Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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249 Earn While You Learn with James Chapko : Dentistry Uncensored with Howard Farran

249 Earn While You Learn with James Chapko : Dentistry Uncensored with Howard Farran

12/6/2015 2:00:00 AM   |   Comments: 0   |   Views: 677

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AUDIO - HSP #249 - James Chapko

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VIDEO - HSP #249 - James Chapko

• The Vision for the ImplantWide surgicenter

• The Rationale of the ImplantWide surgicenter concept 

• The paradigm shift for delivering dental implants to help GP's learn and place Dental Implants.



Dr. Chapko graduated from Northwestern University in 1985. He currently operates a private practice in Belvidere, IL. For over 28 years, he has treated patients by delivering a broad array of surgical and restorative procedures.


Dr. Chapko was an instructor at Northwestern University Dental School. He is a member of the ICOI, AAID, AGD, and ADA. He demonstrates a unique ability at integrating and teaching surgical implantology from a restorative general practitioner’s vantage point, and is what led him to create and found Implantwide, LLC.


Howard: It is a huge honor for me today to be interviewing my buddy Jim Chapko who we just had dinner, where'd we have dinner a year ago?

Jim: Up at the Grand Geneva in Lake Geneva, Wisconsin. 

Howard: That's the original Playboy Club.

Jim: Yeah, back in the 60s and 70s, a little bit before your and my time. We should have been hanging out there.

Howard: Oh my gosh, yeah. Man, that was Hugh Hefner's retreat, and it's not anything you think. It's not like Las Vegas stripper pole or anything. It's wood.

Jim: Woods and a hundred acres. You drive back there and it's just a beautiful resort and that's the day they had the bunny tail and the ears and the whole bit back there for the guys. 

Howard: I had the most embarrassing event in my entire life happen at that club. I don't think I've ever done anything that stupid in my life. You know what I actually did?

Jim: I'd love to know.

Howard: True story, the sliding glass doors lock behind you for safety because there's all the woods and the golf course and all that stuff, and when you go out there it locks behind you and there's a red little sign by the door that explains that, and I woke up in the morning and I was in my underwear and I just walked out there to see it, and I turn around that door, it automatically shuts and it was locked and it was about twenty-five degrees. I don't know, what was the temperature back then? 

Jim: Twenty-five, yeah.

Howard: I'm from Phoenix and I'm starting to panic, to walk all the way around to the front of the resort to come into the front door without a key and then go to the front desk in your underwear at five o'clock in the morning and ask for a room key, and the lady had just totally knew what had happened the minute I walked in. She goes, "This happens, about once a month this happens, but usually they're not in their underwear." Oh my god.

Jim: That's a great story. 

Howard: Luckily at five in the morning, there's only a few people laughing at me. There wasn't that many people. Basically the reason I wanted the podcast to interview you is you're at the forefront of a new concept of dental implants called Implant-Wide Teaching, and you got a surgeon center. Tell us about your concept.

Jim: You and I are about the same generation. I graduated in '85 from Northwestern Dental School, set up my practice.

Howard: What did you actually do at Northwestern to where as soon as you left they closed the school down. 

Jim: I have to keep that quiet. I forgot they shut the whole thing down.

Howard: Everybody I talked to says they closed it down because you graduated from there. 

Jim: Probably true. We'll have to keep that in the past.

Howard: You got out in '85. What year did they close that?

Jim: They closed it I think the late 90s, around 2000 is where they shut it down. 

Howard: It was for money. They got a big grant for the medical school, research pharma, so they wanted to close the dental school and expand the medical school research right?

Jim: Yeah, right down there in Chicago, all those blocks where the dental school is, they built huge buildings and the money was not in the dental school at all.

Howard: Yeah, I know, it's funny because back then they were closing down dental schools. They close down about six and all the dentists thought the sky was falling, "What's wrong with our profession, they're closing down all the dental schools," and now thirty years later they've opened up about six new ones and now it's the opposite. Everybody thinks they're making too many dentists.

Jim: It's unbelievable how the cycle changes. I've been at practice full times thirty years, going on thirty-one and your boy, I talked to him for five minutes before, I just got married four years ago at age fifty-one for the first time, and I have a two year old boy, so I was talking to your boy thinking I'm going to be seventy-two when my kid Aiden gets out of high school, and I'm actually trying for a second child, so I have to get my second wind here and keep practicing here for a little bit longer.

Howard: That's awesome. When I turned fifty that's when I did starting up for the Iron Man because I got a three year old granddaughter and I thought to myself, "My dad and both grandfathers died at sixty, and I wouldn't live long enough to see her even get to high school." I broke with family tradition and tried exercise, and this is Thursday and I ran ten miles this morning and Sunday's my third Iron Man. I think a granddaughter and you have two children and a reason to make wiser decisions and eat cleaner and work out meaner, we might live to be seventy-four. Seventy-four's the fifty percentile. If you just make the fifty yard line, we could live to be seventy-four.

Jim: Having a boy did change me Howard. At my age I didn't think I was going to have children, but there is a trend in America now where there's older dads. A lot of guys in their fifties and sixties are having their first kids. It's a trend.

Howard: Right on. You're wearing a scrub that says Implant-Wide. What is Implant-Wide? What is your new concept?

Jim: The concept, I started placing implants about twelve years ago, and we got pretty heavily into it, and taken the classes, buying all the stuff and really enjoying it. It was kind of a paradigm shift when I placed my first implant a long time ago that wow, this really wasn't as hard. Your article by the way that you had two months ago in Dentaltown hit the nail on the head. It was the best article I've ever read about how all dentists, GPs need to be placing. That was the greatest and it needed to get out there. I'm thinking a hundred percent along your thought process and you're a pioneer and you're right. It's what needs to be done.

We got a lot of new dentists. A lot of GPs are struggling these days. Restorative has been dropping off lately, looking back over a thirty year period. As long as you have the cone beam and the training, just what you said in the article, there's no reason the GPs should be placing implants. I came upon the idea of a surgeon center where you open a surgeon center and it's like a health club. I figured if you want to work out, we could do two things. You can go to [inaudible 00:06:16] and buy $20,000 worth of exercise equipment, put it in your basement and work out by yourself, or you can go to the health club that has all the equipment there and pay $50 a month and use their equipment.

I figured with implants, why don't we have an implant health club where we have a beautiful facility, it's got all the stuff, all of the equipment, all of the implants, we have twelve different systems, and the dentists would just come and rent the health club to place their implant. If they want to do, we call it solo, if they want to use the facility solo, it's like going to your health club and working out, $50 a month, you just use the equipment on your own, or if you want to have a personal trainer, we have mentors. We have periodontists. One is Anthony Reganato, you know him. He posts on Dentaltown all the time. He's in our area and he helps out at Implant-Wide, and we have a couple of periodontists and an oral surgeon that helps and myself and a couple GPs there more surgical oriented.

The dentists, if they want to rent a mentor, they can come here with their patient, do their implant with their mentor and they bill the patient and they just pay a facility fee. We have locker room and everything, and so we've started this six, seven years ago. I have a partner, Dr. Ted Greenly, he and I have opened this one in Shaumburg about a year ago, so it's a startup. It's a beautiful facility, and we've been starting to get a lot of dentists. We've got about forty dentists now in the last twelve months that have started using us for their scans and doing some of their surgeries.

Howard: How does the fee work? Do you get a percentage of the fee or is it an hourly rate?

Jim: It's roughly a thousand dollars per implant, give or take a little bit, if they want to use the team approach, which is with a mentor. It's roughly five hundred per implant if they want to go solo. They bill patient whatever they want though. They bill the patient and collect. If they want to bill two thousand for an implant, they can bill it, collect the money and then just pay us for a facility. We're the house. Nice cat. I have two cats at my house too Howard. I love cats. They sit on my lap and get fur all over me, and so when I go upstairs to see my wife I've got fur and completely covering myself, exactly like that. 

My cats are oriental. They're short fur. They don't have the big furry tail like that one.

Howard: I'm compensating for my bald hair. There's no hair in this hat except for the cats.

Jim: That's good.

Howard: How long has this been open?

Jim: This one in Shaumburg has been open one year, twelve months. 

Howard: How is it doing as a business?

Jim: It's coming along. We're finally cash flow positive, and each year we're getting more scans and we're getting more dentists that are coming by and liking the concept. It's a whole different thing because we GPs typically don't like each other. We don't play well together. We're all our own islands and this is like a club here. The dentists come, pull up in a nice parking lot right by Woodfield Mall here, it's by O'Hare, and then they come in and use the locker room and bring their patients here.

Howard: Shaumburg, Illinois, a suburb of Chicago is by O'Hare Airport?

Jim: Yeah, it's about ten minutes down the road there, and it's a huge [inaudible 00:09:26].

Howard: I've gone there several times. That's where Bisco is.

Jim: Yes, Bisco's right in this area too, yes. 

Howard: Byoung Suh, he's got to be one of the most amazing men I've ever met in my life. From health. His diet is more serious than his bonding agent. Imagine that. 

Jim: I did not know that Howard.

Howard: This is the guy who invented ALL-BOND. This guy, he is just a role model. When you have a conversation with him about adhesive bonding, I don't know anybody who understands the molecular chemistry like that guy, and then he switches right into talking about his diet. His diet's the same way. He just totally believes it's all what you stick in your mouth. I'm not even going to tell you how old that guy is, but whatever age you think he is, add ten years to it. 

Jim: Jesus. 

Howard: I know, he's a health machine.

Jim: Kind of motivating to hear guys out there like that Howard. It really is.

Howard: What's also cool about him is his family is, I think he's got three daughters or two daughters and a son, but they're all working with him. It's a really neat family affair.

Jim: I didn't know that.

Howard: Is this prototype of what you've done, Implant-Wide, and you go to

Jim: That's correct.

Howard: Do you know of any other business models like this in the United States or around the world?

Jim: I don't. There's many teaching facilities. You've got Whitecap, PK Clark, who you interviewed. He's an innovator. He's been teaching it, he's got a great facility, and there's a lot of places throughout the country where dentists will fly and learn how to place implants.

Howard: That's in Utah.

Jim: Utah, yeah. There's gardeners all over, but I wasn't aware of anybody that just opened a beautiful facility, filled it with all the equipment and the implants and opened it's doors for dentistry.

Howard: Can I give you a business tip?

Jim: Yes sir.

Howard: If you wanted this thing to go national, I can already quote three, the most coveted thing in dentistry is when your state board says that a licensed dentist from another state can come do dentistry there. That is so rare, that's why you see all these implant courses in Dominican Republic and Mexico. I'm in Phoenix and if you drive down to the Mexican border, you stay in a hotel on the American side and in the morning you drive across and they have surgical implant training facilities. They got to the state board because it's just like Supreme Court, they won't hear a case unless it's just completely the perfect case to make clarity. 

There's a million lawsuits a month and the Supreme Court will see like two hundred. You go to your state board and you say, "If I a licensed dentist in good standing in another state comes to my facility and wants to do free volunteer work on an American vet, can he have a temporary license for whatever fee that you need to charge him for administrative fee. Now what state board dental examiner can go defend the answer no to the press with that one. "No, you can't fly here from Oklahoma to treat a vet who went and got wounded in war." So far, I've coached three people into saying this and the state board said, "Well yeah, that's a good thing." Now a dentist in Oklahoma who wants to place an implant on his cousin Eddie, because that's what friends and family are for, they're research monkeys to place your first implant, now he can drag his cousin Eddie to your facility and place his first implant. 

He's got his patient. They can share a hotel room, and then he's got a temporary license. You got to the Illinois State Board of Dental Examiner and get that, you'll now be doing a million dollars a month.

Jim: That's good advice. I didn't think about that. I appreciate that.

Howard: It's got to be a dentist licensed, in good standing in the United States in another state, his license isn't suspended, revoked. He's in good standing, and he's doing volunteer dentistry, not charging anybody on an American vet. Oh my god, so they'll start playing the Star Spangled Banner as soon as you ask a question. I'm serious, you do that.

Now you've had forty dentists come by. Are they all from the Chicago Metro?

Jim: Yeah, some are from downtown Chicago, that's the farthest, or the North Shore. They come about forty-five minutes. The majority of them are probably within a thirty minute driving range.

Howard: How many dentists are in that are? What's your possible pool?

Jim: There's a lot of them. I think there's a thousand at least. We set up here on purpose because it's the hornet's nest. We're right in the middle of all the dentists right here. There's so much competition. The other thing Howard is you know, it's just a set up to get going on the implants. You got to get the courses and then you got to buy the cone beam. That's $100 to $130. Then you have to get all the implant systems, and then you got to, who's got your back when you have a problem. It's just very difficult for GPs these days to incorporate it in their general dental practices. Even though we're talking about it and this should be done, it's really difficult. These new grads, as you know, are coming out two to four hundred thousand in debt and the last thing they want to do is go out and buy cone beams and all these implants just for them to sit on the shelves.

We figured that we'd take that barrier away to entry and just have everything here and they can do it at their own pace. If dentists are experienced, they can just come and use the facility and just pay a low rental fee, and they have their assistants here and it's all the equipment and all the things, and they don't have to invest in their own practice. Because too many dentists will go buy the surgical kits because we talked to all the reps. We've talked to probably fifteen different companies, and they'll go out and sell the kit to the dentist for five to twenty thousand or so with twenty implants and it sits on the shelf. A year later the rep goes back and asks the dentist, "How many implants did you place?" He'll say, "Well I placed two, one on my mother and the second one on my friend and that failed, so I never placed another implant."

All these kits are sitting on shelves across America. It's difficult oftentimes to incorporate the implants in your GP practice if you're busy. 

Howard: Buying a $100,000 CBCT, I bought one, I bought the Carestream one, which is Carestream used to be owned by Kodak, now it's Carestream out of Canada. They're kind of like a smart phone. Nobody's using a five year old smart phone, and a lot of the oral radiologist people tell me that the half life on a CBCT is probably five years, and there's probably new features, new everything. I don't know if you want to buy a $100,000 CBCT and think in your walnut brain that you're going to own it for the next twenty years when the reality is you're not going to own your iPhone for twenty years either.

Jim: I think it's a perfect analogy Howard. I agree. We also have the Carestream 9300 here. Yeah, I think that's true. Just after a while, after thirty years in the business, just like you and I with busy practices, you see what's going on. The cash flow is going out and out all the time, and if you can be doing a lot of implants on an annual basis, couple of hundred, five hundred, you're going to get the return on investment and you're going to get your game down and get good. Many, many dentists that we're talking to here from new grads up to sixty-five year old dentists, they're like, "Well I've been a bread and butter dentists. There's four things you do to a tooth: a filling, a crown a root canal and you pull it. Those are the four things, and they're doing that over and over. 

They see that their schedules are often lightening and all the PPO problems, I mean just read it on Dentaltown, all the corporations, all these issues happening now, and so GPs are either having the lighter schedule with the bread and butter things and all their patients are baby boomers now that all their crown and bridge work is decaying and they all need all on fours, and they all need multiple implants and redos. You probably see that in your practice Howard. It's all changed from what it was in the 70s, 80s and 90s. We're doing root canals, crowns and bridge work on all these people. Now we're in 2015, now all the baby boomers, ten thousand a day turn sixty-five, they're all coming in and all their crown and bridge work is failing and cracking and breaking.

You probably see three day, number nineteen's broken to the gum line. He's had a root canal. You need to be able to extract it and put an implant in there and things very easily. 

Howard: I'm in Phoenix, so basically the way the United States works if you're northeast you retire to Florida, and if you're west of the Mississippi River from Minnesota on over, you come to Phoenix. I probably have twice as many senior citizens as the average practice in Nebraska, Iowa, Kansas, Minnesota, all those places. Holy crap, they live a long time. I would say the biggest mental error that I made in '87, I'd say the first ten years I was a dentist it'd be a really old man and I'd be sitting there thinking, "I just got to patch it. I got to buy this old bird just another year or two," and then twenty years later he's still sitting there and your patient in your practice.

It took me about ten years to realize, man, I don't care if they're eighty. An eighty year old is more likely to live to ninety than a sixty year old because they've already passed through all these areas where they should have died. They're not dying for a reason and they're probably going to live a long time, but yeah, implants is the fastest growing portion of my practice. It's the biggest portion. When I've got out of school, it was nothing to do four molar root canals a day.

In fact, when endodontists would tell me, "Well you should go to endo school if you want to do molar endo," they used to say, and I'd say, "Well how many molar root canals did you do in your two year endo program," because I know the first five years out of school I did that many, you know what I mean?

Jim: Right. 

Howard: You just did a lot. You've seen all the systems. You said you have fifteen implant systems in your office?

Jim: About twelve. 

Howard: Twelve? Can you name all twelve systems? Because there were two hundred and seventy-five implant companies at the Cologne meeting in IDF in Germany.

Jim: It's getting ludicrous. If you do the math permutations, you can't get a dentist to agree upon a bonding agent. Now we're looking at two hundred and fifty implant companies of which each has a catalog a half inch thick, and if you actually did the math it would come to like one with probably fifty zeroes after it, all the permutations of parts pieces, and it does get a little bit ridiculous. You've got your basic systems, right, your Straumann's, your Nobel's, your Zimmer's, your Astra, which is the DENTSPLY implants. You get the main systems and then you have your Hiossen's, your Megagen's, your Impact Directs, your OCO Biomedical's, your BioHorizon's, your 3M M Tech's. Just go down the list here.

There's just so many different ones that they mix and match. You got your internal hex for your Zimmer's and your BioHorizon's and your Implant Direct's, and then you have your outdated Tri-Lobe with the replaced Nobel and then you have your new Nobel Actives, which are phenomenal, but you're getting all these new companies that are duplicating it, like you have [Ositanium 00:20:43], that new company in New Mexico, they have their bioactive implant, which is Nobel Active clone but nano technology. Then you have Megagen, which just came out with their Reflect Rapid line two months ago, and it's basically exactly like the Nobel Active, if not better.

Howard: Is Megagen partly owned by another implant company? 

Jim: Yes, I had heard that Straumann had invested $30 or $40 million towards them.

Howard: That's what I heard, but I can't confirm that. Is that you you heard too?

Jim: I heard it too, yeah. 

Howard: Straumann's out of Switzerland or Sweden? I always get the two S's mixed up. Is it Switzerland?

Jim: You know what, I can't remember if it's Switzerland or Sweden. I don't remember.

Howard: It starts with S.

Jim: I think they own Neodent too Howard. Then they've got a controlling interest in Megagen. They're basically just stratifying. They're going to keep their regular Straumann's price where they're at and then they have the new Megagen line and your Neodent. It's consolidation is the word.

Howard: That's what [Danaher 00:21:40] did. They bought the high cost Nobel Biocare line, and then Danaher turned around and first they bought the low cost implant stride. I guess I want to ask you, is there a price quality curve in here from your high cost Nobel Biocare to the lowest cost? I guess what I'm trying to pin you down, I'm trying to throw you under a bus and have you piss off eleven of the twelve companies that you work with. Because the solo dentists driving to work, she's thirty years old. She says, "Look Jim, I only want to buy one system." What would you tell her?

Jim: You know what, that's throwing me under the bus, but I'd say ...

Howard: What are friends for.

Jim: If you can buy an $80 implant, you can buy a $600 implant. You can buy the trabecular implant from Zimmer, which was a dog but it was $600. Somewhere in there's got to be a sweet spot. In general, I'm seeing a lot of people sweet spotting around $200 for the implant. That seems to be a good price point. I divide above $200 to $600 you got that, and then $200 down to $80.

Howard: What companies are in that $200 sweet spot?

Jim: Well you have Megagen. They have a fantastic implant at Jerome Smith. He's on Dentaltown. I've visited him down in Lafayette, Louisiana and he loves the AnyRidge implant and I have to say, I love the AnyRidge implant from Megagen. It's priced around that $200 sweet spot, it's got all the bells and whistles. It's a great, great implant, regardless of the price.

Howard: I love their founder. I love their founder. Have you met him?

Jim: Dr. Park?

Howard: Yeah.

Jim: Yes, the periodontist who founded Megagen. He's great. He's a genius. I heard him about eight months ago in Chicago, and he's got all these clinics over in Korea, where he invented things, and he came up with the rescue implant about eight years ago, and then he changed design and came out with the AnyRidge and then the AnyOne and now he's got the new Reflect line, which is just as fantastic. They call it Reflect because it reflects back all the majors, so they came out with the Reflect Rapid, which is the Active clone, and then they have the Reflect Zimmer clone, the Reflect Straumann.

Howard: You know what his secret sauce is, besides being a genius and a workaholic and a great man and all that stuff?

Jim: What's that?

Howard: He's like a Rick Workman in the fact that he really built up a monster dental clinic. It's like ten stories high. Every story is like ortho, perio, PO, whatever. When they decided to make implants because he truly believed that the Koreans chewed harder and had different mastication forces and angles and they needed a stronger sturdier implant, he was going to make his own because the implant companies wouldn't listen to his concerns and they didn't buy that the Koreans were different than the Europeans or Africans or anyone else. When he would make a test implant in his own dental office clinic, he could do his own research. When he took a prototype, he could have a thousand of them placed at the end of the month.

His speed of R&D no one can match. Nobody can go from an idea to a made implant that'd take him about a day, and then have a thousand placed at the end of the month and one year absolutely know what's going on. 

Jim: That's a good point. I didn't know that Howard, but you could feel it with the quality and things like that, that there's something cutting edge to it.

Howard: It's his speed. It's people, time and money and that guy's got time down.

Jim: I agree. Back to implants, you can't beat the Nobel Active. 

Howard: Are we still in the $200 range?

Jim: Well the Active's probably in the $400 range but they're probably discounted. It's all over the board, I don't know what they priced it exactly at.

Howard: Back to the sweet spot of the $200 range, besides Megagen what else do you like?

Jim: Well you've got your BioHorizons, that's right around there. You've got your Implant Direct, that's right in there. What else? What other implants? 

Howard: Then go higher. Go above, what would be the above cost ones? No [inaudible 00:25:57].

Jim: I think Zimmer's around $300. Then you've got your, what about Astra and Angelos. I think those are priced up there. 

Howard: Then what would be the low cost? We've go listeners in every country; maybe someone's in Tanzania and says ... 

Jim: 3i's a great implant. It's a little bit probably, I think a buck two hundred, but everybody's changing things all the time, so it's hard to keep up with it. As far as the OCO Biomedical they're priced around $200, slightly less I think, but once again, the reps are always willing to deal. If you buy a thousand implants from a rep, you're going to get a much better implant than if you're a poor GP trying to place two implants a year and you're going to pay full price.

Howard: What percent of the dentists do you believe in the United States, out of all the general dentists in the United States, what percentage do you think have surgical placed an implant?

Jim: Well you hear different statistics. I'm thinking it's probably ten percent, but maybe it's higher. It seems to be changing all the time. In fact, I had heard that just last year that the combined implant placement of all the GPs in America was greater than the combined implant placement of the perios or the oral surgeons for the first time ever. That means that GPs are obviously getting into the game. In your article, I think you said, what, ten, fifteen percent were placing? Sometimes you hear it's higher, twenty, thirty percent, but my experience talking to the dentists that are coming through here, doesn't seem to be thirty percent of them I don't believe are regularly placing. What do you feel?

Howard: One thing I love. There's a research here that says what percent of the implants were placed by general dentists. What I love the most about writing a column or having a podcast, what I like the most is a lot of people have thoughts in their head that they don't know they're wrong. The neat thing, I've had a monthly column from '94 to 2015, so if I ever write anything wrong, what I love the most about it, if I'm wrong I instantly correct it. I remember one time I wrote something as silly, I was making an example that Patton and MacArthur were five star generals. I got like three hundred emails that said that Patton was a four star general. Just little things like that. I said ten percent of the general dentists had placed an implant, and I'm getting all these documents of support bearing numbers, but it's hard to find.

Jim: I think it's hard to find the truth as to what that is. If a dentist places one implant two years ago and never again, does that count as a dentist who's placing implants or not? It's kind of difficult to distill out the truth so much.

Howard: Let's stop right here and let's start with, I'm thinking about my audience. I'm assuming ninety percent have never placed an implant. She's driving to work and she's saying, "I know I want to," but what would be the steps? I've never placed one, I'm driving to work, I'm listening to Jim. Talk me through the steps.

Jim: The first step is she's twenty minutes from this facility. That's where her office is, down the road. She basically knows in her mind she has a patient that needs three implants on a mandible. We're very pattern recognition by the way, dentists. I was a math major, not a biology. David Hawkins wrote a book, Power Versus Force, one of my favorite books of all times, and he says that intelligence usually is just pattern recognition. Dentists, we're the masters of pattern recognition. We're obsessed to the nth degree. This patient in her mind has a patient that has three implants, but she doesn't know what to do with it. Do I refer it out? She's looking at her schedule. She's got holes. She's kind of slow and out of school. She wants to do it. 

What am I going to do? What's my choices? Do I have to take a year, fly to the Dominican and place twenty implants? Do I have to buy the kit? Do I have to cross my fingers? How am I going to pull this off? Well I've heard about this Implant-Wide Surgery Center twenty minutes away. We do the scans for complimentary. We don't charge for the scans and that's the whole thing. We scan a lot of people, and we look at the scans, it's a screening device. We don't charge ever. That dentist would basically send Mary, the patient, to Implant-Wide. The Implant-Wide team will take her, do a scan and a pan on the Carestream 9300, and then the patient would just set up a consultation appointment and leave. That would take twenty minutes.

Then one of the surgeon mentors will look at the scan, come up with a couple of plans. You can look at these scans after you're looking at them all the time, takes you about ten minutes, fifteen minutes. They're not that hard. In fact, looking at a bite when you have to look at scans for years. They place three virtual implants on the lower left, and so the surgeon mentor would then call up Dr. Smith, the dentist down the street, and say, "Listen, Mary came in for a scan. I can see that she needs three implants. This is the bone availability. We can place them now. Well where do they go? Do you have any preference on implants?" If the dentist wants to use any implant, that's fine. She can use any implant she wants. 

We also have a no corkage fee, so if they want to bring their implants in here, we don't make any money on implants. We have an inventory here of several hundred, but we don't mark them up, so they can bring the implants in. She has the patient plan for three implants and our surgeon mentor, one of our periodontists or surgeons, she says, "I can't do it myself. I have to have the team approach. I need to have a mentor helping me." They schedule a patient down the road for those three implants. The patient says yes to the fee. Chris, our office manager at the facility, would then quote the fee, whatever the dentist wanted. Let's say the dentist said, "I want to charge $2,000 per implant for the patient." 

The case is then sold and the patient shows up and pays the money. They all coordinate in the room with the assistant and all the cone beam reports and all the equipment, Dr. Smith, the surgeon mentor and the patient, and then the dentist does have to participate in the surgery. Whether it's anesthesia or a little bit of suturing, they have to participate. Then together they do the three implants. Dr. Smith charged the patient whatever she wants as the billing dentist because she participated. We're the casino, we're the house. We take our cut, and she also gets CE credits. We're AGD Certified so that for every hour that they spend in the surgery center, they get a hour of CE credits through the AGD.

They earn while they learn. That's our thing. They come here and actually earn while they learn.

Howard: Man, earn while you learn. What a concept compared to all the other concepts were drop $5,000 for a weekend.

Jim: That's what I said.

Howard: I say, "Can I see the $5,000 worth of notes saving me $5,000 bucks? Can I just see the notes," and they've got like three pages written down. It's like, "Wow dude, that's $1,500 a page." That is an amazing concept. Here's a woman that's thirty years old, she doesn't want to fly across the country. By the way, she just needs to be licenses in Illinois, so she could be driving all the way from the entire state. How many dentists are in the state of Illinois?

Jim: Fourteen thousand I think.

Howard: Yeah, your market is fourteen thousand because if you can't see the value ... As far as the patient, just like you said to that guy you placed too, you placed one on his sister and one on his friend, to buy a research monkey is usually a hundred grand, and you've got your cousin Eddie at Thanksgiving dinner for free. He'll do it, and all my younger dentists I've talked to in that, they're older uncles and grandfathers. They think it's an honor that little Susie's going to try her first. It's becoming a veteran for their niece or nephew. I don't think you have one uncle who would say no to the deal, even if he didn't want it. They got to drive all the way from Effingham. Who cares to go down there? Wow, earn while you learn. That is just an amazing concept.

Jim: Thank you. They can go at their speed. If they have their game up and they want to just use the facility for solo we call it, they can come and do it without assistance and we don't need a surgeon mentor in the room.

Howard: I want to back up. She's driving to work and she's saying, "Okay Jim, I got that, but I'm recommended a patient, but I've never done one. Do I need pre-recs? Would you recommend I go to a continuum? Is there online CE? Do you have a webinar? What about the didactics? I've never placed one implant." 

Jim: Well you know what, it's on the job training. You're going to come here with the mentor and you will participate because you do know how to give anesthesia.

Howard: Do you guys have a didactic lecture?

Jim: At this point, we haven't gotten around to doing it yet Howard. We just opened the doors, and so it's just been busy doing what we're doing here.

Howard: Well your best marketing would go on Dentaltown. We put up three hundred and fifty courses. They've been viewed over half a million times. You should build up the didactic training for Implant-Wide and then put that up on Dentaltown and then you've got fourteen thousand dentists in Illinois and basically every state's the same about twenty-five percent of the dentists of every state have logged on and off Dentaltown at least once. It's about one-fourth per quarter per state. Then all the states are pretty much the same. 

Fourteen thousand, according to them, half would be seventy-five hundred, half of that would be about thirty-five hundred. Probably thirty-five hundred dentists in Illinois would have that license, you'd be marketing to with the online didactic course, and then they'd get to meet you, your two periodontists. They get to feel familiar with you. You go through the didactics and they go down there and just say, "Look, I'm a newbie. The first one I just want to watch, numb them up or do whatever, but I just want to work with you. I want to earn and learn."

Jim: Thank you for that offer. That would be a great thing Howard, it really would be.

Howard: Then while you're working on that, I swear to God one trip with you and your two periodontists to the Illinois State Board of Dental Examiners, no one, I mean you can lose your job if some reporter put a microphone in front of you and said, "Why are you not allowing dentists from other states to come do volunteer dentistry on bets?" You'd fear your job and pension and career. You just can't say no to that.

Jim: I agree with you. Basically we also do the traditional approach. Back to your question Howard, let's say she wants to just refer the patient and have our periodontist do it all. We do that. We call it traditional. We have three approaches: solo, team or traditional. She could come and watch while the periodontist did everything, and we would just bill the patient as if it was a traditional periodontist doing the implant, and she would just stand there and watch.

Howard: Why did you get two periodontists instead of two oral surgeons?

Jim: Well to be honest, I'm not sure. We met them. Reganato is just a great guy, as you know, he's a dynamo and Dr. [Jodi Peri 00:37:09] is our other periodontist. Then we've had a couple of oral surgeons that have come here, Dr. Michael Jones, Dr. Chris [Chalkis 00:37:14], and they've done cases here, so if we need them they're associated with the club here. They have lockers and things. It's a matter of, as you know, trying to get everybody coordinated so that the dentists and the periodontists, we're just trying to work on coordinating things, but the basic concept has been a real winner with these dentists because they come in and I talk to them all the time. I talked to a couple of new ones yesterday. One was a sixty-five year old dentist, one was a new grad, and they're basically saying all the same thing. "This is a great idea," they say. "I want to start doing implants and my schedule's slightly light, but I don't know what do. Now I can come here and start right away." They like it.

Howard: You've already got your curriculum because Anthony Reganato, he's been on Dentaltown forever. He has fifteen hundred posts, he has two CE courses, and he has a Reganato lecture series on YouTube, which is amazing. 

Jim: It's amazing. He's amazing.

Howard: He's already got two CE courses. Yeah. You basically already have it. He has the socket bone grafting technique using D/PTFE membranes and the course explains advantages of using ... Explain what D/PTFE is. Do you know off the top of your head?

Jim: Yeah. Those are the newer generation of the old Gore-Tex. Those are the dense ones, which are more imperviable. When you remove those, the company has Cytoplasts. They're called Cytoplasts membranes, the Cytoplasts 200, I think they call them the singles out of the company, what is it, Osteogenics I believe in Texas. You buy these membranes for $150, and you don't need primary closure. You can put your flaps, edges and have four to five millimeters of exposed D/PTFE membrane, so that way the keratinized tissue eventually will grow over it. Six weeks later when you go to take the membrane out, you can just tug it out with your forcep as opposed to the Gore-Tex membranes, which you had to flap it and dissect them out. It was much more difficult.

These D/PTFE ones, Cytoplasts is the main one in the country, they're real slick for missing buccal walls or any time you just can't achieve primary closure, they're nice. They're real nice.

Howard: Then he has another course, Minimally Invasive Ridge Augmentation, maximizing clinical efficiency. Yeah, he's already got two courses, and you could put all the YouTube channels, you could combine all them. You probably have a curriculum just from his YouTube channels.

Jim: Yeah. He's a great instructor. He has his own private practice also about fifteen minutes from here, and he travels to about seven or eight dentists I know, nine dentists he travels, and he helps out at our surgery center.

Howard: Is here there now?

Jim: He's not sitting here right now.

Howard: Oh I thought you were just talking to him. 

Jim: I invited him. I wanted him to talk to you and he was busy. Actually he flew to Florida today for the AAP meeting. That's why he couldn't make it today. I invited Anthony to be here.

Howard: We should do a podcast with him and your other periodontists.

Jim: I think that would be wonderful. Jodi Peri, she's a wonderful, probably early 30s, PhD periodontist. Loves teaching. Both her and Reganato, they love teaching the GPs, and that's what we're all about. We want to make a very mentoring, non threatening environment where it's not intimidating for dentists to come and ask silly questions. There is no silly questions, and they can learn implants without an oppressive environment. We're trying to open it up for people. That's what we're trying to do.

Howard: Tell her I'm begging her to do a podcast, because I keep getting the complaint, "How come every time you interview a dentist, it's a man and every time you interview a woman it's a consultant or a hygienist? Is that sexist?" I'm like, "Dude, trust me, there's no bias." I actively search. Joyce Basset, how often do I send her a text? Every three days? She's the first woman president dentist of the American Academy of Cosmetic Dentistry, and she lives up the street and me and Ryan had dinner with her a couple weeks ago. I'm like, "Joyce, you're a woman role model. Half the medical school class is women; they don't want you to see every time there's a dentist talking it's a man." Tell your woman periodontist, I have to have her.

Jim: I invite her too, today she couldn't do it, but I'll tell her and Anthony to get in touch with you and you can do the podcast with those two. It'd be fabulous.

Howard: Yeah, it'd be great marketing. You can also email these podcasts to all the dentists in Illinois. 

Jim: Okay. 

Howard: You can send an email with a link to all three of the podcasts, and then the links to those courses on Dentaltown, and then if we could put all those YouTube videos, splice them together, you can have a nice little curriculum.

Jim: That's very generous of you Howard. You've always been an innovator. I've known about you thirty years, you've been out there, and what you say is almost a hundred percent the truth and you're a visionary. I appreciate what you've done for dentistry man. You've really done a lot.

Howard: Well same back at you buddy. This is the first prototype I've ever heard. I've heard of no one doing this. 

Jim: Well thank you. I figured it just came to me. In fact, the name came to me when I was driving down the road about seven years ago. I was thinking we need a health club for implants. I didn't have a name yet. I was thinking of that ZZ Top song, "I'm bad, I'm nationwide," and all of the sudden it just popped in my head about Implant-Wide. We encompass more than implants. We do grafting and surgery and we're open to mentoring friendly, everybody's welcome here, specialists, NGPs. I came up with the word Implant-Wide.

Howard: While listening to ZZ Top?

Jim: A ZZ Top song was playing, the nationwide. Yeah, it just hit me, it came to me when I was driving down the road. The windows were down and I thought I was 17 years old again back in 1978. 

Howard: ZZ Top had a song called ...

Jim: I'm Bad, I'm Nationwide. I can't remember.

Howard: Nationwide, I don't remember that. The second album I ever bought in my life was ZZ Top Fandango. The first was Head East, Flat As A Pancake.

Jim: Going down for the last time.

Howard: Absolutely. My gosh, that is so funny.

Jim: Good times back then Howard. Good times in the late 70s.

Howard: ZZ Top, what a great business. I remember seeing two concerts back to back, one was ZZ Top Fandango, and I was sitting there the whole time thinking, "Wow, they get to split all this money by three," because the week before I had seen Earth, Wind and Fire and I just thought to myself, "How many people are on that stage? Fourteen? Eleven? Twelve? Half a dozen?" I mean I just thought at the end of the day nobody made much money on this deal. Commodores was the same way. It's like, my god, you guys got way too much overhead in this band. 

Jim: That is so funny Howard. That's the funniest thing I ever heard, honest to god.

Howard: I had more respect for The Police and ZZ Top having only three employees. The Glenn Miller Orchestra, those guys were probably making minimum wage by the time you dissected fifty people onstage.

Jim: One more thing I wanted to say is that we've partnered up with a great dental lab called Hi-Point Lab, it's across the highway here, and they're a really big facility and they have incredible equipment, technicians. Dan Holloway is one of our partners here at the office and he works with the lab, and they do all the grad programs at UIC and the dental school. He bought all the expensive milling machines you don't have to ship it to New Jersey and they've also partnered with Implant-Wide, so when the dentists come here it's not only the placement of the implants but it's the press.

You've got placement and you've got press. He's able to coordinate all the lab stuff that has to do with implants with the dentists, so Dan and Chris and everybody working together just is a neat complete package that doesn't exist anywhere right now. 

Howard: What is the www dot for that lab? Www dot what?

Jim: Www.hipointdental.

Howard: How do you spell Hi-Point?

Jim: High Point, H-I, and then P-O-I-N-T, Hi-Point Dental Lab. 

Howard: Hi-Point Dental Lab. Is that in Shaumburg, Illinois?

Jim: Shaumburg, Illinois, that's correct.

Howard: I want to ask you two controversial things on implants. I'll just name them right off the top. One is to use a surgical guide or not to surgical guide? Thoughts?

Jim: Well you know what, that's a good question. I think you always need to use the cone beam. As long as you're using cone beam properly and you can take measurements accurately off the cone beam and you can use the caliper in the mouth off of landmarks to actually mark spots on the [inaudible 00:46:04] with ink using calipers and cone beams, you can be very, very safe without a surgical guide, but surgical guides are great. It's going to be an extra step, but they've come down in price. Many, many dentists are drawn to surgical guides because it's very easy. You just drill the hole and stick it through the guide, and there's nothing wrong with that.

I don't use them a lot. I know Dr. Reganato, we asked him this question about four weeks ago. He was giving a lecture here at Implant-Wide, and I said, "Anthony, out of all the implants you've placed, you're a legend at dental implants on Dentaltown and your YouTube." I said, "How many surgical guides do you use?" He goes, "Exactly zero." So Anthony doesn't use them, but there's that oral surgeon on Dentaltown that uses them a hundred percent of the time out of California.

Howard: Dave Resnick.

Jim: Yeah, Resnick. Everybody's a customer. I personally don't use a lot of surgical guides, but you do need to be very careful with your planning at the cone beams and make sure you don't hit the vital structures and safety first. I would say it's not a panacea though Howard. You can't not have the surgical skills because the few times that if you had an issue with the guide or whatever, you need to be able to flap and do basic surgery and suturing and placement of bond, to be able to do implants properly. Yeah, the guides are fine but they're not a panacea I would say.

Howard: You've had forty-four dentists, right, come in and use your facility?

Jim: Yes.

Howard: If a hundred cases are being done, what percent would you use a surgical guide on in Implant-Wide?

Jim: Right now about zero.

Howard: That's what I love about Dentaltown because young people think by no meal. Yes, no, up, down, right, left, and older people who are fifty know that life is fifty shades of gray and I can name a thousand dentists who producing like a million dollars a year and don't place implants, they don't have a CBCT, they don't have a Cerec machine, they don't have a laser and all they do is fillings and crowns. Then I can show you another thousand dentists that have every one of those toys. It's fifty shades of gray, you know what I mean?

Jim: I agree. Our profession allows that. We can take any kind of path we choose and it's very forgiving in that regards, that we can all earn a living doing completely different things it seems to me.

Howard: I want to ask you another taboo. This is dentistry uncensored, I like to ask the uncomfortable questions. Mini implants, a lot of people who place mini implants are kind of in the closet because they feel like on Dentaltown or with periodontists and oral surgeons that a mini implant's not a real implant. Someone comes in with a denture, they use the existing denture, they place two or four little minis and snap on, and then other people are like, "Come on, man up and place a real root form." What are your thoughts on mini and why are they not as popular in the United States as they are in other questions like Germany?

Jim: I think it's ego and politics. It's all ego and politics, because it's titanium. If you do a cone beam a seventy year old lady on a mandible, your denture list, and she's got 2.5 width of an anterior bone between the frame and you're going to not place implants on this lady? She doesn't want to have grafting. She wants to have two to four little implants. Absolutely, put four minis in there, whether or not they're 3Ms or they're [Dentotists 00:49:24] with the wide top where you can just soft line the denture and you don't even need a housing, it just sticks on it. You're doing these people a service by using the minis in these areas.

Now in the posterior maxilla, where you have five millimeters to the sinus and it's wide with type D3/D4 bone, are we going to put a 1.8 by thirteen sticking up in there? Probably not. We wouldn't do that. It's got its uses, and once again, it's the politics. It's what you just said Howard, it's a black and white thing. Well I don't place minis, hence I'm a superior dentist surgeon. I think that's wrong. A mini has its place for the seventy year old lady that needs a denture to hold it down.

Howard: Back to those mini. You said something. What was it you were saying about the Dentotist mini didn't need a housing case. What's the name of that?

Jim: Dentotist, and it's called an Atlas Mini.

Howard: Who makes that?

Jim: It's out of New York. I think the company's Dentotist. I think Henry Shine might sell them. It's just like the 3M M Tech MDI has its 1.8 by ten or thirteen, but as opposed to that little ball that 3M has where you need little housing at the o-ring, you just basically put these Dentotist ones in that the head is wider, and you can now not use housings. Just take your denture on Mrs. Smith, grind it out on the anterior, put a little bit of GC soft line or something, and just put it in for five minutes and that thing will snap in tight as a rock. It will last her a year, and you don't need any fiddling with housings. It's fantastic. 

Howard: You know how you learn so much by your mistakes? I remember one of the first implant cases I did, I placed six implants on her and then she lost her job, no money and she still had a denture. I took those. I put on the abutments on the implants and gutted out her denture and relined it over just those six implants. There's no o-rings, no attachments. I already had the implants. Back then you had to buy the whole piece. Here he is twenty-eight years later, that thing is firm as a rock, she loves it and she has had six maxillary implants and a denture that seats on those implants. 

Jim: Look at the service you did for that patience. That's what you have to think about. There's three hundred million Americans and these people need our help as dentists. To take a stance that I'm above a mini for whatever reason, I'm a superior surgeon, I have the hands of God and I don't place a mini, what are you saying? How are you helping the seventy year old lady that needs those four minis in the front? Basically the way it is now, you have minis all the way up to the eight millimeter diameter AnyRidge implant or something in between. All different areas and they often have different three dimensionality to it. If you have an area for a mini in the interior, use it if it's going to work. If you have a number seven antenna on somebody that's got very narrow, they don't want to go through grafting, put a couple minis and have a Ridge Lap [inaudible 00:52:20] abutment or whatever they call it. The book from, I can't remember the name of the author right now, that a little crown that just ridge laps on seven to ten.

You're doing them a service and these things work. I think it's all the same. You just analyze your cone beam and you come upon a conclusion as to what implant fits in what site, and whether it's a mini or whether it's a $600 seven millimeter diameter implant, as long as its for the site, take care of the patient.

Howard: Almost every dentist who's never placed an implant in Illinois right now has a mom, a grandma, an aunt, someone with full dentures that would like some implant support.

Jim: All of them have three hundred people in their practice and eight relatives that need to have some help with implants. These poor dentists, I feel bad for the new guys out of school. You and I are fine at our point in life, but they need to get in and help these people with some implants and get into the game somehow safely, so it's safe and proper. You don't just dive in and cause errors, and that's why we came up with this to help.

Howard: Let's switch over to implant surgical designing software. You have the machine, Carestream for the actual CBCT, but do you like any of the treatment planning softwares? There's Anatomage.

Jim: Anatomage and Simplant I've used those. I just actually at this point love Carestream. They come with their own virtual implant software and it's fabulous. 

Howard: You just use the house software.

Jim: I use the house software, yeah. Then you download your library, so we have like a million different implant libraries of which you click on it and you get a beautiful virtual implant and you just drag and drop it into the position and find that it fits in there nicely and everything, and you can do a lot with just the house software.

Howard: What if some dentists in Illinois want to just contact you, talk to you? How do they reach Jim?

Jim: They can take my cell phone. I can give my cell phone or they can go to the Implant-Wide website and just contact me.

Howard: What's your cell phone?

Jim: My cell phone is 815-543-3003. 

Howard: 815-543 ...

Jim: 3003.

Howard: 3003. 

Jim: Yeah, that's my cell.

Howard: Okay, 815-543-3003, and the website is

Jim: That's correct.

Howard: Man, I'm so glad that you spent an hour with me today. I think this is an amazing concept and I wonder if, who knows, maybe ten years from now you might have this in several states or people can just travel to you. 

Jim: Yeah, I'm not sure. To be honest with you Howard, I enjoy it a lot. It's a lot of fun. It's different than practicing the old general dentistry of my associates in the big practice because when you come here it's a brand new facility. I'm interacting, and the periodontists and other dentists are interacting with other dentists as a team approach and it's a whole different dynamic than just going to your office and cranking out dentistry, and it's quite enjoyable actually. It's a lot of fun. 

Howard: You know what, it was Zig Ziglar that said that humans need daily, they need deodorant and motivation, and I think what dentists have is the same with Olympic athletes. Olympic athletes have a very, very high rate of alcoholism because they did one thing, they swim like the hundred meter for an hour before school, an hour after school every year for like twenty years and they had to deal with burnout. Sometimes I think a big problem with dentists is they're burned out of just doing fillings and crowns. 

Jim: You can't blame them. Howard, you and I have been in this game for thirty years. I'm fifty-five, and yeah, you look back and going in and just doing fillings, crowns all day long for thirty-four years, it gets very redundant. If we have the patients that need implants, which we've admitted that we all do, have many, many patients and patients love implants, why don't we just adapt this and make some happiness into our life and make our career a little bit more enjoyable, because I really enjoy it and I know that you've mentioned that you enjoy doing implants too and it changes the dynamic a little bit. 

Howard: I love blood and guts. I just don't excited about a DO composite on number four. You just get the satisfaction of dealing with the human behind the tool, but it's hard dealing with the tooth working with your hands, it's nothing really fun. That's why I never knock any toys, because with the dentist I'm worried more about the mental health than their physical health, and they have good mental health then they'll have good financial health. The ones that buy a laser, you know that they buy a laser they never buy just one. Lasers are like tattoos. You never see someone with one tattoo. They start with one, and you come back ten years later and they got three.

Same thing with lasers. I mean everybody gets a laser, two or three years later they got one for every room. What I see with the laser is they get all excited. It turns them on and then they want to go to work, and now they're playing. As long as they're mentally healthy and happy and playing, I want you to end on this. This is your end. I would like to financially learn how to place implants. I wish I could add $10,000 a month becoming an implantologist, but I'm kind of scared because I don't really think I'm a good surgeon and I refer out all my wisdom teeth. I can pull obviously an incisor, K9 pretty much. Coach them like Vince Lombardi. If she's listening to you and she's just a little scared of the surgery because basically that's not her strong point, but she wants to be an implantologist for financial, but she's a little scared and she doesn't think she's a blood and guts surgeon, what do you say to her?

Jim: Well you know what, come to the health club. Come to Implant-Wide and start working with the mentors and hanging out here. Just come here and hang out with your patient. Bring your patients and you can do a traditional approach and watch and then get into the team and start getting into it. You got someone motivating you who's an expert surgeon. Then you eventually get your skills up, so you can eventually do it solo either at your own office or here at the facility, or you can just continue to do it team approach wise. Dr. Smith, I'm talking to the dentist lady, is that this could be life changing for you because you have many, many patients that now are breaking teeth and need implant related services and prosthetics, and she can be invited to watch surgeries and all these various things.

Realize that for every twenty patients you do fillings on, that twenty first one needs implants. You're right now, you're disregarding that twenty-one person and sending it out of your office for the surgery. Then you see twenty more people that need fillings and crowns and the forty-second one needs an all on four and guess what you're doing? You're not doing it. Then it just goes on and on and on. Every twentieth patient needs $5,000 to $50,000 worth of dentistry, which is enjoyable, a patient that loves it, and you are not doing it but now you have a chance to get started on this in a way that's very unique. 

Howard: You've said all on four a couple of times. You've got to clarify that. Someone's listening.

Jim: The all on four 56. It's the all on four concept. You place four or five or six implants and you do the hybrid bar. It's the clear choice model basically, that type of thing. 

Howard: Do you guys do that at your plant?

Jim: Yes we do.

Howard: Do you like that?

Jim: For certain people yes. I think it's a great thing for certain people, yes. 

Howard: What would clarify the certain people?

Jim: Well it's a cost effective solution. Mrs. Smith, let's talk about her upper arch Howard. She's missing five teeth, she's got bond out seven teeth. She has four choices: a denture for a couple thousand, an over denture that snaps on four to five, six implants with locators, you can do an all on four, which doesn't come in and out Mrs. Smith. It's about $20,000 grand an arch, give or take, or you can do ten implants, bilateral sinus, lifts and crown and bridge work. You can do these choices. We actually have the models. We have all these models, and we lay four models out and say denture, $2,000 or $50,000 for ten implants bilateral sinus lifts will take eight months. You'll have crown and bridge work individual teeth, or we've got these other options for $13,000, you can have a snap on denture with four to six implants or for $20,000 you can have this one that doesn't come out.

You know what, they sit with their spouse and they look at the denture and they drop it on the table and they're like, "I don't think so." Then they grab the $50,000 model with ten implants, they're like, "This is the best. This is awesome, but is it going to be eight months, I got to spend $50,000?" Probably not. It always comes down to the middle two models. $13,000 for this one or $20,000 to $25,000 for this one. This one's only $8,000 more and I don't take it out at night, then they always pick one of the two middle ones. I love the patient, whether they do the denture or they do $50,000 for all arch ten implants, but we as providers need to at least open. There's no selling because you just show the patient the choices and you generally have to be a very genuine person that you really don't care if they do the denture. You'll do the best denture possible. You don't care if they save $50,000, you'll still do the best ten implants, if they want an all on four or a snap.

I don't know. I think we need to step it up in dentistry a little bit and not be so nervous about presenting things because we're not selling something they don't need. Just show the choices.

Howard: That's the skill they need the most because in America for every hundred cavities you diagnose, they only drill, fill and bill thirty-eight. The best dentists are the treatment planning coordinators who can get the other half of the remaining two-thirds. If three people are told they have a cavity, one gets it done, two don't. With a great treatment planning coordinator, another one of those two that didn't get it done will get it done. I think the best online CE course you could make would be an hour of examples of presenting the treatment. Who is that? Do you present the treatment or do you got a treatment coordinator?

Jim: Chris, our office manager, but the other thing I want to show you here. Can you see this?

Howard: Yes. 

Jim: We chart on the pan. We use the Carestream two dimensional pan, which you have also Howard, and they allow you to put these symbols right over the pan. After we've analyzed the cone beam, we don't use any kind of charting anymore. We got rid of the regular charts, no matter what type it, and so everybody gets this. You can be a twenty-three year old hairstylist that's never done anything but snap gum and do hair, and they can look at this and say, "Mrs. Smith, you have eight yellow things here, which are implants, and you need these blue fixed to hybrids and it's going to be $50,000 for this." Honestly, the way of charting makes a big different too because the way that we chart in America is based upon four things to a tooth: a filling, a crown, a root canal or extraction. You got an analogue charting where you circle it needs a crown or you mark it needs a filling, but how do you treatment plan staged implantology on that chart?

Well you can't. We chart on the pan and it's made a big difference, using the models, using Chris as the office manager, it's taken it to a new level of understanding amongst everybody. Everybody gets it.

Howard: You know how we were talking about walking up that stair from I've never placed an implant to placed an implant? The treatment planning and selling the case is the most important part of the case because if the patient's not going to give you a dollar, nothing's ever going to happen. Everybody that gives a course on implantology is all about how to drive to LA, but nobody ever does a course on trying to sell, "Let's drive to LA." I think if you guys got some patient dummies and your treatment coordinator and talking about how you chart this on Carestream and how you get the patient to day yes and open up their checkbook and give you money, that's the confidence and the cash flow that they need to then follow through with learning how to place implants.

Jim: A hundred percent Howard, you're absolutely right. We do actually present, we're starting to get some classes on that because I didn't think of that as such a barrier, but it really is a barrier for many dentists because they get, once again, pattern recognition. They quote fillings, crowns and root canals up to a couple thousand. That's what they're quoting. Now you throw something like this in the mix and they stumble and it's very difficult. Yes, I agree with you a hundred percent. 

Howard: Make that course because the one thing I noticed early on in my career, the difference in Oman Reed and all the other dentists is that Omar Reed didn't blink at telling you you needed full mouth rehab and the $50,000 has rolled off his tongue like, "Can I get you a cup of water?" 

Jim: One other thing I want to point out is if you can do the surgery, it kind of gives you confidence to quote the whole fee. It seems to me that many of the dentists that I've talked to they don't do any surgery yet and they're saying, "I have a hard time quoting anything over $5,000." My answer to them after doing this a long time is, "Doc if you could start doing the surgery, you'll now realize that you are worthy of this fee. You're not just a middle man taking an impression." Maybe they feel like they're not worthy of the fee because they didn't do the surgery, the lab does all the lab work, they just do the impression and charge the patient $10,000 and maybe they're just a middle man. 

I said, "Doc, if you can now get involved with the surgical portion, you'll realize that there is a lot to it and now you won't think twice about quoting a fee because it's worth it. You're not upselling something."

Howard: We are way over time. We went six minutes over, we got to stop. I just want to end on one thing, because my goal is to get this dentist to just get her done, and I want to tell you that Socrates said twenty-five hundred years ago that the best surgeons are the ones who served during war. Because they're out there with just mutilated bodies and I mean they're just blood and guts, and then you go back and do your little appendectomy or something, it's no big deal. I was scared of surgically placing, and in my first course, the first case I saw, I went and sat at Carl Misch, and he's sitting down to a patient who's put under by an anesthesiologist, and he just picks up his weight and he lays a flap from retro molar pad to retro molar pad, re-flaps, sews the lingual to the opposite side.

Anyway, but the whole time he's doing the surgery he's maintaining eye contact with me, talking to me and telling me and the whole time I'm thinking, "Quit looking at me. Look at the [inaudible 01:06:45]." He sat there without breaking a conversation and placed a half a dozen implants on the lower half dozen implants. He wasn't even in the chair for twenty minutes, and I think it was just going to World War. After I saw that, then going back to my office and just placing a little dinky one single implant with a molar was just fearless because you just seen Carl just fillet someone ear to ear without blinking.

I think if these kids just drove to your implant center and just met you in the flex and you walked around the center, that will build their confidence and suppress their fears so that they can engage this decision. 

Jim: I agree a hundred percent with you Howard. That's good.

Howard: All right buddy, thank you so much Jim for spending an hour with me.

Jim: Nice talking to you Howard. My pleasure.

Howard: All right, have a great day. 

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