt on, but anyway, you see me as you see me now.
Speaker 1: I'm going to send an E. Mail off to Seth McFarland now and tell him those new stats, that the British are the biggest in cosmetic dentistry. But dude, than you so much for your time and isn't the internet great?
Speaker 2: It is.
Speaker 1: Here I am in Phoenix and talking to you in the UK.
Speaker 2: Its amazing.
Speaker 1: All right buddy, I will see you on the boards. Bye-Bye.
Speaker 2: Take care.