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343 Restoring Excellence with Lincoln Harris : Dentistry Uncensored with Howard Farran

343 Restoring Excellence with Lincoln Harris : Dentistry Uncensored with Howard Farran

3/26/2016 7:43:18 AM   |   Comments: 0   |   Views: 682

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VIDEO - DUwHF #343 - Lincoln Harris



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AUDIO - DUwHF #343 - Lincoln Harris

This episode’s discussion:

- Aesthetic dentistry

- Simplifying occlusion

- Bridges vs. implants

- And much, much more.

 

Lincoln Harris graduated from the University of Queensland with first class honours in 1998. He then went on to establish the first dental practice in Bargara, Harris Dental Boutique in 2000.

Dr Harris has attended many continuing education courses on Aesthetic Implant Techniques and Full Mouth Rehabilitation in Australia, Europe, Canada, USA, and South East Asia.

With his vast dental knowledge, Dr Harris coaches and trains dentists from all over the world on complex aesthetic dentistry, surgical techniques and business management. Dr Harris has also lectured in multiple cities throughout Australia, North America, Cambodia, Singapore, and Europe, and is in private practice.

 

www.RestoringExcellence.com.au 

Howard:

It is just a huge, huge unbelievable honor today to be podcast interviewing Lincoln Harris. Dude, you have 13,000 posts and you are so amazing. I remember when you came to the United States, you're in Australia. It's 3 in the afternoon here and it's what? 8am where you're at in Queensland?

 

Lincoln:

We moved a patient to squeeze you in, no I'm just kidding.

 

Howard:

Did you do that? You started late today?

 

Lincoln:

We heard there was this dude from Arizona who had a toothache and he wanted it pulled out as cheap as possible.

 

Howard:

Via Skype.

 

Lincoln:

That's the cheapest way to do it, you know? You're outsourcing it. This is tourism dentistry.

 

Howard:

By the way you have 13,000 posts on Dentaltown. I think if someone said, who's the most unbelievable cosmetic restorative dentist on earth, I would say you. I would have said that in 2005 and now it's 2016.

 

Lincoln:

Aw shucks, you say that to all the girls, you big flirt.

 

Howard:

Really Link you are just unbelievable, amazing and by the way my brother just moved to Sydney, Australia from Kansas. I went down there to visit him. I was going to go visit you, but you're kind of far from Sydney. How far was that in a car?

 

Lincoln:

Too far. You get jet lagged. I'd drive it. If you want to get jet-lagged a lot cheaper, what you do is you drive from Sydney to where I live at the [inaudible 00:01:31] in one [inaudible 00:01:34] without stopping and by the time you get here you've got jet lag.

 

Howard:

How long will that drive be?

 

Lincoln:

16 hours.

 

Howard:

16 hours? You're about 3 hours towards the equator from Brisbane Gull Coast?

 

Lincoln:

Yeah, 4.

 

Howard:

4 hours?

 

Lincoln:

Yeah the ride's quite dull so I ten to fly so that's 45 minutes. In my [inaudible 00:01:55] front.

 

Howard:

I'm wondering, I always wonder when I'm talking to the elites of the elites, you're an instructor, you're a dentist for the elite dentist. When I talk to dentist who lecture on the circuit, I ask them who are they big fans of? Who are they learning from? They always talk about you. How did you get out of school, and you're still young, you're only 38 years old, how did you get out of school and just go right to the top?

 

Lincoln:

Well that's actually a little bit of an accident. About, I think it was, I decided that dentistry wasn't exciting. It was back when I used to read self help book, see? I advise people not to read self help books because they just make you feel insecure and you need to buy whatever the person writing the book is selling you.

 

 

Anyway, I used to read a lot of them back then and I read all the this stuff about you had to have a business that you didn't work in. Of course, I think that's absolute non-sense now because even people who don't physically work in their business, they work in their business. There's very few where the owner of a business is just a share holder. Most of those businesses don't run as well, okay?

 

 

I mean, sure you don't all the stuff in Dentaltown but you keep your hands on the lever pretty tight, I'm sure. Anyway, I decided I needed to have some sort of business that wasn't just me drilling teeth. I decided I'd run conferences, it was a terrific idea, in hindsight it was a stupid idea, but at the time I thought it was amazing. People would just go and flock to these conferences and so I set up this conference at whistler because who wouldn't want to go there?

 

 

Turns out a lot of people.

 

Howard:

In Canada?

 

Lincoln:

Yeah. Well, you know, my wife's Canadian and I thought, "Oh this will be a good gig, I'll get other people and we'll be able to go overseas and I'll have a nice time together." I did this conference my budget on 100 people turning up and spent up big on marketing and I got 15. I managed to lose 100,000 dollars on the first one.

 

 

Anyway, while I was there, some guy was, an [inaudible 00:04:15] from Vancouver said, "Man you should go on this website called Dentaltown, it's got a fairly bug following." Around about, I think my first post on Dentaltown was about 2005 which was about the year I ran the first whistler thing. Those 2 went together.

 

 

Initially, I'd like to give you some sort of philosophical reason why I started learning a lot of stuff that's got a really good model to it but I just wanted to sell my courses. I went on Dentaltown and I just wanted summer courses. The business model was, you tell me straight up that the business model was all wrong. I decided I knew a lot more than you so I completely ignored that.

 

 

Sometimes it takes a while to come around I had to lose money for another 4 years before I'd come around [inaudible 00:05:10].

 

Howard:

No, you are [inaudible 00:05:12] right and we have something in common. A lot of people say, "How did you start Dentaltown magazine?" My first magazine that went out lost $90,000 the first month, second month lost $80. I lost $90 a month ...

 

Lincoln:

That's a good trend. That's a good trend.

 

Howard:

I was 90, the 80, then 70, I mean, it didn't , I didn't hit rock bottom until it was $1.8 million under. People just say, "Oh well you got lucky, you started a magazine, you got lucky," and just like wow, okay. I did learn something, you went to Whistler because your wife was Canadian and I want to give courses in Jamaica so I need to marry me a Jamaican. That's my to-do list today, find me a Jamaican that's Ja-makin me crazy.

 

Lincoln:

There's a whole lot of comments that come to mind there and they'd all be regrettable and I'll hit the editing sweep [inaudible 00:06:03] there's only 5 minutes left Howard.

 

Howard:

Have you been t Jamaica?

 

Lincoln:

No, no.

 

Howard:

Oh my god, that is the coolest area in the world. Tell us about, what are you doing now? What's got you excited now?

 

Lincoln:

Look, I'm still excited about dentistry, in fact I'm more excited about dentistry than ever. I know that's going to annoy a whole lot of people because w hole lot of people are all bitter and cynical and, you know, too bad for you.

 

 

I still like the stuff. What's, to me, exciting at the moment is, I had a little accident a few years ago and, in the states, dentistry, it's been very competitive for a long time. Australia is very competitive, but back then it was very competitive. 10, 20 years ago. It you say to me Australia is 20 years behind, I won't take offense, I'll just nod, okay?

 

 

American style marketing is, to some extent, a necessity, you have to do it just to get by. Anyway, I have this small town with a slight shortage of dentists at the time and no one was doing any marketing at all, it was like taboo. I went on TV and I started spending 70, 100, 150,000 dollars a year on marketing and you can just imagine what that did. It just, like, the market share of the advertising space, I had 100%.

 

 

I just had patient after patient after patient who all wanted complex dentistry and I'd [inaudible 00:07:45] on Dentaltown and all the courses I'd been to in the states and when you do consultations day after due, like you're doing 50 new patient consultation all about complex work in a month, you start to realize that some of the stuff they teach at courses is a little bit inflexible. You go to a course on worn dentition and it says, "Okay you take study models on every single person and you mount them and you do a [inaudible 00:08:14] record and all this sort of non-sense."

 

 

That is true, you should do that on some cases but you don't want to do that on every single, you don't want to inflict that on every single patient that comes through the door. You still need your toothache, I'm gentle dentist, I still need ... I had a patient yesterday come in, she's got perio everywhere, she's got decay everywhere, she looks a mess. I pulled out 1 tooth, okay? I don't mind doing that at all, that's the real world. That solved her problem.

 

 

What's exciting to me is I've developing this treatment planning course, it's called RETP, Rapid Efficient Treatment Planning course, it's called RETP, Rapid Efficient Treatment Planning. It is basically how you tackle this high level stuff that you learn at courses like worn dentition but mix it into a general practice where you have the whole range of patients.

 

 

You have patients who need one tooth out, you have patients who want partial denture because they can't afford anything else. Then, occasionally your big fish swims in and you want to be able to land that one too. You don't want to let him go. He wants to spend $50,000, he's got the money, he wants to do it right away, don't let him get by.

 

 

Do your full records on him but don't do full records on the patient who wants a single tooth ripped out as cheap as possible because you'll just annoy them. That's what got me is basically it's hoe to have a a system without having a system.

 

Howard:

Are you teaching this course hand-on in Australia? What is it, [inaudible 00:09:48] Queensland, Australia? Is this an online course? Are you travelling around doing this in different countries?

 

Lincoln:

I'm developing it for online but as you probably know, doing stuff online is never ... Its a fair bit of work. At this stage, I only teach it, I've been teaching it in Australia, I've just launched a course, I'm doing it in Oakland, and Singapore this year and also [inaudible 00:10:11] there's a doorbell donger, that's what mine sounds like. Anyway, Oakland, Singapore, and I've jut launched it for London. London, I launched that 3 days ago, it's nearly sold-out. That will be for the end of the year and a few people say they want me to come to the states. I'm still slightly anxious about the states because everything I've ran in North America was a complete flop, so this is different because it's a course about information, not about tourism.

 

Howard:

How long is the course?

 

Lincoln:

It's 2 days.

 

Howard:

You should do the 2 day course before the towing meeting in Vegas. We'll market it all up, come 2 day early or stay 3 days after. I'll co- put it on with you in Phoenix Arizona, we've been doing local courses at the Talking Sticks Indian casino right by Dentaltown. There's that, if you want to do that.

 

Lincoln:

Well, you've got Gail's email, send her an email and we'll make it happen.

 

Howard:

Ryan said, who? Is that your wife? Gail?

 

Lincoln:

No, no, no, no, no. You've got specific instructions about stuff. She is a ...

 

Howard:

Send it to Gail@restoringexcellence.com.au?

 

Lincoln:

I think it's, look, Ill text it to you later because I can't remember what it is. Gail is the one who is, she's kind of my general manager. She runs a lot of the finances at the office and she overviews all my course stuff and my rental properties and stuff like that.

 

Howard:

Well anything you want help with while we're in Dentaltown, it would just be an honor to work with you. Do you want to talk about your, your calling it RETP, Rapid Efficient Treatment Planning, do you want to talk about that?

 

Lincoln:

No, e can talk about it a bit but we could get a bit bored with that because I talk about it all the time, I'm going to talk about it 3 times, 7 times this year. What have you been doing? You've been jogging up mountains and stuff, you weren't doing that 10 years ago?

 

Howard:

You know when I turned 50 I was 238 pounds and I realized my dad and both grandfathers died at 60 because they were a bunch of fat guys who didn't exercise so I started doing the Iron man every year. Every year I do an Iron man and I climb one of the tallest mountains. I've done 3 Iron man's and I climbed that tallest in Africa, Kilimanjaro, in Australia, I cannot pronounce that name, it's a Polish name.

 

Lincoln:

Kaziosko.

 

Howard:

Kazsokso, that's so hard for my walnut brain to remember.

 

Lincoln:

7 Polish people just died because I pronounced it with an Australian accent.

 

Howard:

I forgot the ...

 

Lincoln:

[crosstalk 00:12:43]

 

Howard:

Now I want to do the their one, the third easiest one I have to do is Russia, or somewhere out there. I need to do that this year.

 

Lincoln:

One of the problems with not being metric is 230 pounds sounds a lot worse than 107 kilos. When you're starting out, first of all, just go metric, that's my advice to people losing weight. Cut it straight down to kilos. The only problem is you have to work twice as hard to lose each kilo thereafter.

 

Howard:

That's my favorite joke, we could solved global warming if we just switched to Celsius. All the the ...

 

Lincoln:

We've offended 2 key stake holders so far so I think we've done well. We've got a [inaudible 00:13:34].

 

Howard:

I'll tell you what is bumming me out thought. What's bad is my brother moved from Kansas to Sydney Australia. I went down there and took my 2 boys who, well the oldest one is married and that younger one has a girlfriend, he can't leave her side. I went down there with the 2 single bachelor boys and I just sit there, I visit them a couple times and I sit there the whole time saying, "I can't leave it."

 

 

How do you leave Sydney and go back to the suburbs of Phoenix. If I walk out my front yard in the suburb and laid down in the middle of the street, no one would even know it for 3 days. You go out my brother's front door and it's just restitution, bar, bookstore, subway. Living in Sydney, and every time you come back I just walk around Phoenix thinking why the hell do I live here? That has got to be the coolest city in the world.

 

Lincoln:

Well it's because it's your home. I go lots of places and they're amazing last year I went to Dallas to see [inaudible 00:14:33] because they're one of the greatest gentlemen in dentistry and if you don't do soft tissue grafting, I mean I teach soft tissue grafting so I shouldn't promote someone who's got a competing course but if anyone hasn't gone and see Pat Ellen, they should.

 

Howard:

What city is he in? P-A-T-A-L-L-E-N?

 

Lincoln:

A-L-L-E-N, Patallen, he does 20/20 plastic surgery. He's probably one of the biggest people in soft tissue grafting. He'll develop, if anyone's ever used a [inaudible 00:15:07] graft, some of their technique comes from him. HE's only just down the road from here, you can drive.

 

Howard:

Yeah, Dallas, Texas, that is interesting.

 

Lincoln:

I hope it's Dallas, it would be embarrassing if I got the wrong city. I went over there, Dallas is a, I'd never been to Texas before and all these people up in the posh part of Northeast America are going to get upset now, it's a beautiful place, I really liked it. Although, it did, I strayed a few blocks off the main city center and there was one bit that went down hill pretty quickly and I retreated from it but hospitality of Pat was just, well his first name is actually, I think Edward. He's one of those people who has a first name that he doesn't use, I think.

 

 

Even on Facebook, pretty hip. I do all these trips to amazing places like Dallas and the next 2 weeks I'm going to Poland for a surgical course and the towns are much more amazing where I live. It's like you, its my home, I like it when I come home.

 

Howard:

Yeah. I love travelling. I'm taking 2 of my boys next week, I've got 3 lectures on Singapore, Indonesia, Japan. I just love doing that, fly around, I love that. Let's talk about specifics, podcasting is big fans of the young. Not a lot of old grandpas know what a podcast is or ever done one but you go into the dental schools, you meet dentist under 30, they all do it. They want to be great like you one day in treatment planning, in aesthetic dentistry, what advice would you give them? What's some low hanging ... What's some advice?

 

Lincoln:

Well, first of all I wouldn't recommend that everyone, one of the most important lectures that I ever went to, from a technical point of view was one back in the, I think it was the Pacific Dental forum in Vancouver. The guy speaking was Jeff [inaudible 00:17:20] who was one of the founders of the American Academy of Cosmetic Dentistry. I didn't even know what the AACD was and I had never heard Jeff before and there was 2 things I remember. One is really funny [inaudible 00:17:33] and just the type of work, I had never seen anything like it. I was inspired.

 

 

It took me a long time to learn that I'm not Jeff [inaudible 00:17:45] so no matter how hard I try, I'm actually a different person. Then I went and listened to some other guru and I tried to be them for a while and then I tried to be someone else. At some point you have to learn that you can't be the person teaching you because they are a different person. There are so many difference in their life. Where they live, their upbringing, their values, everything is different.

 

 

I can't be you and you can't be me. Even if I got to your lecture and I like some of the stuff you say, I can't be a little Howard, okay? I wouldn't recommend anyone try and do exactly what I do. They need to first, figure out who they are. Some people don't enjoy what I do. What I do is, it's certainly not the most profitable type of dentistry by a long shot. IT's profitable enough for me but it's not the the most profitable, it's not suitable for everyone.

 

 

I would recommend don't try and be a guru of any sort because it will just make you unhappy. If you want to do really one work, the things that I'd recommend is one, do a lot of CE, and I used to say that before when I did CE so it wasn't a conflict of interest back then and the other one is, and not to try and earn too much in your first year or 2. That's more difficult, obviously, if you graduate with huge debts but I owed very little for 4 or 5 years.

 

 

You can get people to pay more for something once you have a reputation but it's difficult to get them to pay more for something until you have a reputation. In some extent, you have to do work that is worth more than what you're paying, what you're charging, until the point comes that you can charge enough for it. That's actually still true for me now.

 

 

Quite often when I introduce a new procedure, I will do it for free several times, I will often undercharge for it for a little while until I get enough repetition done under my belt. Only recently have I started charging enough for soft tissue grafting to really make it worth while. I learnt soft tissue grafting off the internet by looking at [inaudible 00:20:01] on Dentaltown. There was no one in Australia that I knew of that taught it.

 

 

I graduated from dental school without actually knowing that a soft tissue graft could be done.

 

Howard:

Danny [inaudible 00:20:10], he's done in Florida isn't he? In Clearwater? Tampa city? Didn't he just retire?

 

Lincoln:

He may well have done, but I don't know.

 

Howard:

I think I was talking to a dentist down there who said he just retired.

 

Lincoln:

Yeah.

 

Howard:

What, did he have YouTube videos or is this on his website?

 

Lincoln:

No, no. He had a DVD disk. He actually sent me a disk. Well, I just saw the cases. People learn in different ways. I learn by seeing, I can watch something get done and then go, "Oh yeah, I see how that's done," and then I can do it. I can't learn how to do something by reading words but other people are different. We all learn in different ways, and that's just me. It's neither good nor bad, it just is.

 

 

I saw his cases, hundreds and hundreds of times, just the photos on Dentaltown. Okay, he's taking a piece of tissue off the pallet and he's done this, and he's [inaudible 00:21:03] it in like that. After a while I thought, well I've got this case and the tissue is terrible. I'm going to cut a piece of pallet off and the suture it in just like he's done. Low and behold it worked, and then I did it.

 

 

I've been doing soft tissue grafting for, since my first one, which I've still got photos of, is 2007. WE're just coming up to 9 years now. I have done, I have started doing more formal courses one it in more recent times. Interestingly, because I knew nothing about what I was supposed to do, I didn't develop this technique because I did something I you're not actually allowed to do which is when you're doing a [inaudible 00:21:45] graft on an implant, it's very difficult to get them to work because there's no blood supply and there' no dent attachment to the implant in the healing phase and so, because I didn't know that you weren't supposed to pull the flap back over the top of the [inaudible 00:21:59] graft, that's what I've always done when I did grafting over implants.

 

 

I think it actually works better. [inaudible 00:22:06] Simon, that guru in a ... Where' he?

 

Howard:

Southern Cal. [inaudible 00:22:11].

 

Lincoln:

Yeah. He sent me this message, he says, "Hey, you're not meant to do that. 2 weeks later I sent him the [inaudible 00:22:18]. He says' "Wow that's really good. You should publish that. That's a new technique."

 

Howard:

Are you going to?

 

Lincoln:

He keeps pushing me to but ... Writing articles is, it's hard work, you've got to look up references and stuff.

 

Howard:

These young kids are overwhelmed. Dental school, everybody complains about what they didn't learn in dental school but they've got to take a kid off the street and then 4 years later give them a license to do anything they want. When I go to the dental schools, they're overwhelmed, they're coming out of school and they're mesmerized by, "Should I learn tissue grafting, sinus lifting, bone grafting, implants, sleep medicine, invisaline, short-term ortho?"

 

 

Give some tips to these young kids, You're probably talking to several thousand dentists under 30. They can't take every online CE course, they can't be a sleep medicine and an orthodontist and an implantologist and do bone grafting. What advice would you give on where to start?

 

Lincoln:

If you have a particular area of interest to follow, that would be my first thing. There are things I don't do. I hate molar indo, so I try not to do, I refer it to an [inaudible 00:23:35].

 

Howard:

Is it the smell that you don't like?

 

Lincoln:

Its just, I just don't like trying to get a .06 file down, I just get frustrated, you know? I want to get stuff done, bang, bang, bang. It's probably, it's not stressful enough probably.

 

Howard:

It's too predictable of you?

 

Lincoln:

No, no, no. It's just, you know, when you're cutting a piece of bone off and [inaudible 00:24:00] it's a lot of stress and you don't get bored. Do things you enjoy. If you find you really enjoy a particular thing, it doesn't matter what it is, you can pursue that. If you do it well enough and for long enough, then you'll do more of it, that's just how it is.

 

 

If you just want to know in general, I would say learn how to do restorative dentistry. How to plan your fillings and your crowns and bridge work first. That drives everything else. I see so many people where they go and learn how to do implant surgery. They have absolutely no idea about general restorative treatment planning. They are general dentist so they actually have to do the restorative as well. Learning to do bone grafting and to do implants and all that before you know how to do decent treatment planning on, I don't even teach, I don't teach the fine details of restorative treatment, I do run a course in my office but it's only for Australian dentists, it's a live patient call.

 

 

I do 3 people a year, that's a whole different thing. Learn to do your general, I guess, if you want to be blunt [inaudible 00:25:12] treatment planning first. Then plug in all the other stuff that allows you to do it. Until you know, "Okay we need to get the soft tissues here, we need to get bone here, we need implants there, and we need to do ortho to change all this so that I can put crowns on or [inaudible 00:25:29] it'll look nice.

 

 

I think learning to do all the other stuff, you learn to design the house first and then learn to do all the plumbing and the electrical work later.

 

Howard:

Are you placing implants?

 

Lincoln:

Of course I have, I've been placing implants for ...

 

Howard:

Is that one of the things you're doing now though? Is it something you lie now?

 

Lincoln:

Yeah, yeah. I place implants. I place ... Things that I like doing in my office. Number 1 thing is basically solving a patient's problem, that is why I'm a dentist. The patient has a goal and I say this is where you are here, that's where you are now, that's where you want to be. How do we get from there to there on a budget you can afford, which is the most difficult part of dentistry. It's the actually bit where you have think.

 

 

Drilling holes in bone is not, you know, it's just woodwork. The stuff that I like doing, I like doing bone grafting, soft tissue grafting, implants, rehabilitating, composite. Really I like, you would say, perio-[inaudible 00:26:28] stuff.

 

Howard:

You like blood and guts?

 

Lincoln:

Yeah. I don't' mind ortho as long as it's ortho just so I can do my restorative. I don't like doing kids. I used to think I wanted to do kids because I would just, everyone else was treating kids and I thought, "Well be, I'd better do kids too just to be like a cool dentist," but I don't really like treating kids. They're unpredictable and they cry and they're little teenagers with braces that are a pain in the butt.

 

Howard:

It reminds me of college when your 5 homies got drunk at a bar, you give the kid the sedation or whatever. One is perfect, one get's sleepy, one gets crazy, on goes nuts. [inaudible 00:27:15] get drunk at a bar, one gets mad, one gets happy, it's just random chaos.

 

Lincoln:

Certainly treating kids reminds me of your college days.

 

Howard:

Yeah. Back to the advice, it's this young kid, they got out of school, they never placed an implant, where would you recommend they go? Would you recommend that they pick a type ...

 

Lincoln:

[inaudible 00:27:38] people ask me all the time, which courses should I do? I don't know, just start doing one. Just do one. People are agonized for days, and days, and days. If you look at my, if you look at the list of courses I've done, there's such a [inaudible 00:27:51] of things. If they want to actually learn really quickly, what they should do is take photos of their work and stick it online somewhere obviously get consent from your patient first so it's not illegal but put your photo up for someone else to look at.

 

 

It's a little bit like the, What is it? That [inaudible 00:28:12] uncertainty principle. You cannot photographed dentistry and see how it was when it wasn't photographed, the process of photographing the industry changes. If you take a photograph of your dentistry, I can guarantee that your prep will be better. If you show it to 10,000 other dentists, I can guarantee it will be a lot better.

 

 

It's impossible, if you know that you're going to photograph the case an put it, your work just gets better. Just photograph it all the time, there you go, there's tip 1, take photos. The most important thing that photography teaches you, it actually teaches you to see as people, we have tunnel vision. Right now, there's 2 things. I can either look right here, down here at your face, but then it looks like I'm looking down the whole time, or I can look up here at the camera so it looks like I'm looking straight at you.

 

 

I switched between the 2 but we're not looking at that, the amount of area I'm looking at is about that big. It's not very big. All this out here I'm completely ignoring because that's how our eyes work. When we do dentistry with a [inaudible 00:29:10] we look at this tiny part of the tooth and we completely ignore everything else that's going on and when we take a photo, it captures everything else that's going on. It forces us to confront it.

 

 

It's a lot like when you go to a wedding and you take a picture of the bride and groom, having their kiss and you go, "Wow, that's going to be an amazing photo," and because of the angle you're on, you've actually got a massive palm tree growing straight over top of the bride's head. You never notice because you had tunnel vision. That happens with your dentistry too. I actually have no idea what point we were originally trying to make, but anyway, take photos of stuff.

 

Howard:

It's true. You'll just become a better dentist with any kind of magnification. Whether you're wearing [inaudible 00:29:49] or a microscope for indo, any form of magnification, I thought that the best thing about buying a [inaudible 00:29:58] machine is the first time I scanned the prep and I saw my prep 40x bigger and you're just like, "Oh my god."

 

Lincoln:

Is that the best thing or the worst thing about the [inaudible 00:30:06] machine? I haven't decided yet.

 

Howard:

Do you use the [inaudible 00:30:07] machine?

 

Lincoln:

I had a [inaudible 00:30:10] machine for a long time and then it fell by the way-side because I started doing too many multi-unit cases and it got, the software at the time was too difficult and at time the machine I had was a bit of a lemon. It used to break down all the time, because I'm so far away, I'm 4 hours from Brisbane by car and 16 hours from Sydney, or 2.5 hours of flying time in transit. If you're machine breaks down you've already prepped the j tooth and you didn't take a pre-op impression, it's a bit of [inaudible 00:30:46].

 

Howard:

How far are you from the Great Barrier Reef?

 

Lincoln:

30 miles.

 

Howard:

Man, that's amazing. I've never made it down to Darwin, that side. I want to go visit you some day and the go all the way to Darwin. Next time I'm with my brother I want to do that.

 

Lincoln:

Ride out there, mm-hmm (affirmative).

 

 

Anyway, [inaudible 00:31:11] software it much better now so it's tickling me. I'm falling into temptation again. I keep seeing the cases, they're getting better.

 

Howard:

Back when you're talking about treatment planning and you're talking about, first you need to learn how to do that fillings, the crown and bridge and all that, and you can go back later and learn the plumbing and electrical if you're going to build a house. One early question these guys have to decide. They're young, they're out of school, they want to go learn inclusion, there's 2 distinct clamps, the neuromuscular group, the [inaudible 00:31:44] group. Any thoughts there?

 

Lincoln:

I've done both. 90% of everything they both teach is exactly the same. Here, I'm going to summarized inclusion for you in 2 minutes. The rest of it is all fine level stuff which everyone argues ... First of all, there's no significant outcome based proof on a lot of this stuff. I've seen, you know, a lot of your studies are anecdotal. Here is inclusion in a nutshell, 1, have all your teeth here at the same time. That's rule number 1. Rule number 2, make sure when the grind from side to side that you don't have any delicate bits of porcelain because porcelain is very brittle when you put it under tension and it breaks.

 

 

If you have any delicate side ledges, they'll break off. 3, stick a piece of plastic of any sort of design that you like between the teeth after you've finished so that when they grind at night time, they don't break stuff. That's it. I can't do an institute on this, it's too simple. Have all your teeth here at the same time, don't have delicate [crosstalk 00:33:04].

 

Howard:

Since this is dentistry uncensored, what percent of the stuff do you hear from the inclusion experts that you think is just voodoo or unproven or their opinion versus just science facts.

 

Lincoln:

How about we just move to dentistry in general? I would say that anything that dentists argue about passionately is probably unproven and that's why they're arguing about it. No one argues about the fact that if you have a tooth that has no bone anywhere near it, and the patient's [inaudible 00:33:38] is swelling up and going to close their airway, that they need to have that extracted.

 

 

We don't argue about that because we just all know it's true. No that I've said that, there's going to be someone writing you a message telling us that that's actually not true and arguing about it. Things that we argue about all the time are things often where it probably doesn't make that much difference which way you do it.

 

 

What actually matters more than which thing you do is how well you do it. I have neuromuscular cases from 9 years ago, full mount 3 hubs that are going well. I don't do anything neuromuscular now and the reason why is because I don't want to have to use $50,000 machinery to take a bite. I want to use a piece of plastic that costs 2 cents. It's cheaper to do, it's just a lot cheaper for me to CR.

 

 

The other thing is the CR type industry for me is much more flexible. I can use it in really cheap cases where I'm only doing a couple of teeth. I can use it in big complex cases, I don't have to do an all or nothing type approach. Most of my stuff now is really verging either on MIP or CR dentistry just because it's more flexible, it's cheaper, it's quicker, and I get the same sorts of results either way.

 

 

I have got a lot of rehabs that were done with neuro, and they're going just fine because all the teethe were here at the same time. Neuromuscular teaches people to do nice rounded cusps, not pointy delicate ones that break off. I still give them all a bite guard anyway.

 

Howard:

What would you call the other one other than neuromuscular? Would you just call it CR inclusion or MIP? What would be the catch-all easiest?

 

Lincoln:

LEt's see how many people we can get arguing over this. I think we should come up with a definition of centric relation during this. It's about 75.

 

Howard:

Yeah, and it's always changing.

 

Lincoln:

[inaudible 00:35:46] is a position where the mandible is somewhere near the skull, in place.

 

Howard:

I love what you said, dentists don't argue about things that are ... You said dentist only argue about things that don't matter or can't be proved. I've always, I used to have a joke with my friends. Why did dentist get on Dentaltown and argue until 3 o'clock in the morning? It's because the stakes are so low.

 

Lincoln:

Well, there's a fir bit of, there is some evidence that the, there's a lot of evidence that the quality of the surgeon matter a lot more than the type of procedure chosen. If you do, people argue all the time about, should you do a [inaudible 00:36:35] post and call or a private post or a pre-form solid metal post, or all this sort of nonsense. Whatever way you do it, if you do one of those types of posts and you don't drill out the side of the root and perforate it, it will be a lot better than if you do.

 

 

If you do one with a beautiful impression or a beatitude scan, where you had beautiful retraction and when you go to cement and bond that crown in, you make absolutely sure there's no biofilm or plaque or gunk or temporary cement on the prep, and you don't have any fluid, say you've got a proper bonding or cementing, I don't care what cement you use, it will still be better than if you used the world's best cement an you've got plaque on your prep.

 

 

Often we argue about which procedure, which way you do it, and there's about 100 different ways that you can ... I used to say, "There's 100 way you can skin a cat," but one of my vegan friends complains every time I say that. There's a 100 ways you can put a post in a tooth. Doing a good job is better than which type of post your choose. Do a good job is my advice.

 

Howard:

Would you say the same thing about implants? It doesn't matter what type f implant? There are 275 implant companies at [inaudible 00:38:05] last year. How is a young townie listening to you right now trying to buy their first system, what advice would give them on picking between 275 different implant systems?

 

Lincoln:

Whoever you like as a teacher, because you get on well with them emotionally and personally, and you like how they teach, and they have a teaching style that you adsorb their information well, and who shows you their values, if they don't show you a single failure in their entire lecture, their lecture is horse poo.

 

 

Every dentists who places implants gets failures. If they don't have a failure, they are lying. If I go to a lecture and I see these amazing cases where they do things that look a little bit too miraculous like, you know, we pulled the front tooth out and we placed the implant and we had a crown on it in 5 minutes and here's the gum tissue, look how it amazing it is and I never have a failure. That's my first advice. If the person teaching you implants doesn't spend a bit of time talking about all the stuff-ups they've made and all the things that went wrong even though they did it perfectly, I would discount their knowledge by at least 20%.

 

 

The other thing is be aware of the word survival rate. Survival rate is the biggest nonsense that's ever been inflicted on implant dentistry and I am still cranky about it because it lead me astray for a long time. An implant that has lost 80% of it's bone and has pus coming out is surviving. It is not successful. The patient will still be unhappy. You need to look at complication rates and the complication rates, when you dig into the literature and ignore, when you look at implant literature, here's some tips on reading implant literature.

 

 

Ignore the abstract, the abstract is lying 99% of the time. It is a marketing piece designed to get you to read the rest of the article or at least [inaudible 00:39:59]. Even more importantly, if you're doing a lecture, you read the abstract. You can put a little thing that says, "Jefferson 2006 said such and such," and you sum an entire complex research article down into one line and it just happens to support what you said in your lecture.

 

 

Ignore abstracts, generally ignore the conclusion because half the time the conclusion is nonsense as well. Go straight to materials and methods. What's you find, and then you have to get your calculator out and actually calculate the stats for yourself because often they won't add up the stats that are really important like all the implant crowns that broke and the screws that came loose, and the ones that lost bone and all that, they don't compile those statistics because they under a bunch of things called complications.

 

 

Wen I look at the literature and add this up myself I find that the complication rate of implant dentistry done by really good well-known implant dentists reaches up to 20% in 2 to 3 years. Why is that important? I consider a complication something that costs me of the patient money. For me, that's a big deal. The implants are surviving, we're getting 89% survival rates of 96 or whatever nonsense you want to believe. The actually complication rate of, so I'll tell you something. I sometimes cut perfectly good enamel off teeth and do bridges because I can't ... how often do you do a bridge that gives you a problem?

 

 

Almost never. All those times that I sat there and said to the patient, "You know what, we're going to do a bridge, we're going to cut this tooth, we're going to cut that tooth," and you pull the little teeth, they're going to cry and they're weak tears of sorrow, they've lost their enamel. Every time you remove an enamel rod from a tooth a baby seal dies.

 

 

Just think, when you're prepping teeth, you're killing seals, okay? The little fluffy ones that are cute. Quite often now, I sit there and go well, the complication rate on bridges, unless you're a complete hack and you can't resist prepping into the pulp because you're just hopeless. If you're that bad, then you shouldn't be doing implants either.

 

 

The complication rate on bridges is very, very low. The complication rate on implants and the cost to if one that goes belly up takes out the profit of the next 4 or 5. Look at complication rates, complication rates on a lot of immediate low cases, definitely in the range of20%, 15 to 20% in 2 years. These full arch cases that are done with hybrid acrylics that are fixed on 4 or 6 implants, complication rates, the implant, the studies will say the implants are surviving. If you read the study, they don't talk, they talk about all the acrylic teeth that fractured off. The screws that come loose.

 

 

The [inaudible 00:42:59] that actually fractured through the framework, the implants that fractured and had to be redone and removed and bone grafted, all those things that are a pain in your practice. "Oh, no Mrs. Jones is in again and her tooth has broken off. She's sheared off all the front teeth," and blah, blah, blah.

 

 

Look at the complication rates because those things add up to a lot. There's my answer to budding implantologists, do more bridges.

 

Howard:

It's true because for the last 5 years, you get a really good looking woman missing a front tooth with a high lip line you can just avoid it with the 3 and a bridge. You go in there and try to do a single root implant and all that stuff, you need a skill level of Beethoven or Mozart or Chopin. It's funny because if you ever heard my buddy who's an ENT talk about, a dentist doesn't want to shave down the enamel so he drills into my sinus and does all this shit and puts all this bovine bone, all that stuff. We're emotional about shaving down enamel we don't ...

 

Lincoln:

The baby seals are dying. Kill some seals, I say, kill some seals.

 

Howard:

My ENT buddy and [inaudible 00:44:10] they think the same about the sinus, they don't want you in their sinus. THey're like you shave down your enamel. We're dentist so we want to blow out their sinus.

 

Lincoln:

Now you've got me, you've got me on the high horse now. Minimal intervention. If there has ever been a word that I tire of in this dental age it's minimal intervention. I knew that the world had gone mad when people started advertising the minimal intervention lateral wall sinus lift.

 

Howard:

Was that [inaudible 00:44:39]?

 

Lincoln:

No [inaudible 00:44:44] this is common. You can flog anything. If you want to sell something, the minimal intervention decapitation technique. The minimal intervention total leg amputation. We use micro surgical techniques. IT is, you can flog anything. Here's my tip to you Howard, don't let the rest in, okay? It's just between you and me but put minimal intervention on the front of anything and you can sell it to dentist by the boat load, okay?

 

 

The minimal intervention full clearance. There it is. See if you can make that happen. I reckon it's a lecture topic. The minimal intervention ... okay here's another one. To avoid doing a little wall in the side of the sinus lift, what we're going to so is we're, and make you a bit swollen, we're going to extract all your teeth and cut off 5mm of bone, in an [inaudible 00:45:37] so that we can put some angled implants in so that we can be minimal interventionists.

 

Howard:

That's the all in 4 technique?

 

Lincoln:

It's not necessarily all in 4, it's just where you ... say you have [inaudible 00:45:48], you're cutting off all this bone to avoid doing a sinus lift because it's minimal intervention, I think that's rubbish. I'm going to cut the side, I'm going to cut your gum and flap it up halfway to your eyeball, cut the bone off the side of your sinus and lift the membrane and stuff it full of cow so that I don't take a bit of enamel off your 2 adjacent teeth because I want to be a minimal interventionist.

 

Howard:

I thought we only use bovine in cow country America. I thought you guys used kangaroo bone?

 

Lincoln:

I haven't thought about that.

 

Howard:

My god, you should do that. You should say [crosstalk 00:46:24] mentally intervention kangaroo bone. Bovine is just too big and fat and intrusive.

 

Lincoln:

HEre's the thing. Right. You know how in America deer are like, there's millions of deer and they eat your lawn and people thing of them as a, they're kind of cute but they're a bit of a pest? That's what kangaroos are in Australia. Everywhere else in the world they're like our national emblem and they're like a fluffy toy that they sit, they take home from their trip to Australia but here they're like deer. There's about 80 to 100 million of them and they eat your lawn and they hit the front of your car and put a hole in your radiator.

 

 

We have quite a few [crosstalk 00:47:04] I don't think we can market kangaroo bone, I don't think it's going to fly.

 

Howard:

I was listening to the debate about whether or not you should, in Arizona, give licenses to kill deer and this guy was showing me a website that more deer are killed, hit by a car on Arizona highways than are given permits to hunters to shoot.

 

 

I want to ask you another controversial thing that these kids are always asking me. They're hearing all these mixed signals on cement or screw on an implant. You could literally find 100 threads saying each side.

 

Lincoln:

You can definitely find 100 threads if it's exposed.

 

Howard:

I mean 100 threads [inaudible 00:47:42].

 

Lincoln:

I know, I know, I know. I just [inaudible 00:47:46].

 

Howard:

That was your pun, that was a pun on the word thread.

 

Lincoln:

[inaudible 00:47:49] because they're easier most of the time. Cementing, people have cemented crowns on implants for a long time but it is a much more difficult thing so let's give it the [inaudible 00:48:05]. Which one is easier simpler, and cheaper.

 

Howard:

Screw [inaudible 00:48:10].

 

Lincoln:

[inaudible 00:48:09] retained. It takes you less. How much time does it take you to screw a crown onto a tooth? About 12 seconds? Then we stuff, we [inaudible 00:48:18] test it. We take an x-ray, there's another 40 seconds. We put some Teflon tape in so I'd say we're up to a minute and a half so far. Then we swizzle a little bit of metal primer and some bonding agent and put some composite and we're all done in 10 minutes or less.

 

Howard:

I really love your ...

 

Lincoln:

With the cement retained, we put the, a [inaudible 00:48:41] in. We know that cement going down the side of it will ruin our day. Then we get the crown and we inject the crown full of silicon so we've got an internal mold of the crown. We put retraction cord down around the [inaudible 00:48:53] and then we put a little bit of cement, just a tiny bit inside the crown and we got our silicon mold that we made already and we stuff it in there to squeeze most the cement out and wipe it off. Then we cement the crown.

 

 

That procedure takes at least twice as long as about 5 times more difficult. Sometimes you have to do it. I know how to do it but try and avoid it. It's just a nuisanse, it's difficult. Then, because occasionally you're so delicate with your cement, the crown get's loose 3 weeks later and you've got to cement it a second time. Complication rate on, basically, screw retained, more profitable.

 

Howard:

Very good. What's the word we're going to site on if it's not neuromuscular? Neuromuscular versus, what would you call it? CR? MIP? What's the simplest word for the other [inaudible 00:49:47] not neuromuscular?

 

Lincoln:

The camp that fights with neuromuscular.

 

Howard:

Yeah, what would that camp be called? The camp that fights with neuromuscular? The neuromuscular versus the anti-neuromuscular?

 

Lincoln:

Just think, I don't care which occlusion you can't be going to, just go to one of them and then go to another one.

 

Howard:

The point I was making is I really love your advice. The main difference between neuromuscular and ...

 

Lincoln:

One of them is worried about joints and one of them is worried about muscles.

 

Howard:

The main difference though ...

 

Lincoln:

You want to know the difference, if you want to realize you know nothing about bites, go to the American, the AES, the American Equilibration Society meeting. I went to that last year. Maybe don't don't' go. This is my advice, don't go to the AES because I went it last year. All I [inaudible 00:50:38]of that is that I know nothing. There is guys that have linked the embryo, what the [inaudible 00:50:49] is doing with later issues and I think, "Oh, I got a visit." What's that dude in Texas, I think he's in Texas, [inaudible 00:50:52]. Someone [inaudible 00:50:55]. He is a genius.

 

 

He is, I just, my brain shriveled up and ran away and hid for several days after listening to him. I haven't gotten the internet open because it would ruin my connection but he's in, I think he's in Texas, he's a very smart dude, his lecture was amazing. Just listening to all those guys at AES, they has everything from chiropractors. They had everything from quacks to Quakers at that place. It was amazing.

 

Howard:

Is it Alex [inaudible 00:51:26]?

 

Lincoln:

No.

 

Howard:

Jeffery [inaudible 00:51:33], San Antonio, Texas?

 

Lincoln:

I think it's Jeff, he's a [inaudible 00:51:34] I think, in Texas, or he was in Texas.

 

Howard:

I liked what you said that if you become a neuromuscular dentist you're going to have to spend $25,000 on equipment, is that what you said?

 

Lincoln:

Yeah, it's just more expensive.

 

Howard:

Is that basically the text scam?

 

Lincoln:

If you do neuromuscular dentistry just do it really well, okay? The one thing that tI got out of , I want to LBI, right and I learned a lot of techniques that I still use. I'm very grateful for what I learned there. I don't use neuromuscular but I do use, still, some of the temporary techniques and techniques for doing preps and stuff like that.

 

 

A lot of those basic practical techniques I use still everyday. The one thing I don't use is the belief that you can take a good impression without suing retraction cord. That, I have learned to [inaudible 00:52:35]. It actually takes longer to take the impression 7 times because you keep missing a couple margins than is does to just stuff retraction cord in all the teeth and take a decent impression first go.

 

Howard:

What about using a dialed laser around the ...

 

Lincoln:

I'm a dinosaur. I use stuff that's, I don't know, some of the stuff I do, I went to dental school and learned all these things and I tried all sorts of new techniques and I migrated back to, sorry about that, I'm not very [inaudible 00:53:02]. Some of my friends use [inaudible 00:53:05] to greater fix. In fact, one of my, he's a friend of mine in Italy and I like him because he's actually a real general dentist who earns all of his income from general dentistry, not from teaching. His name is [inaudible 00:53:18]. That's with a Q not a C [inaudible 00:53:21].

 

 

He is a [inaudible 00:53:23] time. He likes to BBQ tissue like no body's business. He never saw a bit of gum that was in the way of his wedge that he's liked. He likes to get that gum gone.

 

Howard:

The point I was making about what you said about the different inclusion camps is that neuromuscular is a more expensive inclusion earn. When you're talking about an implant system, I've always thought you can always find an implantologist [inaudible 00:53:46] surgeon somewhere within hours of your office drive that will let you be their buddy and teach you everything they know.

 

Lincoln:

I would, okay. I don't know if you have any deals with any implant companies but ...

 

Howard:

I don't have any deals with anybody.

 

Lincoln:

Okay. I would say don't use expensive implants. [inaudible 00:54:08], down there they're still trying to flog implants, 7 or 800 bucks each that's just ridiculous. There you go, there's my tip. Don't use an implant that is incredibly expensive. Implant milling is a very cheap thing to do. In fact, that's why implant companies are always trying ti come out with innovative prosthetic attachments or specialist implants because their margins in regular implants are [inaudible 00:54:33]. There you go.

 

 

Choose one with a good drill kit. Good drill kits are really nice [crosstalk 00:54:40].

 

Howard:

THey're all going to ask you, what system do you use? The reason ...

 

Lincoln:

I'll tell you [inaudible 00:54:45] use and I'll tell you my thoughts on some of them. First of all, implants are screws, I reckon I could use just about anything as long as it wasn't manufactured in a dodge manner. I don't like really rough surfaces, the ones that give you really quick integration times because they also give you quick de-integration times when things go wrong and when you get complications which you will.

 

 

When you get pus around your implant you don't want an implant that's rough. Implants, types that I have restored or done surgery with include [inaudible 00:55:17] Nobel, Southern by Horizons, MIS, and [inaudible 00:55:25]. I have done prosthetics on all of them and I've done surgery using Nobel, Southern, [inaudible 00:55:33], and MIS. MIS was the design that the Nobel [inaudible 00:55:38] active comes from is anyone's not familiar with what it looks like.

 

 

I don't like implants with rough surfaces because when I file, I file really quickly, although maybe that's a plus, I haven't decided yet. MIS and, of the implants companies that I've used, the ones with the nicest drill kits, by far, have been MIS and bi-horizons, now, I haven't used any others. I've used those companies but their drill kits are amazing. They have a thing that says number 1, use this drill here, then there's a big arrow that says, "Now use this one next."

 

 

If you're not an experienced user, or if you're using a kit for the first time with a new implant, even if you're experienced, if you haven't used a drill kit before, that makes a huge difference to the total stress level of your surgery. I love the drill kits in those 2 companies. I have moved away from [inaudible 00:56:31] connections. [inaudible 00:56:33] are absolutely beautiful from a seal point of view. They're a nightmare if you want to do anything that's not single unit.

 

 

Then you've got to buy multi-units to go on top of all your implants and then you're broke because you've just spent huge money. From a milling point of view, the people at the implant companies tell me to mill a multi-unit, is considerable more difficult and time consuming than to mill an implant. That's why multi units cost so much. To actually mill them takes the milling center at the implant company 2 to 3 times longer than to mill an implant. They're very complex. I've moved to the standard all internal hex for a lot of my cases because I just want to keep it simple and try to keep costs down.

 

 

That's not scientific, that's just my person thing. If you want to do something different, go right ahead.

 

Howard:

I want to ask you about another kind of ...

 

Lincoln:

This will have to be the last one because patients are here, I think.

 

Howard:

Oh come on, you're not going to put a patient first, are you? Last question, Australia is home of SDI, which is one of the biggest dental companies in the world and they make glass [inaudible 00:57:46] but it's also one of the largest [inaudible 00:57:47] manufacturers in the world. Is [inaudible 00:57:49] dead in Australia? Do you think, I mean, it's a low cost restoration, you're next to, you're down there in Asia where you're next to poorer countries, China, Indonesia, Africa. Do you think [inaudible 00:58:01] has a place moving forward? Do you think 25 years from now SDI will still be one of the largest [inaudible 00:58:08] manufacturers in the world or is that product just dead on arrival?

 

Lincoln:

People like my teeth. I think that's the end of that, isn't it? People like white teeth. You do get some patients who don't care, I get patients who have gold but I reckon if you were going to bet on the shares of the company a dental gold company is probably not one I'd put money into. That's why all the companies that make gold for dentistry also make ceramics and stuff. They've got their foot in both. They know where the market's going. People, the cases I see online from, you know, poorer countries, I don't see many [inaudible 00:58:48] get done.

 

 

Actually most commonly the cases I see [inaudible 00:58:53] get done is the really, really good dentist who use it in cases they just know they can't do any other way. I no longer try and battle the public. If the public wants all the, you know, some people spend their entire life trying to tell all the patients they need to have fluoride and stuff. I don't care, if people want to all do something that's a bit silly, that's their business. We all do silly things. I don't really get into public health debates about what's good and what's not.

 

 

I haven't used [inaudible 00:59:30] in years, not because I have anything against it, it's a great material I just, the number of patients I have that want it is about 1 a year. Doing a procedure once a year, you're not good at things you only do that often.

 

Howard:

That's personal advice for me because at 53 I don't know if I'm getting old and tired but the anti-flouirdationist, they just seem to get crazier and crazier and crazier ...

 

Lincoln:

Give them what they want. Suck it up.

 

Howard:

I know. I think we should take out the fluoride and put Coca-cola in the water, that'd make them the most happy.

 

Lincoln:

Something like that [crosstalk 01:00:03].

 

Howard:

Seriously thank you for 14,000 posts. Thanks for being my idle thanks for being everyone's role model. Thank you so much fro cancelling your 8 o'clock patient to spend it with me.

 

Lincoln:

All right and thank you for basically starting off the dentist sharing stuff on the internet, which I will say that I have learned more from, I've learned more dentistry from the internet than all the courses put together.

 


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