July 7, 2025 • 39 mins
What happens when Instagram perfection meets clinical reality? Dr. Nestor Marquez pulls back the curtain on full-arch implant dentistry in this candid conversation that every clinician needs to hear.
Practicing in the unique dental tourism hub of "Molar City" (Los Algodones, Mexico) while living just across the border in Yuma, Arizona, Dr. Marquez shares his unconventional journey from failed dental student and aspiring musician to respected implant clinician. With disarming honesty, he reveals how his father's tough love redirected his path toward dentistry—a decision that ultimately led to his passion for complex implant rehabilitation.
The heart of this discussion centers on proper clinical education in today's social media-driven landscape. Dr. Marquez challenges the contemporary rush toward advanced techniques, describing how he watched over 100 surgeries before attempting his first case and completed 500-600 traditional all-on-four cases before incorporating pterygoid implants. This measured approach contrasts sharply with clinicians who attempt complex techniques after a single weekend course.
Perhaps most valuable is Dr. Marquez's transparency about complications. "The gods of full arch have complications," he reveals, describing how even the most respected clinicians privately seek advice when cases go wrong. This reality check serves as a powerful antidote to the curated perfection of dental Instagram, where clinicians showcase their successes while keeping failures private. His advice on patient communication—never guaranteeing specific outcomes—stems from hard-earned experience.
Beyond technical skills, Dr. Marquez emphasizes the psychological components of implant dentistry: managing patient expectations, maintaining perspective, and knowing when personal factors might compromise clinical judgment. These human elements, often overlooked in formal education, prove essential for long-term success.
Whether you're an experienced implantologist or just beginning your journey, this conversation offers rare insights into the realities of full-arch implant treatment. Follow Dr. Nestor Marquez on Instagram (@dr_nes) for his exceptional clinical documentation and educational content that brings transparency to this complex field.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren Papi,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
Hello and welcome back to theFix Podcast.
I'm super excited.
We have a very charismatic andcapable guest today who has
graced us with a beautifulcowboy hat, which I believe he
(00:21):
threw in last minute, but we'resuper appreciative of that.
We're also both sporting someneon signs, you know, repping
our sets and stuff like that.
So today we have on Dr NestorMarquez.
I had the pleasure of meetinghim fairly recently.
It was at the last.
I think it was the Orca.
No, no, it was Orca.
I believe we met at Orca Mostrecently.
(00:43):
That was the Orca Symposium inVegas.
Very, very cool, great session,by the way, definitely one of
the most informative symposiumsI've been in recent memory and
definitely had some heavyhitters for the Full Arch game.
I think that as far asimplant-focused symposiums go,
full Arch definitely gets talkedabout a lot, but there's a big
(01:03):
blend of what implants look likein different dental practices.
But this was really specific tofull arch and there were just a
lot of heavy hitters there andit was really awesome meeting
you, so we just had to get youon the show, and it took us a
little bit of time to coordinateschedules, but it's finally
happening and I couldn't be moreexcited.
Speaker 2 (01:18):
It wasn't all my fault.
All the time man.
Speaker 1 (01:20):
Oh, it was totally my fault.
Speaker 2 (01:25):
I take full accountability for this.
Yeah, absolutely, it's, it'sgood.
I, I, um, I'm happy that you.
You know, I remember in vegasyou were like, hey, man, would
you mind being on the podcast?
I was like, dude, I love it,we'll be in touch.
I was with my wife that night,I remember, and so, like the
rest, is history.
Now it's been a couple monthsand here we are.
Speaker 1 (01:40):
Man, thanks for inviting me no for sure, man,
I've been really excited to haveyou on and I know Soren was
really happy to, really excitedto interview as well, but he's
got a busy schedule too and wecouldn't quite make it happen,
so I know he's got some FOMOright now.
But yeah, man, I've been a hugefan of your work.
If you guys don't follow DrNess on Instagram, you've really
(02:02):
got to see some of his clinicalphotography and what he's
putting out there Just some ofthe cleanest, most
well-documented full arch casesyou'll find anywhere.
And he does these really coolthings where he draws on the
clinical photos, talks about thetechniques that were done.
Little nuances there that maybenot everyone can really pick up
, but if you know what to lookfor, everything is just
(02:22):
clinically executed sobeautifully.
He does a really great job ofdocumenting that and sharing
that.
But before I get you know tootoo into you know blowing smoke,
dr Marquez, if you could justkind of just do us the pleasure
of kind of just doing a briefintro of you know who you are,
what your background is, yourjourney into dentistry, implant
dentistry, all that good stuff.
Speaker 2 (02:42):
Cool Thanks, man Well .
Dentistry, implant dentistry,all that good stuff cool thanks,
man well.
First of all, thanks for allthe accolades or you know,
thanks thanks for everything.
I uh, I instagram just was athing that I started, probably
about seven years ago, you know,and it was just literally.
I opened a different instagram,uh, because my wife was like
nestor, you really shouldn'tpost gross like, and I think I
was posting like wisdom teeth.
(03:03):
Back then, you know like grossthings on instagram like yeah,
my mom, uh, my mother-in-law atthe time, not at the time, she's
still my mother-in-law.
She would be like oh, like, Idon't know, I'm gonna unfollow
nes yeah I opened a specificinstagram.
I thought of dr nes, and thenyeah, and then yeah, that that
kind of started things out.
Instagram wise, you know, uh,school wise man I to.
(03:25):
I did all my schooling inMexico, close to Mexico City.
I was born and raised inArizona but I was as I'm sure
people that know me know I was abad teenager.
Not that I'm completely goodnow, but I'm better.
Speaker 1 (03:41):
You were a bad teenager Now.
You're just a bad adult Now.
Speaker 2 (03:43):
I'm just a bad adult.
My mom was like you know whatReverse American dream guys, we
are leaving the USA and going toher homeland.
You know, which is like MexicoCity area, cool.
I was like oh bummer, you knowlike what we're leaving?
Girlfriend, friends, almostgangs, or whatever.
It was back then.
(04:04):
And reverse american dream.
We, we ended up straighteningour paths over there actually,
and uh, and I joined a churchband, started going to church, I
got better friends, I guess not, I guess I know.
And then it was time for fordental school and and, uh, at
the time I was was like a heavy,heavy musician, like I had
(04:26):
longer hair than I have now.
It was kind of like, you know,I wanted to be Ringo Starr.
You know that, look, you knowwhere you're, just like you're a
hippie in dental school.
It was first year dental schooland I was like actually this is
something that I probablyhaven't said before I flunked
first year of dental schoolbecause I was not like there
(04:46):
mentally nice, that's a badge ofhonor, man man.
My dad was like hey, nestor,like I don't know.
I was like dad, it's because Ithink I'm gonna be a musician
and we're gonna tour the worldand I'm gonna.
He's like nah, man, I don'tthink you are man, I think I
need you to do this.
You know, I feel like that'sone of the hardest like things
my dad has done to me.
(05:07):
He's like you're in a dentist.
I think you're gonna.
You've always kind of wanteddentistry and I kind of did.
You know, I have an uncle who,who, um, is a dentist, was a
dentist and through him I waslike, oh, you know what, I'd
like to be a dentist someday.
And yeah yeah, that turned intoto me leaving music behind.
I dropped out of a music schoolthat I was going to at the
(05:28):
moment, like for classicalguitar wow, awesome music school
thing like professional musical, you know yeah music and uh,
and from there on, on man, itwas like something, something
switched in me.
You know, I became a leader,group leader and um, yeah, from
there my grades started going up.
(05:49):
And you, you better bet man,probably just like you as soon
as we started pulling teeth, Iwas like okay, oh, okay.
You know what I'm saying, Likewhoa, yeah, okay, you know.
Speaker 1 (06:02):
Yeah, yeah, yeah, I can be a rock star of a
different kind.
Speaker 2 (06:04):
Somehow like that, you know.
And then, yeah, I left, I didmy internship.
Actually, this is how I startedliking surgical stuff in a
hospital with a maxillofacialsurgeon, dr Arturo, and like he
taught me so many things Notfull arch, though.
Nothing is full arch really inthe outer world, so to say, of
(06:27):
dentistry.
Speaker 1 (06:28):
Yeah.
Speaker 2 (06:28):
And then, yeah, I did internship.
I came back to the US.
I didn't have money whatsoeverat all.
So I remember I got a job at acooler like a cooling place for
lettuce, because here in arizona, where I am at, oh sure, yuma
arizona a lot of like lettuceproduce and stuff.
(06:50):
So I got a job there.
Three months later I quit thejob.
I went to church one sundaymorning for the first time and
the pastor was like, hey, whydon't you turn around and greet
your neighbor?
You know, I turn around, I seethe most beautiful woman I'd
ever seen, which is my wife now.
And I was like, oh, I need tocome back here.
You know, I met my wife.
I can talk about love storiesand stuff, you know.
(07:15):
But then what happened is Istarted seeing that the type of
I'm in Mexico, by the way, likeI work in Mexico, but I live in
the US.
It's a really tricky thing there.
I live in Yuma Arizona, but 10minutes from Yuma Arizona, 10
minutes literally.
That's my commute Los Algodones, baja California, mexico, also
(07:37):
known as Molar City.
So 10 minutes every day backand forth.
What happened is I startednoticing that the patients that
came in to look for work wereneeding implants, you know, like
dental implants and I was like,oh man, like okay, like single
implants, cool.
But then we would have thesecases that would come and be
like, hey, you know, you guys dothe all-on-four, and I was like
(08:00):
, ooh, that just sounds likehard dentistry, you know.
Speaker 1 (08:05):
Like well no we don't .
Speaker 2 (08:07):
But what we usually do is we call somebody in and
they come in and help us do thesurgeries, you know or I guess
we would say we did, but that itwas a specialist.
Speaker 1 (08:18):
Yeah, you're right, pharmadon yeah.
Speaker 2 (08:21):
I didn't send them out.
I had that specialist come intomy clinic here.
Speaker 1 (08:25):
Right.
Speaker 2 (08:26):
So, anyways, that I started noticing that, the need
for that you know of Americanpeople come into Mexico for more
economic.
Speaker 1 (08:37):
Yeah, so was that mostly American people coming
South of the border, or was it?
Speaker 2 (08:41):
To this day it's still 95, 95 of our patients are
american.
Coming south dental tourism,you know which?
Oh man, that topic is bigbecause you know of course we.
We call it the race down uhyeah, of course, prices in the
us are dropping because of itand, uh, what they don't the us
doesn't see is mexico stillhasn't played that card.
(09:04):
But Mexico can also drop pricesa lot lower.
You know, Like what are wegoing to do?
Speaker 1 (09:08):
Yeah.
Speaker 2 (09:09):
How low is too low, you know?
Speaker 1 (09:11):
Where is the bottom?
Yeah, right, where is thebottom?
Speaker 2 (09:13):
Yeah, because we're talking about different
countries, different you knowcurrencies, so a lot of you can
definitely do an arch with badmaterials for a lot cheaper here
in Mexico.
That's not something we do, youknow.
We we stick to high standards,we use good brands.
We use everything.
But there is that world of likeoh, let me get made in China
(09:37):
stuff you know, and, and then itgoes, yeah.
Speaker 1 (09:40):
So and how was a consumer to know the difference?
Right Like it's just amnestyfor you to be using good stuff,
but you don't have to you knowExactly, man, exactly, unless.
Speaker 2 (09:48):
You want See, my view of that is as a Mexican
American.
I was born in the US but youknow for Mexican parents.
Of course you got to make surethat things are done correctly
here in Mexico, because you hearthe horror stories.
They're not all fake, there's alot of there's a stigma yeah,
(10:09):
there's a stigma, you know, like, oh, don't go to Mexico, you
know, but I get it, you know.
I mean there's good and badeverywhere, but maybe there's
more bad here than there is overthere.
I'm not going to be that person, but we want to race that bar
to make sure that the standardhere in Mexico is up to date,
you know.
Anyways, yeah, where was I?
Yeah.
Speaker 1 (10:29):
So I mean you were just talking about how you know
you were bringing in aspecialist to get all in for
done, and then I'm assuming ofcourse there was a transition
doing it yourself.
Speaker 2 (10:37):
Sure, yeah, so, and I'm sure this might be a
question in the podcast later.
But schooling wise implantdentistry you know I went, I
went through some post degreeshere in Mexico for implant
dentistry.
You know I never didmaxillofacial surgery, I never
did perio, I did.
There's like little postdegrees here in Mexico for
(11:00):
implantology okay happened.
What happened next was I got amentor.
That did.
Full Arch Because a lot ofpeople ask me, like Nesser,
what's the best Full Arch schoolout there?
And now I have an opinion.
But I think I did it the rightway.
And the right way, if you askme, is not through CE, which is
(11:25):
hard, and I have an opinion onthat man.
To me it was a mentor thatlives and works in the same town
that I do.
Why is that different thansaying, oh, dr Nestor is your
mentor, although he's a thousandmiles?
Speaker 1 (11:40):
away Somewhere else yeah.
Speaker 2 (11:42):
Like sure, there's the mentorship that counts, like
that, and you'd hop on callsand stuff.
But what I did and I think thatI did right is I was bugging Dr
Ever, who we're going to give acourse with him later on.
Uh, this year, this one of myfirst mentors Um, I was bugging
him daily.
Man, when I started my clinic,my practice I had three to four
(12:03):
patients a week, so like I had alot of free time and he took
the best that like.
I was like hey, ever like, doyou mind if I come over to your
office man?
He's like no, I'm going to bedoing full arch.
You know, I'm like that's whatI want to see.
You know, and I was there, Iwas there like, and I kid you
(12:23):
not, I probably watched like ahundred surgeries, and a hundred
is a lot, man, if you thinkabout-.
Speaker 1 (12:28):
To watch, yeah.
Speaker 2 (12:29):
To watch.
It's a lot, you know, With mejust being there.
I was just there.
I had nothing to do so I wasthere and of course, I saw
complications.
I saw failed implants, I sawdifferent approaches, I saw
complicated extractions.
I saw a broken buccal bone.
I saw everything extractions Isaw a broken buckle bone.
I saw everything you know, andit was I wasn't really
(12:51):
practicing, though.
But, here again.
One of our problems these daysis that I see a lot is you take
a CE course and you go right todoing pterygoids or psychos, or
you know like all I did man wasall on four or all I saw was all
(13:14):
on four.
That he wasn't even doingpterygoids at the time.
It was all on four, simple, twostraight, two tilted.
You know maybe he did an Mevery now and then and I was
like, okay, you know like wow,repeat.
Okay, you know like wow, repeat, repeat, repeat, repeat.
And I was like, yeah, and afterme doing some studying, after
me having taken some you knowdiplomas on implantology and
(13:36):
stuff, I said you know what I'mgoing to start with overdentures
.
I'm sorry, man, like it almostsounds like oh, it's lame, but I
think I did it the right wayand that's why you?
know overdentures and I starteddoing two straight implants,
mandibular and I did do twoupper implants for overdenture
(13:57):
and I found out what that waslater, you know.
Speaker 1 (14:00):
At least you figured it out, man.
Speaker 2 (14:01):
I did.
Speaker 1 (14:02):
Some people are still doing it or not.
Speaker 2 (14:03):
Yeah, and my mentor was like, hey, Nestor, I
wouldn't do that again, you know.
But it was that separation frommentor and like, oh, I'm going
to do it after watching 100surgeries.
But coming back to my mentor,like, hey, man, why did two
single implants fail on top?
You know he's like, oh, haveyou ever seen me do that, Nestor
?
I?
(14:24):
was like no, but I've was kindof there, you know, I was like
hey, have you ever had thishappen?
You know, hey, have you everhad a patient get mad at you for
this?
Oh, nestor, like you want totalk about patient communication
and dealing with patients,cause that's a whole different
book, yeah.
Yeah, somehow separate it youknow, you think, ce I'm a
bad-ass surgeon?
Separate it.
You know, you think CE I'm abadass surgeon?
(14:46):
Bring the work.
Oh man, I feel like we almosthave to go through psychology
school sometimes, you know.
Speaker 1 (14:53):
Yeah, we do, we do yeah.
Speaker 2 (14:58):
So, anyways, I started having problems, but I
started doing more full arch Allon force.
Then I started to all on forceBuried implants, I would not
load.
Speaker 1 (15:06):
No, loading Okay.
Speaker 2 (15:08):
No loading force buried implants.
I would not load, no loading.
Speaker 1 (15:10):
Okay, no loading.
Speaker 2 (15:11):
I was scared, I was like oh man, I don't know, like
that seems like it's got torque.
But you know, understanding theI'd already seen it I
understood the principles, youknow, the 120 threshold, I, I, I
knew, but I was scared to makethe jump, you know.
But it made me pace myself.
Take my time to get to where Iam right now.
(15:32):
Then I started loading, youknow, and then me.
Don't think I I I'm not sayingcontinuing education is good
like while I was loading and anddoing all these things, I was
learning.
I was reading books.
I was going to courses learningabout it, but it was for me
(15:55):
pacing myself like I'm going todo this.
I'm more comfortable with this.
My stitches are not opening upas much anymore, you know, or my
you know, or I have a goodcommunication with my lab.
Now, now I'll do this, now I'lldo that, now I'll do that.
Then I started doing immediateload this is probably like six
or seven years ago and westarted loading all the cases
(16:17):
and I started finding out whatcluster failures were, you know,
and I started finding out howto deal with patients in a
cluster failure and having tocall in a specialist to do
psychos.
Speaker 1 (16:28):
Yeah.
Speaker 2 (16:29):
And like that's what nobody tells you these days is.
Speaker 1 (16:33):
Right.
Speaker 2 (16:34):
I always call it.
I always I used to have ahashtag that said full arches of
world, like it's not just openplace an implant or four
implants, and wait, there's somuch more.
You know, there's the patientcommunication.
There's the proper prostheticdesign, the good torque, the
good implant design, thetechniques.
(16:55):
What if this goes wrong?
It's so much like that's why wefeel nowadays that implant,
that full arch dentistry, shouldbe kind of like a post degree
of itself, Like it should haveits own little thing, because
it's so much, you know, it's,it's the most aggressive thing
we do, as as in dentistry.
You know, it's not a crown, afull mouth rehab, it's full arch
.
Speaker 1 (17:16):
For sure.
Speaker 2 (17:17):
So, anyway, man, yeah , that's um, that's a little bit
of of the upbringing you knowso far.
Um, my mentor was always therewith me.
I wasn't traveling, I wasn'tcalling him.
I was like, hey, man, do youmind if I do you mind coming
over?
Actually, he would come overonce or twice, he's done that,
that's great.
Imagine doing that instead ofjust we're afraid of what do you
(17:41):
call it?
He's your.
Competencia means like becauseyou're in the same town and you
guys are competing.
We don't want to train ourcompetition.
Speaker 1 (17:51):
You're worried about scarcity and things like that.
Speaker 2 (17:53):
Something like that.
So, like, there's even peoplethese days who are like, oh
shoot, I got to train that guy,but he's in my same city.
I should not do that.
Yeah, that's a way of thinkingthat we never adopted and it was
because my mentor was neverlike that with me, although I
work in the same town, he does,and I do full arches that he
could have done.
(18:13):
You know, that's not themindset man.
You know, yeah, and I have thesame mindset.
There's people here in townthese days that are like hey, dr
Nestor, like can I come watch asurgery?
I'm like text me Monday, I'lltell you when the surgeries are
this week, get over here.
And there's people watching mysurgeries, man, for free, you
know.
Although, there's people thatpay for that.
There's people that are here intown that I want to bless and
(18:34):
be like.
You need to do this the sameway.
Come watch it, you know.
But it's not because we're inthe same place.
It's because we don't have thatmindset of like I need to be
the best and like there's nobodythat can be like me.
Like, if they learn it from you.
They're going to learn it fromsomebody else, you know they're
still going to learn it.
People are still going to docycles, whether and they're
(18:55):
probably going to mess up fivecycles if you don't teach them
the right way or you don't makea comment Right.
Speaker 1 (19:01):
Yeah.
Speaker 2 (19:02):
And then they'll find out the right way.
And it's not going to be you whohelped out, you know, let's
just help each other, so that'sthat's how I got to to basically
where I am, and then I startedmeeting people through instagram
and social media, got invitedplaces.
Uh, I started making morementors.
Now, the type of mentorshipthat I needed wasn't in person,
because I could also already dofull arch.
(19:22):
I needed like little tips andlittle phone calls and little.
You know, I started doingpterygoids because of juan
gonzalez.
He let me come to texas acouple years ago.
I was like dude, likepterygoids, everybody's doing
them, what's up.
You know, he shows me, I seehim do it one time.
By that time, man, I hadalready placed thousands not
thousands maybe, but I probablyalready done like six or 700
(19:46):
arches without pterygoids.
Speaker 1 (19:48):
Yeah.
Speaker 2 (19:48):
Before I did pterygoids guys listen to that I
probably did 500, 600 arches.
That's a simple all on forcebefore pterygoids.
Why is that funny nowadays?
Because everybody's starting upand it's like yeah, I'm doing
pterygoids already, like yeah,there's like a new standard now.
Speaker 1 (20:06):
Yeah.
Speaker 2 (20:13):
That's the new standard, like if you're doing
full arches and not pterigoids,you're really not that good like
and most of the cases that I'ddone man successful cases with
four.
Yeah, of course, yeah, yeah, um, anyways, I I saw juan do it
one time and I was like, oh,thanks, one, like I get it, I
get it.
He, we went through anatomy onetime.
He explained it, you know, andthat's a mentor to me and then
we have so many stories of doingsurgery together nowadays where
(20:36):
he still saves my butt, thatthat you know.
Respect him whom respect is due.
You know, on little detailsthat I'm just like.
There's a saying that says inSpanish here it goes.
It says, and it translates tothe devil knows more because
he's old than because he's thedevil, you know and.
(20:59):
I've always attributed that toJuan Gonzalez, because it's a
experience man.
That's the name of the game isexperience.
Everything is easy and fullarch.
It's simple if you think aboutit.
Tyler, come on if you thinkabout it, it's, it's easy you
open a flap oh yeah, teeth, youcut the bone, you drill, you
(21:20):
close it and take a coolinstagram picture.
You feel like a badass it's thesame dance every time it's the
same dance every time until onelittle thing makes it not the
same dance every time.
It's the same dance every timeuntil one little thing makes it
not the same dance, where youstep on the girl's feet, you
know and everything, and shescreams and like it's not the
same dance.
Then yeah, and you're freakingout and you start getting
nervous and you don't dance thesame.
Those are the.
(21:41):
That's what experience givesyou, you know, and that's where
mentors come in.
You know um.
One other huge thing there thatI would add to that is like we
don't, we seem to Instagram canbe detrimental in the way that
we post so much and we get thisamazing feedback from people
(22:05):
that are our friends or peoplethat –'s.
There's a lot of fan, fangroups out there Sort of say
you're the best goats, greatestof all time, bro, you're killing
it, you're the best in theindustry.
You know that when somethingbad happens cause your ego got
in the way already, it's hard toreach out to people and be like
bro, what the hell did I dowrong here?
(22:25):
So you're alone.
you know, ranger, now you'relike by yourself, because it's
embarrassing to be like guys.
Speaker 1 (22:37):
What did I do wrong?
Speaker 2 (22:37):
here, you know, don't be that person.
Anyways, man ask me a questionor something.
I need to stop talking.
Speaker 1 (22:41):
No, no, this is great .
I'm, I'm, I'm taking notes as Igo, like I don't like to
disrupt your flow.
No, I think that you know a fewthings that you touched on that
were really valuable.
I'm going to go all the wayback to.
You know, like a proper way toget into full arch you talked
about, you know you have someopinions on, you know, great
institutions to go through interms of your schooling, in
terms of your CE.
All those are, of course,necessary and you should do them
(23:03):
.
But you talked about, you know,the, the benefits of finding
not just a mentor but a localmentor.
Someone that you can be overthe shoulder with is going to be
locally there to support you,and that's a huge thing.
And and that's that's what Ihad, um, you know, for myself,
you know my entry into full archwas absolutely mentored.
It was, you know, my hand washeld um, for my first, you know,
six months to a year or so,even though I even though I
(23:23):
still kind of did it at lightspeed, I still had mentors.
You have to have that, and Itotally agree with needing to
have that abundance mentalityand that's really what's pushed
our field forward.
It's not, you know a few likereally solid clinicians, just
being protective of what they do.
It's that willingness to shareand I think by doing that,
that's what's helped you elevateyourself and in terms of your
(23:44):
Full Arch reputation abroad andit's opened up so many doors for
you just by being willing tohelp other people.
And you know, full Arch isstill very much a niche thing.
It's absolutely exploded.
But I think that there's a tonof really bad Full Arch work
being done and it's necessaryfor the people who are doing it
well and at a high clinicalstandard, who have seen the
long-term associated with goodversus bad cases, to help spread
(24:07):
.
You know, you know what itreally takes to accomplish these
cases, because the problem withfull arch is there's a lot of
short-term reward in it.
There's a lot of long-termconsequences, and so I think
that that's something that'sreally fueled that kind of race
to the bottom is everyone'strying to do cheaper arches.
They're trying to spring, youknow they're.
They're swinging for home runswhen a single would do, you know
, and they're taking on complexcases cause they see it all over
(24:29):
Instagram and you know, maybethey accomplish it.
They get something that screwsin and they feel like they did
something, only to find outlater on that there were so many
nuances they missed, there wereso many problems they haven't
run into yet that they're goingto find later.
And you know they're againracing to the bottom, just
setting themselves up forlong-term failure.
And it's so important for peoplelike yourself that have been in
the game longer to help reallyshow like hey, this is why we're
(24:53):
saying you need to walk intothis and you need to have
mentors and you need to havepeople you can bounce off of.
And I totally agree with thebit about ego is like most of
the stuff I share, it's thebetter cases I've done.
There's, there's no questionabout it.
Like you're definitely seeinglike the top.
You know 50 percentile of whatI do.
There's another 50 percentilethat I'm not as quick to share I
(25:13):
would, but you know it's.
It's like you.
You want the flame emoji, youdo Right, you want the flame
emoji.
You do Um and uh.
You know it's very rewardingand I think that when you're
recording yourself and you'reposting it and you're sharing it
, it's cool to have all thatpositive feedback.
But at the same time it breedshubris and it makes us a little
(25:34):
more closeted about where wefall short and trying to learn
from that.
And it's so important to just beopen-minded to getting
criticism for people that havehad more time in the chair and
have been able to the long-termfollow-up on these cases.
You know one of my personalmentors now that I turn to a lot
is Dr Clark Damon.
So he, he really convertedmyself and Soren into placing a
(25:58):
lot more territory ways toprovide additional support and
both of us had several hundredarches of just traditional on
four under our belts before wewent to his courses and started
doing that.
And you know it's so greatbecause every time I have a case
I'm like super proud of it.
I'm like, oh man, I absolutelynailed this.
I'm going to show this to Clarkwithout fail.
There's there's immediatefeedback and it's not.
(26:18):
It's not badgering me, he'sjust telling me you should have
done this, you should have donethat, look out for this next
time.
This is what's going to happen.
And, like, I get that immediatenegative feedback.
That kind of balances out allthe other fire emojis and stuff
and I learned from it and itmakes you a better clinician and
you have to be willing to behumbled to get better at this.
You can't just live in an echochamber of positivity.
Speaker 2 (26:37):
I love that we say here in Mexico el que se aguita
pierde Him who like feels badloses.
You know what I'm saying?
It's very easy everybody likesto just be praised over
something that you're like dude,at least look at the badass
picture I took, you know, butlike we don't need praise man
(26:58):
like we don't need it, if youreally want yeah in this for
long term and if you want to bea happy mental person, you want
your cases to be successful, notyour pictures.
Who cares about?
the picture nobody sees of thatbeautiful all on six became a
cluster failure.
Speaker 1 (27:13):
You're not gonna post yeah, like right, I'm just
showing you the post-op.
Speaker 2 (27:16):
Yeah just showing you the post-op picture like, or
the before they leave the office.
Yeah, nobody knows if a patientbecame blue and swollen or is
calling oh my god telling youyou're a prick, for you know,
yeah, oh, every time, yeah, allthe time.
Nobody tells you that, yeah.
Speaker 1 (27:30):
Some of my, some of my like proudest cases, even
some that I've put up recently,where people are like, wow,
fantastic, looks really good andI, you know, surgically it was
a great case.
You know.
They don't see the text I getfrom the patient the next day
where they just look like theywere just mauled by the bill of
earth event, right, and I don'tpost it either.
You know, uh, but it totallyhappens, man.
(27:51):
I mean it's, it's, uh, it's,it's a, it's a tough world and I
think that you know, when youhave that personal mentorship,
you can see the more real sideof it, the hard part of it, the
part that you know even keepsthe best clinicians up at night,
like that exists and it's it's,you know, it's prevalent.
We don, we don't talk about it.
Speaker 2 (28:07):
A lot, I, I, I, when I give a course, I always say
that and it's kind of to breakthe ice, you know, because I'm
fortunate to be a teacher togeneral dentist, maxillofacial
surgeons, periodontists like,and breaking the ice with them
is like all right guys, listen,I got friends you know, I don't
(28:29):
have enemies, or I don't thinkso, but I got friends, and some
of my friends, I say, are peopleyou look up to, and and I might
be someone you look up to, butI got friends that are, like you
know, mortals, dr Ness, mortals, gods, you know.
you know what I'm saying yeah ohthat, and I'm in groups with
them, sometimes on WhatsApp orsomething.
(28:50):
Yeah, and guess what they havecomplications.
Speaker 1 (28:54):
Yeah.
Speaker 2 (28:54):
You're saying the gods of full arch have
complications.
Absolutely you bet, andsometimes the gods of full arch
will text in the group and belike hey guys, send your prayers
.
You know this patient's havingthis complication.
We're not sure exactly what'sgoing on.
If it's a medication they'retaking, if it's this, send your
prayers, boys.
Speaker 1 (29:13):
And it's like wait a minute, just cross your fingers.
Speaker 2 (29:16):
Prayers, you know, so like that should humble anybody
man Like whether you're thebest maxillofacial surgeon from
your class or you feel likeyou've done 300, 400 arches and
you're a pro.
It should humble you enough tobe like okay, so like we're all
in the same boat together.
You know, sure, there's littlestars and like there's achilles
(29:37):
in the boat.
You know there's.
There's the hierarchies.
Speaker 1 (29:40):
You know there's, there's a badass yeah but, but
we're learning and we're sharingand we're just reminding you,
like no need to play the game ofof the king of full arches, you
know like yeah yeah, yeah, no,I, I totally agree and I I think
that's a a really refreshingnote and even me personally,
like I, I kind of need that kindof reminder every now and then,
(30:02):
because it's so easy to just,you know, put people on a
pedestal and just assume thateverything they touch is gold
and, uh, it's not true.
I so much of what reallyoccupies like the busy,
successful surgeons mind istheir complications, like that's
what's actually going on intheir minds, what the hell
they're going to do about thiscase or that case.
They're not even thinking aboutthe one they posted.
You know, like man, I got someother shit going on back here.
(30:26):
You know that's got me divingback in textbooks trying to
figure out where to go from here, you know.
So, yeah, I mean, I thinkthat's a, that's a really good,
you know, dose of of reality.
And you know, one thing we tryto do with the podcast too is is
we, we want to show the goodand the bad.
We want to show where things gowrong and where we get humbled,
because that's that's wherelearning happens.
You know, when the case goessuper smooth, like I had one
yesterday, that was just great,I mean, it was like a double.
(30:48):
I posted it.
It was a double.
I did it in like an hour and 45minutes.
It was six over six.
It was just clean.
Pretty Everything was rightwhere it needed to be, but I
learned nothing.
You know, like I got nothingfrom it I'm not going to grow
(31:12):
from, and so you know, where I'mat is really just an
accumulation of all the casesthat that made me sweat and make
me question myself.
It's not the ones where I patmyself on the back and I go
share on Instagram and be likehey, look what I did.
Speaker 2 (31:23):
You know, yeah, yeah.
The case is that you're likewhen did I decide?
Why did I decide to get intofull arched industry again, you
know?
Remind me why I started doingthis, for why, why, I think it's
a good idea, you know?
Yeah, yeah, of course I've hadthe case where you're just like
this, you know, like yeah.
Speaker 1 (31:42):
Right.
Speaker 2 (31:43):
You're doing the upper arch.
The patient is either generalor intubated or IV.
Speaker 1 (31:49):
Yeah, and you're like I can't do it man, I can't do
it.
Speaker 2 (31:52):
Call somebody, man.
I've called my brotherdownstairs and I'm like dude,
I'm done.
Man, I don't want to do thiscase.
We'll do the upper and we'll dothe lower in a month or so.
And he's like that's true, dude, dude, take a break.
Man, come here, take my glovesoff.
And he's like what's going on,you know, and we forget
sometimes.
I'm like sometimes it's noteven just a surgery.
(32:12):
You might have some stuff goingon back at home.
You might have that life is life, you know, and I'm like, yeah,
thanks bro, you finished thecase and that actually lets you
that.
That's a growth.
Speaker 1 (32:23):
I was like yeah, I can conquer the emotions that
I'm having during a complicatedfull arch surgery, to you know
anyways show up, you have tohave a good night's sleep, you
(32:49):
have to be adequatelycaffeinated or whatever it is
that you pregame with.
You know, and yeah, I mean youcan't, you can't afford to give
a patient.
You know less than your bestand they've invested in this and
you know there's a lot ofthings that can come about.
If you just you said it'sreally not that complicated.
It's the part that is soimmeasurable and can't be shown
(33:12):
in terms of CE hours or gradesor diplomas or whatever you got.
It's just that stomach liningto perform when maybe you're not
at your best.
Speaker 2 (33:22):
Exactly, man, exactly , that's something not so spoken
of.
That is necessary when I start,and maybe we'll talk about ways
of the arches later.
But when I start my course Ihave a special portion, the
first portion, and I say, heyguys, we'll talk about arches.
This first portion is notexactly about arches.
(33:43):
It's about a little bit aboutmental health, a little bit
about communication with thepatient.
what you should say to thepatient what you shouldn't say
to the patient, why you saycertain things to the patient
it's.
I have a friend that says hey,man, teeth are easy.
Teeth are easy.
Full arches yeah, it's, whoholds the full arch.
(34:06):
That's hard, you know.
Right, you're placing it to.
That's hard yeah yeah, it's,it's, it's reading into the
patient.
You know those that um what ishouse?
Speaker 1 (34:17):
or millis house classification, remember that uh
I think I know what you'retalking about the patients that
were becoming oh, like theexacting and the uh, all the
different.
Yeah, yeah, those guys, yeahsure, those guys, that's yeah
that was written 1950 orsomething.
Speaker 2 (34:33):
I'm like.
Doctors have struggled withpatients that are in the
edentulous world for many years.
You know, and and back then1950s they were like you should
not get into a fight, get intoit with this patient.
You know that one needspsychological evaluation, which
is not something we really do.
Speaker 1 (34:53):
No, I've never sent anybody out for a psyche ball.
Speaker 2 (34:55):
I looks like a nice person.
Sure, let's do the full arch.
You know, three years later,like God, help me.
Speaker 1 (35:03):
Yeah, yeah, and you know it's like this is a complex
population.
You know you get quite aspectrum of people and, uh, you
know, I mean the thing is islike you're always tempted to
just do the arch and even if youdo see some of these red flags,
a lot of times you're like, youknow, I still want to do the
case, like I still can make adifference in this person's life
.
Maybe it'll be different.
And you know, sometimes youkind of set yourself up for
(35:25):
these things.
Speaker 2 (35:26):
You know, sometimes you kind of set yourself up for
these things, you know, I know,I do it, that happens so many
times and this is anotherhumbling reason why I start the
courses that way is like guys,somebody lift a hand here who
hasn't had a complicated patient, you know, and everybody's like
, yeah, I have, you know.
Like kind of like the firststone.
If you haven't, you know.
Yeah, it's like we've all had apatient that you wish you
hadn't treated or at least andthis is part of our teaching is
(35:50):
you reprogram the patient?
And reprogramming means sayingthe right things Like hey,
listen, this might be forever.
Speaker 1 (36:02):
This could also not be forever?
Speaker 2 (36:02):
How long does it last ?
This could work out perfectly.
This could also come back.
You get some failed implantssome failed implants.
Listen, we're gonna have toredo surgery, oh my god.
So it's not like a one and donesometimes.
Sometimes it's not, you knowand all these things that you
have to say when I talk about itin my course, like, make sure
you tell the patient this beforethey get into this.
(36:25):
You might be immediate load.
Speaker 1 (36:27):
There's a possibility you walk out of here with
dentures again Wait a minute,but don't you do Somebody?
Speaker 2 (36:32):
goes and stuff like that.
There's a possibility that youwalk out of here with dentures,
you in it or not, you know.
Yeah, those little things CauseI had the patient about six
years ago.
Man, One time it happened, onetime only.
I told them hey, don't worry, Iteach about this, I know
different techniques.
I said you walk out of herewith fixed teeth.
I said that man, I don't knowhow many people say that Like
(36:53):
yeah, yeah, we're doing fixed,you know Fixed podcast.
But we're doing fixed Well ofcourse it's fixed.
Speaker 1 (37:00):
You see the light up sign I got in my office.
Speaker 2 (37:03):
Of course you're walking out with fixed teeth,
the, the ways of the arches, Iknow all the ways, man, that's
right.
And little did I know.
Like it was not a butter caseyou know even SIGOS, like I
wasn't doing SIGOS back then,but like it was a butter all
throughout case and I was likeJust push it through, yeah.
Then your patient wakes up.
We had a problem.
We had a little argument.
Obviously I didn't you know.
(37:24):
Case is fine now, but that'sthe last time I said.
This is fixed.
Speaker 1 (37:30):
I said yeah, you don't, you don't give a
guarantee.
Speaker 2 (37:32):
You want fixed.
We both want fixed, you know,yeah, but we'll see.
And my patients, nowadays I geta case if I do, which is super,
super rare, but if I do thatit's not fixed.
It's like oh all right, drNestor, three months with this
denture, you know sure we'll doit.
Speaker 1 (37:53):
Yeah, I think that's a great way to put that too.
And, like I, you know it's beena while since I haven't loaded
a case.
I think it's been maybe a yearand a half or so, like, maybe
something like that.
But you know, I tell thepatient I was like look, you
know, I want you to have thepeace of mind.
Almost all of our cases walkout of here with fixed teeth.
But there is that chance.
It's a non-zero probability.
But you know what?
If things don't go well, thenyou're just going to go through
the same process that everybodywas 20 years ago and it should
(38:14):
work out okay.
We just have a differentapproach for that.
And 100% you have to open thedoor and let a patient walk
through it.
You can't just pull themthrough after the fact.
Explaining, because it's, youknow, explaining it after the
fact is an excuse.
You know.
Explaining beforehand thatthat's consent, that's letting
them know that that's there.
So it's not a surprise andthat's one of the best lessons
(38:35):
you can learn in full arts isjust don't set yourself up for
having that really difficultconversation of hey, I know I
said you were going to be goodand you're not, and this is why
you know.
So yeah, no, that's a great bitthere.
My name is Dr Tyler Tolbert and I'm Dr Soren Papi,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
Hello and welcome back to theFix Podcast.
I'm super excited.
We have a very charismatic andcapable guest today who has
graced us with a beautifulcowboy hat, which I believe he
(00:21):
threw in last minute, but we'resuper appreciative of that.
We're also both sporting someneon signs, you know, repping
our sets and stuff like that.
So today we have on Dr NestorMarquez.
I had the pleasure of meetinghim fairly recently.
It was at the last.
I think it was the Orca.
No, no, it was Orca.
I believe we met at Orca Mostrecently.
(00:43):
That was the Orca Symposium inVegas.
Very, very cool, great session,by the way, definitely one of
the most informative symposiumsI've been in recent memory and
definitely had some heavyhitters for the Full Arch game.
I think that as far asimplant-focused symposiums go,
full Arch definitely gets talkedabout a lot, but there's a big
(01:03):
blend of what implants look likein different dental practices.
But this was really specific tofull arch and there were just a
lot of heavy hitters there andit was really awesome meeting
you, so we just had to get youon the show, and it took us a
little bit of time to coordinateschedules, but it's finally
happening and I couldn't be moreexcited.
Speaker 2 (01:18):
It wasn't all my fault.
All the time man.
Speaker 1 (01:20):
Oh, it was totally my fault.
Speaker 2 (01:25):
I take full accountability for this.
Yeah, absolutely, it's, it'sgood.
I, I, um, I'm happy that you.
You know, I remember in vegasyou were like, hey, man, would
you mind being on the podcast?
I was like, dude, I love it,we'll be in touch.
I was with my wife that night,I remember, and so, like the
rest, is history.
Now it's been a couple monthsand here we are.
Speaker 1 (01:40):
Man, thanks for inviting me no for sure, man,
I've been really excited to haveyou on and I know Soren was
really happy to, really excitedto interview as well, but he's
got a busy schedule too and wecouldn't quite make it happen,
so I know he's got some FOMOright now.
But yeah, man, I've been a hugefan of your work.
If you guys don't follow DrNess on Instagram, you've really
(02:02):
got to see some of his clinicalphotography and what he's
putting out there Just some ofthe cleanest, most
well-documented full arch casesyou'll find anywhere.
And he does these really coolthings where he draws on the
clinical photos, talks about thetechniques that were done.
Little nuances there that maybenot everyone can really pick up
, but if you know what to lookfor, everything is just
(02:22):
clinically executed sobeautifully.
He does a really great job ofdocumenting that and sharing
that.
But before I get you know tootoo into you know blowing smoke,
dr Marquez, if you could justkind of just do us the pleasure
of kind of just doing a briefintro of you know who you are,
what your background is, yourjourney into dentistry, implant
dentistry, all that good stuff.
Speaker 2 (02:42):
Cool Thanks, man Well .
Dentistry, implant dentistry,all that good stuff cool thanks,
man well.
First of all, thanks for allthe accolades or you know,
thanks thanks for everything.
I uh, I instagram just was athing that I started, probably
about seven years ago, you know,and it was just literally.
I opened a different instagram,uh, because my wife was like
nestor, you really shouldn'tpost gross like, and I think I
was posting like wisdom teeth.
(03:03):
Back then, you know like grossthings on instagram like yeah,
my mom, uh, my mother-in-law atthe time, not at the time, she's
still my mother-in-law.
She would be like oh, like, Idon't know, I'm gonna unfollow
nes yeah I opened a specificinstagram.
I thought of dr nes, and thenyeah, and then yeah, that that
kind of started things out.
Instagram wise, you know, uh,school wise man I to.
(03:25):
I did all my schooling inMexico, close to Mexico City.
I was born and raised inArizona but I was as I'm sure
people that know me know I was abad teenager.
Not that I'm completely goodnow, but I'm better.
Speaker 1 (03:41):
You were a bad teenager Now.
You're just a bad adult Now.
Speaker 2 (03:43):
I'm just a bad adult.
My mom was like you know whatReverse American dream guys, we
are leaving the USA and going toher homeland.
You know, which is like MexicoCity area, cool.
I was like oh bummer, you knowlike what we're leaving?
Girlfriend, friends, almostgangs, or whatever.
It was back then.
(04:04):
And reverse american dream.
We, we ended up straighteningour paths over there actually,
and uh, and I joined a churchband, started going to church, I
got better friends, I guess not, I guess I know.
And then it was time for fordental school and and, uh, at
the time I was was like a heavy,heavy musician, like I had
(04:26):
longer hair than I have now.
It was kind of like, you know,I wanted to be Ringo Starr.
You know that, look, you knowwhere you're, just like you're a
hippie in dental school.
It was first year dental schooland I was like actually this is
something that I probablyhaven't said before I flunked
first year of dental schoolbecause I was not like there
(04:46):
mentally nice, that's a badge ofhonor, man man.
My dad was like hey, nestor,like I don't know.
I was like dad, it's because Ithink I'm gonna be a musician
and we're gonna tour the worldand I'm gonna.
He's like nah, man, I don'tthink you are man, I think I
need you to do this.
You know, I feel like that'sone of the hardest like things
my dad has done to me.
(05:07):
He's like you're in a dentist.
I think you're gonna.
You've always kind of wanteddentistry and I kind of did.
You know, I have an uncle who,who, um, is a dentist, was a
dentist and through him I waslike, oh, you know what, I'd
like to be a dentist someday.
And yeah yeah, that turned intoto me leaving music behind.
I dropped out of a music schoolthat I was going to at the
(05:28):
moment, like for classicalguitar wow, awesome music school
thing like professional musical, you know yeah music and uh,
and from there on, on man, itwas like something, something
switched in me.
You know, I became a leader,group leader and um, yeah, from
there my grades started going up.
(05:49):
And you, you better bet man,probably just like you as soon
as we started pulling teeth, Iwas like okay, oh, okay.
You know what I'm saying, Likewhoa, yeah, okay, you know.
Speaker 1 (06:02):
Yeah, yeah, yeah, I can be a rock star of a
different kind.
Speaker 2 (06:04):
Somehow like that, you know.
And then, yeah, I left, I didmy internship.
Actually, this is how I startedliking surgical stuff in a
hospital with a maxillofacialsurgeon, dr Arturo, and like he
taught me so many things Notfull arch, though.
Nothing is full arch really inthe outer world, so to say, of
(06:27):
dentistry.
Speaker 1 (06:28):
Yeah.
Speaker 2 (06:28):
And then, yeah, I did internship.
I came back to the US.
I didn't have money whatsoeverat all.
So I remember I got a job at acooler like a cooling place for
lettuce, because here in arizona, where I am at, oh sure, yuma
arizona a lot of like lettuceproduce and stuff.
(06:50):
So I got a job there.
Three months later I quit thejob.
I went to church one sundaymorning for the first time and
the pastor was like, hey, whydon't you turn around and greet
your neighbor?
You know, I turn around, I seethe most beautiful woman I'd
ever seen, which is my wife now.
And I was like, oh, I need tocome back here.
You know, I met my wife.
I can talk about love storiesand stuff, you know.
(07:15):
But then what happened is Istarted seeing that the type of
I'm in Mexico, by the way, likeI work in Mexico, but I live in
the US.
It's a really tricky thing there.
I live in Yuma Arizona, but 10minutes from Yuma Arizona, 10
minutes literally.
That's my commute Los Algodones, baja California, mexico, also
(07:37):
known as Molar City.
So 10 minutes every day backand forth.
What happened is I startednoticing that the patients that
came in to look for work wereneeding implants, you know, like
dental implants and I was like,oh man, like okay, like single
implants, cool.
But then we would have thesecases that would come and be
like, hey, you know, you guys dothe all-on-four, and I was like
(08:00):
, ooh, that just sounds likehard dentistry, you know.
Speaker 1 (08:05):
Like well no we don't .
Speaker 2 (08:07):
But what we usually do is we call somebody in and
they come in and help us do thesurgeries, you know or I guess
we would say we did, but that itwas a specialist.
Speaker 1 (08:18):
Yeah, you're right, pharmadon yeah.
Speaker 2 (08:21):
I didn't send them out.
I had that specialist come intomy clinic here.
Speaker 1 (08:25):
Right.
Speaker 2 (08:26):
So, anyways, that I started noticing that, the need
for that you know of Americanpeople come into Mexico for more
economic.
Speaker 1 (08:37):
Yeah, so was that mostly American people coming
South of the border, or was it?
Speaker 2 (08:41):
To this day it's still 95, 95 of our patients are
american.
Coming south dental tourism,you know which?
Oh man, that topic is bigbecause you know of course we.
We call it the race down uhyeah, of course, prices in the
us are dropping because of itand, uh, what they don't the us
doesn't see is mexico stillhasn't played that card.
(09:04):
But Mexico can also drop pricesa lot lower.
You know, Like what are wegoing to do?
Speaker 1 (09:08):
Yeah.
Speaker 2 (09:09):
How low is too low, you know?
Speaker 1 (09:11):
Where is the bottom?
Yeah, right, where is thebottom?
Speaker 2 (09:13):
Yeah, because we're talking about different
countries, different you knowcurrencies, so a lot of you can
definitely do an arch with badmaterials for a lot cheaper here
in Mexico.
That's not something we do, youknow.
We we stick to high standards,we use good brands.
We use everything.
But there is that world of likeoh, let me get made in China
(09:37):
stuff you know, and, and then itgoes, yeah.
Speaker 1 (09:40):
So and how was a consumer to know the difference?
Right Like it's just amnestyfor you to be using good stuff,
but you don't have to you knowExactly, man, exactly, unless.
Speaker 2 (09:48):
You want See, my view of that is as a Mexican
American.
I was born in the US but youknow for Mexican parents.
Of course you got to make surethat things are done correctly
here in Mexico, because you hearthe horror stories.
They're not all fake, there's alot of there's a stigma yeah,
(10:09):
there's a stigma, you know, like, oh, don't go to Mexico, you
know, but I get it, you know.
I mean there's good and badeverywhere, but maybe there's
more bad here than there is overthere.
I'm not going to be that person, but we want to race that bar
to make sure that the standardhere in Mexico is up to date,
you know.
Anyways, yeah, where was I?
Yeah.
Speaker 1 (10:29):
So I mean you were just talking about how you know
you were bringing in aspecialist to get all in for
done, and then I'm assuming ofcourse there was a transition
doing it yourself.
Speaker 2 (10:37):
Sure, yeah, so, and I'm sure this might be a
question in the podcast later.
But schooling wise implantdentistry you know I went, I
went through some post degreeshere in Mexico for implant
dentistry.
You know I never didmaxillofacial surgery, I never
did perio, I did.
There's like little postdegrees here in Mexico for
(11:00):
implantology okay happened.
What happened next was I got amentor.
That did.
Full Arch Because a lot ofpeople ask me, like Nesser,
what's the best Full Arch schoolout there?
And now I have an opinion.
But I think I did it the rightway.
And the right way, if you askme, is not through CE, which is
(11:25):
hard, and I have an opinion onthat man.
To me it was a mentor thatlives and works in the same town
that I do.
Why is that different thansaying, oh, dr Nestor is your
mentor, although he's a thousandmiles?
Speaker 1 (11:40):
away Somewhere else yeah.
Speaker 2 (11:42):
Like sure, there's the mentorship that counts, like
that, and you'd hop on callsand stuff.
But what I did and I think thatI did right is I was bugging Dr
Ever, who we're going to give acourse with him later on.
Uh, this year, this one of myfirst mentors Um, I was bugging
him daily.
Man, when I started my clinic,my practice I had three to four
(12:03):
patients a week, so like I had alot of free time and he took
the best that like.
I was like hey, ever like, doyou mind if I come over to your
office man?
He's like no, I'm going to bedoing full arch.
You know, I'm like that's whatI want to see.
You know, and I was there, Iwas there like, and I kid you
(12:23):
not, I probably watched like ahundred surgeries, and a hundred
is a lot, man, if you thinkabout-.
Speaker 1 (12:28):
To watch, yeah.
Speaker 2 (12:29):
To watch.
It's a lot, you know, With mejust being there.
I was just there.
I had nothing to do so I wasthere and of course, I saw
complications.
I saw failed implants, I sawdifferent approaches, I saw
complicated extractions.
I saw a broken buccal bone.
I saw everything extractions Isaw a broken buckle bone.
I saw everything you know, andit was I wasn't really
(12:51):
practicing, though.
But, here again.
One of our problems these daysis that I see a lot is you take
a CE course and you go right todoing pterygoids or psychos, or
you know like all I did man wasall on four or all I saw was all
(13:14):
on four.
That he wasn't even doingpterygoids at the time.
It was all on four, simple, twostraight, two tilted.
You know maybe he did an Mevery now and then and I was
like, okay, you know like wow,repeat.
Okay, you know like wow, repeat, repeat, repeat, repeat.
And I was like, yeah, and afterme doing some studying, after
me having taken some you knowdiplomas on implantology and
(13:36):
stuff, I said you know what I'mgoing to start with overdentures
.
I'm sorry, man, like it almostsounds like oh, it's lame, but I
think I did it the right wayand that's why you?
know overdentures and I starteddoing two straight implants,
mandibular and I did do twoupper implants for overdenture
(13:57):
and I found out what that waslater, you know.
Speaker 1 (14:00):
At least you figured it out, man.
Speaker 2 (14:01):
I did.
Speaker 1 (14:02):
Some people are still doing it or not.
Speaker 2 (14:03):
Yeah, and my mentor was like, hey, Nestor, I
wouldn't do that again, you know.
But it was that separation frommentor and like, oh, I'm going
to do it after watching 100surgeries.
But coming back to my mentor,like, hey, man, why did two
single implants fail on top?
You know he's like, oh, haveyou ever seen me do that, Nestor
?
I?
(14:24):
was like no, but I've was kindof there, you know, I was like
hey, have you ever had thishappen?
You know, hey, have you everhad a patient get mad at you for
this?
Oh, nestor, like you want totalk about patient communication
and dealing with patients,cause that's a whole different
book, yeah.
Yeah, somehow separate it youknow, you think, ce I'm a
bad-ass surgeon?
Separate it.
You know, you think CE I'm abadass surgeon?
(14:46):
Bring the work.
Oh man, I feel like we almosthave to go through psychology
school sometimes, you know.
Speaker 1 (14:53):
Yeah, we do, we do yeah.
Speaker 2 (14:58):
So, anyways, I started having problems, but I
started doing more full arch Allon force.
Then I started to all on forceBuried implants, I would not
load.
Speaker 1 (15:06):
No, loading Okay.
Speaker 2 (15:08):
No loading force buried implants.
I would not load, no loading.
Speaker 1 (15:10):
Okay, no loading.
Speaker 2 (15:11):
I was scared, I was like oh man, I don't know, like
that seems like it's got torque.
But you know, understanding theI'd already seen it I
understood the principles, youknow, the 120 threshold, I, I, I
knew, but I was scared to makethe jump, you know.
But it made me pace myself.
Take my time to get to where Iam right now.
(15:32):
Then I started loading, youknow, and then me.
Don't think I I I'm not sayingcontinuing education is good
like while I was loading and anddoing all these things, I was
learning.
I was reading books.
I was going to courses learningabout it, but it was for me
(15:55):
pacing myself like I'm going todo this.
I'm more comfortable with this.
My stitches are not opening upas much anymore, you know, or my
you know, or I have a goodcommunication with my lab.
Now, now I'll do this, now I'lldo that, now I'll do that.
Then I started doing immediateload this is probably like six
or seven years ago and westarted loading all the cases
(16:17):
and I started finding out whatcluster failures were, you know,
and I started finding out howto deal with patients in a
cluster failure and having tocall in a specialist to do
psychos.
Speaker 1 (16:28):
Yeah.
Speaker 2 (16:29):
And like that's what nobody tells you these days is.
Speaker 1 (16:33):
Right.
Speaker 2 (16:34):
I always call it.
I always I used to have ahashtag that said full arches of
world, like it's not just openplace an implant or four
implants, and wait, there's somuch more.
You know, there's the patientcommunication.
There's the proper prostheticdesign, the good torque, the
good implant design, thetechniques.
(16:55):
What if this goes wrong?
It's so much like that's why wefeel nowadays that implant,
that full arch dentistry, shouldbe kind of like a post degree
of itself, Like it should haveits own little thing, because
it's so much, you know, it's,it's the most aggressive thing
we do, as as in dentistry.
You know, it's not a crown, afull mouth rehab, it's full arch
.
Speaker 1 (17:16):
For sure.
Speaker 2 (17:17):
So, anyway, man, yeah , that's um, that's a little bit
of of the upbringing you knowso far.
Um, my mentor was always therewith me.
I wasn't traveling, I wasn'tcalling him.
I was like, hey, man, do youmind if I do you mind coming
over?
Actually, he would come overonce or twice, he's done that,
that's great.
Imagine doing that instead ofjust we're afraid of what do you
(17:41):
call it?
He's your.
Competencia means like becauseyou're in the same town and you
guys are competing.
We don't want to train ourcompetition.
Speaker 1 (17:51):
You're worried about scarcity and things like that.
Speaker 2 (17:53):
Something like that.
So, like, there's even peoplethese days who are like, oh
shoot, I got to train that guy,but he's in my same city.
I should not do that.
Yeah, that's a way of thinkingthat we never adopted and it was
because my mentor was neverlike that with me, although I
work in the same town, he does,and I do full arches that he
could have done.
(18:13):
You know, that's not themindset man.
You know, yeah, and I have thesame mindset.
There's people here in townthese days that are like hey, dr
Nestor, like can I come watch asurgery?
I'm like text me Monday, I'lltell you when the surgeries are
this week, get over here.
And there's people watching mysurgeries, man, for free, you
know.
Although, there's people thatpay for that.
There's people that are here intown that I want to bless and
(18:34):
be like.
You need to do this the sameway.
Come watch it, you know.
But it's not because we're inthe same place.
It's because we don't have thatmindset of like I need to be
the best and like there's nobodythat can be like me.
Like, if they learn it from you.
They're going to learn it fromsomebody else, you know they're
still going to learn it.
People are still going to docycles, whether and they're
(18:55):
probably going to mess up fivecycles if you don't teach them
the right way or you don't makea comment Right.
Speaker 1 (19:01):
Yeah.
Speaker 2 (19:02):
And then they'll find out the right way.
And it's not going to be you whohelped out, you know, let's
just help each other, so that'sthat's how I got to to basically
where I am, and then I startedmeeting people through instagram
and social media, got invitedplaces.
Uh, I started making morementors.
Now, the type of mentorshipthat I needed wasn't in person,
because I could also already dofull arch.
(19:22):
I needed like little tips andlittle phone calls and little.
You know, I started doingpterygoids because of juan
gonzalez.
He let me come to texas acouple years ago.
I was like dude, likepterygoids, everybody's doing
them, what's up.
You know, he shows me, I seehim do it one time.
By that time, man, I hadalready placed thousands not
thousands maybe, but I probablyalready done like six or 700
(19:46):
arches without pterygoids.
Speaker 1 (19:48):
Yeah.
Speaker 2 (19:48):
Before I did pterygoids guys listen to that I
probably did 500, 600 arches.
That's a simple all on forcebefore pterygoids.
Why is that funny nowadays?
Because everybody's starting upand it's like yeah, I'm doing
pterygoids already, like yeah,there's like a new standard now.
Speaker 1 (20:06):
Yeah.
Speaker 2 (20:13):
That's the new standard, like if you're doing
full arches and not pterigoids,you're really not that good like
and most of the cases that I'ddone man successful cases with
four.
Yeah, of course, yeah, yeah, um, anyways, I I saw juan do it
one time and I was like, oh,thanks, one, like I get it, I
get it.
He, we went through anatomy onetime.
He explained it, you know, andthat's a mentor to me and then
we have so many stories of doingsurgery together nowadays where
(20:36):
he still saves my butt, thatthat you know.
Respect him whom respect is due.
You know, on little detailsthat I'm just like.
There's a saying that says inSpanish here it goes.
It says, and it translates tothe devil knows more because
he's old than because he's thedevil, you know and.
(20:59):
I've always attributed that toJuan Gonzalez, because it's a
experience man.
That's the name of the game isexperience.
Everything is easy and fullarch.
It's simple if you think aboutit.
Tyler, come on if you thinkabout it, it's, it's easy you
open a flap oh yeah, teeth, youcut the bone, you drill, you
(21:20):
close it and take a coolinstagram picture.
You feel like a badass it's thesame dance every time it's the
same dance every time until onelittle thing makes it not the
same dance every time.
It's the same dance every timeuntil one little thing makes it
not the same dance, where youstep on the girl's feet, you
know and everything, and shescreams and like it's not the
same dance.
Then yeah, and you're freakingout and you start getting
nervous and you don't dance thesame.
Those are the.
(21:41):
That's what experience givesyou, you know, and that's where
mentors come in.
You know um.
One other huge thing there thatI would add to that is like we
don't, we seem to Instagram canbe detrimental in the way that
we post so much and we get thisamazing feedback from people
(22:05):
that are our friends or peoplethat –'s.
There's a lot of fan, fangroups out there Sort of say
you're the best goats, greatestof all time, bro, you're killing
it, you're the best in theindustry.
You know that when somethingbad happens cause your ego got
in the way already, it's hard toreach out to people and be like
bro, what the hell did I dowrong here?
(22:25):
So you're alone.
you know, ranger, now you'relike by yourself, because it's
embarrassing to be like guys.
Speaker 1 (22:37):
What did I do wrong?
Speaker 2 (22:37):
here, you know, don't be that person.
Anyways, man ask me a questionor something.
I need to stop talking.
Speaker 1 (22:41):
No, no, this is great .
I'm, I'm, I'm taking notes as Igo, like I don't like to
disrupt your flow.
No, I think that you know a fewthings that you touched on that
were really valuable.
I'm going to go all the wayback to.
You know, like a proper way toget into full arch you talked
about, you know you have someopinions on, you know, great
institutions to go through interms of your schooling, in
terms of your CE.
All those are, of course,necessary and you should do them
(23:03):
.
But you talked about, you know,the, the benefits of finding
not just a mentor but a localmentor.
Someone that you can be overthe shoulder with is going to be
locally there to support you,and that's a huge thing.
And and that's that's what Ihad, um, you know, for myself,
you know my entry into full archwas absolutely mentored.
It was, you know, my hand washeld um, for my first, you know,
six months to a year or so,even though I even though I
(23:23):
still kind of did it at lightspeed, I still had mentors.
You have to have that, and Itotally agree with needing to
have that abundance mentalityand that's really what's pushed
our field forward.
It's not, you know a few likereally solid clinicians, just
being protective of what they do.
It's that willingness to shareand I think by doing that,
that's what's helped you elevateyourself and in terms of your
(23:44):
Full Arch reputation abroad andit's opened up so many doors for
you just by being willing tohelp other people.
And you know, full Arch isstill very much a niche thing.
It's absolutely exploded.
But I think that there's a tonof really bad Full Arch work
being done and it's necessaryfor the people who are doing it
well and at a high clinicalstandard, who have seen the
long-term associated with goodversus bad cases, to help spread
(24:07):
.
You know, you know what itreally takes to accomplish these
cases, because the problem withfull arch is there's a lot of
short-term reward in it.
There's a lot of long-termconsequences, and so I think
that that's something that'sreally fueled that kind of race
to the bottom is everyone'strying to do cheaper arches.
They're trying to spring, youknow they're.
They're swinging for home runswhen a single would do, you know
, and they're taking on complexcases cause they see it all over
(24:29):
Instagram and you know, maybethey accomplish it.
They get something that screwsin and they feel like they did
something, only to find outlater on that there were so many
nuances they missed, there wereso many problems they haven't
run into yet that they're goingto find later.
And you know they're againracing to the bottom, just
setting themselves up forlong-term failure.
And it's so important for peoplelike yourself that have been in
the game longer to help reallyshow like hey, this is why we're
(24:53):
saying you need to walk intothis and you need to have
mentors and you need to havepeople you can bounce off of.
And I totally agree with thebit about ego is like most of
the stuff I share, it's thebetter cases I've done.
There's, there's no questionabout it.
Like you're definitely seeinglike the top.
You know 50 percentile of whatI do.
There's another 50 percentilethat I'm not as quick to share I
(25:13):
would, but you know it's.
It's like you.
You want the flame emoji, youdo Right, you want the flame
emoji.
You do Um and uh.
You know it's very rewardingand I think that when you're
recording yourself and you'reposting it and you're sharing it
, it's cool to have all thatpositive feedback.
But at the same time it breedshubris and it makes us a little
(25:34):
more closeted about where wefall short and trying to learn
from that.
And it's so important to just beopen-minded to getting
criticism for people that havehad more time in the chair and
have been able to the long-termfollow-up on these cases.
You know one of my personalmentors now that I turn to a lot
is Dr Clark Damon.
So he, he really convertedmyself and Soren into placing a
(25:58):
lot more territory ways toprovide additional support and
both of us had several hundredarches of just traditional on
four under our belts before wewent to his courses and started
doing that.
And you know it's so greatbecause every time I have a case
I'm like super proud of it.
I'm like, oh man, I absolutelynailed this.
I'm going to show this to Clarkwithout fail.
There's there's immediatefeedback and it's not.
(26:18):
It's not badgering me, he'sjust telling me you should have
done this, you should have donethat, look out for this next
time.
This is what's going to happen.
And, like, I get that immediatenegative feedback.
That kind of balances out allthe other fire emojis and stuff
and I learned from it and itmakes you a better clinician and
you have to be willing to behumbled to get better at this.
You can't just live in an echochamber of positivity.
Speaker 2 (26:37):
I love that we say here in Mexico el que se aguita
pierde Him who like feels badloses.
You know what I'm saying?
It's very easy everybody likesto just be praised over
something that you're like dude,at least look at the badass
picture I took, you know, butlike we don't need praise man
(26:58):
like we don't need it, if youreally want yeah in this for
long term and if you want to bea happy mental person, you want
your cases to be successful, notyour pictures.
Who cares about?
the picture nobody sees of thatbeautiful all on six became a
cluster failure.
Speaker 1 (27:13):
You're not gonna post yeah, like right, I'm just
showing you the post-op.
Speaker 2 (27:16):
Yeah just showing you the post-op picture like, or
the before they leave the office.
Yeah, nobody knows if a patientbecame blue and swollen or is
calling oh my god telling youyou're a prick, for you know,
yeah, oh, every time, yeah, allthe time.
Nobody tells you that, yeah.
Speaker 1 (27:30):
Some of my, some of my like proudest cases, even
some that I've put up recently,where people are like, wow,
fantastic, looks really good andI, you know, surgically it was
a great case.
You know.
They don't see the text I getfrom the patient the next day
where they just look like theywere just mauled by the bill of
earth event, right, and I don'tpost it either.
You know, uh, but it totallyhappens, man.
(27:51):
I mean it's, it's, uh, it's,it's a, it's a tough world and I
think that you know, when youhave that personal mentorship,
you can see the more real sideof it, the hard part of it, the
part that you know even keepsthe best clinicians up at night,
like that exists and it's it's,you know, it's prevalent.
We don, we don't talk about it.
Speaker 2 (28:07):
A lot, I, I, I, when I give a course, I always say
that and it's kind of to breakthe ice, you know, because I'm
fortunate to be a teacher togeneral dentist, maxillofacial
surgeons, periodontists like,and breaking the ice with them
is like all right guys, listen,I got friends you know, I don't
(28:29):
have enemies, or I don't thinkso, but I got friends, and some
of my friends, I say, are peopleyou look up to, and and I might
be someone you look up to, butI got friends that are, like you
know, mortals, dr Ness, mortals, gods, you know.
you know what I'm saying yeah ohthat, and I'm in groups with
them, sometimes on WhatsApp orsomething.
(28:50):
Yeah, and guess what they havecomplications.
Speaker 1 (28:54):
Yeah.
Speaker 2 (28:54):
You're saying the gods of full arch have
complications.
Absolutely you bet, andsometimes the gods of full arch
will text in the group and belike hey guys, send your prayers
.
You know this patient's havingthis complication.
We're not sure exactly what'sgoing on.
If it's a medication they'retaking, if it's this, send your
prayers, boys.
Speaker 1 (29:13):
And it's like wait a minute, just cross your fingers.
Speaker 2 (29:16):
Prayers, you know, so like that should humble anybody
man Like whether you're thebest maxillofacial surgeon from
your class or you feel likeyou've done 300, 400 arches and
you're a pro.
It should humble you enough tobe like okay, so like we're all
in the same boat together.
You know, sure, there's littlestars and like there's achilles
(29:37):
in the boat.
You know there's.
There's the hierarchies.
Speaker 1 (29:40):
You know there's, there's a badass yeah but, but
we're learning and we're sharingand we're just reminding you,
like no need to play the game ofof the king of full arches, you
know like yeah yeah, yeah, no,I, I totally agree and I I think
that's a a really refreshingnote and even me personally,
like I, I kind of need that kindof reminder every now and then,
(30:02):
because it's so easy to just,you know, put people on a
pedestal and just assume thateverything they touch is gold
and, uh, it's not true.
I so much of what reallyoccupies like the busy,
successful surgeons mind istheir complications, like that's
what's actually going on intheir minds, what the hell
they're going to do about thiscase or that case.
They're not even thinking aboutthe one they posted.
You know, like man, I got someother shit going on back here.
(30:26):
You know that's got me divingback in textbooks trying to
figure out where to go from here, you know.
So, yeah, I mean, I thinkthat's a, that's a really good,
you know, dose of of reality.
And you know, one thing we tryto do with the podcast too is is
we, we want to show the goodand the bad.
We want to show where things gowrong and where we get humbled,
because that's that's wherelearning happens.
You know, when the case goessuper smooth, like I had one
yesterday, that was just great,I mean, it was like a double.
(30:48):
I posted it.
It was a double.
I did it in like an hour and 45minutes.
It was six over six.
It was just clean.
Pretty Everything was rightwhere it needed to be, but I
learned nothing.
You know, like I got nothingfrom it I'm not going to grow
(31:12):
from, and so you know, where I'mat is really just an
accumulation of all the casesthat that made me sweat and make
me question myself.
It's not the ones where I patmyself on the back and I go
share on Instagram and be likehey, look what I did.
Speaker 2 (31:23):
You know, yeah, yeah.
The case is that you're likewhen did I decide?
Why did I decide to get intofull arched industry again, you
know?
Remind me why I started doingthis, for why, why, I think it's
a good idea, you know?
Yeah, yeah, of course I've hadthe case where you're just like
this, you know, like yeah.
Speaker 1 (31:42):
Right.
Speaker 2 (31:43):
You're doing the upper arch.
The patient is either generalor intubated or IV.
Speaker 1 (31:49):
Yeah, and you're like I can't do it man, I can't do
it.
Speaker 2 (31:52):
Call somebody, man.
I've called my brotherdownstairs and I'm like dude,
I'm done.
Man, I don't want to do thiscase.
We'll do the upper and we'll dothe lower in a month or so.
And he's like that's true, dude, dude, take a break.
Man, come here, take my glovesoff.
And he's like what's going on,you know, and we forget
sometimes.
I'm like sometimes it's noteven just a surgery.
(32:12):
You might have some stuff goingon back at home.
You might have that life is life, you know, and I'm like, yeah,
thanks bro, you finished thecase and that actually lets you
that.
That's a growth.
Speaker 1 (32:23):
I was like yeah, I can conquer the emotions that
I'm having during a complicatedfull arch surgery, to you know
anyways show up, you have tohave a good night's sleep, you
(32:49):
have to be adequatelycaffeinated or whatever it is
that you pregame with.
You know, and yeah, I mean youcan't, you can't afford to give
a patient.
You know less than your bestand they've invested in this and
you know there's a lot ofthings that can come about.
If you just you said it'sreally not that complicated.
It's the part that is soimmeasurable and can't be shown
(33:12):
in terms of CE hours or gradesor diplomas or whatever you got.
It's just that stomach liningto perform when maybe you're not
at your best.
Speaker 2 (33:22):
Exactly, man, exactly , that's something not so spoken
of.
That is necessary when I start,and maybe we'll talk about ways
of the arches later.
But when I start my course Ihave a special portion, the
first portion, and I say, heyguys, we'll talk about arches.
This first portion is notexactly about arches.
(33:43):
It's about a little bit aboutmental health, a little bit
about communication with thepatient.
what you should say to thepatient what you shouldn't say
to the patient, why you saycertain things to the patient
it's.
I have a friend that says hey,man, teeth are easy.
Teeth are easy.
Full arches yeah, it's, whoholds the full arch.
(34:06):
That's hard, you know.
Right, you're placing it to.
That's hard yeah yeah, it's,it's, it's reading into the
patient.
You know those that um what ishouse?
Speaker 1 (34:17):
or millis house classification, remember that uh
I think I know what you'retalking about the patients that
were becoming oh, like theexacting and the uh, all the
different.
Yeah, yeah, those guys, yeahsure, those guys, that's yeah
that was written 1950 orsomething.
Speaker 2 (34:33):
I'm like.
Doctors have struggled withpatients that are in the
edentulous world for many years.
You know, and and back then1950s they were like you should
not get into a fight, get intoit with this patient.
You know that one needspsychological evaluation, which
is not something we really do.
Speaker 1 (34:53):
No, I've never sent anybody out for a psyche ball.
Speaker 2 (34:55):
I looks like a nice person.
Sure, let's do the full arch.
You know, three years later,like God, help me.
Speaker 1 (35:03):
Yeah, yeah, and you know it's like this is a complex
population.
You know you get quite aspectrum of people and, uh, you
know, I mean the thing is islike you're always tempted to
just do the arch and even if youdo see some of these red flags,
a lot of times you're like, youknow, I still want to do the
case, like I still can make adifference in this person's life
.
Maybe it'll be different.
And you know, sometimes youkind of set yourself up for
(35:25):
these things.
Speaker 2 (35:26):
You know, sometimes you kind of set yourself up for
these things, you know, I know,I do it, that happens so many
times and this is anotherhumbling reason why I start the
courses that way is like guys,somebody lift a hand here who
hasn't had a complicated patient, you know, and everybody's like
, yeah, I have, you know.
Like kind of like the firststone.
If you haven't, you know.
Yeah, it's like we've all had apatient that you wish you
hadn't treated or at least andthis is part of our teaching is
(35:50):
you reprogram the patient?
And reprogramming means sayingthe right things Like hey,
listen, this might be forever.
Speaker 1 (36:02):
This could also not be forever?
Speaker 2 (36:02):
How long does it last ?
This could work out perfectly.
This could also come back.
You get some failed implantssome failed implants.
Listen, we're gonna have toredo surgery, oh my god.
So it's not like a one and donesometimes.
Sometimes it's not, you knowand all these things that you
have to say when I talk about itin my course, like, make sure
you tell the patient this beforethey get into this.
(36:25):
You might be immediate load.
Speaker 1 (36:27):
There's a possibility you walk out of here with
dentures again Wait a minute,but don't you do Somebody?
Speaker 2 (36:32):
goes and stuff like that.
There's a possibility that youwalk out of here with dentures,
you in it or not, you know.
Yeah, those little things CauseI had the patient about six
years ago.
Man, One time it happened, onetime only.
I told them hey, don't worry, Iteach about this, I know
different techniques.
I said you walk out of herewith fixed teeth.
I said that man, I don't knowhow many people say that Like
(36:53):
yeah, yeah, we're doing fixed,you know Fixed podcast.
But we're doing fixed Well ofcourse it's fixed.
Speaker 1 (37:00):
You see the light up sign I got in my office.
Speaker 2 (37:03):
Of course you're walking out with fixed teeth,
the, the ways of the arches, Iknow all the ways, man, that's
right.
And little did I know.
Like it was not a butter caseyou know even SIGOS, like I
wasn't doing SIGOS back then,but like it was a butter all
throughout case and I was likeJust push it through, yeah.
Then your patient wakes up.
We had a problem.
We had a little argument.
Obviously I didn't you know.
(37:24):
Case is fine now, but that'sthe last time I said.
This is fixed.
Speaker 1 (37:30):
I said yeah, you don't, you don't give a
guarantee.
Speaker 2 (37:32):
You want fixed.
We both want fixed, you know,yeah, but we'll see.
And my patients, nowadays I geta case if I do, which is super,
super rare, but if I do thatit's not fixed.
It's like oh all right, drNestor, three months with this
denture, you know sure we'll doit.
Speaker 1 (37:53):
Yeah, I think that's a great way to put that too.
And, like I, you know it's beena while since I haven't loaded
a case.
I think it's been maybe a yearand a half or so, like, maybe
something like that.
But you know, I tell thepatient I was like look, you
know, I want you to have thepeace of mind.
Almost all of our cases walkout of here with fixed teeth.
But there is that chance.
It's a non-zero probability.
But you know what?
If things don't go well, thenyou're just going to go through
the same process that everybodywas 20 years ago and it should
(38:14):
work out okay.
We just have a differentapproach for that.
And 100% you have to open thedoor and let a patient walk
through it.
You can't just pull themthrough after the fact.
Explaining, because it's, youknow, explaining it after the
fact is an excuse.
You know.
Explaining beforehand thatthat's consent, that's letting
them know that that's there.
So it's not a surprise andthat's one of the best lessons
(38:35):
you can learn in full arts isjust don't set yourself up for
having that really difficultconversation of hey, I know I
said you were going to be goodand you're not, and this is why
you know.
So yeah, no, that's a great bitthere.
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.
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
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.