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• How big change always starts small
• How Robet Gottlander is helping bring cohesion to the industry
• All the facets of Henry Schein
Robert Gottlander, DDS is Vice President, prosthetic solutions, at Henry Schein
Howard: This is a great honor today, to be podcast interviewing Robert Gottlander, whose first test in dental school in Sweden was from Dr. Branemark.
Robert: That's correct. The first exam I did was craniofacial nerve number XI. I do remember it.
Howard: He just passed. Was it this year?
Robert: He passed away last year, actually.
Howard: Last year? What was he like, the man, the legend?
Robert: The man, the legend, he was a phenomenal man to be with. His vision was just phenomenal. He was fun to be with, a little bit challenging at times, but, a fantastic individual.
Howard: Did you ever work for Nobel?
Robert: I spent almost 29 years doing that.
Howard: That saw a huge change over the years. The company started out with Dr. Branemark and then it changed to Nobel Biocare.
Robert: Actually, it was not a company really when Dr. Branemark ... Dr. Branemark was running it just like a research project for a long, long time. All of the first patients that were treated was not done in the company. It was done at the University. It was done like a research project. At the end of the 1970's, the patent was acquired by a Swedish company called Bofors. Then, Bofors Nobelpharma.
The real access didn't start until 1982, which was, if you remember, the year of the Toronto conference. That was the beginning of it. For me personally, I was supposed to be an orthodontist. It never happened because I started to work with a PhD on implants in Oslo, this type of a [inaudible 01:51], I called it the project, was [scope he 01:55] commercialized. That's how I ended up running education for Nobelpharma in the mid-90's.
It was a journey. Why I started in Nobel, it was 7, 8 people. It was not an office. We were renting 3 rooms in an office building. We shared a secretary with 4 or 5 other start-ups.
Howard: Wow, what a journey.
Robert: It was a journey. It was fun.
Howard: Now, it just recently got bought by one of the largest, Danaher. What do you call a company like Danaher? A conglomerate, a holder company?
Robert: Yeah, conglomerate. They have a lot of businesses. They have a lot of dental businesses as well.
Howard: They picked up Nobel Biocare and Implants Direct.
Robert: Yeah, I think they had Implant Direct for quite some time, then they added Nobel to that.
Howard: Now, you left work [crosstalk 02:43].
Robert: I left Nobel before that. I've been with Henry Schein now for, what was it, 4-1/2 years a little more than 4 years.
Howard: What was your mission coming over to Henry Schein? What did Stan Bergman tell you he wanted you to do?
Robert: It was actually a funny story. I've known Mr. Bergman for some time. We were at the, what this was called, the Dean's Board at NYU together. I've known him back then. I always thought that Schein is an interesting company, because, within Henry Schein, you have all the bits and pieces. Everything is there. They're not always coordinated because they're such a big company and you have so many different organizations within the company. It might not always be obvious, but it's such a big organization.
My task was actually to see how can we change the whole thought process, so, instead of thinking about all the products, thinking about, what's the needs of the dentist, and how can we satisfy that need in the, say, actually not going to say the future of dentistry for us, but the special focus on CAD/CAM. The CAD/CAM and digital, you can discuss for a week, what's the difference, but to really think about how we can see what other areas of the [port 04:17] or the treatment of the patient. What digital will enhance or improve, or whatever word you use. I'm not native English, you know, so, dentistry. How can we then, from the company's point of view, put this together, not only because I mean, you know that it is not only about the hardware and technology when you talk about CAD/CAM. It's actually about, "How do I make this work in my practice?"
Howard: Name all the digital companies within Schein and what challenges they all have putting it together a manual.
Robert: You say challenge. I mean, we work, as you see here in this pavilion, that we work very closely with Planmeca, Planmeca FIT. We work with from a scanning point of view, with TRIOS. We work with 3M on the TV side. When it comes to cone beams, we work with Danaher and i-Cat. We work with Planmeca, we work with others as well. We with several number of milling companies on the laboratory side. We work with several of the printing companies. There is a lot of technology available, but we believe in open architecture. You should have a choice, as a dentist, to see "How does it fit my needs?" Depending on what kind of practice you have, you actually have different needs. There are some systems that fit you better than others.
That's really what we would like to explore together with the business solutions team. We have to see what really is the best solution for that practice. Then, to see how we can put this together, how can we educate not only dentists, but the staff. Really, I can say this, since I'm a dentist, that there's a lot of enthusiastic dentists coming home to the practice after a weekend program and not all of these ideas get implemented in the practice. We really take an effort to make sure that also, we are a part of not only the education, but also the integration into the practice.
Howard: Do you sometimes feel like you've bit off more than you can chew, trying to integrate all these digital pieces?
Robert: I feel that all the time. That's the challenge, because, right or wrong, I believe I can chew it. You cannot, like the joke about, how do you eat an elephant? One piece at a time. You can have the vision that where you want to go. I think that has to be fairly clear. You cannot take the whole bite at one time. You have to see what are the different pieces.
We've been working on this now for 3 or 4 years, to having the vision to put the pieces together. This is the first time we show this to the U.S. in this pavilion. It's not only to put the pieces together, but also to communicate, to communicate in a way so it's not complicated. There's no reason in reality to use technology if the technology doesn't make it better for the profession or the patient. To use technology by itself, just because it's new, I mean, then it's just an expense.
Howard: Yeah, if it's not solving a problem, then it is a problem.
Robert: It is a problem.
Howard: Yeah. I'm going to ask you something. You hear all kinds of numbers for the American market, how many of them have CAD/CAM. You hear anywhere from 8-13,000. Some people say 13,000 have bought it only 8,000 regularly use it. Do you think the next big wave, do you think it'll be more digital scanning impressions and have then, the lab make it, or do you think the piece of the dentist milling out the crown in the office will continue to grow? Some of us guys think that it just seems easier just to scan the impression and send it to the lab, by-pass the impression. Everybody agrees the whole market's going digital as opposed to analog, but do you-
Robert: I think it depends a little bit on the practice itself. I do really like that you're saying that you think the market is going digital, because I'm absolutely convinced about it. I think it depends on the practice and how the setup is and what laboratory you work with. I think a lot of this has to do with, how was your cooperation with the laboratory, how quickly can you get the crown back, and then, there's cost factors involved. If ask patients, and you ask them, "Do you want to come once or twice for a crown?", most people say, "Once."
Howard: I disagree.
Howard: If you come in, and I ask you, "Okay, it's Monday morning at 10. You have two options: You can be here 30 minutes, leave in a temporary, come back in 2 weeks for 30 minutes, or, you can stay here and get it all done today in about 2 hours." In America, 4 out of 5 people say, "You know what? It's Monday, it's 10. I'd rather just be done in a half hour and come back in 2 weeks."
Robert: Then I think that the answer is, actually, in a big way, depending on what the patient's going to say.
Howard: Right. I think a lot of people tend to be extremists. Everything's yes, no, up, down, right, left, where I think in business, it's moderation. I think that there's a market for same-day crowns. I also think there's a big market for, "We need to just scan this impression, get it to the lab, and free up my assistant in this room."
Robert: I agree with you.
Howard: For another patient.
Robert: I agree with you, because I think it will come down to some way to a big extent, in the end, what's the patient's view?
Robert: "Do I want to come twice, or do I want to do one visit?" You, as a dentist, you might have the opportunity to do both. It might be that you will listen to what the patient is saying, and you would have the option to do both. You would send away some, you're going to produce some. Depending on-
Howard: Which one of those 2 pieces do you think is growing faster, the milling, same-day crown in the office, or oral scanning for impressions? In the next 5 or 10 years, what do you think will grow faster?
Robert: I really can't say. I think both will grow.
Howard: Both will grow about evenly?
Robert: Both will grow. What we don't know today is, what we see happening, the technology is developing, the prices are changing. I think that it's really hard to say. I think both will grow. Right now, I think both are growing about the same speed. I think how laboratory decides to handle this is a big factor in it. What's happening with the prices of crowns. There's a lot of unknowns in this prediction.
Howard: I'm going to ask you, I want to switch back over to your roots, with your first test being Doctor, what do you call him? PI Branemark?
Robert: Professor PI Branemark, yeah. In English, you say "Bran-eh-mark", but in Swedish, you say, "Brawn-eh-mark".
Howard: Is it just P. Branemark?
Robert: Yeah, PI.
Howard: What's the PI mean?
Robert: Per-Ingvar. It's a double name.
Robert: Per-Ingvar, yeah.
Howard: When he first came to North America, he would only train oral surgeons, or surgeons to place implants. For the first 20 or so years in the United States, mostly oral surgeons were placing all the implants and perios [inaudible 11:53]. Now, some people are saying in 2015, that, last year in North America, half the implants were placed by general dentists, and half by specialists. Do you agree with those numbers, that it was about half and half?
Robert: Sounds right, yeah.
Howard: Do you think a big part of that was because of the CBCT 3D X-ray, making surgical guides, not being so afraid of where anatomical structures are?
Robert: I think that's a part of it. I also think that the patient selection is a big part of it. What I don't now, is know exactly what kinds of positions different dentists are placed in. What you hear different dentists talking all the time, is that, the surgeons are doing most of the more challenging cases. The dentist would have the not so challenging cases. I think it certainly guides some part of it. If you look upon, I should say, not how many, but how few [inaudible 13:01] are still being produced is talked about a lot. It will be a lot of them because that's also a procedure that is just in the beginning.
Howard: What do you think the next big thing is in digital dentistry?
Robert: I think that the next big thing is that, it really will be adopted in every office. It will really be a part of the offices that, not only to get into all new kinds of technology, that the changes in dental environment, where you have to be more efficient, or you have to do perhaps faster dentistry. These tools will help you to do that. I really believe that there will be much faster uptake in dental technology in the upcoming 5 years, than what you have seen in the past 5 years.
Howard: I agree, especially the young kids coming out of school. They were born with cellphones in their hands.
Robert: They were born with cellphones in their hands, and they look upon it in a very different way. I think that also the insurance systems are changing, patient's demands, patients want their treatments faster. Somebody shouldn't use this technology in dentistry where it's used in so many other areas. What's important is, that you realize, I have this occur sometimes, that this doesn't mean that the dentists have to know less. The dentists have to know more.
Howard: Why is that?
Robert: There's nothing you can take away from your knowledge and how to treat the patient just because you add technology. You still have to know how to prep a tooth. You have to know how to, you need to know the basics, you have to do what's right and, then, instead of using impression of material, you do a scan.
Howard: What year was it when you were taking a test for Dr. Branemark?
Robert: Back in '75.
Howard: 1975. I just want to remind these young viewers, I graduated in '87. I was in dental school from '83 to '87. Most of these people don't realize, but in '83, the oral surgeons that were placing implants, like blades, subperiositeals, they were made fun of in all the dental associations and dental schools. They were referred to as crazy, butchers, not right in the head. Now, in 2015, 30 years later, implants are just standard of care.
Now, there's people saying you shouldn't be doing a 3-unit bridge, a 4-unit bridge, that's that not standard of care. That's funny. I practiced where people are doing implants were the crazy ones, and now, it's standard of care. I mean, did you sense any of that early in your career?
Robert: It was, at that time, when I [inaudible 15:49] in the beginning, it was not a discussion about what brand of implants. It was, like you said, implants does not work. When I talked to my professor and said I'm going to start working with the [inaudible 16:05] with Professor Branemark, I was told, "Really, this really doesn't make sense. Do you think that anyone can never make a living out of a titanium screw?"
Howard: I know.
Robert: I know. This is mid-80's. Now, the school's completely different. I think that in all kinds of new technology, there is a piece of information and education has to go with it. It has to get into society, dental society, then it takes some time. We should remember that CAD/CAM has been around for 30 years. It's not new, either.
Robert: It's not new, either.
Howard: That was a long haul getting going, because when they were starting CAD/CAM, or, you mean, France?
Howard: The computers were so slow and the processes were so slow.
Robert: I was involved very much with Procera once upon a time as well. It was a completely different environment, but CAD/CAM has been around and it's not new. I think that, now, together with the technology and the materials, we should not forget about the materials, then it really makes sense to adopt this much faster into the everyday dentistry. I think that's going to happen. I think dentistry is phenomenal. It's so fun. I sometimes say I don't practice dentistry, but, I think I'm the most well-educated dentist not practicing.
Howard: The most well-educated dentist not practicing dentistry. Is Schein growing equally in all the continents, minus Antarctica? I mean, is North and South America, Africa, Asia, Europe, are they all, is dentistry doing well across all?
Robert: I think we are doing well. We are doing well. We are not working in Africa, we are not as big in all markets yet, but, we have a good growth in all markets. I mean, dentistry is a good business. There's a lot of challenges [crosstalk 17:58].
Howard: You're not in Africa right now?
Robert: Not in Africa.
Howard: North and South America?
Robert: We just started in Brazil.
Howard: Just started in Brazil?
Robert: Yeah. We have business in Asia as well, not everywhere, but we are in China, Thailand, Japan.
Howard: When are you going to see Stan Bergman again?
Robert: I will see him in about 30 minutes.
Howard: You've got to tell him a funny story for me before you go. Then, I'll let you go, because I know you've got to go. I was in Tanzania on a missionary dentistry trip. Of course, several times in my life, when I've gone to a missionary dentistry trip, and the whole place was donated by Henry Schein. I'm out in the middle of Tanzania and, all of a sudden, I've got the nice, six operatories in Tanzania and it's an orphanage, and it's all decked out by Schein. I tell these kids, I said, "Well, this guy that donated this is Stan Bergman. He's my friend." I got out my YouTube, I said, "I want you to all come and say thank you to my friend." The translation, and everything, I said, "OK, say thank you." They all starting singing "Happy Birthday". I didn't, I couldn't [inaudible 19:01].
I posted it on YouTube, but it was a couple of years ago. You can find it under Howard Farran in YouTube, but they're all singing "Happy Birthday" to Stan. They're trying to say "Thank you." They were all standing in line. There were 6 of us dentists wearing a big smile. Just tell Stan that's 3 times in my 20 years I've been in the middle of nowhere, jungle, third world, and there's a complete dental office by Stan Bergman.
Robert: I will tell him that. We try to do well by doing good.
Howard: Well, he's a good man. Don't tell him "Thank you", just start singing "Happy Birthday" to him.
Robert: I'll do that, okay. Thank you.
Howard: All right, buddy, thank you very much.
Robert: Yeah, bye.