May 5, 2025 • 45 mins
Dr. Sven Bone brings his extraordinary blend of physics, mathematics, and prosthodontics expertise to The Fixed Podcast in an episode that challenges conventional thinking about dental prosthetic design. With his perfectly fitting last name, Dr. Bone's journey from studying complex mathematical modeling in Montana to revolutionizing implant dentistry showcases how interdisciplinary knowledge can transform clinical practice.
At the heart of our conversation is Dr. Bone's innovative approach to prosthetic failure prevention through his company, Smart Mouth Technologies. Their groundbreaking "Will It Break" application employs finite element analysis - a computational method that maps stress distributions in prosthetic designs before they're manufactured. This advancement promises to move dentistry away from subjective rules of thumb toward quantifiable, evidence-based design parameters that can dramatically reduce prosthetic complications.
We explore the critical relationship between clinical excellence and laboratory precision, with Dr. Bone emphasizing how his experience running Bone Dental Lab has deepened his understanding of the entire prosthetic creation process. From standardizing record-taking protocols to ensuring manufacturing quality control, mastering both sides of the restoration equation leads to superior patient outcomes.
Perhaps most compelling is our discussion about patient-specific factors in prosthetic success. Dr. Bone illustrates how two patients with identical prosthetic designs might have dramatically different outcomes based on their unique bite forces, chewing patterns, and parafunctional habits. This highlights the urgent need for more sophisticated diagnostic tools and personalized design approaches in modern implant dentistry.
Ready to bring engineering rigor to your implant practice? This episode offers invaluable insights for clinicians seeking to minimize complications and maximize long-term prosthetic success. Subscribe to The Fix Podcast for more conversations at the cutting edge of implant dentistry.
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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 to theFix Podcast, your source for
all things implant dentistry.
All right, and welcome back tothe Fix Podcast.
Just to update you guys, Iguess it was maybe the weekend
before last, the weekend beforethat everything blurs together,
but I attended the first annualORCA symposium in Las Vegas,
(00:26):
which had a really, reallyimpressive lineup of speakers,
and one of them is here with ustoday, dr Sven Bone.
He got up on stage and you knowthere were so many different
lecturers there that came from avariety of backgrounds and
spoke to so many differentthings, and it was really an
incredible conference.
I really enjoyed it.
But Dr Bone got up there Firstof all coolest name in dentistry
(00:49):
, I'm just going to go ahead andput that out there and he got
into some really, reallyinteresting concepts.
We're going to get into themtoday.
You know including, I mean, drBone is bringing a whole lot of
experience from a background inphysics that we'll talk about.
He has his own lab, he's aprosthodontist, he also does
surgery, he does full arch, allthese wonderful things that we
(01:10):
talk about and I got to talkingwith him after the symposium
about some of the things wespoke about and we got into some
really cool topics that I justthought would be amazing for the
show, and he's been graciousenough to come on.
So, Dr Sven, thank you so muchfor coming on.
Dr. Sven Bone (01:21):
Of course.
Yeah, it's a pleasure to behere, and I do have one
correction I actually don't dosurgeries anymore.
Dr. Tyler Tolbert (01:27):
Oh, okay.
Well, yeah, you've done them.
Yeah, you're aware of theconcepts.
Dr. Sven Bone (01:31):
Yeah, you know my , my implant experiences is I've
, I've placed, um, I, probablyaround a hundred or so, so not
not a ton.
Oh, okay, and and basically Ireally dove into the
manufacturing, the design, andreally kind of stuck with the
process, the process side ofthings.
Dr. Tyler Tolbert (01:53):
Got it?
Yeah, sure, sure, yeah, well, Imean I think that's all the
better and really, when you knowwe argue that when people go
about learning this, learningthe process first and then kind
of working your way backward isreally the appropriate way to do
it, because the differencebetween just being able to say
you did this and doing this wellreally goes down to those types
of fundamentals.
So I'm really really happy tohave you on here and I know you
can go deep on that kind ofstuff, yeah totally, I think you
(02:15):
know, and if we look in theliterature you know the number.
Dr. Sven Bone (02:19):
if you just look at complications, you're going
to see them.
They're all kind of a lot ofthem are orbiting around the
process side of things you knowon complication rates.
So so I think I think a solidfoundation in this is is is
really critical.
Surgery is sexy, right, surgeryis, and all the surgeons will
(02:43):
admit to that.
But the prosth side sometimesthat's where things can get
really kind of challenging.
Dr. Tyler Tolbert (02:52):
Yeah, yeah, and if you're not doing the
prosth side correctly, thenyou'll be doing a whole lot more
surgery, but probably not thekind that you want to be doing.
Yeah, possibly.
Dr. Sven Bone (02:58):
Yeah, yeah.
Dr. Tyler Tolbert (02:59):
Absolutely, that's right.
So yeah, before we get intobrass tacks and everything for
those that are unacquainted withyou, could you just kind of
give us a walkthrough of yourwhole academic journey to you
know what's what's kind of fedinto all that?
I know we don't have to go toodeep, yeah, but but, yeah, let's
, let's kind of yeah.
Dr. Sven Bone (03:16):
You know, I started out so I left home.
I grew up in Western NorthCarolina as a kid and I left
home when I was 18 and I movedout to Montana and so I studied.
I knew I wanted to studyphysics as an undergraduate and
so I did.
(03:37):
And in that time I you knowphysics majors have to get
minors in mathematics in orderto get a degree, and so I was
kind of I ended up.
At the time, you know, a bigrevolution was happening in
(04:00):
biology and I became reallyinterested in kind of the
biology and and and kind of thebiology side.
So I took a few biology classesand, um, one of my lab partners
was going to be a dentist.
And so, uh, you know cause Iasked him, I was like, what are
you going to do, johnny?
He goes, I'm going to be adentist.
And so I'd never thought ofthat before, never once.
(04:22):
And and I started looking intoit and then I realized like, wow
, dentistry is a beautifulcombination of medicine, it's
art and engineering reallymechanics, yeah and so so I was
like, wow, this could be areally good avenue for me.
so so I uh ended up, uh, so Iended up taking more pre-med
(04:45):
type classes and decided to goon and finish a degree in
mathematics.
And so I have two undergraduatedegrees, one's in physics, the
(05:08):
other one's in mathematics, withmore of an applied side.
So so basically, it's trying tosolve real world, real world
problems, like how do we modelthese sophisticated mechanical
problems?
And and also I mean just I tooka graduate course in in it was
it was called like I think itwas biologic, biological
mathematics and biology, orsomething like that.
I ended up modeling the calciumfluxes, like the voltages
(05:35):
through the heart through thecardiac muscle and also I
remember modeling insulinrelease in the beta cells in the
pancreas, so really kind ofcomplex, fun stuff.
And so I finished that up andthen I applied to dental school
(05:59):
and I got accepted to.
I think it was there's nodental school in Montana.
I got accepted to.
I think it was there's nodental school in Montana.
So I got accepted to I believeit was Tufts and Boston and UOP
and I think Creighton, nice yeah.
Dr. Tyler Tolbert (06:15):
So I ended up going to UOP.
Okay, very nice, yeah, so Iwanted to move to San Francisco
and be on the West Coast and youknow, I thought it was.
Dr. Sven Bone (06:20):
And so I went to move to San Francisco and and
and and be on the West coast andand you know I thought it was,
and so so I went to dentalschool and then, when I was in
dental school, I you know,western schools are very pro
kind of, you know like basically, hey, we're going to teach you
everything you need to know.
And I, when I was in dentalschool, I knew that there was
(06:44):
more complexity involved with,like full mouth rehabilitations
and large like restorative likeprocedures.
So I decided to work for oneyear after dental school back in
Montana, and I encountered somecases that I knew were complex
(07:05):
and I didn't feel like I was asprepared as I wanted to be, and
so I decided to move on to PROSand I applied to PROS programs
and got accepted to Carolina andthen Baylor, and so I decided
to go to Baylor for my PROS.
Dr. Tyler Tolbert (07:24):
Okay, nice, very nice.
Um.
So yeah, I mean it sounds likeyou kind of caught that bug uh,
sort of on a whim, just like inphysics lab and sort of just
drawn to the complexity of it.
That's fantastic, um, you know,I actually I had a lot of
interest in physics while I wasin college.
I was reading a whole bunch oflike Carl Sagan and you know um
(07:44):
astronomical stuff and um, Ifound out pretty quickly you do
have to be able to do math to dophysics.
And that was that was kind ofthe problem, that that was what
was in my way, um.
So, uh, yeah, I was.
I stood no chance of beingcontributory to that field, um,
but fortunately I did.
I did have a, uh, you know, amind for biology and things like
that and working with my handsand physics kind of had a very
(08:06):
roundabout way of sorry.
Dentistry had a roundabout wayof finding me, but but yeah,
that's fantastic.
So you went to a prostresidency at Baylor and you know
you've ended up in Bozeman, sokind of you know what was that
journey out of prost residencyinto dentistry?
Did you go directly intoprivate practice or what?
What was that like?
Dr. Sven Bone (08:24):
residency, uh, into dentistry.
Did you go directly intoprivate practice or what?
What was that like?
Yeah, I worked, um, I, you know, after my process residency, I,
I, I just needed a job.
So I worked in Dallas for for acouple like two or three years,
I think about three years andthen, and then, um, and then I
was like yep, time to go.
So I wanted I knew my compassalways pointed back to um, I
(08:44):
knew I wanted to go back toSouthwest Montana, so it's
always felt like home for me andand so so I I just kind of
packed up and it was time for meto head on out, and so I came
out here and worked, uh, Icommuted and worked in uh, a
couple of private practices andthen, uh, when a space came
(09:07):
available, I I started my ownpractice.
Dr. Tyler Tolbert (09:10):
Very good, very good.
So you're starting your ownpractice.
It's a prosthodontic practice.
I imagine you're doing fullmouth rehabs.
You're maybe doing someimplants.
I mean, what was kind of likeyour, your mix right off the bat
, what was really?
What got you going?
Dr. Sven Bone (09:23):
I mean, at first, I think it's anything you're,
you know you.
It takes a few years to toreally determine what you wanted
.
Who are you?
You know what.
What do I want to do, and and,and I think I think focus is is,
uh, I think, a key part ofevolving as a clinician.
I think you find your.
(09:48):
You find what you really areinterested in and that's what
you're going to end up doing,you know, and so so at first I
was did more general dentistryand then now it's.
It's pretty much implant based.
Dr. Tyler Tolbert (09:58):
Okay, okay.
So is there like a network ofreferring doctors or surgeons
that are doing the cases andthen they're coming back to you
to get restored?
Dr. Sven Bone (10:06):
Okay, yeah, it's mostly I do toothborne.
You know toothborne rehabs andsome, you know it's a.
It's a mix, but generally onthe full arch side I usually do
about two cases to maybe five amonth or so, it just depends on
the demand.
There's not a lot of people inMontana, so it's.
Dr. Tyler Tolbert (10:26):
Yeah, sure, I understand.
Um so I'm aware, of course,that you have a bone dental lab
as well.
Um so when did that come about?
What was the impetus forstarting your own lab?
Dr. Sven Bone (10:38):
Um, I started my own lab just because, um, just
like anything in life, if youwant to truly master something,
you really have to do the hardwork and dive deep.
And so I started.
I think I started my lab mainlyout of just, you know, in
residency we make a lot.
(10:59):
I mean, basically we do a lotof lab work is part of the
requirement, and so I somewhatmissed that.
And then also I was reallyexcited about the transformation
that the lab industry has gonethrough, and so I wanted to, I
really wanted to dive deep intothat, and so I started the bone
(11:22):
dental lab, mainly for just myown curiosity, my own desire to
control the, I think, reallycontrol the the the whole
process for my patients, becausethe, you know, understanding
from A to Z is very important tominimize your risks.
Dr. Tyler Tolbert (11:46):
Yeah, yeah, no, I totally agree with that.
I think, one of the mosttransformative times in my own
clinical practice.
I do have like an all digitalworkflow for my full arch now,
and so the lab can do a lot ofheavy lifting for me, um, but
thankfully I there was a timebefore that for me where, um, I
did have an in-house lab and alab technician that would do all
my conversions, and we had aweek where I had, um, three
(12:09):
double arches and, um, he, um,his father was sick in Israel
and he wanted to go back andspend some time with him.
I was like, of course, you knowyou have to go do that, and so I
had to do my own conversionsfor a week, and that's when I
learned you know how good andbad of a surgeon that I was, you
know because I figured out whatneeded to be done in order to
simplify that conversion processand by even just like the third
(12:31):
conversion that I did that week, I was significantly better and
giving my tech a lot better ofa time when he came back to do
my conversion.
So I definitely learned thatlive, just starting with the end
in mind and working your waybackward.
Dr. Sven Bone (12:42):
You know, I think there's a lot of truth in what
you said.
Like the best surgeons that Iknow and work with really
understand the prosthetic sideand their center synergy back
and forth, and and, and.
I think that it's inherently amultidisciplinary uh treatment
and and and.
(13:02):
I think that's what's what's uh.
You can't.
Everybody has to be on the samepage If you want to have the
most amount, the greatest amountof success and the minimal
amount of risk is thateverybody's kind of like mind
melded together yeah, you knowfor sure gotta be reading the
(13:23):
same sheet of music.
Dr. Tyler Tolbert (13:24):
yeah, um, so with the lab, do you have
technicians that are working inthere as well?
Dr. Sven Bone (13:29):
are they serving like other practices, or is it
all just you know the work thatyou're doing in out of your
clinic, or yeah, so we do have,um, we, we do accept like
digital, like like cliniciansthat do have fully digital
workflows, we, we will acceptcases from them.
Um, and then we, locally, youknow we'll, we have, uh, in the
(13:51):
past we've gone out and donerecords and do the whole like,
basically do the whole thing.
Oh cool, yeah, Okay, and so uh.
But you know Montana is a bigstate and so drive in three
hours, you know it can bechallenging.
Dr. Tyler Tolbert (14:05):
No, that's a lot to ask, for sure.
Well, fortunately, you know,everything's the speed of the
internet now, especially ifyou're up to date on a fully
digital workflow, so that'sfantastic.
Um, so you know how?
Has that kind of experience ofbuilding out the lab then kind
of taught you more, as you knowa prosthodontist like what does
that development really looklike?
Dr. Sven Bone (14:22):
Yeah, it's, it's a it's honestly it's very
challenging Like I can't evenimagine, yeah, like
manufacturing in general, is isa very challenging field and you
know my I think that I have alot of sympathy and respect for
for laboratory technicians andand and what they do?
Dr. Tyler Tolbert (14:44):
I'm wearing a t-shirt right now.
Dr. Sven Bone (14:47):
Yeah, I mean they , they, they really are our
partners and and and I thinkthat is I think it's super
critical to be you know, toreally defend each other and to
be and work well together,because that's kind of what
really makes the full circle,yeah, you know, so we can have a
(15:09):
good outcome.
It's, I think you know, for me,because I do all the CAD designs
and stuff for my patients.
I tend to get a little lazywith communication with the lab,
but I can't under emphasize howcritical that is.
(15:29):
You know, as far as, like, howyour relationships are with your
other, with the people you workwith, how your relationships
are with with your other, withthe people you work with.
Like, how well do youcommunicate with them and how
clear is your from the clinicalperspective?
How clearly can you describewhat you, what you intend the
outcome to be?
Because the more informationyou can communicate with the
(15:51):
people that are, you know,fabricating these things, um,
the the the better.
I think, like I tell mypatients, I don't want any
surprises and so that's what wewrite.
That's why we kind of gothrough a lot of that, why I'm
very systematic about thingsyeah, that makes sense.
Dr. Tyler Tolbert (16:11):
I think you know, a lot of times there's a
bit of a void in knowledge whena dentist is looking for
different labs to go to.
Let's say you're looking for adigital lab to do your designs
and milligrids or conias.
You know you'll ask questionsabout what the lab wants right,
like what, what kind of recordswere they looking for?
You know what are the differentstages they work with and
things like that.
But there's a lot of questionsI think dentists don't know to
(16:32):
ask, right In terms of, like,how they actually make their
prosthetics.
Um, you know different, not noteven just turnaround times, but
just like, what is their qualitycontrol?
Like, um, you know, how manydesigners do they have on the
team?
How experienced are they?
What you know, how, how haseverything?
You know, uh, what are thedifferent departments look like
and how has all that flow?
And I and I'm curious about youknow, with you having such a
(16:52):
direct relationship with yourlab and them making that final
product from start to finish hasthat kind of taught you some
things that dentists might needto be a little bit more
discerning about when they'relooking at different labs?
Dr. Sven Bone (17:03):
Yeah, one is on your end, I think on the
clinician's end.
We absolutely need to have veryconsistent and standardized
record taking and I think that'sbeen the most powerful thing
(17:25):
that has changed just my ownpride, like you know.
I came, I kind of like came outof the womb, you know, out of a
prost residency right, knowingkind of like, like just having
that beaten into my head as faras how you, you know, of a prost
residency right knowing kind oflike like just having that
beaten into my head as far ashow you, you know take records
and and things and I think thatstandardization and record
(17:46):
record taking is massive, um,yeah, as far as like getting a
reducing the entropy or chaosthat's in the, in all the the
information that that thelaboratories receive, and and so
I think that, uh, so one isportraits or face scans, um, and
then the other one is shadesyou know, standard shade
(18:10):
selection with photos, and thensome sort of job relationship
record.
You know treatment position, andso, on the clinician side,
their responsibility is todetermine the treatment position
and then also, you know, beable to provide enough data so
(18:35):
that the technician canreproduce the patient in their
like in front of the screen.
And, and that's the goal andthat's what I do with all my
patients on.
So that's helped me on theclinical side and then on the on
the laboratory side, on themanufacturing side, they to, um,
(18:56):
absolutely understand theirmaterials.
Uh, on the cad design part, uh,it's a little chaos out there.
We'll probably get into thatyeah, oh yeah, let's do it right
and and on the and on themanufacturing, like tool changes
, uh things like that.
Like all the little details tokeep your uh systems uh.
Like that, like all the littledetails to keep your uh systems
(19:18):
uh.
Like machining, like what kindof validation and verification
are you doing for your machining?
Dr. Tyler Tolbert (19:24):
Yeah, yeah.
So I have two um, you knowcontext, that kind of.
They don't educate me aboutthose things, but they make me
vaguely aware of them and humbleme a little bit.
So, uh, my dad uh comes fromaerospace engineering, so he had
a manufacturing company.
He made parts for BoeingGulfstream and that was like my
summer job was working a CNCmachine and learning about, you
know, quality control andtolerances and you know the
(19:47):
human error that can be involvedin those manufacturing
processes.
And then, on top of that, beforeI got into dental school, part
of the things that I was doingto build out my resume was
working at a dental lab.
So I worked in the CAD gamedepartment for a lab and the
number one thing that gotdrilled into me before I ever
learned how to do any type ofdentistry was shit in, shit out
right, like if the record's bad,their product's going to be bad
.
And you know, dennis had thisidea that somehow, you know,
(20:10):
given it's almost like thatscene and the really cliche
scene in movies where they theyzoom into a very, you know,
poorly resolved image and thenthey they resolve it more and
somehow it's higher qualityafter they zoom in, dennis think
that labs can do that yeah yeahthe, the born, or like the
satellite.
Yeah, that's not how data worksyeah, yeah, exactly so somehow
(20:34):
it's, it's not it longer.
Yeah, we're just trying tominimize the loss of accuracy,
but somehow we're supposed tocreate it.
But those have really gotten mea better appreciation for what
it takes to have high qualityrecords and result in a high
quality product.
And generally, as hard as alab's job is, it's a lot easier
when that data is accurate andwhen it's good and it makes the
(20:55):
lab, it makes the doctor feel alot better when things work well
.
But that's only if they did therecords correctly.
You can't create accuracy, sobut yeah, no, that's, that's
really good.
So you've got the, obviouslyyour prosthodontic practice, you
got the dental lab, and then Ialso learned a little bit about
what you're doing with yoursmart mouth technologies company
(21:16):
.
Dr. Sven Bone (21:27):
So can you tell us a little bit about what
you're doing with your smartmouth technologies company?
So can you tell us a little bitabout that?
Yeah, so I started a I I I justkind of, I think, just having
my background and like atechnical background and then
also having a clinicalbackground, I think I'm
particularly good at kind ofteasing out like some
fundamental problems, that thatwhere I think we need
improvement.
And so I started a engineeringI guess that would be a tech
company really and and I I haveabout five engineers on staff
(21:54):
and we essentially we have abunch of projects that we're
working on, and so the.
I think one of the biggest firstprojects that we're working on
is a web application called Willit Break, and that's a finite
element analysis for dentalprosthetics, and essentially
(22:17):
what it does is it tests designs.
So what we want to know, and Ithink what is really important
for designers to know is aretheir designs set up for failure
from the beginning?
And so the you you know we havea bunch of rules of thumb,
(22:37):
right, you know, cathedrals werebuilt on rules of thumb, but
structural engineers don't userules of thumb anymore to build,
you know, uh, skyscrapers andbuildings, and you're right, you
know that kind of stuff, so weuse um.
Basically we want.
Our goal is to increase theengineering rigor into this
space and make it moresophisticated.
Dr. Tyler Tolbert (22:59):
Okay, yeah, so can you just fundamentally,
can you tell us what finiteelement analysis is, how it
works and exactly what it tellsus?
Dr. Sven Bone (23:08):
Yeah, so the interpretation.
So what finite element analysisis is it's basically a
numerical, uh, salute, it's anumerical computational method
for solving incredibly complexequations.
And and these, when you take astructure or or like, let's say,
(23:29):
a full arch, and you, uh, andlet's say, a patient bites on it
, or let's say they grab somebeef jerky and bites down right
on that distal cantilever, sowhat happens is a very complex
tensor field is created in thatstructure, in that full arch,
(23:53):
and it what it does is is thatthat field describes how that
force is experienced, I guess,by this, this, uh, by this full,
by this prosthesis, and.
And so finite element analysisis a numerical method of
breaking that, um, breaking thatfull arch into tiny little
(24:17):
chunks.
And the reason why that finiteelement method works is because
computers are very, very good atbasics, summing up a bunch of
little solutions together.
And essentially what it does,the output is stress, so it
(24:40):
calculates this very complextensor field that that is
created and strain in the in, inthe prosthesis, so so so the
interpretation of that.
And you can also tack on afailure theory.
So so there's theories about amaterial has, you know, ultimate
(25:03):
tensile strength and thingslike that we can describe those
little teeny elements and sumthem up and and, and we can
apply a failure theory to it andthe output is essentially.
Here's where.
Uh, usually the output is in ina heat map, and the heat if
(25:26):
you've ever seen this before,you'll see it in some of the
dental literature too.
The heat map tells you wherethe stresses are and then,
depending on the material, youcan somewhat figure out where
it's likely to fail.
Dr. Tyler Tolbert (25:36):
Okay, okay, yeah.
So something I'm I'm curiousabout um and I don't mean to
break your stride on explainingwhat, what all this can do Um.
So I I saw, you know, in yourpresentation you had several
different um designs.
It was actually a really cool.
Part of your presentation wasjust like an A and B of like
which one is going to break, andit's just kind of everyone's
(25:58):
just being intuitive about it.
You're not seeing a heat map oranything and it was very
counterintuitive and you kind oftalked about the multifactorial
processes and stuff like that.
But back to my question.
So something I'm very curiousabout and I hear this talked
about without a whole lot ofreally substantial argument.
It's just kind of, you knowit's hand-waving for the most
part.
So, you know, something we'veseen in the past several years
is the proliferation of directto multi-unit design, as opposed
(26:20):
to using tie bases in theserestorations.
Through finite element analysis, have you been able to make any
conclusions about stress pointsbetween those different systems
and what's better set up forsuccess long term?
Dr. Sven Bone (26:35):
No, I wouldn't say I have definitive evidence
on one or the other.
I do.
I, I can tell you that there is.
So, theoretically, when you'redesigning any kind of complex
mechanical system, you want to,you want to simplify as much as
(26:56):
you can, and, um, and I thinkthat when you, I, I don't think
there's enough evidence to showwhich one is best.
However, there's a phenomenoncalled tolerance, stacking.
So so, when you add a lot ofthings together and you're
(27:17):
trying to to get them all to fittogether, you, you compounding
inaccuracy, yeah, you compoundyour error, and so, uh, I think
theoretically, uh, direct to MUAis doable.
I think there's some, there'ssome fundamental problems with
that as well, um, but I thinkboth are are doable, and I don't
(27:38):
believe I can answer thatquestion Okay.
Dr. Tyler Tolbert (27:41):
Yeah, yeah, fair enough, fair enough.
I appreciate you not having ananswer, because most people like
to have some time.
Dr. Sven Bone (27:46):
No, no, yeah, no, I think I think we should, you
know, and that goes on.
Yeah, I mean, I think we shouldhave real, actual evidence.
Dr. Tyler Tolbert (27:58):
The thing that I've noticed anecdotally is
there is some issues with thestructural integrity of the.
I've heard them referred to aschimneys I don't know if we have
a prosodonic term for them yetbut the fluted end that actually
(28:18):
screws down into the multi-unitif you have a very long flute
of this, know, of this thinzirconia material.
I have definitely seen thatchip.
Yeah, oh yeah, that's set upfor that yeah for sure.
Dr. Sven Bone (28:24):
I mean this goes.
This goes down to like who'sdoing the designing and that
that's why wib exists isbasically you know that I mean
the the who's doing thedesigning is you're not having a
engineer.
You know there's not amechanical engineer designing
your designs, it's, it'ssomebody you know.
(28:44):
It's typically you knowsomebody with like a high school
diploma or something like that.
It doesn't necessarily meanthat they don't know anything
about.
You know mechanics, but theodds are they don't yeah Right.
Mechanics, but the odds arethey don't yeah Right.
And so I think it's on thatside of things, on the design
side, there's a lot moreemphasis on you know, does it
(29:08):
look like teeth?
And that's important, but atthe same time it's got to work,
you know.
Dr. Tyler Tolbert (29:12):
Yeah, yeah.
Dr. Sven Bone (29:13):
You know it's got to be structurally sound and so
I think there's a the, the, the, this pendulum is going to
swing.
I think, back towards more likewe, we, we absolutely know like
fractures and prostheticcomplications are extremely
inefficient part of in ourindustry, like, like right now,
(29:36):
prosthetic complications andstuff are huge efficient
inefficiency that needs to be,addressed For sure.
Dr. Tyler Tolbert (29:43):
So you know, I'm curious do you think that,
um, this is probably a difficultstatement to really make, but
you know, when it comes down to,you know what is making a
prosthesis vulnerable.
Is it more so going to be, youknow, a design aspect or some
some aspect of how that's beenconfigured, or is it going to be
more on the fabrication side ofthings how well lab handles
(30:07):
zirconia and centers it, youknow so on and so forth.
Dr. Sven Bone (30:10):
I think it's a, it's a I hate to say this, but
it's a combination, it's got tobe.
It's multiple, multiplevariables, like, come into this
equation, and so so I think theI think there's not one silver
bullet here to to to go that'sgoing to solve every, all the
(30:32):
problems, um, but I think we, wekind of, you know, I, I know
that on the design side, um, youknow we're, we're very focused
on getting a very nice, validtool for designers to use to
help them design better, youknow, as far as improving the
(30:53):
structural predictability oftheir, of their um processes, um
, and and, and I think, on thelab, on the manufacturing side,
um, you know there's, there'sother things that need to be
done as well.
Okay, okay, fair enough?
Dr. Tyler Tolbert (31:10):
And and with the, with the uh, will it break
application?
Um, so I, as far as I remember,when I, when I saw the
different heat maps and stuff,it looked like they were mostly
being mapped on to monolithicdesigns.
Yeah, um, are you able to doanalysis for uh, a system that
has a substructure, let's say atitanium?
Dr. Sven Bone (31:28):
so yeah, so we're actively working on on on
assemblies, essentially and sothat would be the term is
basically in a complex assemblyand then and then analyzing
those that that is much morechallenging to to code for.
Dr. Tyler Tolbert (31:47):
Yeah, I would imagine.
Yeah.
Dr. Sven Bone (31:49):
And we have to, we have to account for cement
and and things like.
Right, it's, it's a, it's a,it's a pretty complex problem.
I I'm kind of um, I'm reallycurious about what we're going
to find, like I'm yeah, no, Imean I'm really interested in,
yeah, and how you know and andand what, what we're gonna see
from the design side, andwe're're also, you know, we're
(32:11):
also embarking on mechanicaltesting as well, for about you
know, you know validation.
Dr. Tyler Tolbert (32:17):
Yeah, I think .
I think that's great becausethere's there's just so many
different design and fabrication.
You know options out there andwe all kind of have these vague
ideas of what can work indifferent situations and what
you should do, but it's, it'svery difficult for us to really
quantify those things.
Yeah, yeah, you should do, butit's, it's very difficult for us
to really quantify those things.
Dr. Sven Bone (32:34):
Yeah, yeah, and go ahead, please.
Well, that's the goal is to getaway from from opinions and,
you know, get away from fromopinions and have really, you
know, quantifiable objectivedata that we can, can get.
That's the, that's the, thefuture, that's what's going to
happen, and, and you know, and,and and so I think we're going
to see less polarization, um, asas we get more data, um and so.
(32:59):
So we're kind of in the, youknow, we're in more of a
speculation kind of landscaperight now because we just don't
have the tools, we don't, youknow, and and I, I think, I
think that's the key the goal isto is to get as far away from
that as we can.
Dr. Tyler Tolbert (33:15):
You know, to move things forward, we need, we
need the right to the righttools and we need good data ask
me you know what's going to be,you know the best restorative
material for you know any givencase, you know the safest thing
(33:36):
to say is, oh, it'smultifactorial, right.
But you know, really, theanswer that people will have is
entirely dependent on whothey've been talking to.
You know their own experienceand who they've been talking to.
But both of those things areinherently biased, right?
You know, some people justswear by monolithic zirconia.
It's God's gift to earth, it's,it's fantastic.
Other people will tell you themodulus of elasticity is way off
and you get saucer defectsaround implants and all these
(33:57):
things.
Some people will say you haveto have a titanium substructure.
Other people say, oh well, thenthe superstructure is going to
be thinner and more prone tofracture or something.
We're all just kind of, youknow, shooting in the dark.
So I'm very interested to seewhat comes up from that.
Dr. Sven Bone (34:09):
Yeah, yeah, me too, and this kind of also.
I think this also kind of cango into another.
I think thing that's going toimpact dentistry significantly
too is a lot of our studies andour observational studies and
(34:37):
our observational studies, and Ithink that we are.
I think we need to move intomore patient specific data.
I think we need more resolutionon that patient that's sitting
in the chair before while we'remaking these decisions about,
okay, what, how am I going todesign this prosthesis and how
and what you know as far as theimplant, the surgical plan and
(34:57):
things like that.
But I think, like bite force,just one, I mean a little old
lady I think I said this in mytalk.
You know, a big, massivecantilever totally broke any
kind of rule of thumb, but thatone is going to do fine because
it's in a different environment.
We're all different and so youknow, a middle-aged male that
(35:21):
bruxes is going to be entirelydifferent than a little old lady
that's, you know, eating mushall day, you know.
Yeah, I mean, it's just totallydifferent environment and so we
really need to step away fromfrom these.
We kind of need to evolve pastlike get, get through this.
(35:42):
You know, period of, and, and,and and throw down our, our
rules of thumb, and, and startusing more sophisticated tools
to make these decisions.
Dr. Tyler Tolbert (35:52):
Yeah, I totally agree with that and I
think that, you know, rules ofthumb can be very useful because
they are able to assume all ofthe all, of the complexity and
the different dynamics that gointo these systems as equal
right across all patients, andthat's great.
But, you know, still that's notreally enough to inform every
decision you make for eachpatient.
Something that I really enjoyedfrom Dr Sonata, who went, and
(36:15):
you know, of course, he wastalking about his FP1 cases and
had some beautiful documentationand everything, but one of the
things that really, you know, Ileft with was he was just
talking about the FMA angle andhow he assessed his cases and
you know I was aware of that,but you know he was like I can
look at a patient and I can tellhow big of a problem they're
really going to be for me froman occlusal standpoint in terms
of the bite forces Just off ofthat.
Dr. Sven Bone (36:37):
Yeah, every prosthodontist is just that they
have that burned in their brain.
That's the one.
Yeah, going through aprosthodontist is basically like
I mean, you just show up and itjust gets hammered into your
head eventually, and eventuallyyou learn.
(36:58):
But FMA is a, it really is avery, it is a useful, you know,
a tool or a diagnostic aid and atreatment planning aid, but
again, it is just an aid, right,of course, and I think that
we're even going to get better,like you know what I mean, with
(37:19):
more data, like as far as, like,hey, bite, force, things like
that.
Dr. Tyler Tolbert (37:24):
Yeah, yeah, well, I think, yeah, as we get
more.
You know technology andmetroscopy to check out what
occlusal forces look like in agiven system, right.
You know technology andmetroscopy to to check out what
occlusal forces look like in agiven system, right.
But with like um, with like theT scan looking at you know
where someone is.
I mean, uh, even just knowinghow they chew is a really
important thing, right.
If you're, you're might beconcerned about some you know
structural, uh integrity issueon the left side, but they never
even chew over there, right.
(37:45):
So, like, just knowing how theyfunction is extremely important
.
We don't even really measurefor that.
Dr. Sven Bone (37:50):
No, no, like the envelope of function, like like
where, where, where they'reactually spending most of their
time, and you know, and, andthen, and then we, we have you
know, and then, and then moreresolution on like what's the
pair of functional possibilities, and then how much?
Load, could that be?
Dr. Tyler Tolbert (38:09):
Yeah, yeah, and, and to you know, we know we
talk about, um, there's anissue with making a patient fit
a prosthesis, right, and we havethese rules of thumb about how
much space we need for a givenmaterial, um, and why do we
think that we have to get to,you know, 15 or 18 millimeters
of prosthetic space for everysingle patient?
Um, do you really need to dothat?
Right?
And we're not necessarilymaking an informed decision,
(38:30):
we're just going off again that.
Do you really need to do that,right?
We're not necessarily making aninformed decision.
We're just going off again thatrule of thumb, and that's
affecting how the patient isbeing treated.
It's affecting what you'redoing as a surgeon, um, so
that's that's kind of anuninformed decision, um, so,
yeah, I think we we stand togain, you know, uh, a lot of
advancement in terms of you knowhow we take care of people and
what we're able to do.
Dr. Sven Bone (38:45):
Yeah, and you know, I think this kind of
segues into a concept of everyclinician forms, a model in
their head.
We have a biomechanical bucket,a biomechanical model.
We have an aesthetics andphonetics model.
(39:07):
We have like a physiology orkind of a pathology model and a
medical model about how thispatient is going to.
You know, what should I do?
So we start filling in inputsin all those buckets and we
start figuring out okay, givenall this input, what should I do
(39:31):
?
How am I going to treat thispatient?
And then what's the outcomegoing to be?
And I think it's reallyimportant, I think, to get to
mastery, I think it's reallycritical to make those models
(39:55):
one very diverse, like complex.
So you have lots of inputs andyou're analyzing lots of
different data points, and thenI think it's also really
critical is to harvest as muchexperience or much knowledge as
you can from your experiencepoints.
So every case is an opportunityto make, to enhance those
(40:15):
internal models, and so I thinkthe clinicians that reach
mastery I'm not saying I'm amaster by any means, but I think
all of us are, or most of usshould be, on that path Like how
do I get, how do I really getyou know good at this and and I
think that's the the kind of thepathway because you know
(40:37):
experience, you can kind ofrinse and repeat, uh, the kind
of robotically right.
Uh and and I think your job as aclinician is to is to really um
grow in your sophistication asrapidly as you can.
Dr. Tyler Tolbert (40:53):
Right, right, no, I totally agree with that.
And I think that a lot of timesthe feedbacks that we're
looking at are not alwayssomething that really lends to
that kind of mastery that you'retalking about.
Like a lot of dentists, theytake all those different models
that you just mentioned and theyform a certain formula for
their practice and they, likeyou said, rinse and repeat day
(41:14):
in, day out.
And you know, sometimes as longas the office is doing well,
you know you get this idea that,like you're doing something,
you're doing something right andyou're doing it the best and
other people should be doing itthat way too.
And you know you're notnecessarily committing yourself
to excellence that way, becauseyou're looking at different
surrogate markers that aren'tnecessarily, you know, tied to.
You know what is the endproduct, what have you provided
(41:36):
for the patient, what's reallygoing to be the best long-term?
And you know one thing aboutfull arch is you know we are
measuring our success on kind ofa monthly basis.
Right, it's just, how much didthe office do?
How many arches did you do Not?
You know, did the thing thatyou did today is?
Did you do not?
You know did, did the thingthat you did today.
Is that going to last thepatient 25 years?
And we have no idea.
But maybe if we had some datawe could have a better idea.
Dr. Sven Bone (41:56):
Yeah, right, yeah , and, and, and.
A happy patient isn'tnecessarily the best metric.
Dr. Tyler Tolbert (42:01):
If it's screwed in, they're probably
right, and that's that's notenough.
Dr. Sven Bone (42:04):
Yeah, you know, I mean you should look at your
input, we, you, you should lookat your input.
What was my outcome and did I?
Did I achieve my goals?
And and I think I think that'sthat's like a um I I think
that's so important to to get toa place where you, where we all
want to be, you know yeah, andit's it's easy to to kind of
(42:26):
rinse and repeat.
Oh the patient's happy.
You know I must do a great job.
But yeah, but no issues, rightright but it's when, because
when you have a, when you, whenyou have that like mentality as
far as, like I'm really going to, you know, analyze all of my
(42:46):
outputs or all my outcomes, thenwhen you get into a tough one,
that's when, that's what's goingto save you.
Dr. Tyler Tolbert (42:55):
Yeah, yeah, right, so that that that makes a
lot of sense.
Yeah, cause they're not alleasy.
Dr. Sven Bone (43:00):
They're.
It's like if you, if you lookat rebuilding a mouth, it's
incredibly complex and and wehave great technology.
You know like photogrammetryhas been a game changer.
There's no question about that,and a lot of the, you know,
(43:21):
interaural scanners have been,you know, very useful and so.
But I do think that they are,but inherently it's very
complicated and so sometimes weget bit.
Dr. Tyler Tolbert (43:38):
Sometimes it doesn't work, so well.
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi and you're listening to theFix Podcast, your source for
all things implant dentistry.
All right, and welcome back tothe Fix Podcast.
Just to update you guys, Iguess it was maybe the weekend
before last, the weekend beforethat everything blurs together,
but I attended the first annualORCA symposium in Las Vegas,
(00:26):
which had a really, reallyimpressive lineup of speakers,
and one of them is here with ustoday, dr Sven Bone.
He got up on stage and you knowthere were so many different
lecturers there that came from avariety of backgrounds and
spoke to so many differentthings, and it was really an
incredible conference.
I really enjoyed it.
But Dr Bone got up there Firstof all coolest name in dentistry
(00:49):
, I'm just going to go ahead andput that out there and he got
into some really, reallyinteresting concepts.
We're going to get into themtoday.
You know including, I mean, drBone is bringing a whole lot of
experience from a background inphysics that we'll talk about.
He has his own lab, he's aprosthodontist, he also does
surgery, he does full arch, allthese wonderful things that we
(01:10):
talk about and I got to talkingwith him after the symposium
about some of the things wespoke about and we got into some
really cool topics that I justthought would be amazing for the
show, and he's been graciousenough to come on.
So, Dr Sven, thank you so muchfor coming on.
Dr. Sven Bone (01:21):
Of course.
Yeah, it's a pleasure to behere, and I do have one
correction I actually don't dosurgeries anymore.
Dr. Tyler Tolbert (01:27):
Oh, okay.
Well, yeah, you've done them.
Yeah, you're aware of theconcepts.
Dr. Sven Bone (01:31):
Yeah, you know my , my implant experiences is I've
, I've placed, um, I, probablyaround a hundred or so, so not
not a ton.
Oh, okay, and and basically Ireally dove into the
manufacturing, the design, andreally kind of stuck with the
process, the process side ofthings.
Dr. Tyler Tolbert (01:53):
Got it?
Yeah, sure, sure, yeah, well, Imean I think that's all the
better and really, when you knowwe argue that when people go
about learning this, learningthe process first and then kind
of working your way backward isreally the appropriate way to do
it, because the differencebetween just being able to say
you did this and doing this wellreally goes down to those types
of fundamentals.
So I'm really really happy tohave you on here and I know you
can go deep on that kind ofstuff, yeah totally, I think you
(02:15):
know, and if we look in theliterature you know the number.
Dr. Sven Bone (02:19):
if you just look at complications, you're going
to see them.
They're all kind of a lot ofthem are orbiting around the
process side of things you knowon complication rates.
So so I think I think a solidfoundation in this is is is
really critical.
Surgery is sexy, right, surgeryis, and all the surgeons will
(02:43):
admit to that.
But the prosth side sometimesthat's where things can get
really kind of challenging.
Dr. Tyler Tolbert (02:52):
Yeah, yeah, and if you're not doing the
prosth side correctly, thenyou'll be doing a whole lot more
surgery, but probably not thekind that you want to be doing.
Yeah, possibly.
Dr. Sven Bone (02:58):
Yeah, yeah.
Dr. Tyler Tolbert (02:59):
Absolutely, that's right.
So yeah, before we get intobrass tacks and everything for
those that are unacquainted withyou, could you just kind of
give us a walkthrough of yourwhole academic journey to you
know what's what's kind of fedinto all that?
I know we don't have to go toodeep, yeah, but but, yeah, let's
, let's kind of yeah.
Dr. Sven Bone (03:16):
You know, I started out so I left home.
I grew up in Western NorthCarolina as a kid and I left
home when I was 18 and I movedout to Montana and so I studied.
I knew I wanted to studyphysics as an undergraduate and
so I did.
(03:37):
And in that time I you knowphysics majors have to get
minors in mathematics in orderto get a degree, and so I was
kind of I ended up.
At the time, you know, a bigrevolution was happening in
(04:00):
biology and I became reallyinterested in kind of the
biology and and and kind of thebiology side.
So I took a few biology classesand, um, one of my lab partners
was going to be a dentist.
And so, uh, you know cause Iasked him, I was like, what are
you going to do, johnny?
He goes, I'm going to be adentist.
And so I'd never thought ofthat before, never once.
(04:22):
And and I started looking intoit and then I realized like, wow
, dentistry is a beautifulcombination of medicine, it's
art and engineering reallymechanics, yeah and so so I was
like, wow, this could be areally good avenue for me.
so so I uh ended up, uh, so Iended up taking more pre-med
(04:45):
type classes and decided to goon and finish a degree in
mathematics.
And so I have two undergraduatedegrees, one's in physics, the
(05:08):
other one's in mathematics, withmore of an applied side.
So so basically, it's trying tosolve real world, real world
problems, like how do we modelthese sophisticated mechanical
problems?
And and also I mean just I tooka graduate course in in it was
it was called like I think itwas biologic, biological
mathematics and biology, orsomething like that.
I ended up modeling the calciumfluxes, like the voltages
(05:35):
through the heart through thecardiac muscle and also I
remember modeling insulinrelease in the beta cells in the
pancreas, so really kind ofcomplex, fun stuff.
And so I finished that up andthen I applied to dental school
(05:59):
and I got accepted to.
I think it was there's nodental school in Montana.
I got accepted to.
I think it was there's nodental school in Montana.
So I got accepted to I believeit was Tufts and Boston and UOP
and I think Creighton, nice yeah.
Dr. Tyler Tolbert (06:15):
So I ended up going to UOP.
Okay, very nice, yeah, so Iwanted to move to San Francisco
and be on the West Coast and youknow, I thought it was.
Dr. Sven Bone (06:20):
And so I went to move to San Francisco and and
and and be on the West coast andand you know I thought it was,
and so so I went to dentalschool and then, when I was in
dental school, I you know,western schools are very pro
kind of, you know like basically, hey, we're going to teach you
everything you need to know.
And I, when I was in dentalschool, I knew that there was
(06:44):
more complexity involved with,like full mouth rehabilitations
and large like restorative likeprocedures.
So I decided to work for oneyear after dental school back in
Montana, and I encountered somecases that I knew were complex
(07:05):
and I didn't feel like I was asprepared as I wanted to be, and
so I decided to move on to PROSand I applied to PROS programs
and got accepted to Carolina andthen Baylor, and so I decided
to go to Baylor for my PROS.
Dr. Tyler Tolbert (07:24):
Okay, nice, very nice.
Um.
So yeah, I mean it sounds likeyou kind of caught that bug uh,
sort of on a whim, just like inphysics lab and sort of just
drawn to the complexity of it.
That's fantastic, um, you know,I actually I had a lot of
interest in physics while I wasin college.
I was reading a whole bunch oflike Carl Sagan and you know um
(07:44):
astronomical stuff and um, Ifound out pretty quickly you do
have to be able to do math to dophysics.
And that was that was kind ofthe problem, that that was what
was in my way, um.
So, uh, yeah, I was.
I stood no chance of beingcontributory to that field, um,
but fortunately I did.
I did have a, uh, you know, amind for biology and things like
that and working with my handsand physics kind of had a very
(08:06):
roundabout way of sorry.
Dentistry had a roundabout wayof finding me, but but yeah,
that's fantastic.
So you went to a prostresidency at Baylor and you know
you've ended up in Bozeman, sokind of you know what was that
journey out of prost residencyinto dentistry?
Did you go directly intoprivate practice or what?
What was that like?
Dr. Sven Bone (08:24):
residency, uh, into dentistry.
Did you go directly intoprivate practice or what?
What was that like?
Yeah, I worked, um, I, you know, after my process residency, I,
I, I just needed a job.
So I worked in Dallas for for acouple like two or three years,
I think about three years andthen, and then, um, and then I
was like yep, time to go.
So I wanted I knew my compassalways pointed back to um, I
(08:44):
knew I wanted to go back toSouthwest Montana, so it's
always felt like home for me andand so so I I just kind of
packed up and it was time for meto head on out, and so I came
out here and worked, uh, Icommuted and worked in uh, a
couple of private practices andthen, uh, when a space came
(09:07):
available, I I started my ownpractice.
Dr. Tyler Tolbert (09:10):
Very good, very good.
So you're starting your ownpractice.
It's a prosthodontic practice.
I imagine you're doing fullmouth rehabs.
You're maybe doing someimplants.
I mean, what was kind of likeyour, your mix right off the bat
, what was really?
What got you going?
Dr. Sven Bone (09:23):
I mean, at first, I think it's anything you're,
you know you.
It takes a few years to toreally determine what you wanted
.
Who are you?
You know what.
What do I want to do, and and,and I think I think focus is is,
uh, I think, a key part ofevolving as a clinician.
I think you find your.
(09:48):
You find what you really areinterested in and that's what
you're going to end up doing,you know, and so so at first I
was did more general dentistryand then now it's.
It's pretty much implant based.
Dr. Tyler Tolbert (09:58):
Okay, okay.
So is there like a network ofreferring doctors or surgeons
that are doing the cases andthen they're coming back to you
to get restored?
Dr. Sven Bone (10:06):
Okay, yeah, it's mostly I do toothborne.
You know toothborne rehabs andsome, you know it's a.
It's a mix, but generally onthe full arch side I usually do
about two cases to maybe five amonth or so, it just depends on
the demand.
There's not a lot of people inMontana, so it's.
Dr. Tyler Tolbert (10:26):
Yeah, sure, I understand.
Um so I'm aware, of course,that you have a bone dental lab
as well.
Um so when did that come about?
What was the impetus forstarting your own lab?
Dr. Sven Bone (10:38):
Um, I started my own lab just because, um, just
like anything in life, if youwant to truly master something,
you really have to do the hardwork and dive deep.
And so I started.
I think I started my lab mainlyout of just, you know, in
residency we make a lot.
(10:59):
I mean, basically we do a lotof lab work is part of the
requirement, and so I somewhatmissed that.
And then also I was reallyexcited about the transformation
that the lab industry has gonethrough, and so I wanted to, I
really wanted to dive deep intothat, and so I started the bone
(11:22):
dental lab, mainly for just myown curiosity, my own desire to
control the, I think, reallycontrol the the the whole
process for my patients, becausethe, you know, understanding
from A to Z is very important tominimize your risks.
Dr. Tyler Tolbert (11:46):
Yeah, yeah, no, I totally agree with that.
I think, one of the mosttransformative times in my own
clinical practice.
I do have like an all digitalworkflow for my full arch now,
and so the lab can do a lot ofheavy lifting for me, um, but
thankfully I there was a timebefore that for me where, um, I
did have an in-house lab and alab technician that would do all
my conversions, and we had aweek where I had, um, three
(12:09):
double arches and, um, he, um,his father was sick in Israel
and he wanted to go back andspend some time with him.
I was like, of course, you knowyou have to go do that, and so I
had to do my own conversionsfor a week, and that's when I
learned you know how good andbad of a surgeon that I was, you
know because I figured out whatneeded to be done in order to
simplify that conversion processand by even just like the third
(12:31):
conversion that I did that week, I was significantly better and
giving my tech a lot better ofa time when he came back to do
my conversion.
So I definitely learned thatlive, just starting with the end
in mind and working your waybackward.
Dr. Sven Bone (12:42):
You know, I think there's a lot of truth in what
you said.
Like the best surgeons that Iknow and work with really
understand the prosthetic sideand their center synergy back
and forth, and and, and.
I think that it's inherently amultidisciplinary uh treatment
and and and.
(13:02):
I think that's what's what's uh.
You can't.
Everybody has to be on the samepage If you want to have the
most amount, the greatest amountof success and the minimal
amount of risk is thateverybody's kind of like mind
melded together yeah, you knowfor sure gotta be reading the
(13:23):
same sheet of music.
Dr. Tyler Tolbert (13:24):
yeah, um, so with the lab, do you have
technicians that are working inthere as well?
Dr. Sven Bone (13:29):
are they serving like other practices, or is it
all just you know the work thatyou're doing in out of your
clinic, or yeah, so we do have,um, we, we do accept like
digital, like like cliniciansthat do have fully digital
workflows, we, we will acceptcases from them.
Um, and then we, locally, youknow we'll, we have, uh, in the
(13:51):
past we've gone out and donerecords and do the whole like,
basically do the whole thing.
Oh cool, yeah, Okay, and so uh.
But you know Montana is a bigstate and so drive in three
hours, you know it can bechallenging.
Dr. Tyler Tolbert (14:05):
No, that's a lot to ask, for sure.
Well, fortunately, you know,everything's the speed of the
internet now, especially ifyou're up to date on a fully
digital workflow, so that'sfantastic.
Um, so you know how?
Has that kind of experience ofbuilding out the lab then kind
of taught you more, as you knowa prosthodontist like what does
that development really looklike?
Dr. Sven Bone (14:22):
Yeah, it's, it's a it's honestly it's very
challenging Like I can't evenimagine, yeah, like
manufacturing in general, is isa very challenging field and you
know my I think that I have alot of sympathy and respect for
for laboratory technicians andand and what they do?
Dr. Tyler Tolbert (14:44):
I'm wearing a t-shirt right now.
Dr. Sven Bone (14:47):
Yeah, I mean they , they, they really are our
partners and and and I thinkthat is I think it's super
critical to be you know, toreally defend each other and to
be and work well together,because that's kind of what
really makes the full circle,yeah, you know, so we can have a
(15:09):
good outcome.
It's, I think you know, for me,because I do all the CAD designs
and stuff for my patients.
I tend to get a little lazywith communication with the lab,
but I can't under emphasize howcritical that is.
(15:29):
You know, as far as, like, howyour relationships are with your
other, with the people you workwith, how your relationships
are with with your other, withthe people you work with.
Like, how well do youcommunicate with them and how
clear is your from the clinicalperspective?
How clearly can you describewhat you, what you intend the
outcome to be?
Because the more informationyou can communicate with the
(15:51):
people that are, you know,fabricating these things, um,
the the the better.
I think, like I tell mypatients, I don't want any
surprises and so that's what wewrite.
That's why we kind of gothrough a lot of that, why I'm
very systematic about thingsyeah, that makes sense.
Dr. Tyler Tolbert (16:11):
I think you know, a lot of times there's a
bit of a void in knowledge whena dentist is looking for
different labs to go to.
Let's say you're looking for adigital lab to do your designs
and milligrids or conias.
You know you'll ask questionsabout what the lab wants right,
like what, what kind of recordswere they looking for?
You know what are the differentstages they work with and
things like that.
But there's a lot of questionsI think dentists don't know to
(16:32):
ask, right In terms of, like,how they actually make their
prosthetics.
Um, you know different, not noteven just turnaround times, but
just like, what is their qualitycontrol?
Like, um, you know, how manydesigners do they have on the
team?
How experienced are they?
What you know, how, how haseverything?
You know, uh, what are thedifferent departments look like
and how has all that flow?
And I and I'm curious about youknow, with you having such a
(16:52):
direct relationship with yourlab and them making that final
product from start to finish hasthat kind of taught you some
things that dentists might needto be a little bit more
discerning about when they'relooking at different labs?
Dr. Sven Bone (17:03):
Yeah, one is on your end, I think on the
clinician's end.
We absolutely need to have veryconsistent and standardized
record taking and I think that'sbeen the most powerful thing
(17:25):
that has changed just my ownpride, like you know.
I came, I kind of like came outof the womb, you know, out of a
prost residency right, knowingkind of like, like just having
that beaten into my head as faras how you, you know, of a prost
residency right knowing kind oflike like just having that
beaten into my head as far ashow you, you know take records
and and things and I think thatstandardization and record
(17:46):
record taking is massive, um,yeah, as far as like getting a
reducing the entropy or chaosthat's in the, in all the the
information that that thelaboratories receive, and and so
I think that, uh, so one isportraits or face scans, um, and
then the other one is shadesyou know, standard shade
(18:10):
selection with photos, and thensome sort of job relationship
record.
You know treatment position, andso, on the clinician side,
their responsibility is todetermine the treatment position
and then also, you know, beable to provide enough data so
(18:35):
that the technician canreproduce the patient in their
like in front of the screen.
And, and that's the goal andthat's what I do with all my
patients on.
So that's helped me on theclinical side and then on the on
the laboratory side, on themanufacturing side, they to, um,
(18:56):
absolutely understand theirmaterials.
Uh, on the cad design part, uh,it's a little chaos out there.
We'll probably get into thatyeah, oh yeah, let's do it right
and and on the and on themanufacturing, like tool changes
, uh things like that.
Like all the little details tokeep your uh systems uh.
Like that, like all the littledetails to keep your uh systems
(19:18):
uh.
Like machining, like what kindof validation and verification
are you doing for your machining?
Dr. Tyler Tolbert (19:24):
Yeah, yeah.
So I have two um, you knowcontext, that kind of.
They don't educate me aboutthose things, but they make me
vaguely aware of them and humbleme a little bit.
So, uh, my dad uh comes fromaerospace engineering, so he had
a manufacturing company.
He made parts for BoeingGulfstream and that was like my
summer job was working a CNCmachine and learning about, you
know, quality control andtolerances and you know the
(19:47):
human error that can be involvedin those manufacturing
processes.
And then, on top of that, beforeI got into dental school, part
of the things that I was doingto build out my resume was
working at a dental lab.
So I worked in the CAD gamedepartment for a lab and the
number one thing that gotdrilled into me before I ever
learned how to do any type ofdentistry was shit in, shit out
right, like if the record's bad,their product's going to be bad
.
And you know, dennis had thisidea that somehow, you know,
(20:10):
given it's almost like thatscene and the really cliche
scene in movies where they theyzoom into a very, you know,
poorly resolved image and thenthey they resolve it more and
somehow it's higher qualityafter they zoom in, dennis think
that labs can do that yeah yeahthe, the born, or like the
satellite.
Yeah, that's not how data worksyeah, yeah, exactly so somehow
(20:34):
it's, it's not it longer.
Yeah, we're just trying tominimize the loss of accuracy,
but somehow we're supposed tocreate it.
But those have really gotten mea better appreciation for what
it takes to have high qualityrecords and result in a high
quality product.
And generally, as hard as alab's job is, it's a lot easier
when that data is accurate andwhen it's good and it makes the
(20:55):
lab, it makes the doctor feel alot better when things work well
.
But that's only if they did therecords correctly.
You can't create accuracy, sobut yeah, no, that's, that's
really good.
So you've got the, obviouslyyour prosthodontic practice, you
got the dental lab, and then Ialso learned a little bit about
what you're doing with yoursmart mouth technologies company
(21:16):
.
Dr. Sven Bone (21:27):
So can you tell us a little bit about what
you're doing with your smartmouth technologies company?
So can you tell us a little bitabout that?
Yeah, so I started a I I I justkind of, I think, just having
my background and like atechnical background and then
also having a clinicalbackground, I think I'm
particularly good at kind ofteasing out like some
fundamental problems, that thatwhere I think we need
improvement.
And so I started a engineeringI guess that would be a tech
company really and and I I haveabout five engineers on staff
(21:54):
and we essentially we have abunch of projects that we're
working on, and so the.
I think one of the biggest firstprojects that we're working on
is a web application called Willit Break, and that's a finite
element analysis for dentalprosthetics, and essentially
(22:17):
what it does is it tests designs.
So what we want to know, and Ithink what is really important
for designers to know is aretheir designs set up for failure
from the beginning?
And so the you you know we havea bunch of rules of thumb,
(22:37):
right, you know, cathedrals werebuilt on rules of thumb, but
structural engineers don't userules of thumb anymore to build,
you know, uh, skyscrapers andbuildings, and you're right, you
know that kind of stuff, so weuse um.
Basically we want.
Our goal is to increase theengineering rigor into this
space and make it moresophisticated.
Dr. Tyler Tolbert (22:59):
Okay, yeah, so can you just fundamentally,
can you tell us what finiteelement analysis is, how it
works and exactly what it tellsus?
Dr. Sven Bone (23:08):
Yeah, so the interpretation.
So what finite element analysisis is it's basically a
numerical, uh, salute, it's anumerical computational method
for solving incredibly complexequations.
And and these, when you take astructure or or like, let's say,
(23:29):
a full arch, and you, uh, andlet's say, a patient bites on it
, or let's say they grab somebeef jerky and bites down right
on that distal cantilever, sowhat happens is a very complex
tensor field is created in thatstructure, in that full arch,
(23:53):
and it what it does is is thatthat field describes how that
force is experienced, I guess,by this, this, uh, by this full,
by this prosthesis, and.
And so finite element analysisis a numerical method of
breaking that, um, breaking thatfull arch into tiny little
(24:17):
chunks.
And the reason why that finiteelement method works is because
computers are very, very good atbasics, summing up a bunch of
little solutions together.
And essentially what it does,the output is stress, so it
(24:40):
calculates this very complextensor field that that is
created and strain in the in, inthe prosthesis, so so so the
interpretation of that.
And you can also tack on afailure theory.
So so there's theories about amaterial has, you know, ultimate
(25:03):
tensile strength and thingslike that we can describe those
little teeny elements and sumthem up and and, and we can
apply a failure theory to it andthe output is essentially.
Here's where.
Uh, usually the output is in ina heat map, and the heat if
(25:26):
you've ever seen this before,you'll see it in some of the
dental literature too.
The heat map tells you wherethe stresses are and then,
depending on the material, youcan somewhat figure out where
it's likely to fail.
Dr. Tyler Tolbert (25:36):
Okay, okay, yeah.
So something I'm I'm curiousabout um and I don't mean to
break your stride on explainingwhat, what all this can do Um.
So I I saw, you know, in yourpresentation you had several
different um designs.
It was actually a really cool.
Part of your presentation wasjust like an A and B of like
which one is going to break, andit's just kind of everyone's
(25:58):
just being intuitive about it.
You're not seeing a heat map oranything and it was very
counterintuitive and you kind oftalked about the multifactorial
processes and stuff like that.
But back to my question.
So something I'm very curiousabout and I hear this talked
about without a whole lot ofreally substantial argument.
It's just kind of, you knowit's hand-waving for the most
part.
So, you know, something we'veseen in the past several years
is the proliferation of directto multi-unit design, as opposed
(26:20):
to using tie bases in theserestorations.
Through finite element analysis, have you been able to make any
conclusions about stress pointsbetween those different systems
and what's better set up forsuccess long term?
Dr. Sven Bone (26:35):
No, I wouldn't say I have definitive evidence
on one or the other.
I do.
I, I can tell you that there is.
So, theoretically, when you'redesigning any kind of complex
mechanical system, you want to,you want to simplify as much as
(26:56):
you can, and, um, and I thinkthat when you, I, I don't think
there's enough evidence to showwhich one is best.
However, there's a phenomenoncalled tolerance, stacking.
So so, when you add a lot ofthings together and you're
(27:17):
trying to to get them all to fittogether, you, you compounding
inaccuracy, yeah, you compoundyour error, and so, uh, I think
theoretically, uh, direct to MUAis doable.
I think there's some, there'ssome fundamental problems with
that as well, um, but I thinkboth are are doable, and I don't
(27:38):
believe I can answer thatquestion Okay.
Dr. Tyler Tolbert (27:41):
Yeah, yeah, fair enough, fair enough.
I appreciate you not having ananswer, because most people like
to have some time.
Dr. Sven Bone (27:46):
No, no, yeah, no, I think I think we should, you
know, and that goes on.
Yeah, I mean, I think we shouldhave real, actual evidence.
Dr. Tyler Tolbert (27:58):
The thing that I've noticed anecdotally is
there is some issues with thestructural integrity of the.
I've heard them referred to aschimneys I don't know if we have
a prosodonic term for them yetbut the fluted end that actually
(28:18):
screws down into the multi-unitif you have a very long flute
of this, know, of this thinzirconia material.
I have definitely seen thatchip.
Yeah, oh yeah, that's set upfor that yeah for sure.
Dr. Sven Bone (28:24):
I mean this goes.
This goes down to like who'sdoing the designing and that
that's why wib exists isbasically you know that I mean
the the who's doing thedesigning is you're not having a
engineer.
You know there's not amechanical engineer designing
your designs, it's, it'ssomebody you know.
(28:44):
It's typically you knowsomebody with like a high school
diploma or something like that.
It doesn't necessarily meanthat they don't know anything
about.
You know mechanics, but theodds are they don't yeah Right.
Mechanics, but the odds arethey don't yeah Right.
And so I think it's on thatside of things, on the design
side, there's a lot moreemphasis on you know, does it
(29:08):
look like teeth?
And that's important, but atthe same time it's got to work,
you know.
Dr. Tyler Tolbert (29:12):
Yeah, yeah.
Dr. Sven Bone (29:13):
You know it's got to be structurally sound and so
I think there's a the, the, the, this pendulum is going to
swing.
I think, back towards more likewe, we, we absolutely know like
fractures and prostheticcomplications are extremely
inefficient part of in ourindustry, like, like right now,
(29:36):
prosthetic complications andstuff are huge efficient
inefficiency that needs to be,addressed For sure.
Dr. Tyler Tolbert (29:43):
So you know, I'm curious do you think that,
um, this is probably a difficultstatement to really make, but
you know, when it comes down to,you know what is making a
prosthesis vulnerable.
Is it more so going to be, youknow, a design aspect or some
some aspect of how that's beenconfigured, or is it going to be
more on the fabrication side ofthings how well lab handles
(30:07):
zirconia and centers it, youknow so on and so forth.
Dr. Sven Bone (30:10):
I think it's a, it's a I hate to say this, but
it's a combination, it's got tobe.
It's multiple, multiplevariables, like, come into this
equation, and so so I think theI think there's not one silver
bullet here to to to go that'sgoing to solve every, all the
(30:32):
problems, um, but I think we, wekind of, you know, I, I know
that on the design side, um, youknow we're, we're very focused
on getting a very nice, validtool for designers to use to
help them design better, youknow, as far as improving the
(30:53):
structural predictability oftheir, of their um processes, um
, and and, and I think, on thelab, on the manufacturing side,
um, you know there's, there'sother things that need to be
done as well.
Okay, okay, fair enough?
Dr. Tyler Tolbert (31:10):
And and with the, with the uh, will it break
application?
Um, so I, as far as I remember,when I, when I saw the
different heat maps and stuff,it looked like they were mostly
being mapped on to monolithicdesigns.
Yeah, um, are you able to doanalysis for uh, a system that
has a substructure, let's say atitanium?
Dr. Sven Bone (31:28):
so yeah, so we're actively working on on on
assemblies, essentially and sothat would be the term is
basically in a complex assemblyand then and then analyzing
those that that is much morechallenging to to code for.
Dr. Tyler Tolbert (31:47):
Yeah, I would imagine.
Yeah.
Dr. Sven Bone (31:49):
And we have to, we have to account for cement
and and things like.
Right, it's, it's a, it's a,it's a pretty complex problem.
I I'm kind of um, I'm reallycurious about what we're going
to find, like I'm yeah, no, Imean I'm really interested in,
yeah, and how you know and andand what, what we're gonna see
from the design side, andwe're're also, you know, we're
(32:11):
also embarking on mechanicaltesting as well, for about you
know, you know validation.
Dr. Tyler Tolbert (32:17):
Yeah, I think .
I think that's great becausethere's there's just so many
different design and fabrication.
You know options out there andwe all kind of have these vague
ideas of what can work indifferent situations and what
you should do, but it's, it'svery difficult for us to really
quantify those things.
Yeah, yeah, you should do, butit's, it's very difficult for us
to really quantify those things.
Dr. Sven Bone (32:34):
Yeah, yeah, and go ahead, please.
Well, that's the goal is to getaway from from opinions and,
you know, get away from fromopinions and have really, you
know, quantifiable objectivedata that we can, can get.
That's the, that's the, thefuture, that's what's going to
happen, and, and you know, and,and and so I think we're going
to see less polarization, um, asas we get more data, um and so.
(32:59):
So we're kind of in the, youknow, we're in more of a
speculation kind of landscaperight now because we just don't
have the tools, we don't, youknow, and and I, I think, I
think that's the key the goal isto is to get as far away from
that as we can.
Dr. Tyler Tolbert (33:15):
You know, to move things forward, we need, we
need the right to the righttools and we need good data ask
me you know what's going to be,you know the best restorative
material for you know any givencase, you know the safest thing
(33:36):
to say is, oh, it'smultifactorial, right.
But you know, really, theanswer that people will have is
entirely dependent on whothey've been talking to.
You know their own experienceand who they've been talking to.
But both of those things areinherently biased, right?
You know, some people justswear by monolithic zirconia.
It's God's gift to earth, it's,it's fantastic.
Other people will tell you themodulus of elasticity is way off
and you get saucer defectsaround implants and all these
(33:57):
things.
Some people will say you haveto have a titanium substructure.
Other people say, oh well, thenthe superstructure is going to
be thinner and more prone tofracture or something.
We're all just kind of, youknow, shooting in the dark.
So I'm very interested to seewhat comes up from that.
Dr. Sven Bone (34:09):
Yeah, yeah, me too, and this kind of also.
I think this also kind of cango into another.
I think thing that's going toimpact dentistry significantly
too is a lot of our studies andour observational studies and
(34:37):
our observational studies, and Ithink that we are.
I think we need to move intomore patient specific data.
I think we need more resolutionon that patient that's sitting
in the chair before while we'remaking these decisions about,
okay, what, how am I going todesign this prosthesis and how
and what you know as far as theimplant, the surgical plan and
(34:57):
things like that.
But I think, like bite force,just one, I mean a little old
lady I think I said this in mytalk.
You know, a big, massivecantilever totally broke any
kind of rule of thumb, but thatone is going to do fine because
it's in a different environment.
We're all different and so youknow, a middle-aged male that
(35:21):
bruxes is going to be entirelydifferent than a little old lady
that's, you know, eating mushall day, you know.
Yeah, I mean, it's just totallydifferent environment and so we
really need to step away fromfrom these.
We kind of need to evolve pastlike get, get through this.
(35:42):
You know, period of, and, and,and and throw down our, our
rules of thumb, and, and startusing more sophisticated tools
to make these decisions.
Dr. Tyler Tolbert (35:52):
Yeah, I totally agree with that and I
think that, you know, rules ofthumb can be very useful because
they are able to assume all ofthe all, of the complexity and
the different dynamics that gointo these systems as equal
right across all patients, andthat's great.
But, you know, still that's notreally enough to inform every
decision you make for eachpatient.
Something that I really enjoyedfrom Dr Sonata, who went, and
(36:15):
you know, of course, he wastalking about his FP1 cases and
had some beautiful documentationand everything, but one of the
things that really, you know, Ileft with was he was just
talking about the FMA angle andhow he assessed his cases and
you know I was aware of that,but you know he was like I can
look at a patient and I can tellhow big of a problem they're
really going to be for me froman occlusal standpoint in terms
of the bite forces Just off ofthat.
Dr. Sven Bone (36:37):
Yeah, every prosthodontist is just that they
have that burned in their brain.
That's the one.
Yeah, going through aprosthodontist is basically like
I mean, you just show up and itjust gets hammered into your
head eventually, and eventuallyyou learn.
(36:58):
But FMA is a, it really is avery, it is a useful, you know,
a tool or a diagnostic aid and atreatment planning aid, but
again, it is just an aid, right,of course, and I think that
we're even going to get better,like you know what I mean, with
(37:19):
more data, like as far as, like,hey, bite, force, things like
that.
Dr. Tyler Tolbert (37:24):
Yeah, yeah, well, I think, yeah, as we get
more.
You know technology andmetroscopy to check out what
occlusal forces look like in agiven system, right.
You know technology andmetroscopy to to check out what
occlusal forces look like in agiven system, right.
But with like um, with like theT scan looking at you know
where someone is.
I mean, uh, even just knowinghow they chew is a really
important thing, right.
If you're, you're might beconcerned about some you know
structural, uh integrity issueon the left side, but they never
even chew over there, right.
(37:45):
So, like, just knowing how theyfunction is extremely important
.
We don't even really measurefor that.
Dr. Sven Bone (37:50):
No, no, like the envelope of function, like like
where, where, where they'reactually spending most of their
time, and you know, and, andthen, and then we, we have you
know, and then, and then moreresolution on like what's the
pair of functional possibilities, and then how much?
Load, could that be?
Dr. Tyler Tolbert (38:09):
Yeah, yeah, and, and to you know, we know we
talk about, um, there's anissue with making a patient fit
a prosthesis, right, and we havethese rules of thumb about how
much space we need for a givenmaterial, um, and why do we
think that we have to get to,you know, 15 or 18 millimeters
of prosthetic space for everysingle patient?
Um, do you really need to dothat?
Right?
And we're not necessarilymaking an informed decision,
(38:30):
we're just going off again that.
Do you really need to do that,right?
We're not necessarily making aninformed decision.
We're just going off again thatrule of thumb, and that's
affecting how the patient isbeing treated.
It's affecting what you'redoing as a surgeon, um, so
that's that's kind of anuninformed decision, um, so,
yeah, I think we we stand togain, you know, uh, a lot of
advancement in terms of you knowhow we take care of people and
what we're able to do.
Dr. Sven Bone (38:45):
Yeah, and you know, I think this kind of
segues into a concept of everyclinician forms, a model in
their head.
We have a biomechanical bucket,a biomechanical model.
We have an aesthetics andphonetics model.
(39:07):
We have like a physiology orkind of a pathology model and a
medical model about how thispatient is going to.
You know, what should I do?
So we start filling in inputsin all those buckets and we
start figuring out okay, givenall this input, what should I do
(39:31):
?
How am I going to treat thispatient?
And then what's the outcomegoing to be?
And I think it's reallyimportant, I think, to get to
mastery, I think it's reallycritical to make those models
(39:55):
one very diverse, like complex.
So you have lots of inputs andyou're analyzing lots of
different data points, and thenI think it's also really
critical is to harvest as muchexperience or much knowledge as
you can from your experiencepoints.
So every case is an opportunityto make, to enhance those
(40:15):
internal models, and so I thinkthe clinicians that reach
mastery I'm not saying I'm amaster by any means, but I think
all of us are, or most of usshould be, on that path Like how
do I get, how do I really getyou know good at this and and I
think that's the the kind of thepathway because you know
(40:37):
experience, you can kind ofrinse and repeat, uh, the kind
of robotically right.
Uh and and I think your job as aclinician is to is to really um
grow in your sophistication asrapidly as you can.
Dr. Tyler Tolbert (40:53):
Right, right, no, I totally agree with that.
And I think that a lot of timesthe feedbacks that we're
looking at are not alwayssomething that really lends to
that kind of mastery that you'retalking about.
Like a lot of dentists, theytake all those different models
that you just mentioned and theyform a certain formula for
their practice and they, likeyou said, rinse and repeat day
(41:14):
in, day out.
And you know, sometimes as longas the office is doing well,
you know you get this idea that,like you're doing something,
you're doing something right andyou're doing it the best and
other people should be doing itthat way too.
And you know you're notnecessarily committing yourself
to excellence that way, becauseyou're looking at different
surrogate markers that aren'tnecessarily, you know, tied to.
You know what is the endproduct, what have you provided
(41:36):
for the patient, what's reallygoing to be the best long-term?
And you know one thing aboutfull arch is you know we are
measuring our success on kind ofa monthly basis.
Right, it's just, how much didthe office do?
How many arches did you do Not?
You know, did the thing thatyou did today is?
Did you do not?
You know did, did the thingthat you did today.
Is that going to last thepatient 25 years?
And we have no idea.
But maybe if we had some datawe could have a better idea.
Dr. Sven Bone (41:56):
Yeah, right, yeah , and, and, and.
A happy patient isn'tnecessarily the best metric.
Dr. Tyler Tolbert (42:01):
If it's screwed in, they're probably
right, and that's that's notenough.
Dr. Sven Bone (42:04):
Yeah, you know, I mean you should look at your
input, we, you, you should lookat your input.
What was my outcome and did I?
Did I achieve my goals?
And and I think I think that'sthat's like a um I I think
that's so important to to get toa place where you, where we all
want to be, you know yeah, andit's it's easy to to kind of
(42:26):
rinse and repeat.
Oh the patient's happy.
You know I must do a great job.
But yeah, but no issues, rightright but it's when, because
when you have a, when you, whenyou have that like mentality as
far as, like I'm really going to, you know, analyze all of my
(42:46):
outputs or all my outcomes, thenwhen you get into a tough one,
that's when, that's what's goingto save you.
Dr. Tyler Tolbert (42:55):
Yeah, yeah, right, so that that that makes a
lot of sense.
Yeah, cause they're not alleasy.
Dr. Sven Bone (43:00):
They're.
It's like if you, if you lookat rebuilding a mouth, it's
incredibly complex and and wehave great technology.
You know like photogrammetryhas been a game changer.
There's no question about that,and a lot of the, you know,
(43:21):
interaural scanners have been,you know, very useful and so.
But I do think that they are,but inherently it's very
complicated and so sometimes weget bit.
Dr. Tyler Tolbert (43:38):
Sometimes it doesn't work, so well.
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