January 27, 2025 • 52 mins
Unlock the secrets of modern implant dentistry with Dr. James Rutkowski, the visionary director of Jacksonville University's Comprehensive Oral Implantology Residency Program. Dr. Rutkowski takes us on an extraordinary journey from his early career as a pharmacist to becoming a trailblazer in implant dentistry. With stories of placing his first implant back in 1983 using makeshift tools, his narrative is both inspiring and enlightening for anyone passionate about advancing in the field. Discover how his dedication to education and innovation has shaped a residency program that is setting new standards in dental education.
Immerse yourself in the transformative power of a residency program that weaves together the complexities of pharmacology and implant dentistry. This unique curriculum offers a holistic approach, equipping residents with the skills needed to navigate the intricacies of real-world clinical settings. By integrating diagnosis, surgical placement, prosthetic restoration, and maintenance, the program prepares dentists like Soren and Tyler to tackle complex cases with confidence. Residents also benefit from hands-on training and the opportunity to earn a stipend, ensuring both financial stability and comprehensive education.
Explore the myriad benefits of this pioneering residency model, which blends academic rigor with practical experience. Dr. Rutkowski and his team have redefined dental education by emphasizing community, collaboration, and continuous learning. With access to a network of clinics across the U.S., residents gain invaluable experience while patients receive affordable care. This innovative approach not only enhances the residents' skills but also supports their professional growth, offering an enticing alternative to traditional dental education paths. Join us for an engaging discussion that promises to expand your understanding of what it truly means to excel in implant dentistry today.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Tyler Tolbert (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
Hello and welcome back to theFix Podcast.
Super excited for our guesttoday, dr James Rakowski.
He's on.
I got connected with himthrough Dr Todd Erickson, so
shout out to him.
He was a fan of our show, hadbeen listening to us for quite
(00:24):
some time and, uh, he wanted totell us about this uh residency
program that he was directing.
And uh, we talked a good bitabout, uh, what they were doing
over there.
And you know, there's not awhole lot of uh residencies that
when people reach out to us andthey're asking about, uh, what
kind of programs that theyshould be looking into out of
school if they're trying to getinto implants and are really
(00:46):
serious about surgery, there'snot a lot of programs that we
really point people towards, notnecessarily because there's not
good programs out there, butjust because it's hard to find
programs that are really aspecific funnel for what it is
that we do.
And as soon as I heard aboutthe kind of caseload that these
dentists are able to do, I wasreally impressed and this is
certainly a program that I'msteering people towards uh
(01:07):
myself.
So, uh, he referred me over toDr James Rakowski.
We have uh here with us today,who's going to be talking about
uh, the Jackson Jacksonvilleuniversity comprehensive uh oral
implantology residency program.
It's a bit of a mouthful, um,but that's because it's a.
It's a load of content as well,so I'm really excited to hear
about all the things that youguys are doing and hear a little
bit about your story.
(01:27):
So, dr James, thank you so muchfor coming on.
Well, thank you for the inviteand thank you for the interest
in our program.
Dr. James Rutkowski (01:34):
Of course, it's really appreciated that
there are people that want tosee to it that those that are
doing implants get the finesteducation that they possibly can
get, and that's what drives ourprogram and drives all our
residents.
Dr. Tyler Tolbert (01:51):
So thank you for having us For sure, for sure
.
So I'm hoping that you can giveus a little bit of context you
know really about yourself andyour own background in
implantology, how long you'vebeen doing it, your own training
, and just kind of walk usthrough what got you to being
the program director of the yeartoday.
Dr. James Rutkowski (02:08):
Okay, well , I started out as a pharmacist.
I graduated from DuquesneUniversity School of Pharmacy in
1972, and from there I wentdirectly into dental school,
where I graduated from theUniversity of Pittsburgh in 1976
.
And then I went into generalpractice and I immediately saw
that there was a real problemwith patients who were missing
(02:32):
teeth, particularly full arches,that lower dentures in
particular.
There was nothing that youcould do that would really make
it work.
Occasionally Maybe you get theone or two in a hundred that
just said I love my lowerdenture, but you got got 98
people who said isn't thereanything better, doc, and distal
extension, partial dentures andwhatnot.
So I started taking implantcourses from Midwest Implant
(02:55):
Institute with Dr Jack Hahn andDr Duke Kellett, as well as many
other people Lenny Linkow,those people that have gone
before us and I've been able tostand on their shoulders and see
what was possible.
They took care of a lot of theinitial issues for us.
I placed my very first implantin 1983, which we did not have
(03:17):
any kits went to the hardwarestore, got some drills, got some
.
I think they were calledosteotones.
They were really leather ballswe sterilized them, tapped them
with some foam and we put theseimplants in and I could see that
there were some real issueswith the way we were doing
things, but it was all that wehad.
(03:37):
I stayed with it, did afellowship with the Midwest
Implant Institute as well asother courses, got very active
in the American Academy ofImplant Dentistry.
The AAID Continued on, got myassociate fellowship, my
fellowship with the AAID andthen my diplomate status with
the American Board of OralImplantology and Implant
Dentistry.
Was doing a lot of bonegrafting.
(04:00):
I was one of the earliestadopters of implant dentistry in
Pennsylvania, in westernPennsylvania, where I practiced.
I moved to a small town becausethat's where my wife and I
wanted to raise our children.
And so there I was.
I was in central Pennsylvaniain a small town and wanted to do
implants and people said you'llnever do them here.
But lo and behold, there werepeople there that needed
(04:22):
implants.
But lo and behold, there werepeople there that needed
implants and we started doingthem and we traveled and we
built a practice that was veryheavy into dental implants.
I was doing a lot of bonegrafting.
I realized that we had a lot ofdeficiencies with bone grafting
and my wife and I became emptynesters.
Our kids were out of college,so I decided I would go back to
(04:47):
school.
I always had a strong interestin pharmacology and to me
everything that we do ispharmacology, whether it's
signaling of bone cells to goahead and start osseointegration
or de novo bone formation force.
So I went back to duquesneuniversity.
I kept my my practice threedays a week but I went back to
get a PhD in pharmacology at 51.
(05:08):
I finished that seven yearslater, when I was 58.
I put a research laboratory inmy office.
I actually hired technicians tohelp do that research.
I had to know how all theresearch was being done because
I had to do my defense.
But actually doing it, um, Ihad people up that would be
working with all the cells anddoing all the things for it and
(05:30):
whatnot.
And so at 58 I graduated with myphd and, uh, started with some
of those things into practice inthe clinical practice, opened
up a research company called theclararing research group.
We developed a small molecularcompound, small molecule, that
synthetic that shortens thesigma for bone formation from 16
(05:53):
weeks down to about 10 to 12weeks predictably, and started
to work with some people inorthopedics and our products
started to be used in spinalfusion on a research capacity
clinical research as well asdentistry and also took a strong
interest in postmenopausalwomen and the issues they have
(06:16):
with bone formation and theirestrogen levels, and so we did a
lot of research with that, withthe research company and
Salivary Diagnostics for thesepeople, these individuals.
So it's been a great ride.
I continued to practice until Iwas 70, although, I must admit,
beyond the age of 60, it wasonly two and a half, three days
(06:38):
a week, because I was involvedin the research the rest of the
time and I left clinicalpractice in July of 2020 and I
was doing just fine with all thethings that I was doing.
I was doing CE lecturing, withmaxi courses as well as other
invites, and was enjoying life.
(06:59):
And then the JacksonvilleUniversity program.
They reached out to me andasked me if I'd become director
and I said initially, I said no,that's okay, everything's fine,
thank you for thinking of me.
And they came back in about amonth and they said well, you're
going to do it.
And I said well, actually Ithought I answered that question
(07:20):
.
And they said well, we'll giveyou another month.
And I said well, I don't thinkit's going to change.
And then the dean called me andhe and I hit it off we, we hit
it off and my, my wife, couldoverhear the phone conversation
and she said to me she said well, how did that phone
(07:40):
conversation go?
Remember, you're retired now.
You don't do everything.
And I said yeah, but I'll tellyou what I think we can make
something happen, and so I saidsure, and I'm glad that I did.
It's kind of like when you goto the dog pound and they hand
you the puppy.
Once they hand you the puppy,you can't give it back.
(08:04):
You're going to take it home,and that's exactly what happened
with this program.
I'm very energized by ourresidents.
They are outstandingindividuals, they are dedicated,
they want to do the very bestthey can, and that's what drives
the entire program.
Let's just make the besteducated implant dentist,
(08:24):
because implant dentistry is socomplex, whether it be the
surgical component of it, thebone grafting component of it,
just taking the tooth out how dowe get the tooth out?
What we're going to do to growthe bone, put the implant and
that old excuse why put the, theimplant where the bone was?
Yeah, that worked in 1988.
It does not work in 2025, though, and so we know a lot more now
(08:48):
than we did in the 80s and 90s,whether it be implant services,
thread design, treatmentplanning, methods of treating
prosthetics, everything atpharmacology, medical evaluation
.
All these patients come in,they are in their 70s, 80s and
90s, they have a long list ofpathologies and a long list of
(09:12):
medications, and all thosethings do affect the results for
us.
So we've just put together aprogram where we get to be able
to bring everything together tohelp these young doctors and
middle-aged doctors.
I'm surprised at how manymiddle-aged people we have
coming into the program.
Dr. Tyler Tolbert (09:27):
Wow, wow, yeah, that is a quite the
illustrious career and I reallycommend you for your commitment
to education and and taking onall the things that you took on.
I mean having a doctorate inpharmacology, in addition to all
the things and yourcontributions to implant
dentistry and the research andeverything.
I just it doesn't seem likeyou've had enough time to do all
(09:47):
the things that you've done.
So I really commend you for allthat and also praise you for
continuing to recommit yourselfto a whole new thing into your
70s.
So that's, that's reallyfantastic and there's there's a
lot of different avenues we cango down and I'm also very
curious too, and we cancertainly get into this.
You know, aside from talkingabout the residency itself, is
you know?
You kind of already alluded toit is you know the?
(10:13):
I think your pharmacologydegree has only become more
useful over time becausepolypharmacy and what we do is
more common than ever before.
I mean, I've had a patient Isent it to Dr Poppy as well that
had literally just 20 pages ofprescriptions and I said you
know, I'm going to look throughhere and see about the things
that I know about.
There are going to becontraindications, but as far as
how all this works together asa system, I couldn't tell you,
(10:34):
so I'm sure that's certainlycome in handy for you.
But yeah, soren, did you haveanything to glean from all that?
That's quite a repertoire.
Dr. Soren Paape (10:42):
I mean, I just I really appreciate the fact
that you know, we we as asyounger dentists in the
profession of implants, you know, benefit greatly from, from
people like you who contributeto the research and, like you
said, like the advancements ingrafting and techniques like
that.
You know, I feel like Tyler andI have come into the into the
(11:04):
implant game while, whilethere's so many things that have
improved before us, um, andit's, it's allowed our job to be
that much easier, when, notthat it's an easy job, but you
know from, from where you wereat in the eighties to where
we're at now, uh, it's we'vecome into the profession at such
a good time where there's a lotof advancements in these
(11:24):
techniques and we're able toprovide treatment for patients
that they weren't able to getbefore, and we're not going to
the hardware store for ourinstruments anymore.
Dr. Tyler Tolbert (11:33):
Yeah, absolutely.
Dr. Soren Paape (11:36):
I would love to hear more and I'm sure our
listeners would love to hearmore specifically about the
residency kind of like timelengths of it.
I know you were talking alittle bit about it prior to the
episode starting so just whatthe residency is, how it differs
from other residencies, whatpeople in the residency can kind
(11:57):
of get out of it, and I thinkthat would be excellent for our
listeners.
Dr. James Rutkowski (12:02):
I think that would be excellent for our
listeners.
Okay, Well, great, let's juststart how our residency differs
from the other residencyprograms that are out there,
whether it be oral surgery, perior cross, that do have an
implant component to it.
Those residency programs, ifit's the oral surgery, then they
are looking at it from asurgical aspect.
(12:23):
That's where they put theiremphasis on it and they do place
a reasonable number of implantsin their residency programs.
Typical six year residency inoral surgery they may place 70
to 100 implants, of which theydon't restore any of them.
Okay, so they put them in andthen they never get to see what
(12:47):
do they look like, necessarily.
Or maybe they do get onepost-op when they do see that
the actual prosthesis in place,but they're not there and seeing
.
Well, you know where, theircomplications and whatnot.
Perio, and they contribute allthese perioprocess oral surgery.
They contribute a great deal toimplant dentistry and they
(13:08):
certainly have a place inimplant dentistry.
But so do general practitioners, okay, Because implant
dentistry is oral surgery,perioprocess and a big component
of general dentistry.
So in perio, you know theyfocus on, you know the soft
tissue, the aesthetics.
They know the literatureextremely well.
They've contributed to thevolume of literature greatly.
(13:29):
Who knows prosthetics betterthan a prosthodontist?
Absolutely nobody.
They know their literature andwhatnot but they don't
necessarily get to do all thesurgical placement.
Where our program bringseverything in implant dentistry
together is the diagnosis, it isthe evaluation of the patient,
it is the treatment plan, it isgetting acceptance of the
(13:52):
treatment plan, it is thesurgical placement of the
prosthesis or, excuse me, of theimplants.
It is the managing surgicalcomplications, most immediate
and maybe long-term, and how youprevent all of those.
Then our program, also ourresidents, not only did they
(14:13):
place those implants, but nowthey restore those implants and
so then they deal with theprosthetic planning.
And that had to be all donebefore they ever started the
case, obviously.
But they deal with thatprosthetic planning at the
beginning and then doing thatprosthesis for them, then
maintenance, that prosthesiswhat kind of complications were
(14:36):
there, you know?
Does the patient come back andsay you know, I really can't get
my floss threader in there,which you know that didn't,
wasn't necessarily a concern ofthe oms, you know.
Well, you got to see theprosthetist for that, you know.
And the prosthetist goes well,you know, that's where you put
the implant and that's they'retoo close together, that's the
best I can do.
So then there gets to be thisfinger pointing where ours, the
(14:58):
program, is.
They do it all start to finish.
They do reach out and rely onthe other dental specialties
though when they feel that it isnecessary.
So this isn't it's all us andjust us.
No, we believe that implantdentistry involves everybody.
It's just that we're trying toeducate a dentist who can take
(15:18):
the case from start to finish,either themselves or in
conjunction with others, so theymake it all work together.
Then in our residency program,they also follow these patients
afterwards so they see what itlooks like in six months and a
year.
Another big difference to ourresidency programs is it occurs
(15:40):
in the real world.
It occurs in clinical practices.
Across the United States Rightnow we have 21 different
clinical sites where we have atotal of 27 different residents.
Some of the programs have morethan one resident, but they are
in the real world.
Now, that real world may beprivate practices where you, you
(16:02):
know, they hear about thepatient saying something about
well, you know, I, I don't likethe price, I don't like the fee,
or, you know, when it's alldone, I don't like the shade or
I don't like this, and that werethat if you are in a dental
school or a hospital you don'tnecessarily get to hear all
those things, because there is abilling department that takes
(16:23):
care of all that billing.
There is a department head thathas to put up with that.
Somebody is unhappy, there arecomplaints about the end result
and so you know you've got adepartment head or a dean who's
taking care of all those thingsand you're not necessarily we're
here.
You are the one that's involvedwith this patient.
You have a resident directorthat works with you and
(16:51):
supervises you.
They are people that are wellexperienced in implant dentistry
.
Whether they are oral surgeons,periopros or diplomates of the
ABOI or diplomates of the ICOI,individuals will have a great
deal of experience that cansupervise these residents as
they go through their programwith it.
So our program is, I think, themost well.
(17:11):
I don't think I know.
It is the most comprehensive.
And not only is itcomprehensive clinically but
then didactically.
We go into great deep dives inevery single topic.
I know there's topics that incontinuing education they may
get an hour lecture on it or afour-hour lecture on it, where
(17:35):
in our program that mayrepresent a six or eight-week
didactic lecture that they areactually evaluated, assessed on,
because there are homeworkassignments, there are quizzes
and tests that they have to take, final examinations, there are
papers that they have to write.
So there is an assessment,there are assessment tools in
(17:57):
place where in the CE world youdon't necessarily get that place
, where in the CE world youdon't necessarily get that.
And now you asked me severalquestions there, dr Poppy, and I
think I only got through thefirst one.
Dr. Soren Paape (18:10):
I don't remember all the others no, and
I actually have a couple ofquestions now, after you said it
.
I think the others were numberof residents, which I think you
answered you said 27, correct?
And then I asked length of theprogram, and then I wanted you
to elaborate a little bit on.
You talked about how you getyour master's in the program,
(18:31):
but I don't think you discussedthat just now.
So a couple of those detailswould be great, great.
Dr. James Rutkowski (18:36):
Well, the program currently has 27
residents, of which we'll begraduating our first cohort at
the end of April.
That first cohort only had fiveresidents, so that'll give us
22.
But as of December 31st we have16 residents who have been
(18:57):
accepted and are into theprogram.
They are matched with theirsites but but we probably have
another five or 10 that will becoming in.
So this incoming class will bea minimum of 16, but probably
more.
So that would take us to 38residents and we might actually
end up with 40, 45 residentsgoing forward.
(19:20):
The program is currently athree-year program but we have
made petition to the universityand the university is very much
in favor of it is to reduce theprogram from three years to two
years.
When I took over the program atthe end of its first year, I
took a hard look at thatcurriculum and I said, ken, is
there anything I can streamlinehere?
It's still deep dives intoeverything.
(19:42):
It's just I'm making the bestuse of everybody's time and the
university is very much in favorof it.
So I full well expect that theprogram will be a two-year
program and those that came inin cohort three in July of 24,
they came in on the three-yearprogram but they are going to
(20:04):
morph into the two-year program.
It's the second and third yearthat got combined.
The first year stayed prettymuch the same.
Second and third year gotcombined so we'll have two
classes of three years and thenthe third year, cohort three and
cohort four.
They will be two year programs.
They are year-round programs.
(20:26):
It's on a tri-semester and theydo their clinical work in the
clinic.
We want them to be in theclinic eight to ten hours a day,
a minimum of three days a week.
They do their didactic portionMonday through Thursday, 8 to 9
(20:47):
30 pm Eastern time.
It is done virtually All thelectures are reported so they
can do it asynchronously.
So if somebody cannot make alecture on a Tuesday night
because a lot of our doctorsthey have families or they're
starting their families orthey're out looking to make a
(21:09):
family, they've got a date onTuesday night and they can't
make it, they can binge watchover the weekend, get caught up
on all their homework.
The homework assignments areusually due two weeks after the
presentations.
There are reading assignments.
We encourage them to attend asmany lectures as they possibly
(21:31):
can.
Some lectures they must attendbecause they have to do
presentations to and whatnot,but for the most part they get
to do it asynchronously, whichthat certainly helps, but that
is a full-time program.
They get to do itasynchronously, which that
certainly helps, but that is afull-time program.
The clinical portion of theprogram is based on entrusted
(21:51):
professional activities, epas,entrustable professional
activities, and they start outwith the simpler things, or the
things where you would start,where it is onboarding a new
patient, an examination, medicalevaluation, pharmacological
evaluation, dental evaluation,presenting the case to the
patient, the treatment plan,getting acceptance of the
(22:11):
treatment plan so that's one epagetting informed consent and
doing all that.
That's one epa.
Then other epas they may start,start out with a single implant
in the non-aesthetic zone, nografting necessary.
Then maybe in an immediateimplant in the non-aesthetic
zone, then maybe a singleimplant in the posterior maxilla
(22:36):
, where you do have to do asinus intervention, whether it
be a crest or a lateral windowapproach and then posterior
mandible etc.
Full arch treatments, the setzone, multiple implants in the
set zone, fp1s, twos, threes,rp3s, fours, five so you know
I'm the awful party fours andfives, so the whole spectrum of
(22:59):
it.
They do an IV conscious sedationprogram that lasts about seven
months.
Now that they do have to go toDayton Ohio, for they have about
six visits to Dayton Ohio forthat IV conscious sedation
program, but they do get theirIV sedation permit.
It is the most rigorous IVsedation program in the country.
It's accepted in all 50 states.
(23:21):
Some IV sedation programs arenot accepted in some of the
states.
Ours is um dr steveshuffleberger, who many people
already know uh, is theinstructor for that program and
it is a very rigorous program.
Um.
So these epas, they they gofrom those basic things to where
(23:42):
they then the full arches aswell as zygomatic implants,
pterygoid implants, and if theclinic they're in does not
necessarily perform some ofthose procedures, then they will
rotate through other clinicswhere they may or may not be
able to get to do thoseprocedures in those clinics
because they may not have alicense for that state, but they
(24:02):
will at least assist in them.
Then they will write a paper onthat and then they will sit
with for an oral examinationfrom me to assure that they
really do have a goodunderstanding of all of those
procedures.
Um number of implants, I justtalked with one of our residents
who in his first two years andone semester has placed well
(24:30):
over 600 implants, has currentlyrestored 90% of them and has
done 60 full arches.
Dr. Soren Paape (24:40):
That's excellent.
Yeah, that is a very robusteducation yeah, plants well, I'm
surprised you guys.
You guys are even doing remoteanchorage, like zygomatics and
and pterygoids.
That's, that's very cool.
Um, so do you guys haveclinical suites where, like so,
each resident is in like adifferent clinic and then
(25:02):
they're?
How does that work exactly?
Dr. James Rutkowski (25:04):
right, yeah, so, um, we have.
We have these 21 clinics allover the united states and, uh,
some of them are just privatepractices.
Uh, others are, uh, 501cnon-profit clinics where
patients go there and they gettheir implants done at a reduced
fee.
But even in the privatepractices, many times those
(25:27):
practices.
They will have their standardfee and then a patient may say
gee, I can't bite off that much.
Is there an alternative?
And instead of giving maybe aninferior implant alternative?
they say well, we do haveanother treatment method for you
, where we have a resident fromJacksonville University who,
instead of assisting me in thiscase and they have done these
(25:50):
cases they've assisted.
You know, this is the directorspeaking.
My resident will do the caseand it might be at a 50% to 75%
of the normal feet, so thatentices patients to stay with it
.
We have many manufacturers whowe have partnered with who give
substantial discounts to theclinics for the cases that the
(26:14):
resident is doing.
So they get the benefit ofpaying less for the implants,
less for the bone graftmaterials, less for the
membranes, barriers, the wholenine yards, the digital hardware
, the digital software thatneeds to be had.
We have companies that givediscounts for every single thing
(26:36):
that is done in implantdentistry and that entices these
private practices to say youknow what I can bring in.
We call them associateresidents, where they are to do
whatever an associate does inthat practice.
That means a re-exam, a newpatient exam, take care of an
emergency, you know, and if itis a non just 100% implant
(27:07):
practice, they might have to sitdown and do a composite
restoration.
They might be doing an occlusalor a do on number 15 that's
sadistic.
Now, I personally think that'sharder than doing some implants,
oh it is oh yeah, it'd be anightmare, but they have to be
contributing to that practiceand you know what I that
practice and you know what Itell all my residents.
you know what, if an assistantcalls in sick that day or they
have a sick child and they can'tcome into work that day and
(27:30):
they need someone to help seekpatients, help scrub instruments
, help clean rooms, guess what?
And even though I practiced for44 years and I was seven years
old when I quit you know what?
If we were short-handed, Ipitched in and did it.
Dr. Tyler Tolbert (27:45):
Yeah, that's right.
Oh yeah, that's awesome, ahundred percent.
You know we we get asked allthe time about.
You know the decision pointbetween do I go into a residency
after school or do I just gostraight into private practice.
And just you know, take a beton taking a bunch of CE and
because you know you're inprivate practice, you're making
private practice money, you canpay for the CE.
(28:05):
You're doing these weekendcourses, the week courses and
things like that.
And I think it's always a, it'sa calculus of, well, how much
are you learning over a givenamount of time and you know how
much are you progressing andwhat are going to be the returns
over time for how much you'velearned in that given amount of
time.
Right, and I think the case iswith so many residencies is they
might be two, three yearprograms and you know you might
(28:26):
come out having placed 15, 20implants and it's like, well,
you've spent a long timelearning a bunch of stuff
didactically speaking, but interms of reps, you didn't really
get a ton of reps during thattime and so there's not as much
of a return on investment butwhat you just described in terms
of what these residents aredoing in a private practice
environment and in the breadthof skills that they're learning
(28:49):
and coming into contact with,all the way up to remote
Anchorage, getting their IVconscious sedation, which is,
you know, a pain to do whileyou're trying to balance, you
know, running a business or whathave you?
Going through all thesedifferent competenciesencies and
getting that kind of volume.
I mean that is a two yearsincredibly well spent.
That is going to, you know,have a absolutely massive return
(29:10):
for all of your residents forthe rest of their careers and
that's really an accelerant, inmy opinion, and I wish this kind
of thing were around when I wascoming out of school, because
in the fact that you guys makethis available to general
practitioners is just a it'sit's a career hack and I'm
really, really impressed withyou guys have put together and I
love the private practicecomponent of that.
That's not something I wasactually aware of before we got
on here.
Dr. James Rutkowski (29:31):
Yeah, that and and you know, I I have had
discussions with a couple ofdental schools, a couple, of
prosthetic residency programs,some AEGD residency programs,
where they say is there some waythat we can partner with you or
just how are you doing this?
I mean, I had one dental schoolrecently where they actually
(29:51):
closed their implant dentistrydepartment because there was a
conflict, internal conflict,between oral surgery, perio and
pros at this school and implantdentistry.
Because the patients werecoming for implants and said,
well, yeah, I'll go to theimplant dentistry, I'll go to
implant dentistry.
So all the patients that neededimplants were going to implant
(30:14):
dentistry.
They weren't thinking, you know, I'll go to oral surgery, pros
or perio, and they were beingdirected internally in the
dental school to the implantdentistry department because
they needed implants and thatcreated an issue within the
school and so they hadto close the implant dentistry
department because it was incompetition with oral surgery
(30:35):
very on cross.
And I, I don't want us to be incompetition with with anybody,
I want us to just be out theregiving the best education, right
, and that's where this dentalschool, they said so let me get
this straight.
You have your residents outthere in the real world all over
the united states, notcompeting with any dental school
.
And we said, yeah, that's whatmakes it work.
(31:00):
Our residents.
We want them to spend a minimumof three days a week in the
clinic.
For that the clinic has agreedto give them a stipend of
$50,000 a year.
But we strongly suggest and theagreement is between the
(31:23):
resident- and the clint site.
What we suggest, though, as theuniversity, that if their
collections goes beyond 200 000,after lab fees are paid, then
they get 30 of their collections.
That also allows them two daysa week to go out in moonlight in
(31:48):
a practice and just make somereal money.
So we have many, many residentsthat are making 80 to 100, 150.
I have one resident who'smaking $180,000 a year, and I
got to admit now, the firstthree or four months it's kind
of a push.
You know they're new, they'rejust learning.
And then those of you that havehad associates, you know you
(32:10):
get an associate the first three, four months nobody wants to go
to them.
You know they want to see apain doctor, et cetera.
You know those kinds of thingsit's a little bit awkward, and
you know you got to get theirfeet wet, and you know security
and plan on the ground, and sothe first three, four months
it's a push.
They may not be earning theirkeep.
But then I have residentdirectors tell me that after
(32:34):
they're there, five, six, seven,eight, nine, ten months hey,
man, this is a big win for mebecause I've got someone who is
dedicated for two years, becauseso many times associates come
in.
They stay six, nine months, gettheir feet wet and they want to
go Right.
Well, here they've got atwo-year commitment to them and
then also it's an avenue forfuture partnership or buyouts
(32:59):
with them.
And I, you know, I think theassociate resident model works
well.
The university confers amaster's degree.
It is not a code approvedprogram, because implant
dentistry is not a specialty.
It's not a code approvedspecialty program.
(33:20):
But we are approved by andaccredited by sax, that's the
southern association of collegesand universities.
Um, that's where we get ouraccreditation through, so we're
able to show a master of sciencedegree in dentistry with a
certificate in comprehensiveoral implantology.
And then I'll talk aboutanother whole avenue we have
(33:42):
here in a few minutes.
Dr. Soren Paape (33:46):
Yeah, that sounds like a win-win for
everyone.
I mean, you know, I think oneof the major concerns, like you
said, are in like a dentalschool setting or like a
residency setting, is number ofreps.
Right, like you only have somany implants that need to be
placed by however many providersyou have at a single location.
(34:07):
So the fact that you guys areinstead doing it where you have
X amount of 21 clinics acrossthe US, one, that's great for
the residents because they don'tneed to move their entire
families in some situations to,like a certain university,
they're still getting theirmaster certain university,
they're still getting theirmaster's degree and they're
making an income while the youcall them the head of the clinic
(34:31):
, right?
Dr. James Rutkowski (34:32):
Like the what was it?
Dr. Soren Paape (34:33):
Yeah, resident director, the resident director.
It's kind of a win for thembecause they're essentially
getting an associate for a lowfee, right.
Dr. James Rutkowski (34:43):
So it's a hack it right, it's a hack, it
is, it's a win-win.
Dr. Soren Paape (34:47):
The residents are getting amazing reps that
they wouldn't get in a privatepractice setting.
It sounds like someone's overtheir shoulder for some of these
procedures and I could see itbeing extremely beneficial.
I agree with Tyler that ifsomething like this was around
when we were coming out ofschool, it would have been
excellent.
Instead, tyler and I spent many, many nights up until midnight
(35:10):
1 am just studying this stuff.
My background is I did a yearunder an oral surgeon and
basically we were rounding inthe hospitals until midnight
every single night just to getmy surgical reps in.
And I know Tyler took so muchCE on the weekends and he did
(35:31):
his IV course.
Like all this stuff people don'trealize Like a lot of people
will come out of school andthey'll be like, okay, I'm going
to go to these CE programs andget these reps, but what ends up
happening is life just happensright when all of a sudden,
family time, all of these thingsoccur and it just gets pushed
off and off and off and theymight never get that education
(35:54):
that they wanted to when theycame out of school.
So I see something like thisbeing extremely beneficial for
someone that's looking to getinto implants.
And another thing that I hearfrom my colleagues a lot who are
doing general dentistry theyget all these promises made by
going into offices by associates.
(36:14):
In their associate they're toldlike, hey, yeah, you're going
to get a bunch of surgery,you're going to get a bunch of
implants.
And then what ends up happeningis they go into these clinics
and the primary provider is like, well, I'm actually going to do
those implants because that'sthe moneymakers, right, and you
take these patients or theseearly cases, and a lot of times
(36:35):
they don't get that experiencethat they were promised, right.
So being able to kind ofguarantee those reps is so
powerful and it'll get like twoyears.
Dr. James Rutkowski (36:48):
In a program like this it's probably
10 years of CE that they wouldbe taking outside of the clinics
.
Our tuition when we go to thetwo-year program will be $37,500
a year.
So for two years it would be$75,000.
But if you take all of thecourses that we offer, both
didactically and in the clinicalthat it comes into with the IV
(37:10):
sedation it comes into about, ifyou went out and just did it
with CE, it would be about$135,000.
Oh yeah, plus you would havehad airline.
Yeah, I mean sedation alonecould be $15,000.
Dr. Tyler Tolbert (37:20):
Oh yeah, plus sedation alone is 25.
Yeah, pardon, I mean sedationalone can be 15, $25,000.
Just just that.
Dr. James Rutkowski (37:25):
Yeah and um the uh, so you know you don't
have airplane tickets to buy,of course.
Yeah, oh yeah.
You don't have hotel bills.
Uh, you get to come home atnight, you get to be with your
family and not away everyweekend.
When I'm like you guys, I meanI came up the CE pathway and I
(37:47):
mean a lot of weekends are great, it's expensive.
I work till 5 o'clock, 6 o'clock, get in the car, drive for four
hours, get in the hotel, staythere for Saturday and Sunday
lecture, drive home and get backhome on funny night at midnight
, 1 o'clock in the morning.
Get up the next morning, monday, and go into the office and
start working again all over andmiss that whole weekend with my
(38:10):
family.
Dr. Soren Paape (38:11):
Oh yeah, and what Tyler and I typically have
done is we have to take weeksoff of our clinics to go
overseas, right, so you spend$2,000.
Spend two, three thousanddollars on a flight overseas and
then you have a hotel there fora week and then you got to
factor in your um the cost ofclosing your clinic down for the
week, right production costsfor that week on top of a course
(38:34):
.
That's typically a lot of.
These courses are 20.
You know these like remoteanchorage courses, zygomatic
implants, you you can be payingup to 30 K uh to get you know a
week's worth of a course.
Um and, and that's a whole yearfor your guys' program, which
is excellent.
Dr. James Rutkowski (38:50):
And and and you, when you place those
implants, you never get to seedid they work or not.
Dr. Tyler Tolbert (38:55):
You're run through it.
I mean you're you, you're luckyto do.
You know a handful of cases andyou don't ever see them again.
You have no idea how theyturned out.
You know you're just seeing asnapshot of that process and
you're still, I mean, paying somuch for it.
Dr. Soren Paape (39:06):
And I think the most important thing when going
to those programs is, you know,anybody can put a screw into
bone right, like a zygomaticimplant.
I mean, the zygomatic implantsare obviously more complex than
that.
But what I'm trying to say isthe complications.
That's the difficult part andthat's the part that you should
be paying, because once thezygomatic implant's in, that's
(39:27):
one thing, but handling thecomplications after the fact,
that's the most difficult part,in my opinion.
Dr. James Rutkowski (39:33):
You're absolutely right and you've got
to be able to experienceeverything that goes with
implant dentistry if you'regoing to place implant dentistry
and you have to know how tomanage it.
And when you go and I've taughtthose courses in Mexico and
whatnot and people come down,they do them and they say, okay,
(39:55):
well, I did a science lift, nowI'm going to go back and I'm
going to do it.
Then they're reaching out to mebecause I make myself
accessible to them.
They reach out to me and theysay, hey, jimmy, and I was just
an instructor brought in, itwasn't my program, but I got
this problem.
I got this.
What do I do?
What do I do?
And they're in surgery and theyhave no idea what to do because
(40:22):
they don't have anybody lookingover the shoulder.
We're here, you've got anexperienced director who you
know you can be in there andyour epa's and trustable
professional activities is isafter you do it.
That's not just doing each 189things one time.
No, when you do it, you recordit and then you sign it and your
resident director signs it andyou're asked the question do you
feel you could go in the roomand do the next one all by
yourself?
(40:43):
And if you say yes, then youcheck, yes, then your instructor
, your director, signs it andhe's asked this can this
resident go in the room and dothe next one all by himself?
And if one of you says no, wellyou know what?
Then you do it again.
And we want a volume of work.
I don't want to see like justthe lateral windows.
(41:04):
It's not that you do onelateral window when you're done.
No, no, no.
I want you to do at least fivelateral windows with no tears of
the shinerium membrane, but Iwant at least five, five
shinerium membranes torn alsoNow.
I don't want you tearing themeventually, don't?
get me wrong.
But if you say I've done 15 andyou ever have a tear.
(41:26):
No, well then, I can't sign youoff you haven't done it Because
.
I don't know if you know how tomanage a tear.
Dr. Tyler Tolbert (41:32):
And it's not that you've got to manage one
tear, no you've got to do thisfive times.
Dr. Soren Paape (41:46):
You say, oh, oh , you know I did this and it
worked, and now I know how to doit.
I'm not gonna panic, I'm notgonna freeze.
When it does happen, you know,you know I'll say too, something
that's super beneficial, that,um, I feel like a lot of people
don't realize when they go tothe ce programs, um, and, and
you know, not not like rippingon ce either, like Like CE is
great right.
Like excellent.
But once you go like, let's say, you do a full arch course A
lot of these courses don't dothe prosthetic side of things
(42:09):
and again you can place a coupleimplants and four implants on
the top and then all of a suddenyou go to put your prosthetic
in and if you don't angle thoseimplants correctly, you can end
up with the patient for the restof their life ends up with this
prosthetic.
That's super thick, right, theywent in to get something that
was like something close totheir natural teeth and if you
(42:32):
don't place those implants, youdon't angle them correctly, you
don't know how to angle yourmulti-units, you can end up with
the prosthetic that's notfavorable for the patient.
So being able to see that, seehow to manage the prosthetic
side as well, is insane, super,super powerful.
And that's what will put youapart from other dentists when
(42:52):
you come out.
You know, when I sell treatmentto my patients, I get patients
that ask me a lot about you knowthey'll come from a general
office, a GP office, where theywere just going to refer them
out to the oral surgeon, andthen come back to the office to
get it restored and I let themknow like, hey, you know that's
that is a good way to do it, andI'm and I'm sure the oral
surgeon will place the implantscorrectly and I'm sure the
(43:13):
general dentist can restore itwell.
But what separates our clinicsfrom from those clinics is I'm
the one restoring those cases.
So I want to ensure that myimplant placement is perfect.
That way the prosthetic's niceand thin.
So I'm happy, you're happy, andI don't have to deal with a
frustrated patient after thefact.
(43:34):
Right.
Dr. Tyler Tolbert (43:35):
And another shortcoming of continuing
education too is you'd be veryhard-pressed to make a course.
You can make a course aboutmanaging complications, but it's
not going to be a live patientcourse.
How do you crowd a weekendcourse with complications of
patients Like, oh, you're havinga complication right now, well,
that's great, we have a coursehappening in a month.
Just hang on for a bit.
(43:55):
We've got to run some peoplethrough and they're going to
manage this complication.
No, courses are like that.
But in you know, a residencysituation you can do that and
it's important to be able toactually live manage those
complications.
And you know, I was doing aninterview with Jason Auerbach.
He's a bloody tooth guy onInstagram and he said, you know
and he's an oral surgeon buthe's very liberal with you know,
(44:16):
general dentists doing surgicalprocedures, so long as they
know how to manage thecomplications, says you know, as
long as you can do anything youwant, so long as you know what
to do when something goes wrong.
And you know the issue with thatis you know, if you've just
been doing continuing education,how many times have you
actually seen something go wrong?
You've probably only seen it goright and you're going to have
to run into it in the wildwithout that support and, just
(44:36):
you know, shoot from the hip anduh, that's just kind of the
reality of it.
It's like you're not going tosee these things go wrong until
you're doing them.
But in this situation you'regetting the best of both worlds.
It's happening, uh, in privatepractice, but you still have
that angel on your shoulderthat's looking over, that's
going to be able to take care ofyou when you don't know what to
do.
Um, and so to thank both of you, because we've been talking
here for roughly 50 minutes.
Dr. James Rutkowski (45:06):
And not once have we talked about
implant dentistry being aspecialty.
What we've talked about for 50minutes is making the best
educated implant dentist that wecan get Right, and I think that
means more to a patient thanwhether you have a CODA
recognized specialty from theADA.
Dr. Tyler Tolbert (45:28):
Oh, you bet.
Dr. James Rutkowski (45:30):
But that doesn't mean anything to the
patient, the only thing thatpatient wants is is this a
highly educated, highly skilled?
And has this doctor who's goingto be doing my treatment have?
They seen it all yep, you know,and that's the good, the bad
and the ugly, because I don'twant the bad and the ugly, I
want them to know and that'swhat you, the three of us, have
(45:51):
been talking about right for 50minutes.
It's just taking the besteducated implant dentist because
the three of us have been inthe field.
Oh yeah, past and current you're.
You're fighting the fire rightnow.
Every day, you see what happensif it's not done right.
Dr. Soren Paape (46:11):
Yeah, oh yeah, it's you know, tyler and I tyler
and I were clinical directorsfor a large amount of dental
offices uh, that focused onimplant dental treatments.
And I can tell you the numberone thing that kind of drove
people out of doing like we hada lot of doctors that would come
in.
You know they thought they hadwhat it took to do this and then
(46:34):
the second, they ran into somemore difficult complications.
That's really what it couldpush them out of the field
completely.
The implant field and beingable, you know, it takes a
special person to kind of do iton their own and manage those
complications on their own.
And that's kind of what Tylerand I have done.
But I'll tell you, tyler and Ihad plenty of conversations
(46:55):
early in our career.
Like man, I don't know if, likelike you know some of these
things, they're difficult todeal with and being able to kind
of like slowly work your way upand manage one complication
after another slowly, it willput you so much further in the
field because you know, one badcomplication it can really mess
(47:17):
with you know, your anxietylevels when doing these
procedures.
It can really mess with youranxiety levels when doing these
procedures and being able tohave someone there for you.
It helps out a lot when dealingwith some of these major
complications.
Dr. James Rutkowski (47:28):
Several of our EPAs are managing a
particular complication surgicalcomplications or preventing
those complications as well andprosthetic complications.
So that is, a big part of ourEPA's is just complication
management and another portionis preventing those
complications.
(47:48):
That's what it's all about.
I want our graduates to comeout and I wanted to be
successful.
I want to be able to sleep atnight.
I wanted to be able to enjoytheir families.
I don't want them to go totheir kids soccer game and not
be there.
I mean, they might bephysically there, but mentally
they're worried about thatpatient who's got that open
(48:10):
suture line and what am I goingto do now?
And all that titanium mesh isexposed and it's just one week
post-op.
What you know?
What?
What am I going to?
You know, I want our people tobe able to prevent that and if
they do get it, how they goahead and manage it.
And then they have a network,because all our residents, they
get to know each other, theybond together.
(48:32):
And so I tell them you knowwhat, these individuals, that
you are in this residencyprogram with these 26 other
people, they are going to beyour colleagues, that you're
going to rely on for the rest ofyour life and I tell them when
you have a good day, I want youto be able to call up any one of
those 26 people and you willnot be perceived as bragging,
(48:55):
but they will be happy for youbecause you had a good day.
But also, if you have a bad day, you can call them up and say,
hey, have you ever had this?
How do you manage it?
And, um, as well, as all of ourfaculty as well, they're all
very approachable.
Dr. Tyler Tolbert (49:11):
Yeah, yeah, no, that's fantastic.
And I think culture in theresidency um space is is super
important.
And you find, uh, there are alot of programs and I know
people that have dropped out ofprograms because of that issue
where they felt like it was thisvery overbearing thing and
perfection was expected andthere wasn't a whole lot of
humility and they didn't getthat sort of sense of community
out of it.
It just be two or threeresidents and they didn't really
(49:33):
feel safe coming to uh, theresidency directors or the chief
, uh resident, whoever they maybe about some complication
they're having.
And you know something we wetalk about a lot, not
necessarily in the context ofresidencies, but just in our
experience working with otherdoctors that we've trained or
been trained by is you don'twant to work in a silo in this
when you have that kind of badday.
You want to be able tocommiserate and get advice from
(49:54):
someone else who's run into thisbefore.
You don't want to be runninginto issues that you don't have
an answer for at all or can'tfind an answer for, and having
that kind of community and beingable to foster that community
in the context of a residency isan accomplishment that you know
can't really be understated oroverstated, I agree.
Dr. James Rutkowski (50:12):
I agree 100%.
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
Hello and welcome back to theFix Podcast.
Super excited for our guesttoday, dr James Rakowski.
He's on.
I got connected with himthrough Dr Todd Erickson, so
shout out to him.
He was a fan of our show, hadbeen listening to us for quite
(00:24):
some time and, uh, he wanted totell us about this uh residency
program that he was directing.
And uh, we talked a good bitabout, uh, what they were doing
over there.
And you know, there's not awhole lot of uh residencies that
when people reach out to us andthey're asking about, uh, what
kind of programs that theyshould be looking into out of
school if they're trying to getinto implants and are really
(00:46):
serious about surgery, there'snot a lot of programs that we
really point people towards, notnecessarily because there's not
good programs out there, butjust because it's hard to find
programs that are really aspecific funnel for what it is
that we do.
And as soon as I heard aboutthe kind of caseload that these
dentists are able to do, I wasreally impressed and this is
certainly a program that I'msteering people towards uh
(01:07):
myself.
So, uh, he referred me over toDr James Rakowski.
We have uh here with us today,who's going to be talking about
uh, the Jackson Jacksonvilleuniversity comprehensive uh oral
implantology residency program.
It's a bit of a mouthful, um,but that's because it's a.
It's a load of content as well,so I'm really excited to hear
about all the things that youguys are doing and hear a little
bit about your story.
(01:27):
So, dr James, thank you so muchfor coming on.
Well, thank you for the inviteand thank you for the interest
in our program.
Dr. James Rutkowski (01:34):
Of course, it's really appreciated that
there are people that want tosee to it that those that are
doing implants get the finesteducation that they possibly can
get, and that's what drives ourprogram and drives all our
residents.
Dr. Tyler Tolbert (01:51):
So thank you for having us For sure, for sure
.
So I'm hoping that you can giveus a little bit of context you
know really about yourself andyour own background in
implantology, how long you'vebeen doing it, your own training
, and just kind of walk usthrough what got you to being
the program director of the yeartoday.
Dr. James Rutkowski (02:08):
Okay, well , I started out as a pharmacist.
I graduated from DuquesneUniversity School of Pharmacy in
1972, and from there I wentdirectly into dental school,
where I graduated from theUniversity of Pittsburgh in 1976
.
And then I went into generalpractice and I immediately saw
that there was a real problemwith patients who were missing
(02:32):
teeth, particularly full arches,that lower dentures in
particular.
There was nothing that youcould do that would really make
it work.
Occasionally Maybe you get theone or two in a hundred that
just said I love my lowerdenture, but you got got 98
people who said isn't thereanything better, doc, and distal
extension, partial dentures andwhatnot.
So I started taking implantcourses from Midwest Implant
(02:55):
Institute with Dr Jack Hahn andDr Duke Kellett, as well as many
other people Lenny Linkow,those people that have gone
before us and I've been able tostand on their shoulders and see
what was possible.
They took care of a lot of theinitial issues for us.
I placed my very first implantin 1983, which we did not have
(03:17):
any kits went to the hardwarestore, got some drills, got some
.
I think they were calledosteotones.
They were really leather ballswe sterilized them, tapped them
with some foam and we put theseimplants in and I could see that
there were some real issueswith the way we were doing
things, but it was all that wehad.
(03:37):
I stayed with it, did afellowship with the Midwest
Implant Institute as well asother courses, got very active
in the American Academy ofImplant Dentistry.
The AAID Continued on, got myassociate fellowship, my
fellowship with the AAID andthen my diplomate status with
the American Board of OralImplantology and Implant
Dentistry.
Was doing a lot of bonegrafting.
(04:00):
I was one of the earliestadopters of implant dentistry in
Pennsylvania, in westernPennsylvania, where I practiced.
I moved to a small town becausethat's where my wife and I
wanted to raise our children.
And so there I was.
I was in central Pennsylvaniain a small town and wanted to do
implants and people said you'llnever do them here.
But lo and behold, there werepeople there that needed
(04:22):
implants.
But lo and behold, there werepeople there that needed
implants and we started doingthem and we traveled and we
built a practice that was veryheavy into dental implants.
I was doing a lot of bonegrafting.
I realized that we had a lot ofdeficiencies with bone grafting
and my wife and I became emptynesters.
Our kids were out of college,so I decided I would go back to
(04:47):
school.
I always had a strong interestin pharmacology and to me
everything that we do ispharmacology, whether it's
signaling of bone cells to goahead and start osseointegration
or de novo bone formation force.
So I went back to duquesneuniversity.
I kept my my practice threedays a week but I went back to
get a PhD in pharmacology at 51.
(05:08):
I finished that seven yearslater, when I was 58.
I put a research laboratory inmy office.
I actually hired technicians tohelp do that research.
I had to know how all theresearch was being done because
I had to do my defense.
But actually doing it, um, Ihad people up that would be
working with all the cells anddoing all the things for it and
(05:30):
whatnot.
And so at 58 I graduated with myphd and, uh, started with some
of those things into practice inthe clinical practice, opened
up a research company called theclararing research group.
We developed a small molecularcompound, small molecule, that
synthetic that shortens thesigma for bone formation from 16
(05:53):
weeks down to about 10 to 12weeks predictably, and started
to work with some people inorthopedics and our products
started to be used in spinalfusion on a research capacity
clinical research as well asdentistry and also took a strong
interest in postmenopausalwomen and the issues they have
(06:16):
with bone formation and theirestrogen levels, and so we did a
lot of research with that, withthe research company and
Salivary Diagnostics for thesepeople, these individuals.
So it's been a great ride.
I continued to practice until Iwas 70, although, I must admit,
beyond the age of 60, it wasonly two and a half, three days
(06:38):
a week, because I was involvedin the research the rest of the
time and I left clinicalpractice in July of 2020 and I
was doing just fine with all thethings that I was doing.
I was doing CE lecturing, withmaxi courses as well as other
invites, and was enjoying life.
(06:59):
And then the JacksonvilleUniversity program.
They reached out to me andasked me if I'd become director
and I said initially, I said no,that's okay, everything's fine,
thank you for thinking of me.
And they came back in about amonth and they said well, you're
going to do it.
And I said well, actually Ithought I answered that question
(07:20):
.
And they said well, we'll giveyou another month.
And I said well, I don't thinkit's going to change.
And then the dean called me andhe and I hit it off we, we hit
it off and my, my wife, couldoverhear the phone conversation
and she said to me she said well, how did that phone
(07:40):
conversation go?
Remember, you're retired now.
You don't do everything.
And I said yeah, but I'll tellyou what I think we can make
something happen, and so I saidsure, and I'm glad that I did.
It's kind of like when you goto the dog pound and they hand
you the puppy.
Once they hand you the puppy,you can't give it back.
(08:04):
You're going to take it home,and that's exactly what happened
with this program.
I'm very energized by ourresidents.
They are outstandingindividuals, they are dedicated,
they want to do the very bestthey can, and that's what drives
the entire program.
Let's just make the besteducated implant dentist,
(08:24):
because implant dentistry is socomplex, whether it be the
surgical component of it, thebone grafting component of it,
just taking the tooth out how dowe get the tooth out?
What we're going to do to growthe bone, put the implant and
that old excuse why put the, theimplant where the bone was?
Yeah, that worked in 1988.
It does not work in 2025, though, and so we know a lot more now
(08:48):
than we did in the 80s and 90s,whether it be implant services,
thread design, treatmentplanning, methods of treating
prosthetics, everything atpharmacology, medical evaluation
.
All these patients come in,they are in their 70s, 80s and
90s, they have a long list ofpathologies and a long list of
(09:12):
medications, and all thosethings do affect the results for
us.
So we've just put together aprogram where we get to be able
to bring everything together tohelp these young doctors and
middle-aged doctors.
I'm surprised at how manymiddle-aged people we have
coming into the program.
Dr. Tyler Tolbert (09:27):
Wow, wow, yeah, that is a quite the
illustrious career and I reallycommend you for your commitment
to education and and taking onall the things that you took on.
I mean having a doctorate inpharmacology, in addition to all
the things and yourcontributions to implant
dentistry and the research andeverything.
I just it doesn't seem likeyou've had enough time to do all
(09:47):
the things that you've done.
So I really commend you for allthat and also praise you for
continuing to recommit yourselfto a whole new thing into your
70s.
So that's, that's reallyfantastic and there's there's a
lot of different avenues we cango down and I'm also very
curious too, and we cancertainly get into this.
You know, aside from talkingabout the residency itself, is
you know?
You kind of already alluded toit is you know the?
(10:13):
I think your pharmacologydegree has only become more
useful over time becausepolypharmacy and what we do is
more common than ever before.
I mean, I've had a patient Isent it to Dr Poppy as well that
had literally just 20 pages ofprescriptions and I said you
know, I'm going to look throughhere and see about the things
that I know about.
There are going to becontraindications, but as far as
how all this works together asa system, I couldn't tell you,
(10:34):
so I'm sure that's certainlycome in handy for you.
But yeah, soren, did you haveanything to glean from all that?
That's quite a repertoire.
Dr. Soren Paape (10:42):
I mean, I just I really appreciate the fact
that you know, we we as asyounger dentists in the
profession of implants, you know, benefit greatly from, from
people like you who contributeto the research and, like you
said, like the advancements ingrafting and techniques like
that.
You know, I feel like Tyler andI have come into the into the
(11:04):
implant game while, whilethere's so many things that have
improved before us, um, andit's, it's allowed our job to be
that much easier, when, notthat it's an easy job, but you
know from, from where you wereat in the eighties to where
we're at now, uh, it's we'vecome into the profession at such
a good time where there's a lotof advancements in these
(11:24):
techniques and we're able toprovide treatment for patients
that they weren't able to getbefore, and we're not going to
the hardware store for ourinstruments anymore.
Dr. Tyler Tolbert (11:33):
Yeah, absolutely.
Dr. Soren Paape (11:36):
I would love to hear more and I'm sure our
listeners would love to hearmore specifically about the
residency kind of like timelengths of it.
I know you were talking alittle bit about it prior to the
episode starting so just whatthe residency is, how it differs
from other residencies, whatpeople in the residency can kind
(11:57):
of get out of it, and I thinkthat would be excellent for our
listeners.
Dr. James Rutkowski (12:02):
I think that would be excellent for our
listeners.
Okay, Well, great, let's juststart how our residency differs
from the other residencyprograms that are out there,
whether it be oral surgery, perior cross, that do have an
implant component to it.
Those residency programs, ifit's the oral surgery, then they
are looking at it from asurgical aspect.
(12:23):
That's where they put theiremphasis on it and they do place
a reasonable number of implantsin their residency programs.
Typical six year residency inoral surgery they may place 70
to 100 implants, of which theydon't restore any of them.
Okay, so they put them in andthen they never get to see what
(12:47):
do they look like, necessarily.
Or maybe they do get onepost-op when they do see that
the actual prosthesis in place,but they're not there and seeing
.
Well, you know where, theircomplications and whatnot.
Perio, and they contribute allthese perioprocess oral surgery.
They contribute a great deal toimplant dentistry and they
(13:08):
certainly have a place inimplant dentistry.
But so do general practitioners, okay, Because implant
dentistry is oral surgery,perioprocess and a big component
of general dentistry.
So in perio, you know theyfocus on, you know the soft
tissue, the aesthetics.
They know the literatureextremely well.
They've contributed to thevolume of literature greatly.
(13:29):
Who knows prosthetics betterthan a prosthodontist?
Absolutely nobody.
They know their literature andwhatnot but they don't
necessarily get to do all thesurgical placement.
Where our program bringseverything in implant dentistry
together is the diagnosis, it isthe evaluation of the patient,
it is the treatment plan, it isgetting acceptance of the
(13:52):
treatment plan, it is thesurgical placement of the
prosthesis or, excuse me, of theimplants.
It is the managing surgicalcomplications, most immediate
and maybe long-term, and how youprevent all of those.
Then our program, also ourresidents, not only did they
(14:13):
place those implants, but nowthey restore those implants and
so then they deal with theprosthetic planning.
And that had to be all donebefore they ever started the
case, obviously.
But they deal with thatprosthetic planning at the
beginning and then doing thatprosthesis for them, then
maintenance, that prosthesiswhat kind of complications were
(14:36):
there, you know?
Does the patient come back andsay you know, I really can't get
my floss threader in there,which you know that didn't,
wasn't necessarily a concern ofthe oms, you know.
Well, you got to see theprosthetist for that, you know.
And the prosthetist goes well,you know, that's where you put
the implant and that's they'retoo close together, that's the
best I can do.
So then there gets to be thisfinger pointing where ours, the
(14:58):
program, is.
They do it all start to finish.
They do reach out and rely onthe other dental specialties
though when they feel that it isnecessary.
So this isn't it's all us andjust us.
No, we believe that implantdentistry involves everybody.
It's just that we're trying toeducate a dentist who can take
(15:18):
the case from start to finish,either themselves or in
conjunction with others, so theymake it all work together.
Then in our residency program,they also follow these patients
afterwards so they see what itlooks like in six months and a
year.
Another big difference to ourresidency programs is it occurs
(15:40):
in the real world.
It occurs in clinical practices.
Across the United States Rightnow we have 21 different
clinical sites where we have atotal of 27 different residents.
Some of the programs have morethan one resident, but they are
in the real world.
Now, that real world may beprivate practices where you, you
(16:02):
know, they hear about thepatient saying something about
well, you know, I, I don't likethe price, I don't like the fee,
or, you know, when it's alldone, I don't like the shade or
I don't like this, and that werethat if you are in a dental
school or a hospital you don'tnecessarily get to hear all
those things, because there is abilling department that takes
(16:23):
care of all that billing.
There is a department head thathas to put up with that.
Somebody is unhappy, there arecomplaints about the end result
and so you know you've got adepartment head or a dean who's
taking care of all those thingsand you're not necessarily we're
here.
You are the one that's involvedwith this patient.
You have a resident directorthat works with you and
(16:51):
supervises you.
They are people that are wellexperienced in implant dentistry
.
Whether they are oral surgeons,periopros or diplomates of the
ABOI or diplomates of the ICOI,individuals will have a great
deal of experience that cansupervise these residents as
they go through their programwith it.
So our program is, I think, themost well.
(17:11):
I don't think I know.
It is the most comprehensive.
And not only is itcomprehensive clinically but
then didactically.
We go into great deep dives inevery single topic.
I know there's topics that incontinuing education they may
get an hour lecture on it or afour-hour lecture on it, where
(17:35):
in our program that mayrepresent a six or eight-week
didactic lecture that they areactually evaluated, assessed on,
because there are homeworkassignments, there are quizzes
and tests that they have to take, final examinations, there are
papers that they have to write.
So there is an assessment,there are assessment tools in
(17:57):
place where in the CE world youdon't necessarily get that place
, where in the CE world youdon't necessarily get that.
And now you asked me severalquestions there, dr Poppy, and I
think I only got through thefirst one.
Dr. Soren Paape (18:10):
I don't remember all the others no, and
I actually have a couple ofquestions now, after you said it
.
I think the others were numberof residents, which I think you
answered you said 27, correct?
And then I asked length of theprogram, and then I wanted you
to elaborate a little bit on.
You talked about how you getyour master's in the program,
(18:31):
but I don't think you discussedthat just now.
So a couple of those detailswould be great, great.
Dr. James Rutkowski (18:36):
Well, the program currently has 27
residents, of which we'll begraduating our first cohort at
the end of April.
That first cohort only had fiveresidents, so that'll give us
22.
But as of December 31st we have16 residents who have been
(18:57):
accepted and are into theprogram.
They are matched with theirsites but but we probably have
another five or 10 that will becoming in.
So this incoming class will bea minimum of 16, but probably
more.
So that would take us to 38residents and we might actually
end up with 40, 45 residentsgoing forward.
(19:20):
The program is currently athree-year program but we have
made petition to the universityand the university is very much
in favor of it is to reduce theprogram from three years to two
years.
When I took over the program atthe end of its first year, I
took a hard look at thatcurriculum and I said, ken, is
there anything I can streamlinehere?
It's still deep dives intoeverything.
(19:42):
It's just I'm making the bestuse of everybody's time and the
university is very much in favorof it.
So I full well expect that theprogram will be a two-year
program and those that came inin cohort three in July of 24,
they came in on the three-yearprogram but they are going to
(20:04):
morph into the two-year program.
It's the second and third yearthat got combined.
The first year stayed prettymuch the same.
Second and third year gotcombined so we'll have two
classes of three years and thenthe third year, cohort three and
cohort four.
They will be two year programs.
They are year-round programs.
(20:26):
It's on a tri-semester and theydo their clinical work in the
clinic.
We want them to be in theclinic eight to ten hours a day,
a minimum of three days a week.
They do their didactic portionMonday through Thursday, 8 to 9
(20:47):
30 pm Eastern time.
It is done virtually All thelectures are reported so they
can do it asynchronously.
So if somebody cannot make alecture on a Tuesday night
because a lot of our doctorsthey have families or they're
starting their families orthey're out looking to make a
(21:09):
family, they've got a date onTuesday night and they can't
make it, they can binge watchover the weekend, get caught up
on all their homework.
The homework assignments areusually due two weeks after the
presentations.
There are reading assignments.
We encourage them to attend asmany lectures as they possibly
(21:31):
can.
Some lectures they must attendbecause they have to do
presentations to and whatnot,but for the most part they get
to do it asynchronously, whichthat certainly helps, but that
is a full-time program.
They get to do itasynchronously, which that
certainly helps, but that is afull-time program.
The clinical portion of theprogram is based on entrusted
(21:51):
professional activities, epas,entrustable professional
activities, and they start outwith the simpler things, or the
things where you would start,where it is onboarding a new
patient, an examination, medicalevaluation, pharmacological
evaluation, dental evaluation,presenting the case to the
patient, the treatment plan,getting acceptance of the
(22:11):
treatment plan so that's one epagetting informed consent and
doing all that.
That's one epa.
Then other epas they may start,start out with a single implant
in the non-aesthetic zone, nografting necessary.
Then maybe in an immediateimplant in the non-aesthetic
zone, then maybe a singleimplant in the posterior maxilla
(22:36):
, where you do have to do asinus intervention, whether it
be a crest or a lateral windowapproach and then posterior
mandible etc.
Full arch treatments, the setzone, multiple implants in the
set zone, fp1s, twos, threes,rp3s, fours, five so you know
I'm the awful party fours andfives, so the whole spectrum of
(22:59):
it.
They do an IV conscious sedationprogram that lasts about seven
months.
Now that they do have to go toDayton Ohio, for they have about
six visits to Dayton Ohio forthat IV conscious sedation
program, but they do get theirIV sedation permit.
It is the most rigorous IVsedation program in the country.
It's accepted in all 50 states.
(23:21):
Some IV sedation programs arenot accepted in some of the
states.
Ours is um dr steveshuffleberger, who many people
already know uh, is theinstructor for that program and
it is a very rigorous program.
Um.
So these epas, they they gofrom those basic things to where
(23:42):
they then the full arches aswell as zygomatic implants,
pterygoid implants, and if theclinic they're in does not
necessarily perform some ofthose procedures, then they will
rotate through other clinicswhere they may or may not be
able to get to do thoseprocedures in those clinics
because they may not have alicense for that state, but they
(24:02):
will at least assist in them.
Then they will write a paper onthat and then they will sit
with for an oral examinationfrom me to assure that they
really do have a goodunderstanding of all of those
procedures.
Um number of implants, I justtalked with one of our residents
who in his first two years andone semester has placed well
(24:30):
over 600 implants, has currentlyrestored 90% of them and has
done 60 full arches.
Dr. Soren Paape (24:40):
That's excellent.
Yeah, that is a very robusteducation yeah, plants well, I'm
surprised you guys.
You guys are even doing remoteanchorage, like zygomatics and
and pterygoids.
That's, that's very cool.
Um, so do you guys haveclinical suites where, like so,
each resident is in like adifferent clinic and then
(25:02):
they're?
How does that work exactly?
Dr. James Rutkowski (25:04):
right, yeah, so, um, we have.
We have these 21 clinics allover the united states and, uh,
some of them are just privatepractices.
Uh, others are, uh, 501cnon-profit clinics where
patients go there and they gettheir implants done at a reduced
fee.
But even in the privatepractices, many times those
(25:27):
practices.
They will have their standardfee and then a patient may say
gee, I can't bite off that much.
Is there an alternative?
And instead of giving maybe aninferior implant alternative?
they say well, we do haveanother treatment method for you
, where we have a resident fromJacksonville University who,
instead of assisting me in thiscase and they have done these
(25:50):
cases they've assisted.
You know, this is the directorspeaking.
My resident will do the caseand it might be at a 50% to 75%
of the normal feet, so thatentices patients to stay with it
.
We have many manufacturers whowe have partnered with who give
substantial discounts to theclinics for the cases that the
(26:14):
resident is doing.
So they get the benefit ofpaying less for the implants,
less for the bone graftmaterials, less for the
membranes, barriers, the wholenine yards, the digital hardware
, the digital software thatneeds to be had.
We have companies that givediscounts for every single thing
(26:36):
that is done in implantdentistry and that entices these
private practices to say youknow what I can bring in.
We call them associateresidents, where they are to do
whatever an associate does inthat practice.
That means a re-exam, a newpatient exam, take care of an
emergency, you know, and if itis a non just 100% implant
(27:07):
practice, they might have to sitdown and do a composite
restoration.
They might be doing an occlusalor a do on number 15 that's
sadistic.
Now, I personally think that'sharder than doing some implants,
oh it is oh yeah, it'd be anightmare, but they have to be
contributing to that practiceand you know what I that
practice and you know what Itell all my residents.
you know what, if an assistantcalls in sick that day or they
have a sick child and they can'tcome into work that day and
(27:30):
they need someone to help seekpatients, help scrub instruments
, help clean rooms, guess what?
And even though I practiced for44 years and I was seven years
old when I quit you know what?
If we were short-handed, Ipitched in and did it.
Dr. Tyler Tolbert (27:45):
Yeah, that's right.
Oh yeah, that's awesome, ahundred percent.
You know we we get asked allthe time about.
You know the decision pointbetween do I go into a residency
after school or do I just gostraight into private practice.
And just you know, take a beton taking a bunch of CE and
because you know you're inprivate practice, you're making
private practice money, you canpay for the CE.
(28:05):
You're doing these weekendcourses, the week courses and
things like that.
And I think it's always a, it'sa calculus of, well, how much
are you learning over a givenamount of time and you know how
much are you progressing andwhat are going to be the returns
over time for how much you'velearned in that given amount of
time.
Right, and I think the case iswith so many residencies is they
might be two, three yearprograms and you know you might
(28:26):
come out having placed 15, 20implants and it's like, well,
you've spent a long timelearning a bunch of stuff
didactically speaking, but interms of reps, you didn't really
get a ton of reps during thattime and so there's not as much
of a return on investment butwhat you just described in terms
of what these residents aredoing in a private practice
environment and in the breadthof skills that they're learning
(28:49):
and coming into contact with,all the way up to remote
Anchorage, getting their IVconscious sedation, which is,
you know, a pain to do whileyou're trying to balance, you
know, running a business or whathave you?
Going through all thesedifferent competenciesencies and
getting that kind of volume.
I mean that is a two yearsincredibly well spent.
That is going to, you know,have a absolutely massive return
(29:10):
for all of your residents forthe rest of their careers and
that's really an accelerant, inmy opinion, and I wish this kind
of thing were around when I wascoming out of school, because
in the fact that you guys makethis available to general
practitioners is just a it'sit's a career hack and I'm
really, really impressed withyou guys have put together and I
love the private practicecomponent of that.
That's not something I wasactually aware of before we got
on here.
Dr. James Rutkowski (29:31):
Yeah, that and and you know, I I have had
discussions with a couple ofdental schools, a couple, of
prosthetic residency programs,some AEGD residency programs,
where they say is there some waythat we can partner with you or
just how are you doing this?
I mean, I had one dental schoolrecently where they actually
(29:51):
closed their implant dentistrydepartment because there was a
conflict, internal conflict,between oral surgery, perio and
pros at this school and implantdentistry.
Because the patients werecoming for implants and said,
well, yeah, I'll go to theimplant dentistry, I'll go to
implant dentistry.
So all the patients that neededimplants were going to implant
(30:14):
dentistry.
They weren't thinking, you know, I'll go to oral surgery, pros
or perio, and they were beingdirected internally in the
dental school to the implantdentistry department because
they needed implants and thatcreated an issue within the
school and so they hadto close the implant dentistry
department because it was incompetition with oral surgery
(30:35):
very on cross.
And I, I don't want us to be incompetition with with anybody,
I want us to just be out theregiving the best education, right
, and that's where this dentalschool, they said so let me get
this straight.
You have your residents outthere in the real world all over
the united states, notcompeting with any dental school
.
And we said, yeah, that's whatmakes it work.
(31:00):
Our residents.
We want them to spend a minimumof three days a week in the
clinic.
For that the clinic has agreedto give them a stipend of
$50,000 a year.
But we strongly suggest and theagreement is between the
(31:23):
resident- and the clint site.
What we suggest, though, as theuniversity, that if their
collections goes beyond 200 000,after lab fees are paid, then
they get 30 of their collections.
That also allows them two daysa week to go out in moonlight in
(31:48):
a practice and just make somereal money.
So we have many, many residentsthat are making 80 to 100, 150.
I have one resident who'smaking $180,000 a year, and I
got to admit now, the firstthree or four months it's kind
of a push.
You know they're new, they'rejust learning.
And then those of you that havehad associates, you know you
(32:10):
get an associate the first three, four months nobody wants to go
to them.
You know they want to see apain doctor, et cetera.
You know those kinds of thingsit's a little bit awkward, and
you know you got to get theirfeet wet, and you know security
and plan on the ground, and sothe first three, four months
it's a push.
They may not be earning theirkeep.
But then I have residentdirectors tell me that after
(32:34):
they're there, five, six, seven,eight, nine, ten months hey,
man, this is a big win for mebecause I've got someone who is
dedicated for two years, becauseso many times associates come
in.
They stay six, nine months, gettheir feet wet and they want to
go Right.
Well, here they've got atwo-year commitment to them and
then also it's an avenue forfuture partnership or buyouts
(32:59):
with them.
And I, you know, I think theassociate resident model works
well.
The university confers amaster's degree.
It is not a code approvedprogram, because implant
dentistry is not a specialty.
It's not a code approvedspecialty program.
(33:20):
But we are approved by andaccredited by sax, that's the
southern association of collegesand universities.
Um, that's where we get ouraccreditation through, so we're
able to show a master of sciencedegree in dentistry with a
certificate in comprehensiveoral implantology.
And then I'll talk aboutanother whole avenue we have
(33:42):
here in a few minutes.
Dr. Soren Paape (33:46):
Yeah, that sounds like a win-win for
everyone.
I mean, you know, I think oneof the major concerns, like you
said, are in like a dentalschool setting or like a
residency setting, is number ofreps.
Right, like you only have somany implants that need to be
placed by however many providersyou have at a single location.
(34:07):
So the fact that you guys areinstead doing it where you have
X amount of 21 clinics acrossthe US, one, that's great for
the residents because they don'tneed to move their entire
families in some situations to,like a certain university,
they're still getting theirmaster certain university,
they're still getting theirmaster's degree and they're
making an income while the youcall them the head of the clinic
(34:31):
, right?
Dr. James Rutkowski (34:32):
Like the what was it?
Dr. Soren Paape (34:33):
Yeah, resident director, the resident director.
It's kind of a win for thembecause they're essentially
getting an associate for a lowfee, right.
Dr. James Rutkowski (34:43):
So it's a hack it right, it's a hack, it
is, it's a win-win.
Dr. Soren Paape (34:47):
The residents are getting amazing reps that
they wouldn't get in a privatepractice setting.
It sounds like someone's overtheir shoulder for some of these
procedures and I could see itbeing extremely beneficial.
I agree with Tyler that ifsomething like this was around
when we were coming out ofschool, it would have been
excellent.
Instead, tyler and I spent many, many nights up until midnight
(35:10):
1 am just studying this stuff.
My background is I did a yearunder an oral surgeon and
basically we were rounding inthe hospitals until midnight
every single night just to getmy surgical reps in.
And I know Tyler took so muchCE on the weekends and he did
(35:31):
his IV course.
Like all this stuff people don'trealize Like a lot of people
will come out of school andthey'll be like, okay, I'm going
to go to these CE programs andget these reps, but what ends up
happening is life just happensright when all of a sudden,
family time, all of these thingsoccur and it just gets pushed
off and off and off and theymight never get that education
(35:54):
that they wanted to when theycame out of school.
So I see something like thisbeing extremely beneficial for
someone that's looking to getinto implants.
And another thing that I hearfrom my colleagues a lot who are
doing general dentistry theyget all these promises made by
going into offices by associates.
(36:14):
In their associate they're toldlike, hey, yeah, you're going
to get a bunch of surgery,you're going to get a bunch of
implants.
And then what ends up happeningis they go into these clinics
and the primary provider is like, well, I'm actually going to do
those implants because that'sthe moneymakers, right, and you
take these patients or theseearly cases, and a lot of times
(36:35):
they don't get that experiencethat they were promised, right.
So being able to kind ofguarantee those reps is so
powerful and it'll get like twoyears.
Dr. James Rutkowski (36:48):
In a program like this it's probably
10 years of CE that they wouldbe taking outside of the clinics
.
Our tuition when we go to thetwo-year program will be $37,500
a year.
So for two years it would be$75,000.
But if you take all of thecourses that we offer, both
didactically and in the clinicalthat it comes into with the IV
(37:10):
sedation it comes into about, ifyou went out and just did it
with CE, it would be about$135,000.
Oh yeah, plus you would havehad airline.
Yeah, I mean sedation alonecould be $15,000.
Dr. Tyler Tolbert (37:20):
Oh yeah, plus sedation alone is 25.
Yeah, pardon, I mean sedationalone can be 15, $25,000.
Just just that.
Dr. James Rutkowski (37:25):
Yeah and um the uh, so you know you don't
have airplane tickets to buy,of course.
Yeah, oh yeah.
You don't have hotel bills.
Uh, you get to come home atnight, you get to be with your
family and not away everyweekend.
When I'm like you guys, I meanI came up the CE pathway and I
(37:47):
mean a lot of weekends are great, it's expensive.
I work till 5 o'clock, 6 o'clock, get in the car, drive for four
hours, get in the hotel, staythere for Saturday and Sunday
lecture, drive home and get backhome on funny night at midnight
, 1 o'clock in the morning.
Get up the next morning, monday, and go into the office and
start working again all over andmiss that whole weekend with my
(38:10):
family.
Dr. Soren Paape (38:11):
Oh yeah, and what Tyler and I typically have
done is we have to take weeksoff of our clinics to go
overseas, right, so you spend$2,000.
Spend two, three thousanddollars on a flight overseas and
then you have a hotel there fora week and then you got to
factor in your um the cost ofclosing your clinic down for the
week, right production costsfor that week on top of a course
(38:34):
.
That's typically a lot of.
These courses are 20.
You know these like remoteanchorage courses, zygomatic
implants, you you can be payingup to 30 K uh to get you know a
week's worth of a course.
Um and, and that's a whole yearfor your guys' program, which
is excellent.
Dr. James Rutkowski (38:50):
And and and you, when you place those
implants, you never get to seedid they work or not.
Dr. Tyler Tolbert (38:55):
You're run through it.
I mean you're you, you're luckyto do.
You know a handful of cases andyou don't ever see them again.
You have no idea how theyturned out.
You know you're just seeing asnapshot of that process and
you're still, I mean, paying somuch for it.
Dr. Soren Paape (39:06):
And I think the most important thing when going
to those programs is, you know,anybody can put a screw into
bone right, like a zygomaticimplant.
I mean, the zygomatic implantsare obviously more complex than
that.
But what I'm trying to say isthe complications.
That's the difficult part andthat's the part that you should
be paying, because once thezygomatic implant's in, that's
(39:27):
one thing, but handling thecomplications after the fact,
that's the most difficult part,in my opinion.
Dr. James Rutkowski (39:33):
You're absolutely right and you've got
to be able to experienceeverything that goes with
implant dentistry if you'regoing to place implant dentistry
and you have to know how tomanage it.
And when you go and I've taughtthose courses in Mexico and
whatnot and people come down,they do them and they say, okay,
(39:55):
well, I did a science lift, nowI'm going to go back and I'm
going to do it.
Then they're reaching out to mebecause I make myself
accessible to them.
They reach out to me and theysay, hey, jimmy, and I was just
an instructor brought in, itwasn't my program, but I got
this problem.
I got this.
What do I do?
What do I do?
And they're in surgery and theyhave no idea what to do because
(40:22):
they don't have anybody lookingover the shoulder.
We're here, you've got anexperienced director who you
know you can be in there andyour epa's and trustable
professional activities is isafter you do it.
That's not just doing each 189things one time.
No, when you do it, you recordit and then you sign it and your
resident director signs it andyou're asked the question do you
feel you could go in the roomand do the next one all by
yourself?
(40:43):
And if you say yes, then youcheck, yes, then your instructor
, your director, signs it andhe's asked this can this
resident go in the room and dothe next one all by himself?
And if one of you says no, wellyou know what?
Then you do it again.
And we want a volume of work.
I don't want to see like justthe lateral windows.
(41:04):
It's not that you do onelateral window when you're done.
No, no, no.
I want you to do at least fivelateral windows with no tears of
the shinerium membrane, but Iwant at least five, five
shinerium membranes torn alsoNow.
I don't want you tearing themeventually, don't?
get me wrong.
But if you say I've done 15 andyou ever have a tear.
(41:26):
No, well then, I can't sign youoff you haven't done it Because
.
I don't know if you know how tomanage a tear.
Dr. Tyler Tolbert (41:32):
And it's not that you've got to manage one
tear, no you've got to do thisfive times.
Dr. Soren Paape (41:46):
You say, oh, oh , you know I did this and it
worked, and now I know how to doit.
I'm not gonna panic, I'm notgonna freeze.
When it does happen, you know,you know I'll say too, something
that's super beneficial, that,um, I feel like a lot of people
don't realize when they go tothe ce programs, um, and, and
you know, not not like rippingon ce either, like Like CE is
great right.
Like excellent.
But once you go like, let's say, you do a full arch course A
lot of these courses don't dothe prosthetic side of things
(42:09):
and again you can place a coupleimplants and four implants on
the top and then all of a suddenyou go to put your prosthetic
in and if you don't angle thoseimplants correctly, you can end
up with the patient for the restof their life ends up with this
prosthetic.
That's super thick, right, theywent in to get something that
was like something close totheir natural teeth and if you
(42:32):
don't place those implants, youdon't angle them correctly, you
don't know how to angle yourmulti-units, you can end up with
the prosthetic that's notfavorable for the patient.
So being able to see that, seehow to manage the prosthetic
side as well, is insane, super,super powerful.
And that's what will put youapart from other dentists when
(42:52):
you come out.
You know, when I sell treatmentto my patients, I get patients
that ask me a lot about you knowthey'll come from a general
office, a GP office, where theywere just going to refer them
out to the oral surgeon, andthen come back to the office to
get it restored and I let themknow like, hey, you know that's
that is a good way to do it, andI'm and I'm sure the oral
surgeon will place the implantscorrectly and I'm sure the
(43:13):
general dentist can restore itwell.
But what separates our clinicsfrom from those clinics is I'm
the one restoring those cases.
So I want to ensure that myimplant placement is perfect.
That way the prosthetic's niceand thin.
So I'm happy, you're happy, andI don't have to deal with a
frustrated patient after thefact.
(43:34):
Right.
Dr. Tyler Tolbert (43:35):
And another shortcoming of continuing
education too is you'd be veryhard-pressed to make a course.
You can make a course aboutmanaging complications, but it's
not going to be a live patientcourse.
How do you crowd a weekendcourse with complications of
patients Like, oh, you're havinga complication right now, well,
that's great, we have a coursehappening in a month.
Just hang on for a bit.
(43:55):
We've got to run some peoplethrough and they're going to
manage this complication.
No, courses are like that.
But in you know, a residencysituation you can do that and
it's important to be able toactually live manage those
complications.
And you know, I was doing aninterview with Jason Auerbach.
He's a bloody tooth guy onInstagram and he said, you know
and he's an oral surgeon buthe's very liberal with you know,
(44:16):
general dentists doing surgicalprocedures, so long as they
know how to manage thecomplications, says you know, as
long as you can do anything youwant, so long as you know what
to do when something goes wrong.
And you know the issue with thatis you know, if you've just
been doing continuing education,how many times have you
actually seen something go wrong?
You've probably only seen it goright and you're going to have
to run into it in the wildwithout that support and, just
(44:36):
you know, shoot from the hip anduh, that's just kind of the
reality of it.
It's like you're not going tosee these things go wrong until
you're doing them.
But in this situation you'regetting the best of both worlds.
It's happening, uh, in privatepractice, but you still have
that angel on your shoulderthat's looking over, that's
going to be able to take care ofyou when you don't know what to
do.
Um, and so to thank both of you, because we've been talking
here for roughly 50 minutes.
Dr. James Rutkowski (45:06):
And not once have we talked about
implant dentistry being aspecialty.
What we've talked about for 50minutes is making the best
educated implant dentist that wecan get Right, and I think that
means more to a patient thanwhether you have a CODA
recognized specialty from theADA.
Dr. Tyler Tolbert (45:28):
Oh, you bet.
Dr. James Rutkowski (45:30):
But that doesn't mean anything to the
patient, the only thing thatpatient wants is is this a
highly educated, highly skilled?
And has this doctor who's goingto be doing my treatment have?
They seen it all yep, you know,and that's the good, the bad
and the ugly, because I don'twant the bad and the ugly, I
want them to know and that'swhat you, the three of us, have
(45:51):
been talking about right for 50minutes.
It's just taking the besteducated implant dentist because
the three of us have been inthe field.
Oh yeah, past and current you're.
You're fighting the fire rightnow.
Every day, you see what happensif it's not done right.
Dr. Soren Paape (46:11):
Yeah, oh yeah, it's you know, tyler and I tyler
and I were clinical directorsfor a large amount of dental
offices uh, that focused onimplant dental treatments.
And I can tell you the numberone thing that kind of drove
people out of doing like we hada lot of doctors that would come
in.
You know they thought they hadwhat it took to do this and then
(46:34):
the second, they ran into somemore difficult complications.
That's really what it couldpush them out of the field
completely.
The implant field and beingable, you know, it takes a
special person to kind of do iton their own and manage those
complications on their own.
And that's kind of what Tylerand I have done.
But I'll tell you, tyler and Ihad plenty of conversations
(46:55):
early in our career.
Like man, I don't know if, likelike you know some of these
things, they're difficult todeal with and being able to kind
of like slowly work your way upand manage one complication
after another slowly, it willput you so much further in the
field because you know, one badcomplication it can really mess
(47:17):
with you know, your anxietylevels when doing these
procedures.
It can really mess with youranxiety levels when doing these
procedures and being able tohave someone there for you.
It helps out a lot when dealingwith some of these major
complications.
Dr. James Rutkowski (47:28):
Several of our EPAs are managing a
particular complication surgicalcomplications or preventing
those complications as well andprosthetic complications.
So that is, a big part of ourEPA's is just complication
management and another portionis preventing those
complications.
(47:48):
That's what it's all about.
I want our graduates to comeout and I wanted to be
successful.
I want to be able to sleep atnight.
I wanted to be able to enjoytheir families.
I don't want them to go totheir kids soccer game and not
be there.
I mean, they might bephysically there, but mentally
they're worried about thatpatient who's got that open
(48:10):
suture line and what am I goingto do now?
And all that titanium mesh isexposed and it's just one week
post-op.
What you know?
What?
What am I going to?
You know, I want our people tobe able to prevent that and if
they do get it, how they goahead and manage it.
And then they have a network,because all our residents, they
get to know each other, theybond together.
(48:32):
And so I tell them you knowwhat, these individuals, that
you are in this residencyprogram with these 26 other
people, they are going to beyour colleagues, that you're
going to rely on for the rest ofyour life and I tell them when
you have a good day, I want youto be able to call up any one of
those 26 people and you willnot be perceived as bragging,
(48:55):
but they will be happy for youbecause you had a good day.
But also, if you have a bad day, you can call them up and say,
hey, have you ever had this?
How do you manage it?
And, um, as well, as all of ourfaculty as well, they're all
very approachable.
Dr. Tyler Tolbert (49:11):
Yeah, yeah, no, that's fantastic.
And I think culture in theresidency um space is is super
important.
And you find, uh, there are alot of programs and I know
people that have dropped out ofprograms because of that issue
where they felt like it was thisvery overbearing thing and
perfection was expected andthere wasn't a whole lot of
humility and they didn't getthat sort of sense of community
out of it.
It just be two or threeresidents and they didn't really
(49:33):
feel safe coming to uh, theresidency directors or the chief
, uh resident, whoever they maybe about some complication
they're having.
And you know something we wetalk about a lot, not
necessarily in the context ofresidencies, but just in our
experience working with otherdoctors that we've trained or
been trained by is you don'twant to work in a silo in this
when you have that kind of badday.
You want to be able tocommiserate and get advice from
(49:54):
someone else who's run into thisbefore.
You don't want to be runninginto issues that you don't have
an answer for at all or can'tfind an answer for, and having
that kind of community and beingable to foster that community
in the context of a residency isan accomplishment that you know
can't really be understated oroverstated, I agree.
Dr. James Rutkowski (50:12):
I agree 100%.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Boysober
Have you ever wondered what life might be like if you stopped worrying about being wanted, and focused on understanding what you actually want? That was the question Hope Woodard asked herself after a string of situationships inspired her to take a break from sex and dating. She went "boysober," a personal concept that sparked a global movement among women looking to prioritize themselves over men. Now, Hope is looking to expand the ways we explore our relationship to relationships. Taking a bold, unfiltered look into modern love, romance, and self-discovery, Boysober will dive into messy stories about dating, sex, love, friendship, and breaking generational patterns—all with humor, vulnerability, and a fresh perspective.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com