Dentistry Uncensored with Howard Farran
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386 Today’s Technology with Assen and Daniela Dobrikov : Dentistry Uncensored with Howard Farran

386 Today’s Technology with Assen and Daniela Dobrikov : Dentistry Uncensored with Howard Farran

5/6/2016 6:34:18 AM   |   Comments: 0   |   Views: 306
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VIDEO - DUwHF #386 - Assen and Daniela Dobrikov


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AUDIO - DUwHF #386 - Assen and Daniela Dobrikov


Dani Dental Studio was established in 1993 by owners Assen and Daniela (Dani) Dobrikov. After graduating from Dental Technology College in Sofia, Bulgaria in 1988, Assen and Dani began their ? careers as dental technicians. ? In 1990, they relocated to the United States and have followed the philosophies of Dr. Peter Dawson, David S. Hornbrook, Carl Misch, Terry Tanaka, Gordon J. Christensen and Frank Spear. ?Co-owners Dani and Assen assure meticulous attention to detail and a commitment to perfection. Dani Dental Studio has a loyal following of dentists nationwide. Assen and Daniela Dobrikov are always available to assist dentists by telephone or in-office visits to provide their expertise and offer recommendations on challenging cases. Dani Dental Studio can fulfill all of your technical dental needs.

 ww.DaniDental.com 

Howard:

Hey, it is a huge honor for me today to be podcast interviewing Assen and Dani, how do you say your last name?

 

Assen:

Dobrikov.

 

Howard:

Dobrikov?

 

Assen:

Dobrikov, yes.

 

Howard:

That's Bulgarian?

 

Assen:

Yeah, actually, the English translation is a good man.

 

Howard:

Oh, really? Good man, well you are a good man, I can vouch for that. I've know you guys since the earliest ... What year did you guys open up in Tempe, Arizona?

 

Assen:

We opened the business in '93 but we moved here in Tempe in our last building, which right now, is almost nine years old.

 

Howard:

Nine years old.

 

Assen:

About 2007.

 

Howard:

You guys were born in Bulgaria?

 

Assen:

Yes.

 

Howard:

Did you meet in Bulgaria? Did you come married?

 

Assen:

We met at college. Right at the first day at college. Laid eyes on Dani and that was it. I was chasing her for the next three years.

 

Howard:

Awe, that is so cool. What's the capital of Bulgaria?

 

Assen:

Sofia.

 

Howard:

Oh, Sofia.

 

Assen:

Yes.

 

Howard:

That's right. Did you go to college in Sofia?

 

Assen:

Yeah, the college was in Sofia and we went to college in 1986. We've been together since '86.

 

Howard:

How many years is that?

 

Assen:

30.

 

Howard:

Is it 30, 80, 90, 1,000, 16?

 

Assen:

Mm-hmm (affirmative).

 

Howard:

Is it?

 

Daniela:

Wow, you're old and I'm old.

 

Howard:

So Dani, if you would have shot him at that first date and killed him, you'd be getting out of jail right now.

 

Daniela:

Probably.

 

Assen:

I didn't count, so here yes, but there no.

 

Howard:

The reason I wanted to get you on there is because you've always been a leader. You've always been on top of CE. What I specifically want to talk to you about is ... When I got out of school in '87, when you and Dani had been together one year, there were 15,000 labs.

 

Assen:

Mm-hmm (affirmative)

 

Howard:

Now, half the labs are gone. It's all starting to move digital. How do you describe crown and bridge labs today, as how they were different when you opened yours up in '93.

 

Assen:

Oh, huge difference. I mean, back then we started with used equipment, old oven, and left-over porcelain from a friend of ours. Today, without new technology, you're just kind of writing yourself out. I got people calling me almost on a monthly basis that they're losing their clients, they can't afford the new equipment, and they're just looking for a job. It's insane. It's totally different dentistry today. It's all about digital and CAD/CAM and be more productive and more efficient.

 

Howard:

It used to be some of these lab techs could only make five PFMs a day ...

 

Assen:

Yep.

 

Howard:

... and now some of these lab techs on CAD/CAM are making 50 crowns a day.

 

Assen:

Correct, that can design anywhere from ... A good design, so anywhere from 30 to 50 a day, thanks to technology. The funny thing is when CAD/CAM came out, like 17 years ago, we all thought "Oh, we're going to hire these kids that are playing video games and they know computers and softwares and they're just going to rock out our crowns for 10 bucks an hour," you can't. You need a good people who know dentistry still. They need to know morphology, anatomy, and all that stuff, function. It didn't work that way. We try to transform our technicians who would like to change because some people don't want to change. From the banks, from the regular manual waxing procedures to the computer. Usually those become the best designers for us.

 

Howard:

I'm just going to ask you a gazillion questions like I always have been for 30 years.

 

Assen:

No problem.

 

Howard:

I've been in your lab several times. You're an amazing man. Let's just start with the old school impressions. I'm just gonna bullet-fire through a lot of questions. Is there any impression material you guys like more than others? I mean, there's basically, like me, the old Impergum guys. I think I've only used Impergum.

 

Assen:

If you mention Impergum, I would say the same thing. We probably see the most consistency with the Impergum, by the way.

 

Howard:

That's 3M ESPE. That's a polyether?

 

Assen:

Yes.

 

Howard:

Why do you like a polyether? Do you like polyethers better than polyvinyls?

 

Assen:

For me, it doesn't matter because I don't work in the mouth with impression itself and how [inaudible 00:04:43], but I see more consistency with a polyether.

 

Howard:

And do you think it's because everybody that uses it buys that Pentamix mixer and it just mix better than say, a hand caulking 00:04:54 gun on the chair-side?

 

Assen:

Probably or just because the material is more consistent.

 

Howard:

It's just a better material.

 

Assen:

I think you know that stuff. I really don't have a personal preference on which impression comes to me, as long as we don't have to remake it. It looks good in a mold, it should fit in a mouth, but we see probably, the Impergum is the one that's most consistent that people who use the Impergum, I think, will have the lowest rate of remakes.

 

Howard:

That was a German company, ESPE and then 3M bought it up, now it's a 3M ESPE. If they were going use a polyvinyl? Is polyvinyl, polyvinyl, polyvinyl ... I mean, is it all generic or is there any brands that you think are higher quality?

 

Assen:

The thing is when it comes to us, we don't see the brands.

 

Howard:

You can't tell just by looking at it?

 

Assen:

I cannot tell the brand anymore because there's so many knockouts out there that look alike and introduce them maybe under a different name, but I can definitely distinguish the Impergum right away.

 

Howard:

Here's another question. I think most dentists know when you can go from a single bite. What do you call those?

 

Assen:

Quadrant?

 

Howard:

A quadrant bite tray for a single molar. Most common tooth crown is the first molar. Most crowns are sent in one at a time. First molar, do you have any problem with just a quadrant tray?

 

Assen:

No, it's fine.

 

Howard:

Do you have any preference with sides or side-less? There's a side-less premier triple tray. Do you like the sides to hold the impression better or do you think that alters the bite and you like side-less premier?

 

Assen:

Well, what we see actually with the quadrant impressions, we see quite a big challenge with those aluminum trays.

 

Howard:

The reusable?

 

Assen:

The reusable. Especially the aluminum, we see a lot of inconsistency because aluminum has no memory, so when you pull it from the mouth, or my technician holds it a little bit heavier and if it squeezes little bit, has no memory to go back. Those are really not favorite to us. The plastic ones are pretty good and the higher the borders on the side ...

 

Daniela:

As long as they don't bite on the plastic.

 

Assen:

Yeah, as long as they don't bite on the plastic area with their teeth or usually the retro-molar path sometime, really there's a little space between retro-molar path and the tuberosity on the top. As long as these two don't squeeze the impression material, most of the time we have no problems. The higher the borders buckle lingually, the more compressed the material to the gingiva so you got a better result that way.

 

Howard:

Then you don't like a side-less triple. You like sides.

 

Assen:

Yes. Side-less are not very ... You get sometimes half of the opposing.

 

Howard:

Okay, so then when do you want full arch impression, upper and lower?

 

Assen:

Anytime that we have, say three in a bridge or more than two units.

 

Daniela:

More than three.

 

Assen:

Two or three units, I would prefer a full arch impression.

 

Howard:

Okay, Dani said more than three. Is that four and above, or is that three and above?

 

Assen:

Three and above.

 

Daniela:

Three and above.

 

Howard:

Three and above. So, three and above you want full arch.

 

Assen:

Yes.

 

Howard:

When do you want a Face-Bow transfer on a semi-adjustable articulator?

 

Assen:

Honestly, I went to a lot of Face-Bow classes and with Franz Pier and a lot of other people but doctors don't use a lot of Face-Bow, they teach them at school and unless you specialize how to use a Face-Bow, we have a lot of inconsistency coming to us, unless you take the Face-Bow and articulate yourself, almost 50% of the time it's way off, either to the side or up or degree of inclination. Our favorite one actually, if you want me to mention, it's a Kois face-bow. Very inexpensive, very easy to use, there's a 5 minute video you can watch and anybody can do it. We usually do a lot of full arch cases with a lot of doctors who have been to a lot of schooling and stuff. Actually, 99% of the cases we do with the Kois face-bow. It's so easy and forgiving and predictable. We barely have any problems.

 

Howard:

You want me to give you a clean up trick with that?

 

Assen:

Yes.

 

Howard:

When you want to clean up the Kois face-bow, just use Windex.

 

Assen:

Okay.

 

Howard:

Because he's Greek. Did you see that movie, The Big Fat Greek Wedding?

 

Assen:

There you go. I was going to say ...

 

Howard:

That was just a joke.

 

Daniela:

Connection to the Greek.

 

Howard:

What's that?

 

Daniela:

Any relation to the Greek?

 

Assen:

The Greeks?

 

Howard:

Is he any relation to the Greek?

 

Assen:

Yeah.

 

Howard:

He's 100% Greek.

 

Assen:

There you go.

 

Howard:

Explain more. A lot of these listeners, they've never seen the Kois Face-Bow. Why is the Kois Face-Bow better?

 

Assen:

It's a very simple ... It's a fox plate with a vertical stick. If you go and Google it, Kois.com or Kois Face-Bow, you can see the beauty. It's such a cool thing and it's very simple to use. It's a horizontal plate with a vertical stick. That's all you need to capture all the relations, the proper position of the model for the laboratory and it's very simple and it touches only one single plastic plate to the fox plate and you just unplug that and send only this little thing, the little white plate, to the laboratory. You keep everything with you and the lab gets the little disposable plastic plate which you have the total registration of the horizontal plate. It's very simple, nothing gets distorted and it's just right on the money every time and inexpensive. It's under $300, compared to $1500 or $2500 of the other Face-Bow's, which is very, very challenging to use. I'm not against them, don't get me wrong. I'm all about doing things precisely and ...

 

Daniela:

So complicated.

 

Assen:

... the best way, but it's so complicated sometime. Doctors get lost very quickly unless you constantly use it all the time and you dealing with the condyle problems and stuff. For the day to day dentistry and a simple full mouth reconstruction, Kois is just plenty.

 

Howard:

I need to get someone to make an online course for the Kois Face-Bow.

 

Assen:

The Kois people actually do that. They have online stuff. They have videos, they're right on, live video. How to use the Kois Face-Bow and the benefits and everything.

 

Howard:

Right on. That's good, and a good shout out to Dr. Kois, I'm sure he's very happy now. I just saw that his son is getting married.

 

Assen:

Oh yeah?

 

Howard:

He's got to be happy about that.

 

 

So let's switch to when I was in dental school, taking my first crown and bridge classes, you're talking about '84-'85, they were saying that CAT CEREC was coming. It started with a guy in France, it's been all over these countries. It finally came to America but anyway, they said that was going to be the end of labs. There would never be a lab when the CEREC was done. So I bought it. I bought the CEREC 1, it's horrible. Then I bought the CEREC 2. But it's come a long way in these 30 years. What is the CEREC machine specifically done to crown and bridge labs in America?

 

Assen:

Really took a lot of business away, unless you're CEREC Connect and you have the same equipment. I mean, it's not a bad system. It's reality. We all adapt to it. We had also the first CEREC in lab was a disaster. It's a good system for itself but with today's technology, you can go a lot more reasonable and much more open because one thing with the CEREC, really, it's a closed system. They say it's opened but it's still closed. You cannot do everything that they do with the same equipment. What I've done, every laboratory is using business here and there, so instead of the easy bread and butter from these doctors, we're getting the most challenging stuff. Actually it learn us to do more challenging. We always done challenging stuff but we like complications, but for other laboratories, if you're no good on the complicated stuff, combo stuff, multiple units, I mean, that thing can run you out of business but if you can do both, you're okay because soon ... Anyway, the doctor was saying about difficult stuff and the veneers and the multiple units, multiple implants are kind of tough to do yourself.

 

Howard:

So are you CEREC Connect?

 

Assen:

Yes, we are CEREC Connect.

 

Howard:

What percent of your clients, from just say the last 10 years, 2007-2016, what percent of your clients did get a CEREC machine?

 

Assen:

Probably about 7%.

 

Howard:

7?

 

Assen:

7%, yes.

 

Daniela:

It's more than that.

 

Assen:

Yeah.

 

Daniela:

It's more than that.

 

Howard:

Dani, you think it's more?

 

Assen:

She thinks it's more but that's not only CEREC, that's E4D and all that stuff because a lot of doctors buying some of those systems also.

 

Howard:

Yeah, the E4D, Planmeca.

 

Assen:

Yeah. I'll say 10% now, maybe 12% of the doctors have already some kind of digital milling in the office.

 

Howard:

They're mostly doing a lot of their single units and then sending you the multiple units?

 

Assen:

Yeah, and after a few months they're realizing that that's a lot of work.

 

Howard:

Right. Right.

 

Assen:

They start doing a little bit less so they send more again but they're stuck, they're stuck with it and they have to use it. Actually, I'm having doctors calling me more and more. The milled units, [inaudible 00:14:43] they used to get from laboratory or they did it themselves, they kind of, anywhere between 3 and 4 years they start cracking and breaking and you start replacing some of them. Not all of them but quite a bit. I just had a phone call last week from another doctor with the same problem.

 

 

Pressed is always stronger than the milled in-house but some laboratory, because they bought the equipment, they only milled it because it's easier and quicker. Milled is always more fragile than pressed.

 

Howard:

If someone was going to get a CAD/CAM, you said CEREC was a closed system, are there any open systems that you like?

 

Assen:

Oh yeah, if you ask my opinion really every system that is open that can work with any other equipment, it's preferable because the dentist has more freedom and the cost is a little bit lower, quite a bit lower sometimes.

 

Howard:

What name brands would that be?

 

Assen:

Of course, the most expensive scanner is the 3Shape but the 3Shape just got voted again the most accurate scanner on the market. 3M is also open, Planmeca open.

 

Howard:

What's 3M's called?

 

Assen:

3M is the 3M.

 

Howard:

What's the brand name?

 

Assen:

It's from 3M.

 

Howard:

Right.

 

Assen:

It's the intraoral scanner.

 

Howard:

But it has a name though.

 

Assen:

I had the name somewhere.

 

Howard:

3Shape is out of Denmark, isn't it?

 

Assen:

Yeah, 3Shape is from Denmark. Also, another thing why the 3Shape is really getting more and more popular because 80% of the laboratories in the world are using a 3Shape.

 

Howard:

80%?

 

Assen:

80% in the world, the laboratories are using a 3Shape so it's more direct communication with the lab. The image from the chair goes directly to the laboratory.

 

Daniela:

And it's easier to ...

 

Assen:

And it's easier ...

 

Daniela:

... to design it.

 

Assen:

... to work with the software and it's constantly evolving. Oh the other ones evolving ...

 

Howard:

3M's is True Definition, isn't it? Isn't it called ... Yeah, the 3M True Definition Scanner.

 

Assen:

Yes. The True Definition is a 3M, yes.

 

Howard:

But you like the 3Shape better?

 

Assen:

Well ...

 

Daniela:

Yes.

 

Assen:

... it's definitely better. A more precise image but it seems to me more and more people buying 3M because the distant image and I think because of price but 3Shape is probably, if you ask any laboratory, I bet they will tell you they're with 3Shape and that's the real truth.

 

Daniela:

It's easy to design in that system.

 

Assen:

Easy to work, easy to design and the quality of the image is ...

 

Daniela:

Most of the quality ...

 

Assen:

... the most accurate.

 

Howard:

For 3Shape?

 

Assen:

For 3Shape.

 

Howard:

What percent of your business is coming in on an oral scanner as opposed to an old polyether, polyvinyl impression?

 

Assen:

Almost, I would say, 8% now, and actually almost every month it's growing more and more because people are calling me on a bi-weekly basis almost, "What should I buy? What should I buy? What should I buy?"

 

 

Digital is definitely is going to be here to stay and the prediction is the next 2-3 years it's going to be in every office like a digital x-ray. If you don't have it, you're behind.

 

Howard:

Have you seen less remakes?

 

Assen:

Absolutely, that's the biggest. The remake factor, the precision and the consistency of the final restoration is what really pays off the whole deal. We used to do a lot of regular impression and PFMs and when we started doing the digital, it's really, the demand, the consistent in margins and contacts, it's amazing. We barely have to touch anything and we barely have any remake, because of the open margin and short margin, anymore. It also helps the doctor really improve the preparation because they see the prep view on a huge screen before they send it out and sometimes, so they're like "Did I really do that?"

 

Howard:

I know.

 

Assen:

They stop working and improving the preps, margins, everything. If we can do it all digital ...

 

Howard:

Well, to me, that's what I loved the most about CEREC when I first got it is, first you have naked eye vision in the '80s then you get 2 and a half lubes then you get up to 3 and it's so much better. When you take those purple Impergums and you're trying to look under the light and then I bought this magnification light thing and I'd stick it under there, but when you scan an impression and you see that tooth 40x up on that screen, my god that just shows you everything that's going on.

 

Assen:

Exactly.

 

Howard:

Yeah.

 

Assen:

It makes them better dentists very quickly and we have a better result and we almost 0.5% remake and margins on those on fittings. It's finally a dream come true but it's going to take time to really convert more and more dentists.

 

Howard:

How much is that 3Shape TRIOS?

 

Assen:

I think the 3Shape TRIOS is the most expensive one on the market. It's around $35,000 average. I've bought also the most expensive scanners for me because I need that consistency and quality and productivity to really go up, in order to make me challenge myself everyday so it's just really worth the money. If people can afford it.

 

Howard:

What is your bread and butter, a 3M bridge? If I said to you, the 80/20 rule, what is 80% of your oven in? Is it still a single unit?

 

Assen:

It's still singles. Yes, EMACS and BruxZir zirconium and up to 3M bridge.

 

Howard:

Now BruxZir, that's a brand name.

 

Assen:

Always a full zircon BRX.

 

Howard:

BRX?

 

Assen:

Yeah.

 

Howard:

Full zirconium, because BruxZir, that name's owned by Glidewell, right?

 

Assen:

I know that so that's why we did it. That's a nickname. Everybody's using it just to communicate things between themselves. Yeah, our brand is full zircon BRX.

 

Howard:

You're actually friends with Jim Glidewell, aren't you?

 

Assen:

Say again?

 

Howard:

You're actually friends with Jim Glidewell, aren't you?

 

Assen:

Yeah, we've met numerous times. I walk his facility with Donnie before we designed Donnie Dental at the moment and he's been always a great communicator and friend and sharing anything we walked with him.

 

Howard:

4 times I've had the honor to lecture for CAL labs meeting in Chicago. I just thought that was so cool that he was the biggest man in the industry and he had no problem lecturing that group, answering any questions, telling you anything he did right or wrong, he was a good guy. You've been that way too. You've always had an open door. Anybody can go down there and interrupt you making money to ask you questions.

 

Assen:

Yep. Yep.

 

Howard:

Yeah.

 

Assen:

We don't keep secrets and sharing with each other actually makes you better and stronger. If you've got a small heart, you think "Oh I'm not going to tell anybody about this because they can take my business." I don't see the competition as a competitor stealing my business, it's if I lose somebody, it's my problem. I didn't do something right. I always try to work with my colleagues as close as we can. I can only improve us and get better than the other way around.

 

Howard:

That was the same thing I noticed in my practice here for 30 years is  when I got here as a young eager dentist and I ran across the street and knocked on all the dentist doors think they're all going to be my buddies and friends. Half of them saw me as a competitor and slammed the door and didn't want anything to do with anything and the other half were just like "Yeah let's go have a beer and watch a game and let's talk. Talk dentistry." 30 years later, those guys who thought in hope, growth and abundancy, crushed it, and the other half who thought inferior and scarce, they just had miserable careers that I thought would be very unsatisfying. I love that hope, growth and abundancy. I like saying that because I know abundancy is not a word. That's why I use it, just like my book "Uncomplicate Business." So many people email me, "When I typed in 'uncomplicate,' it spell checks and wants to correct the spelling." I said "That's exactly why I used it." You type in 'uncomplicate' in Google and my book comes up.

 

Assen:

Yep.

 

Howard:

You say that your bread and butter is still a single unit.

 

Assen:

Yes. Definitely. It seems to me that it's kind of one of those things that the last few years, it's either the single up to 3M bridge or these bigger cases that couldn't wait anymore and now it's time to do the full mouth 1 arch or something, combo stuff. It's either or. It's almost nothing in the middle anymore like it used to be.

 

Howard:

What do you think that's from?

 

Assen:

Because of the way technology push in our bread and butter and also implants. Implants now are a huge thing. GPs are really open to implants instead of a 4, 5, 6 unit bridges. We barely have any of those which is, we know how long they last. People try to put in more implants so it becomes to a single and stuff.

 

Howard:

2015 was the first year in the United States that all the implant manufacturer dated in the United States you saw on GPs last year for the first time place more implants than the specialists which is mostly oral surgeons.

 

Assen:

Yeah and it's going to keep growing. It's going to keep growing.

 

Howard:

The dentists, they know they're in, they cut the crap. they back the cord, they know they're in but they don't get to spend any time at your end. Even if they went and visited a lab, that's still not even going to be 1% of the time that they're in. What do you think that dentists needs to know about your end? What are some low hanging fruit best practices? Things they can do to increase their quality? The other thing, the dentists sending in their impression, they only see their impression. How many different doctors impressions do you get to see? You get to see a lot so talk to them about what it's like being on your end and what they can do to increase their quality, reduce their remakes. What do you think you see every day that they don't?

 

Assen:

They don't see the molar [inaudible 00:25:27]. Even when I go and help with Dr. Chestnut, as you said, we look at the impression and it looks good but when you poor the stone you always see more. That's why I'm sure its a practice of every laboratory, almost 15% of the work that comes in ends up on a phone call bench.

 

Howard:

15%?

 

Assen:

15%. I'm not lying to you.

 

Howard:

1-5?

 

Assen:

1-5. Sometimes even a little bit more. It depends on the situations. Either not enough reduction, not clear margins, not full instructions written down. These are the things that we're seeing more. More than anything, unclear impression, unclear margins and not enough reduction of posterior teeth, which is very challenging for everybody. I don't blame them. They just have to pay more attention and use some kind of check, little tops that give you 1 and half to 2 of occluding tops to make sure you have the clearance. That's why digital is so helpful. It's when you scan your stuff, you see everything and even you see the closer clearance, if it's too close or too high. Very often, the back second molars and front exterior, it's very big in it. They're not just here for most people who do prosthodontics and teaching. They say "The second molar can extrude. It looks good on the impression but by the time the crown is done and extrude a little bit more and the temper is very light." Even from the very first day when you prep it. That's why those are one of the first ones to go because they are pounding themselves. The sooner you prep the bite just relaxes down and closes space a little bit more. Those are often things that people should keep in mind.

 

Howard:

Do you agree with this statement or not because as an old fart, I think when you get an impression and there's not enough clearance, from my end, I think the thing was, they took the impression before they made the final temporary. I think that's the most common mistake I see and when you trim back your temporary one, if you can see the margin on the temporary, how the hell are you going to see it with the impression?

 

Assen:

Exactly.

 

Howard:

You're doing your temporary. I can't tell you how many temporaries I started and then I'm looking at it and I throw it away and go back in there with a high-speed. Then you're making your occlusal and your adjusting the occlusal to your temporary and then you go through. These should all be solved in the temporary and all that means to me is if you can see the margin and you don't have enough reduction, they always make their temporary ... I've stood in a gazillion offices and you see it, they get done prepping, they pack the cord or they break out the MD laser, they take an impression and then they're just done.

 

Assen:

Yep.

 

Howard:

They're just done and it's like, that's totally aspect.

 

Assen:

Yeah and another thing ...

 

Daniela:

The temporary ... If you have a nice good temporary, your contact is the most stable. You don't have to adjust contacts because sometimes you leave the temporary open but they shift in the currents with the contacts.

 

Assen:

Yeah we see that happening, especially seasonally for some reason, after Christmas, before the summer and again before Christmas. I don't know if the whether changes or something.

 

Daniela:

The busiest time.

 

Assen:

Yeah the busiest time people just let it go and then sometimes it's like everything was good and suddenly all my contacts are high or closure is high. We didn't see any difference here. We checked everything to make sure it's good. Then I go to the office sometime and we verify the temporary from the mouth and the crown on the model so when the contacts are usually high when you put the temporary from the mouth on the model, the crown looks good, right? The temporary has space so between medial and distal contact so that means the temporary would lose contact, the teeth shift and they don't have a tight contact. Opposite way, when the temporary is made to tight, they have open contacts that can shift the back teeth sometimes. These are the things that we see and we go and talk and other things and usually just a week later, boom, it's all gone. We kind of communicate that problem with doctors sometimes and make sure we're all on the same page, not saying that we never do the wrong things here but when you check everything and it still continues, then prototype is the last resort which it usually ends up to be.

 

Howard:

What percentage of your dentists do yo think pack cord ... I'm talking about a first molar, that's totally different than an incisor. On a first molar, your standard most common crown, what percent are packing cord versus taking a laser, like and AMB dio-laser and troughing around the tissue and what do you like better?

 

Assen:

For me, sometimes, it's hard to say from the impression every time, but I still see about an 80% of packing cord. I'm not sure about 80% packing cord or double cord. Sometimes it seems to be only one and it's not clear what the margin is. I see more and more with the new dentists, the new generation dentists, really trying hard to do double packing cord and starting to get better and better.

 

Howard:

Do you see any increase quality if they laser trough around the tooth? Is that a game changer or not really?

 

Assen:

Not for me. As long as I can see the margin, it doesn't matter which way we trough the tissue so for me it doesn't matter. What matters later on depends on the packing cord more aggressively or the laser cut, which one will give you more gum recession so when it's done, either your margin is down or up. It's done.

 

Howard:

Did you ever think, in 1993, when you started Crown and Bridge lab, did you ever think that you would see the fall of the PFM?

 

Assen:

Never even thought about it, honestly.

 

Howard:

What percent of your PFM market has been replaced with full porcelain?

 

Assen:

Almost 70%.

 

Howard:

You still do 30% PFMs?

 

Assen:

Yeah we still do some PFMs. I would say close to 30%, 25-30%. Let me tell you, especially with zirconium, when we started doing zirconium 7 years ago, all of us, the technicians, everybody was teaching us. I don't know if you remember, everybody was teaching us, oh zirconium you treat like a PFM. The framework can be in joint, nice, skinny, no it doesn't work that way. If you don't have enough occlusal clearance and thickness to make a nice beefed up joints, almost like a Emax, then we have some zirconium breakage so we learned a lot first couple years. You can not treat zirconium like a regular PFM material and us it everywhere.

 

Howard:

When you're talking about 25-30% as still PFMs, we're talking singles, I'm not talking 3M bridge or something like that.

 

Assen:

Singles and bridges.

 

Howard:

Take out the bridges.

 

Assen:

Yeah.

 

Howard:

If 100 single unit white tooth colored crowns were sent in, what percent of those would be a PFM versus a non-PFM?

 

Assen:

I think about 25.

 

Howard:

Let's talk about that specifically. The dentist sending you in in writing and I want a PFM on tooth number 3, they just see their end. When it gets to you, would you like seeing a number 3 PFM or do you think it should have been zirconium or Emax or talk about that.

 

Assen:

We're actually slowly converting doctors, try to convert them from PFM to zirconium. We talk to them. Zirconium give the best occlusion. A lot of doctors just doing it for insurance purposes or any other purposes that's just comfortable.

 

Daniela:

The old generation is very hard to change their mind.

 

Howard:

Now watch out what you're saying because I'm 53. How old is old?

 

 

I want to know your definition of old, Dani.

 

Daniela:

You are probably with an open mind. There are doctors in your age, they're not old by age but they're old way of doing it.

 

Assen:

They're just old school.

 

Daniela:

They're old school.

 

Assen:

They don't want to give up.

 

Daniela:

The don't want to give up. They used to doing something they thing is good for them and they don't want to change.

 

Howard:

Dogs, cats, donkeys, we just don't like change. If it's not broke ...

 

Assen:

Nobody likes change. I told him to understand them and he works for them and they have a good success. We're still doing it.

 

Daniela:

It's the same way if you have a chamfer, should or knife edge.

 

Assen:

You know?

 

Daniela:

It's like someone who doesn't want to change into a chamfer margin they want to do a knife edge margin.

 

Howard:

What's better on your end a chamfer or a knife edge or a shoulder?

 

Daniela:

Chamfer is better. A chamfer and shoulder, they're almost the same to me. They're almost the same ...

 

Assen:

One is round the other one is 90 degree base.

 

Daniela:

It does not make really a big difference for us.

 

Howard:

If it's a should or a chamfer, there's no difference at your end?

 

Assen:

Yeah for scanning and finishing final projects, not a big deal.

 

Daniela:

There is no big difference but between chamfer, shoulder and knife edge, it's a big difference.

 

Assen:

Yeah, doctors switching from knife edge bevel to sharp edge should, it's very difficult sometimes. Especially if they're used to all their life with a bevel, all around with a straight burr, and never do the finish line and everything, like a shoulder chamfer, those guys are really difficult for them to change.

 

Daniela:

Knife edge is very hard to scan it and design a knife edge because the way we held the machines ...

 

Assen:

Sees everything.

 

Daniela:

... see everything. It's very hard.

 

Howard:

You like a chamfer. If you just picked one you would take a chamfer.

 

Assen:

Yes.

 

Daniela:

Yes.

 

Howard:

Would you say it's a light chamfer, medium, heavy?

 

Assen:

Yep.

 

Daniela:

Not too heavy. Not too heavy.

 

Assen:

Yeah but when you do too big of a chamfer then you go to a J-margin and that's double, so double edge. We've got be careful of that. About a millimeter, 8/10 to a millimeter marks it works perfect.

 

Daniela:

No more than millimeter.

 

Assen:

No more than a millimeter because sometime doctors start chasing cavities and all this stuff with the gingiva and they go too deep, too deep and they will rebuilt and it's huge. These big shoulder margins becomes almost J-margin and it sometimes creates more problems than to help.

 

Howard:

Talking about this dentist right now, it sounds like you want this dentist to switch from a PFM to zirconium. Talk about that. Why?

 

Assen:

Why? First, it's a metal free. It's actually easy to sell to the patients. If you show a female patient on a beautiful PFM with a dark metal inside or even ugly looking zirconium crown, if it's all white, guess which one they pick. They are actually willing to pay a little bit more for it. Also, with all ceramics now, the cause is so good. We all ...

 

Daniela:

Aesthetically it looks better.

 

Assen:

Aesthetically it looks better and the other thing, you don't have to prep as deep on a new ceramics and Emax and zirconium. We can stay off the gum or slightly above the gum because the ceramic restoration blends in with the rest of the tooth and even the gum pulls out later. It looks all the same so you don't have to go as aggressive, so gingerly, you don't have to pack your own cord for most of the time if you stay slightly above the gum unless there is in the posteriors. It's so much easier and cleaner restoration.

 

Daniela:

It's also, you don't have to be aggressive on the buckle side to create the nice shade. On the pierce end, you have to get to the more aggressive buckling because you have a metal, you do opaque and you have to have a certain thickness of porcelain to create the shade, the right shade, otherwise becomes more grayish looking, nothing like what kind of gold you're using.

 

Assen:

Yeah.

 

Howard:

I know people just do everything the same. Some dentist every single time they send into Emax, I'm talking about first molars, so every time the send into Emax, every time it's zirconium. Talk about the difference in Emax versus zirconium on a first molar.

 

Assen:

Emax you should use when you have an ideal occlusion. It easy going no broxing, no grinding and all that stuff, all the rest of the anatomy of the mouth it's existing, so I have a canine guard and all that stuff, no problem you can go Emax all day long. When they start having some wear and occlusion and not a lot of seclusion, then you better go with zirconium. Also, another thing, to connect with the zirconium, people say "Oh, you know you can do zirconium like a gold crown, 0.5 inclusive clearance." You can't. I mean you can but first it will flop, second the zirconiums also breaks. I like the hammer test. It looks beautiful but that ideal. Every time you're pushing the limits along, the occlusion and you try to adjust just a little bit just to make it work, I could ask for trouble. We still should have about another millimeter of occlusion for zirconium.

 

Daniela:

It's more aesthetic. It has a better aesthetic I think than the zirconium.

 

Howard:

I'm looking at you Dani. I never see my teeth. I never see my teeth. I never see them in a picture. It looks like I'm [inaudible 00:38:49]. When I'm looking at you, I'm just seeing a few anteriors. Let's say a woman comes in, high aesthetic needs, high lip line, upper incisors. What material are do you like?

 

Daniela:

Emax.

 

Assen:

Still Emax is the most aesthetic one.

 

Howard:

What about veneers? Would it be Emax or felts padding stacked porcelain?

 

Assen:

We used to do felts padding and I know a lot of people still do but the strength of felts padding is 3x less than an Emax so we can ...

 

Daniela:

It break more easily.

 

Assen:

Yeah they break easier so Emax ...

 

Daniela:

You have to be very aggressive on the prep.

 

Assen:

Yeah properly done Emax with a nice cutback and layer on top, it's stronger and better and it just works great.

 

Howard:

You and I just saw the biggest North American dental company, Dentsply, marry the biggest German company, Sirona, and now its Dentsply Sirona. Dentsply has it's own block, it's own porcelain. Do you think that's going to be a game changer for Ivoclar or does that change the scene on anything?

 

Assen:

That is not going to ... Ivoclar, I'm seeing more and more companies coming up with lithium silco disilica. I think that patent is expiring soon, or if it already did and more and more people are coming with that material and just a matter of time before they flood the market.

 

Howard:

When's lithium silca patent expire?

 

Assen:

I'm not sure. Don't quote me for it but I think it's about to expire so people are already working on a replacement and a knock out for that.

 

Howard:

Do you use an dentsply porcelains in your ...

 

Assen:

We use Ceramco 3 for our PFMs.

 

Howard:

Say that slower.

 

Assen:

Ceramco 3 for our porcelain fused to metal and we use a Vita for all the zirconium restoration to build up.

 

Howard:

Is Vita Dentsply?

 

Assen:

No.

 

Howard:

Okay. Okay. So Ceramco 3 porcelain, that's Dentsply?

 

Assen:

Yeah. That's Dentsply.

 

Howard:

You use Vita which is it's own company?

 

Assen:

Yeah it's own company.

 

Howard:

Out of Germany?

 

Assen:

Yep.

 

Howard:

Is that the only porcelain you use from Dentsfly?

 

Daniela:

Yes.

 

Assen:

That's the only porcelain. Yes.

 

Howard:

What do you think about their CAD/CAM block?

 

Assen:

I actually have some samples that we're going to try pretty soon here. It's early to say. They just came on the market. I hate to be a guinea pig for something and the fell so I'm going to go very slow with just a few doctors, see how they like it, I'm going to monitor it and we'll see how it goes.

 

Howard:

Let's switch to implants. A lot of dentists, they look at implant systems based on them placing it. When your restoring implants, is an implant, an implant, an implant or is some systems more lab friendly?

 

Assen:

Unfortunately for the 3 big ones, Nobel and 3i and Stroman, those are great companies. Thanks to them, we are today where the implants are, it's a great companies and Zimmer, of course, which are one of the pioneers.

 

Howard:

Is it Zimmer or Zimmer Biomed?

 

Assen:

It's Zimmer Biomed

 

Howard:

Okay Zimmer Biomed.

 

Assen:

Yep. I think. It's one of those things that unfortunately a lot of, for them unfortunately, good for everybody else. It's just one of these open world market. A lot of the implants are really not any bad from what these guys are. Seems to me most implants now, they integrate. They integrate and they copy cat some of these 3. It's one of those things today almost doesn't matter which implant system you're using as long as you have a good support, customer service, reasonable price. Doctors are going, more and more GPs are going for everything else but the 4 big ones because it's easier ...

 

Howard:

From your end, from the lab's end, you don't really care what implant system the dentists are using?

 

Assen:

It doesn't matter as long as they have a good connection and consistent supply of parts.

 

Daniela: