If you have burning questions about digital dentistry, this episode is for you.
Payman is joined by International Digital Dentistry Association (IDDA) founder and self-confessed geek Prof. Adam Nulty, who lets us in on the rationale behind setting up the IDDA.
Adam chats all things digital, advises choosing scanners and 3D printers, and discusses the pros and cons of in-house Vs lab production.
Stick around for part two of the conversation coming soon.
In This Episode
01.47 – Digital dentistry
11.18 – IDDA
19.27 – Work ethic and inspiring the next generation
22.53 – Community and networks
33.29 – Scanners
39.53 – Lab Vs in-house
45.53 – 3D printing
About Prof. Adam Nulty
Prof. Adam Nulty graduated from Leeds University in 2006 and completed a master’s degree in aesthetic and restorative dentistry in 2013.
In 2019, Adam became a professor of digital dentistry at the College of Medicine and Dentistry in Birmingham. He is co-founder and president of the IDDA and principal dentist at Dentist on the Rock in Bury, Manchester.
[00:00:00] The key is as well, I think more than anything is just being honest with things. And for us, the main thing that we’ve tried to do more than anything with, with everything that we’ve done with support, with education and and it’s a fine, fine balance, let me tell you, is tried to be tried to be as as as honest and unbiased as you can, which I can say it’s a fine balancing act because we have our own preferences, you know, and you get some things. Sometimes you try things out. Companies will say, Oh, don’t try this out, we’ll give you a discount with this stuff like that. It you know, so you try things out. Sometimes you love it, but then then you question yourself and you’re like, Well, do I love it? Because I was given it and you shouldn’t do. So you try and then be honest and say, well, actually it’s probably not going to make that much difference to you rather than maybe something else or whatever. And we’re not going to go down that road and dig myself into, oh, it’s sort of the manufacturing. But basically it’s a it is a fine balance because like anything, you have your own preferences.
[00:01:08] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry, your hosts Payman, Langroudi and Prav Solanki.
[00:01:26] It gives me great pleasure to welcome Adam, multi author of the podcast. Adam is a practice principal from Bury. He’s got a practice called Dentist on the Rock, probably best known for his digital side, He’s a founder member of the EDTA, which stands for International Dental, Digital, Dental.
[00:01:47] That idea just flows off the tongue. And also now a principal, a co-principal in a London practice in the West End that there’s digital trials. Yeah. So I’ve been wanting to get you on this podcast for a long time too. And you said you haven’t listened to an episode before, but this tends to be a kind of life and times type podcast with you. I just want to ask you this question just from the get go. You’ve got this sort of it’s almost an obsession. With digital. And it’s not only it’s not only the fact that it’s digital, but your output is. I’ve seen it once before in my career. I’ve got a guy called Julian Holmes. Do you ever come across him?
[00:02:40] Oh, no, I don’t actually. I don’t know the name.
[00:02:43] He was. He was big in, in, in the sort of ozone dentistry and unfortunately passed away. But yeah, lovely guy, lovely outside the box thinker as well. But he had this similar thing, just massive output. What is it man. That is that. Is that something you’ve always done or is it just like digital? It’s just completely taken you over and Yeah.
[00:03:08] I mean, you know what? Whenever if I’m doing a long introduction, I’m like a couple of day course or whatever, I’ll probably bore them to death with giving them a big long introduction to me that I’ll give you now if you’d like. Yeah, but basically I’ve always been a bit of a geek and when I was a kid I’d be chipping, I should say, about soldering consoles and obviously fixing them and that sort of thing, putting pieces together from 12. So, you know, doing all that sort of thing. I’ve always been a bit of a geek and I know it sounds cliche, but I’ve always found technology easy. So in not just relating to it, just using it, I, I’m good with programming, I’m good with using it. The intuitive side clicks with me, so I’m good with it. And plus as well, when I was a kid, I really wanted to do art, to be honest with you. I wasn’t even going to do dentistry. I wanted to do art, really. And then I was architecture, which kind of I wanted to meld in the technology side of things, but I didn’t have the right combination of things for doing A-level in the right combination to do architecture. So I kind of didn’t plan ahead enough with that. And I wanted to dentistry because my dad so my dad’s a dentist, a completely different type of dentist thought process, everything.
[00:04:27] I’m probably a lot more like a lot of ways. No disrespect to my dad, just, you know, my, my mum’s a French teacher, and so when I went to uni, I went, I went into it just because my dad did well and went in with that and being a, you know, not being able to do all the technology and outside of things, I probably just skated along. I was never a high flyer. I never really pushed myself hard. So have I always just been driven? Probably not, to be honest with you. At school I was pretty naughty. I got in trouble a lot and you know, all of those things I didn’t really weren’t really the type of person I am now in any way, shape or form after uni. You know, the thing that got me going was two things really. I was doing my set and I liked doing some mentoring at uni and helping at uni and things and I went to do my simply not my page, so sorry, the GDF. So a demand material first because I wanted to go and do Vtt. I was working at my dad’s with, with full NHS practice for a long time and so I was going through my JDF and going in with the teaching side and as I was going, you know, picking up little things, doing a little bit of very, very early cad comes messing around on computers and things and getting into looking at digital X-rays.
[00:05:51] My wife, by the way, is a radiographer, so and she went specialised very early with that. So it’s a CT. So for me, being with her or being with her since I was 19, you know, I understand in CT and getting in with the radiography site itself very easily to me again with the technology. And that kind of led into me with my masters and wanted to do implants. And then it clicked. And ever since that with doing my implants, as soon as I heard about guided surgery, I wanted to get in there and I wanted to use that technology. And as soon as that was, that was probably 11 years or so ago. As soon as that was the case, getting in there was strong. There was me messing around with things with a lady from Strathalbyn at the time that was just awesome. And there was Craig Parker that was obviously doing things over on the East Coast and things with with go to surgery there and you know, obviously looking into him because he was a year or two ahead. But you know, in general it was guided surgery that got me into it.
[00:06:59] So I thought, I’ve seen the future.
[00:07:03] Yeah. And I wanted in, you know, and basically I was that was it dildo straight in everything digital and that kind of coincided with me. Wanted to set my own practice up as well so that when I set my own place up, which is a years ago now. So when I was setting that place up I. Wanted to set it up completely digitally and realistically now completely digitally. But that isn’t anywhere near what digital is for me now. But but it was at the time I wanted everything digital and I even put my solar panels on the roof to make it easy. So I was just kind of there at the beginning, really, which was nice. I mean, not as early as some people like Chris, who I work with. Sorry, do. Yeah, he uses serac a bit earlier with Cirque three and stuff, but I kind of went in through a different way with guided surgery than.
[00:07:57] People, normal people. I was going to ask people, Go get into digital from different angles and serac seems to be one of them 100%. And as you said, guided surgery seems to be another one. And then and then some people, they just want a scanner. Right. And I think we should talk about all of these things. I think we should talk about scanning. I think we should talk about printing. We should talk about milling. We should talk about DSD and the like, all of those other what they call the skin and so forth. But let’s get back to your childhood. And you were you were into computers. Did you not consider becoming a computer geek guy?
[00:08:36] Listen, being completely honest, my dad was did well for himself. And we lived in a nice house. And I obviously wanted to do something successful and do well financially. So and I wanted to do something at first where I was passionate about, which was, you know, designing things. And and like I said, one of the one of the things that made me so driven is the fact that I could really put that into practice. Now, what I really enjoyed back then, so the computer side designing things to me, when I’m designing teeth, I’m doing mock ups. A lot of people think I’m mad with doing so much that I do in terms of basically being a dentist and a lab technician. I mean, I’m not officially a technician, but I do everything. I do literally everything. So with everything there, I love it because it’s I’m using the technology, I’m creating things. And I love when I’ve milled out restorations, you know, finishing them. And I genuinely I’ve had I’ve been a very lucky to have got an early enough that I’ve worked with and partnered with and been friends with some very, very gifted people. So technicians wise, dentist wise, and some of which are very close friends, people like Quintus is a is phenomenal at surface texture. So I look up to them a lot. Phil Redington We’ve done loads of them on years. It’s just awesome, awesome guys, very, very clinically talented. So for me to I, I liked doing that sort of thing. And so I always saw those guys as somewhere to strive to head towards trying to be as good as and I don’t think I’m in there yet, but I think I do nicer work now than I did ten years ago. So yeah, everybody’s on a learning curve, right?
[00:10:27] Especially with digital, right? Because it keeps changing so quickly. You know, I was talking to Andrew Dorward and he was talking about the sort of the technology adoption lifecycle. And, you know, he was he was one of the first people, the first person to get a CT scanner. And then and then he’s got a printing company. He’s got this happening. And he was saying he was saying that this this moment when you get all excited about the technology and then you get it and then there’s this chasm of light, you suddenly realise there’s all these other things you haven’t thought of and new problems and issues. And I can say we’ve got a lab now in enlightenment and the number of things that no one tells you about, calibration of printers and different resins and just so many different questions. So you must have come across this so many times.
[00:11:18] I mean, that’s 100% why we, we started doing what I was doing with, you know, again, being lucky to have met people like Chris Quince and Patrick way back when. And you know, back then the support was pretty poor really. And I mean, you know, I was doing all these digital things and I knew what I wanted and I wanted to be able to export textiles, combine them and guide surgery software and what have you, and the rest would be like, Yeah, yeah, you could do that. Yeah, you can do that, but you couldn’t. And because it was a closed system and they would tell you one thing and you’d find it the other, then you have to jump through hoops, convert it. And I was finding all sorts of ways of programme software that weren’t even related to dentistry, trying to, you know, convert things out of Surrey and which was interesting. But things have opened up now and you can do whatever. But you know, these sorts of things were what we’re frustrated is when we first got going, what we said of the day that we made friends with people around the world and what became the idea basically through frustration and again, the same thing. With why we started doing the whole bigger course. The PGA said Diploma and masters and things and why we started providing scanners again. Born through frustration.
[00:12:35] You know, we recommend in different things to to students. And let me be clear, we are for anybody who is under any illusion, you know, it is all about the students for us. We really support them Well, and that’s the key to it all. Support an education. And we you know, we started doing that because we’d recommend, say, one brand to one person, one brand to another person. They’d go and get that from one reseller and have a great time and be great support and then go through someone else and be completely deserted. Or they would they would fail the smallest of things and we would end up picking up the pieces anyway and providing that support. So we thought, well, why are we not doing that part? Why? Why not just provide it directly? And there’s some really good examples of people worldwide who’ve I think hit similar, similar levels of frustration and ended up creating amazing companies. You know, in in America, there’s, you know, almond with Cadbury and, you know, companies like that all across the world, built through, you know, frustration and passion and wanted to help people. And that’s a lovely thing because, you know, that that if you turn a negative into a positive, then that’s always going to Well, I think, you know, you turn to a positive and that’s good for everybody right now.
[00:13:57] How long this idea been going?
[00:13:59] So I met I met Chris and Chris and Patrick for us, and that was 2016. So about six years ago, just maybe before that, I think it was maybe the November before that.
[00:14:13] That shit, the sheer volume of of just stuff coming out of idea. Is that the four of you?
[00:14:21] Yeah, not really. I mean, a lot of people say this and there’s me with Jason. You know, I’m, I’m good with my jazz hands, but no, I mean, the four of us do work on things a lot. I’m obviously not. I’m up to long. I don’t sleep much. I’m always I’m an ideas and those are also.
[00:14:43] Executing executing as well you know ideas one thing yeah I mean the number of course I was just on the website a number of courses diplomas events.
[00:14:51] Yeah we’ve got we’ve got a load of people we work with now across the world with things and you know, that’s why the I came from with, you know we’ve, we’ve again been lucky to make some really good friends and that we’ve developed in Portugal like how some in Italy Fredricka Iceland and Sweden and America South America and stuff and and all of these people do things for us in different ways or speaker and things run courses, you know, conferences. We used to have a chap in Egypt that we did a conference with there, so it built bigger than just the four of us by far. And now we’ve got remote designers of technicians that work either with us or beyond. One guy stayed working with us and moved to Portugal, now goes to swap. Hugo is an awesome, awesome guy. So you know, all, all of these people, it’s been a hell of a journey and yeah long may it continue. Right? Such good.
[00:15:45] And so what is what’s the structure of it? I mean what’s what Let’s start with the business model if you like. Yeah. What’s that? Is it.
[00:15:53] Education? You know what we’ve been through at different phases. We’ve we’ve been through a different phases of just the four of us running smaller courses. We’ve got we’ve built that through partnerships with different universities, with places like Camden, Ulster University and what have you, with different people who do parts of the admin phase, a few names behind the scenes that do secretary work or admin work or what have you. So, you know, there’s, there’s a fair few people you don’t see that obviously we wouldn’t be able to do without them. And you know, realistically they keep the ball moving. Even partners and wives, you know, there’s a lot of there’s a lot of support with that sort of thing, a lot of forgiveness. You know, we’re here, there and everywhere. So it is what it is really these days. We’ve kind of we tried to get to a phase going back maybe about a year and a half, two years ago, maybe just before COVID, we were trying to step back from the limelight a little bit and bring in elections and stuff like that. The problem with that and the difficulty with that was, was the level of commitment and passion. And the stage wasn’t really ready for that. It was, I think, maybe, maybe in the future. But I mean, for me, as much as you see me, like I say, with a jazz sense, I more and more. Try and manage my time smarter so that I’m not taking too much time away from family and kids. And I see you as a good inspiration to them. I’ll tell you another thing later, which which ties in with this where you say about biggest mistakes with things. The one chap who his words always, always play on my mind.
[00:17:44] He was an awesome guy, always doing things with digital, passed away way too young. So Anoop, that with all the things that he was doing. Yeah, we used to do loads of different things then. Would courses used to teach him MSC with things? And one of the last things that I spoke to him about was the time which we spend away from families and kids. And, and he told me a story about how he was cutting down his time on courses and things because his son glued his laptop together and he he realised that that was it. He needed to sort things out. And I thought, I’ve got to get to grips with this. And this hit home probably a year or so ago with the thing I’ll talk about, but the with I don’t want to get to the point where it’s too late and I’ve got a ten year old and a seven year old and literally I’m away a lot over the next eight months. I think we’re in eight or nine different countries doing different courses with things or meeting people for different things here, there and everywhere. And so from January I minimise my time a little bit with Barry and spend a bit more time focusing in the daytime on things. I don’t know how that’s well is going to work financially, so I’m hoping that I’ll be able to manage that well. But, but we’ve got a few of the plans of things that I need to spend a bit of time on. Things I’ve done other things behind the scenes with patents and things like that. So we’ll we’ll see.
[00:19:18] We’ll see. So we had Anoop was the first guest on this podcast shortly before he passed away. Yeah.
[00:19:26] That’s right.
[00:19:27] Yeah, yeah, yeah. I remember him telling telling that story. You know, I’m involved in education, right? And anywhere on the level that you are. But I’m away basically every other weekend, basically. But at the same time, I don’t really, really do that much work during the week. I do, of course I work, but I don’t have to work. I have to turn up anywhere. And this thing you’re saying about your kids, obviously the subject comes up a lot on this podcast, right? Yeah. And for me, it’s like if your kids watching you doing the extraordinary things you’re doing. That’s a massive inspiration to your kid.
[00:20:08] Yeah, I hope so.
[00:20:09] Oh, it is. It is, Yeah. And if you if you think back to your dad when he was I don’t know the story, but maybe he was on opening up the practice on a Sunday to help someone with a toothache or something.
[00:20:22] He could have been beating himself up about that and saying, I’m not spending time with Adam and the family. Yeah, but you learn something by watching him do that. Yeah. And this thing that you’re doing now, this thing, you know, like, maybe if you had watched your dad grind and work as hard as he did for the good life that he had, maybe you wouldn’t be this obsessed guy whose, by the way, it’s not just about what you contribute to your family, right? It’s what you contribute to the to the profession. Yeah. And especially in this area of digital where it’s so difficult for you know, most people aren’t like you. Most people hate change. And most people are very scared of technology. By the way, I’m one of them. When we when we were we were setting up our lab, I was like, do we really have to do the digital? I don’t want to get into it. And and I think you should you should stop, stop punishing yourself on that front because your your kids will see what you achieved and they’ll, they’ll learn the hard work. How important that is, hopefully, for sure. I wouldn’t bother yourself too much about it, but how often are you in?
[00:21:40] Probably more at the minute. So obviously today, tomorrow I’m in Birmingham teaching CMD last Tuesday night to start tonight I was in Madrid with DSD. The weekend before that we just got back. Didn’t have the weekend free. It was a week before we were in. Oh, no. Yes, sorry. The week before the Wednesday night to the Saturday night, I was at the London dance show with the theatre we did there. Then the Sunday to the Wednesday. Before that I was in Palmer because we were education partners for X got insights. So I’ve had probably in the last three weeks, maybe four nights at home. Three nights.
[00:22:34] Wow. Yeah. Okay. That might be a bit too much.
[00:22:39] Yeah. So I vowed now, next year, with all these places, I’m going to try and take my kids to as many of them as possible. So at least if I’m doing things, I can show them the world of it, you know? The problem is in the school, you know, the school. So there’s.
[00:22:53] Also also, you know, it feels like you guys have been around for ages because of just the output. But six years is still very early days.
[00:23:02] Yeah, well, very long time. It’s crazy. Yeah, I think technology changes so fast and. Exactly. I think, again, we’re lucky that we’ve because we got into things pretty early and made friends so many places. It’s actually a really close community, the digital community. So yeah, not just at the bottom because of with, with the groups that we’ve got on Facebook and what’s up and stuff. But the actual the people at the top who do education, you know, across the world, you know, we speak to them a lot and they there’s, there’s so many lovely, lovely guys who like guys and girls. I made that clear The really the shared stories plan things together. But the more importantly, they recommend each other for different things. So because they know somebody who might be good at doing something else in their place. So it’s, you know, there’s been opportunities because of that for sure. But the key is as well, I think more than anything is just being honest with things. And for us, the main thing that we’ve tried to do more than anything with, with everything that we’ve done with support, with education and and it’s a fine, fine balance, let me tell you, is tried to be tried to be as as honest and unbiased as you can, which I can say it’s a fine balancing act because we have our own preferences, you know, and you get sent things. Sometimes you try things out. Companies will say, Oh, don’t try this out, we’ll give you a discount with this stuff like that. It you know, so you try things out. Sometimes you love it, but then then you question yourself and you’re like, Well, do I love it? Because I was given it and you shouldn’t do. So you try and then be honest and say, well, actually it’s, you know, probably not going to make that much difference to you rather than maybe something else or whatever. And we’re not going to go down that road and dig myself into, oh, it’s sort of the manufacturers. But basically it’s a it is a fine balance because like anything, you have your own preferences.
[00:25:03] And are you on the radar of all the manufacturers now? They all try they all bang your door trying to do you know.
[00:25:08] What again, it’s a mix. We’ll have we have so many that we love working with and they are they have some really, really nice people that you work with. And sometimes it surprises you. Sometimes it’s surprising both in terms of some of the big companies that they will, I think, shy away from you a little bit because they’re a bit wary of the fact that you are. So you try and be so unbiased and you working with so many different things that probably where either have seen have you seen some a negative. Right. But on the other side of the coin, sometimes it’s really surprising when you start working with a company that you really like and then they just don’t I don’t know whether they just want to have you on a leash or what, I don’t know. But they they just don’t do that much then. And you’re like, But I really like you. I want to do more with you. And. And he’s not Can you with him really? Well, it’s a it’s a big mixed bag of tricks. I’ll tell you who really surprised me recently. And and listen, I’m going to I’m going to turn Anita into a positive again. Right. So. The line. So I think they get a bit of a bad rep in terms of reputation and people doubting them. On the other role, you know, and because it’s such a big corporate structure.
[00:26:30] So the fact is that this this company is mega megabit megabit, bigger than many of the other companies combined, Right? Yeah. So, you know, you kind of wary of that for yourselves. And then we did this because we work with Exocad. We were doing a smart trade course at the Allied conference, me and Patrick going back four weeks ago. So the weekend before all those weekends I was away again. So we’re in London for that. And you know what? We went out with a couple of the guys who were like the manager of like this sales for America and whatnot from Europe and stuff. And we had a meal with them the night before and and genuinely they were such a nice crew of people. It was rare that I’ve actually dealt with a company that was as nice as them, and I genuinely don’t say this to flirt with them because we none of us have it. Heroes. And I say this in the nicest way, but we don’t I don’t use Invisalign, so I don’t need one. I’ve got every other scanner under the sun. But they are. They were awesome. They were so organised and it was a real pleasure to be at the event with them. So I think it was surprising.
[00:27:45] The mistake we make sometimes is that we could think of a company as a person. Yeah, and I’ve had this experience, I don’t know, with so many different big companies, so I align being one of them, by the way, or Henry Shine or something. Let’s say I talk to Henry Shine 12 years ago about distributing something by Enlightened. And for the sake of the argument, let’s say it didn’t go well. Yeah. Then. Then last year I contact Henry Shine again. The people are completely different people now.
[00:28:20] Yeah, Yeah. You probably had a totally different experience, right?
[00:28:23] Totally different experience here. But you do you do get yourself, you think of the company as a human, as person, and you actually you.
[00:28:32] Put emotion into it.
[00:28:33] Yeah, you put emotion into the company. Whereas in these huge places, often people change a lot with a line. I think the big thing with them is just the rate of growth of that company. It’s growing so quick that it’s difficult to keep up with the growth when you’re growing that quick. It’s a bit like, I don’t know if you deal with Facebook at all for for ads and things. I mean, they’re a nightmare to deal with. They’re not new. Yeah, they’re really difficult to deal with. Anything goes wrong with your Facebook account real time. But then at the same time, it’s such a beast. Yeah, but a lot of times, Yeah, a lot of times you’re talking to robots, right? And people get pissed off about that. But yeah, it’s a funny one, but I notice you’re quite close to it, I guess, right? Because you give away.
[00:29:24] You know what? So we we’ve done a load of things with them. But before that, I mean we, I didn’t really and again, I’m going to, I’m hopefully not going to annoy them now by saying something else and things. So I didn’t really write them. It, it’s kind of as when it was just the 500, it was okay. It wasn’t at the same level as the other scanners that we use in the we at the time. We would just get in a prime scan when they very first came out and that was an awesome scanner. So the prime scan, I mean, I’ve done a study on it, right? So the primes kind of statistically at the time Superior, it was statistically in a in a group in a war zone. So and not actually dissimilar to lab scanners that accurate. It was an awesome, awesome scanner but that was before the release of the 700 and everything since. And again we had a lot of people a lot of people requesting, you know, who do I get it through and what have you. And and at the same sort of frustrations that we’d had before. So we just thought and this was at the start of when we were on this journey to just about to launch Scan Club and, and the whole thing was club was basically we wanted to provide a way to get on board with the, the sell the diploma but not pay thousands upfront because we wanted to make the education accessible. And I mean it’s a good cost.
[00:30:52] There’s a there’s one or two negative Nazis. I want to be polite and say that have been a little bit unprofessional at times. I’m not going to say any more than that, that I’ve said that to YouTube. It is not. It’s not. There are YouTube videos that we put the some of the short tutorials on both the platform and the thing, but they’re not on the course. So the course is it’s a it’s an ethical level seven course. It’s got, you know, lectures which are an hour and a half or whatever, 120 hours. But the the whole of that thing, realistically, there was a demand for it. The people wanted to get involved with it. So with everything and we saw that from the start of COVID. So the start of COVID, we had a massive uptick in people joining that course. And we thought this is the right time for people to start learning how to do things with digital. And so we did a couple of surveys and things. And for members of how what puts you off joining the course you’ve been on some of the smaller courses, what puts you off during the bigger cost and it was the cost. So realistically we thought, well, let’s make it remote, let’s let’s take away the hands on and let’s get it so you can join on at any time, anywhere and made it so that it was on demand. We still do the shorter tutorials that do go on the platform outside of it and on YouTube and stuff like that.
[00:32:09] But that’s cetera. And so the cost was to improve your knowledge and not kind of led into itself with the whole support side of things. And and that led into looking at the different scanners to partner with. And it just ended up where just through chance really, we were introduced to one of their reps who said, well, do you distribute that side of things? So that’s the only one that we actually provide direct. The rest is all through partners. So it’s all just goes through other people. And I think I’m really glad we did simply for the fact that it’s been incredible watching the journey of of of made it last year, especially because the software not particularly the scanners the scanners are good, don’t get me wrong, but it’s the software more than anything. And the the evolution of that, I think it’s I think it’s probably made a lot of the other companies nervous because they have to step up the game. And you can see that very clearly with with people like Trish, bring them more apps and things like that. And plus as well, they drop the price a lot. So, you know, it makes it more and more accessible all the time. So do we still recommend other scanners? Of course. You know, it’s not right for everybody. And even though we don’t really have anything to do with a line, you know, we still send a lot of people that way if they’re just Invisalign users, you know.
[00:33:29] Let’s let’s let’s let’s break it up then. Let’s start with scanners. Let’s start with scanners. Let’s let’s start with the beginner person. Yeah, sure. So is knows that it’s probably about time to get into scanning.
[00:33:43] You must get asked this question every day, right. I do. Right. Where do I start. Where do I start. What question. Which, which scanner do I go for? How much? Where do you where do you start on on. So I guess you’re asking them, right? What kind of dentist are you. What kind of treatments do you do? Right.
[00:33:56] Yeah. Yeah. So about 14 to 16 months. Gone now, maybe less. I. I programmed an algorithm on a website. It’s like a choose your adventure style thing called which colour dot com. So you go on there and you it asks you different questions about your clinic. In fact, it was less than that. Sorry, maybe about ten months ago. And it takes you on a journey of asking you different questions about the size of your clinic, whether you’re a social principal, Do you work in different do you work in different parts of the different clinics? Do you travel? Is your clinic called different floors? You know, all sorts of questions. There’s about 23 different paths that they can take and then finish it off with budget if it wants to limit it a little bit more. So the reason why I did that was to just try and keep as as unbiased as possible with that. And I wrote a white paper at the end that kind of gives you a little bit more info and stuff points in the direction of us, obviously, if you need more information, but it’s generally you can just go on it. It doesn’t cost anything. You don’t have to contact us. You can just go through it and work out what are.
[00:35:08] The results, what are the results of that, what percentage you’re ending up with, what percentage of ending up with?
[00:35:15] Good question. I can look up for you if you’d like.
[00:35:18] Okay, here’s your special, exceptional piece of work. All right. I know it’s a silly question, but. But sort of in a nutshell, Yeah. If I’m doing Invisalign and got.
[00:35:34] Invisalign, you can make more sense to make sense to it, because at the end of the day, it’s your bread and butter. Right?
[00:35:40] But what about the restorative side of it? How is it for crowns, bridges that sort of.
[00:35:45] Do you know what? I think it’s improved a lot. And I think if you if you stepped in because of the Invisalign, but then decided to go down the road to Restorative as well, I don’t think you’d regret it. There’s some excellent legs now with Exocad because obviously align bought Exocad and also we’ve got the issue with they’ve just brought in this new smile architect side to basically have a restorative version of clinic. So to do a smile design that sort of thing and, and that looks pretty good. I’ll have to say look pretty good. So I don’t think you regret it either way. My personal take on the article personally and this is, again, just my personal opinion, no to service to anybody who chooses wisely. I personally find that that’s kind of a bit big. So if you’ve got little hands, you don’t like the way to it, then it might not be fit. And there’s the Trace three is still an excellent, excellent scanner for Senator Invisalign because you can use it for that. There’s only the Itero scanners and Vice Chair three and the Omnicom you can send to send to Invisalign. Realistically, I doubt you picking on the cam. It’s all the technology now and you’d end up going with three. But Trista is still really nice and you can get it in the move units, the wireless units, that sort of thing.
[00:37:09] There’s four or five different ecosystem. So it’s a bit like looking at things like Apple and Samsung in a way, you know, these different ecosystems, you know, everybody everybody’s going to be different in terms of which one they prefer. And you can’t say really one’s better than the other in terms of shape or media and that sort of thing. In terms of that, they all do different things. The metaphor, I’d say, for people who do a lot of implants is a great scanner for that, simply for the fact that there’s so many tools to help out with your with your choice of bringing in the eye scan very much in and, you know, colour, colour filtering all all these very cool little software features that make it easier to scan on a on a full dental case. But then there’s prime scan. Right. And it’s a lot more expensive, no doubt. But if your main thing is is cad cam or you want to get into in-house dentistry as of yet and I think next year is probably going to be an interesting year for this because I think it’s going to be on it. I think three shape are going to be on more familiar. We’re going to be in house. I don’t even know if Millie may be printing who will see but but I think in house is where they all want to get through with CAD cam easy so I think but the minute full stop if you get it started or if you used to it.
[00:38:37] The Sirona system is a beautiful, streamlined system and it’s very hard to beat the easy workflow that is sirona when it comes to simple restorations of just inlays on nice crowns, you know, even veneers doing in-house same day appointments. It’s very hard to beat. And the only way you can get close to that realistically is using a stroke. M.s. Excel on unlocking it in effect with using in lab cam and and then having your choice of scanner exocad whatever type of CAD software and being able to mill the saddle. Then just simply for the fact that the MSI Excel is a workhorse. It is. It’s a two motor machine. It’s not the most accurate. It’s not the most accurate in terms of the Fisher patterns and stuff, but it’s better than it used to be with smaller birds. But it’s just fast. So you can, you can mill a crown or an inlay or whatever on a straw on a nail for under 10 minutes with something like a VHF set fall or anything like that. You’re looking at you’re looking at realistically at least 15 to 20 minutes plus, depending on the size of restoration. And that makes a big difference if you’re trying to do things in-house. So what you see.
[00:39:53] What you see, the tension between doing things in-house or letting the technician take care of. The bit that they don’t want.
[00:40:04] I think, you know what we were talking about time before. I actually think that and this kind of leads into a little bit the DSD thing that we were away with them and the. For me. I’ve always wanted to do my own thing, but I don’t know whether it’s age. I don’t know whether it’s that guilt thing with the weird thing with my kids always telling me about whether I feel like I’m too much time away from them. But time wise, I kind of feel like now I want to not step back from doing it all myself, but just manage some aspects of it a little bit more wisely. And this probably started when I was doing things, going back a few months ago with with a character and a company in America with doing some remote design services. And we were in the middle of a four hour run for DDA lab, and we’ve launched that now. So for that side of things, we’re having an in-house lab tech and we just hired a lady who works in London with us to do that side of things, do in-house. So I’m probably going to let her do things a little bit more. And I think that’s probably the future of where everything’s heading with with dentists and laptops. I think there was a point where laptops were afraid that they were going to get replaced by in-house, But I actually think that it’s the other way around. I think not entirely, but I think that more than likely over time, we’re going to see dentists join in labs, maybe with a chair in a clinic. And I think we’ll see lab tech shown in dentists. And I think that gradually they’ll merge into work and intrinsically in-house in the same team. But obviously the big centres, the big, big production centres and things that where you need the big machines to to produce. But realistically for the small things and even for us in Bury, we’ve got, you know, for all that we do some things in house, there’s some things you can’t do in know dentures and stuff like that.
[00:42:04] But my point is look you do make your own surgical guy, right? He’s pretty surgical, but you could have a lab do that, right? Yeah. So what’s the advantage of doing it yourself?
[00:42:17] It’s got to be preference, control, cost. Being a kid, being a control freak probably more than anything is probably a good thing that a lot of people want. They just want to control the whole system, you know?
[00:42:29] Yeah, but. But I don’t know. I mean, dentists are obsessed with chair time and your chair. I mean, a surgical guy doesn’t take that much time. But. But what I’m saying is, if you ideologically go on this route of chair side. Yeah, you can use a lot of chair time.
[00:42:49] Yeah. It depends what it is and it depends how fast you get. And I’ll tell you where things are changing for me that I’ll probably relate more to people who want to save the chair time. Say for example, the same day smile design that me and will do in house. I’ll only see one patient that day. So that one patient is the only thing that I’m doing for a same day. Smile design where I’ve already done planning sides before. I’ve already consented with things I’ve already done, mock ups and smile, test drives and that sort of thing. So this is just purely the actual manufacturing of veneers. So say a ten unit case of veneers or crowns or whatever it is, then I’ll start with them. And nine I end up finishing all of the preps and stuff by say, 11, 1130 I’ll be doing the scans and design. They’ll take me to, I don’t know, let’s say half 12. So I’ve got four mils in buried so I’ll mirror over the four mils. And why did I buy four mils for simple cases like that where, you know, it’s just pure time buying with buying those mils. So I’ll churn out all ten or 12 restorations in an hour. So those restorations then tear them all out, I’ll glaze them by three half three. They’re all out of the oven. Already have printed a model. Everything’s ready to go check the fit, make sure the margins are all good and fit them same day. So on a big smile design case, that’s as extreme as it gets. Where it’s becoming.
[00:44:20] What would you charge for that shot?
[00:44:22] It depends where I am, to be honest with you. If in London and Barry, the prices are higher than we charge in London. So I think so very it’s gone up this year. So I think we charge 6 to 5 in London. Seven, nine, five. So per, per tooth. Yeah.
[00:44:41] Because that worth. Is that worth it though. Not worth to spend your whole day on that. I guess it is for 10 minutes. 12.
[00:44:50] It’s so bad. That’s not bad.
[00:44:53] No, no, you’re right. You’re right. But my point is, could you have done two of them if you were using a lab like that? Look, of course, there’s patient issues.
[00:45:02] Patients do that. No, I agree. But 100% you could. And that’s why I think the future is. And that’s what makes me think the future is. Is that the reality of having all of these different components time and using that time efficiently is is becoming more and more important, especially as things become more competitive with it. So you you’ll see prices drop or you’ll see more competition and you people look at work at the same things that always happen with competition. So where will that head? I think you’re exactly right. I think you’ll end up with in-house lab technicians that you’ll have maybe two patients in the morning doing the preps with your maybe one or two lab techs will do all of that work in between the middle of the day, and then you’ll set them in the afternoon. So I think that 100% you’re spot on. I think that’s exactly where.
[00:45:53] Okay, let’s let’s move on. Let’s move on to printers and printing. And you guys do a whole course on printing, don’t you?
[00:45:59] We do. It’s our most popular cost. Is it 100%? Is that.
[00:46:05] I suppose it’s the first thing people want to purchase.
[00:46:08] I don’t know what it is. We just fill them up quickly every single time.
[00:46:14] Let’s start from the beginning. Start from the beginning for a beginner. Okay. What are the things that get printed in dental surgeries?
[00:46:21] So. Okay, so there’s a big range of 3D printers you realistically can step in very quickly and cheaply, cheaply and easily. You can pick up a printer that is an excellent printer now for sub £1,000, possibly even for some of the really nice ones now for like £300. So you can pick up £300 for an algo mas pro three, you know, £300 or whatever on Amazon. What is the difference between that and printers which are thousands of pounds, you know, literally ten times the price, no more. There are a few things. So realistically.
[00:47:05] If we get into if we get into that, what are the things that get printed? Well, the things.
[00:47:11] So to the kind of lends itself with the different type of princess. So we we’ve got models, surgical guides, splints like guides. You can improve bleach and trays. You can now actually print the aligners direct. There’s resins which are literally put it out with that. You can print teeth, you can print crowns, inlays on laser permanent resin, temporary resin. This pretty much everything under the sun. I was doing a lecture about that today actually, with with the different resins that crown resins that you’ve got with things like bigger resin and stuff like that, that you can print permanent restorations with their license for use as crowns. So that kind of lends itself in then with deciding how far down the rabbit oh you go and how much you spend. There’s a big.
[00:48:01] And also also you’re going to need a printer, you’re going to need a washer and a curing.
[00:48:07] 100%. And that again, lends itself to what you’re going to do with it, because there’s a big debate. The minute 3D printing dentistry kind of got divorced maybe six months ago and I say that very apt. They there was a big 3D printing group. Some people were on it, some people split apart from it. We tried to keep separate away from it and be in in between in the middle with an open group. And and there’s on one end you’ve got Rick Ferguson advocating the cheapest appliances of know you can use them for everything. Then you’ve got a lot of other people like while there are any over in America who just purely advocate you know deadly validated workflows to for clinically applicable reasons and and you’ve got different people in between. So who’s right? And I think the reality is, for someone looking at it, they want to find who’s right and they want to know what they’re doing. But the both right, really, because you can do anything on any of them. And there are reasons which are validated for different printers, for open printers. It’s if you if you use everything you have to forever for all of those different purposes, you need to know damn sure that what you’re doing and the work we’re using is going to be safe for the patient more than anything. So a clinically validated workflow is one that’s been tested, that is approved, and that is known to be safe by compatibility wise and also for the purposes of which that material. This fall. So whether it be surgical guides, crowns or whatever.
[00:49:50] So can you program the cheap princes to do those things yet? Should you? Well, I guess it depends on the resume and it depends on your purpose. But for me, the cheaper resin, the cheaper princess are there for printing, specifically for models and for some of the resin, very few far between resins that don’t specify a printer as long as you post process properly and as long as you do things according to the instructions of that specific resin. Right. So then you’ve got more expensive printers and they again range from a couple of thousand up to ten plus. And you’ll get different. It’s like scanners, you’ll get different people telling you this is the best one, this is the best one or whatever. So let’s give you a sneak peek. The which kind of thing. You can probably guess what’s coming next. Right. So we’re going to we’re going to we’re going to end up I’m just in the middle of programming, but it’s a lot more complicated than choice, so. Right. Oh, man. Exactly. So. So yeah. So I mean, he was right with that. The there’s different printers, the different people use and different people advocate. And again, it depends on you as a user what you’re going to do. So the form of print is great. And they were one that really broke the market with with cheaper printers. Yeah, cheaper, accessible, validated dental printers. Pretty good. Do plug and play. Yeah. Yeah. They’re not the fastest anymore. A lot of these are the printers are a lot faster and that was what.
[00:51:23] We started with Formlabs. But that was the problem. The speed was the problem.
[00:51:26] Exactly. So these days now accurate to Sprint Sprint. Ray Sega, you know, desktop health, they’re all great printer systems. They all have their own little reasons why you might use one over the other, what reasons they are. The difficulty, the main difficulty you’ve got as a choice as a user now is looking at that system and seeing whether the system’s resins are constrained to that system in terms of their own resins and also external resins. Can you use external resins all? Is the system an open system? In which case is it a validated or validated system? So for all of those different printers, it has to be a personal choice. And based on what you need in your clinic for the purposes to which you want.
[00:52:18] And have you gotten yourself into the whole the different types of printing, or is that one of the other guys?
[00:52:26] Do you want to be my way?
[00:52:27] Sorry, they’re like SLA and DLP and all that.
[00:52:30] Oh, yes. I mean, you know, listen, I’ve got a ridiculous addiction to 3D printers. I’m trying to get I’ve tried touch them like Pokémon, you know, it’s about catching them all. So I’ve got listen, I at the at the probably the midpoint of my journey with with guided surgery I was messing with blue sky bio and, and I had got this back then before the Formlabs printer it was a filament printer that was a cell robot printer. And you could sort of get biocompatible resins that would food safe, nice, but it wasn’t really proper. So then Formlabs came out and things. But before the Formlabs I was teaching smart at the time, so I’ve been doing guidance over a few years and I’d kind of gone into Smart Mechanic, gone back with that now, which is totally different story. But with Swap at the time is great was cloud based with things and I was speaking to Florian a lot. We were doing a lot of courses with him, Florian Schober, who’s head honcho over at AdMob and you know, he’s a I’m going to be rude here. He’s either German or Austrian, but he lives in Basel and he’s got this accent and he’s going to probably listen to this and kill me. But he was like, Why do you want to pretend? No, nobody wants to bring it. And I was like, Well, I do. And I’m sure a lot of other people would rather, you know, and have it done in house and stuff.
[00:54:01] And I’ve got this cheap Chinese transfer just bought and I’ve got some resin for it. Can I get my sales and print it myself? No, you can’t read them. And then that was basically one of the reasons why we ended up doing less with Swap at the time was we wanted to we wanted to get them to do a model like Blue Sky Bio where you could you could have your own exports and we moved on to other systems with things and the whole, the whole printing side of things is evolving from there. And I’ve ended up with form labs with weird Chinese ones, which again, no disservice to anything or anybody from China. My goodness, those those guys, they just evolve fast. They’re just constantly constant. William Bates, an apprentice, so you can have one. And then literally a few months later, it’ll be another one totally different again and evolve it. So all of these different prints, we keep trying and then at the same time going for more expensive ones and the validated workflows about them actually vs about the accurate ones. We’ve we’ve got a D for K from Vision Tech in London, which is now the desktop health brand, you know, all these different principles. I think over time I bought three peak printers that I gamble with to try and print implant frameworks, all sorts of silly printers, which which didn’t work out very well.
[00:55:22] Have you ever printed metals, Titanium.
[00:55:25] So I’m, I have actually. So yeah, one of the things that I’ve been doing my PhD the last seven years, I’ve been trying desperately to get it finished, which the hope. David Wood and the chaps that leads listen to this, because I saw them last December and I would really like to finish my PhD now, but, but that’s a different story and I won’t go on at that one. But yeah, I really need to get it to the external examples. Anyway. So my PhD is on guided surgery and adventurous guided surgery and improving the accuracy of it. So one of the things which are patented, these little things I won’t go into, it’s not ready for market yet, but it will be soon. But that we were for the prototypes I was getting printed with like an online printing service a few years ago, which they printed them on the left printer to to get them. But it’s not, it’s not the same level as as machined metal. It’s just it’s not there yet. It’s not the same resolution. It’s cool. It’s very cool. But but the screw pads weren’t very good. So good for things maybe for, like, I don’t know, chrome frameworks, maybe you could do with it and polish it up after that might be a cool thing and frameworks if you polish it up after.
[00:56:39] But how are the aligners?
[00:56:42] Good question. We’re in the process of trialling those minutes. So with Patrick’s little baby as the deadline deadline is lop side of things.
[00:56:52] So before you go on so so there was the way of printing the models. Yeah. And then pressure forming onto the models the old way. Yeah right. That was, that was one form of making your own aligners. Right. Yeah. But now you’re telling me we can print the aligner itself in a practice, in dental practice? Does it make sense.
[00:57:14] In the future? I make 100% because if you think about it, cost wise and time wise, yeah, someone loses in a Line-Up, you can print a new one in 30 minutes. They can then wash it again. And. And the amount of resin that you would use is a very thin. It would be a mess. Not to say that it was cheap. I think one of the big, big, big, big.
[00:57:36] How worried is the client? How worried are the guys at the line about this? You must have I think.
[00:57:42] They’re already on this, you know, right? I think so. And I’ll tell you why I think so is there’s so much development with the resin that if they’re not, they’d be silly because the resins that that we’re testing, the reason why we’re trialling them is I want before we recommend anything, I want to know that it works well. Right? So you have to think about Aligners in a different way using principle liners, because it’s like any resin is flexible. So a thermal forms aligner, when it’s thermal formed gradually over time, it loses that pressure on the teeth and it distorts. Whereas the things that they put into some of these 3D printed resins like fibres and carbon fibres or whatever it is, I need to look it up. So forgive me for being wrong with that, but they, they introduce the whole concept of four dimensional stability in the in the actual shape of the aligner. So body heat heating it up will return it to its original shape a little bit like the nightie files that we have with Endo so that that metal is supposed to heat it up, supposed to go back to the original shape. So the whole thing with these is going to change the way that we design aligners, the number of aligners and all of that, because potentially you might be able to put more stress on the tooth or rather more of a change in the position because it’s going to put a more gentle pressure over longer, but actually try and return it to that shape that you’ve printed that line of two. So. I think the whole line of workflow is going to change with 3D printing, not just in terms of number of lines, but the actual thinking of the mechanics. So we’ll see. It’s going to be an interesting one with them.
[00:59:36] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts. Payman, Langroudi and Prav. Solanki.
[00:59:52] Thanks for listening, guys. If you got this file, you must have listened to the whole thing. And just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming you got some value out of it. If you did get some value out of it, think about subscribing and if you would share this with a friend who you think might get some value out of it too. Thank you so, so, so much for listening. Thanks. And don’t forget our six star rating.