Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Tyler Tolbert (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
So you mentioned a little bitabout digital technologies and
the improvement that we've hadin record-taking.
A moment ago we were gettinginto CAD design a little bit and
I did want to ask know the therelative inexperience of a lot
(00:25):
of designers that are out there?
Um, what are some of the thingsthat you see in terms of how
arches are being designed?
Um, that is more often going tolead to failure?
Maybe it's getting overlookedum by dentists and they're
getting designed back.
It looks like teeth.
It's screwed in, cool.
You know what are some of thoselike little nuances that should
be looked out for that?
Maybe we're uncovering fromsome of this finite element
(00:45):
analysis.
What are some of those thingsthat people are getting wrong?
They're causing mechanicalstress.
Dr. Sven Bone (00:49):
Yeah, um.
One is um, definitely stressconcentrations and embrasures.
Um, oh, okay, yeah, so, so, um,and the other one is screw
channels.
So so where, where the screwchannels are located and then
also the overall implantdistribution, so where the
(01:19):
platforms are and how well.
The takeaway here is isdefinitely you, when you're
dealing with a high stress area,you really have two options in
CAD software.
You can add material to kind ofreinforce it, sure, or you can
(01:41):
smooth the.
The material so embrasures highpinch points, that's stress.
That's where all those tensorfields are going to like, that's
where all that stress is goingto concentrate in those areas,
and so crack initiation andpropagation will occur at some
(02:02):
of these really high pinchpoints propagation will occur at
some of these really high pinchpoints.
Dr. Tyler Tolbert (02:10):
Okay, so when you mentioned those embrasures,
are you specifically talkingabout the embrasures between
teeth or embrasures elsewhere inthe design.
Dr. Sven Bone (02:13):
Yeah, so embrasures, occlusal embrasures,
lingual embrasures and facialembrasures.
Dr. Tyler Tolbert (02:18):
Okay, okay.
So in areas where that's alittle bit too sharp, we have a
concentration of stresses andthat's where a crack and start
and then it can propagatethroughout the year.
Dr. Sven Bone (02:27):
Dr.
Yeah, and it depends on wherethe prosthesis is loaded, and so
it's hard to guess where that'sgoing to be.
But generally, like on the, Iknow, on my designs I typically
on the lingual and occlusalembrasures.
I tend to smooth those out moreand so that's you know, they're
(02:52):
less noticeable.
That's good, okay, yeah, andthen on the screw channel side,
we're finding that you know,obviously you want to have the
smallest access hole as possible.
I mean, ideally it'd be magic,right, we just like they just
magically stay on.
(03:12):
But we need screws, right, likeprosthetic screws are quite
simple.
You know they have one job todo, and I don't know if you
heard in the Q&A session, butbasically that you know
prosthetic screws have one joband that, and it should be
(03:33):
explained pretty simply becausethat's what they do.
They're meant to torque, theyscrew down and they fasten the
prosthesis to the platform ofthe multi-unit equipment, and
their job is to maintain acertain clamping force for as
(03:53):
long as possible.
And and the second job thatthey have is to, uh, essentially
not over, especially like aceramic or a polymer.
So so their job is to get asmuch clamping force as possible,
um, within the limits of, ofbeing able to, you know, without
(04:15):
popping the, without deformingthe screw.
So you're, you know you'resupposed to clamp it down with
as much clamping force aspossible and put as least, uh,
stress on the material as youcan.
And okay, and so, and and thegoal is to maintain that until
the next like, at least untilthe next uh recall cycle.
(04:38):
So I want people to understandthat too is that everything
fatigues, right, there'smovement and micromotion in all
of our prostheses, because thehuman mouth is a fatigue machine
, basically.
Yeah, constantly, it's meant to,yeah, Going back and forth.
(04:59):
So these prostheses and screwsare cyclic loaded, you know, all
the time.
So these prostheses and screwsare cyclic loaded all the time.
And so the goal with a fixedprosthesis is to get it to at
least the recall without anycomplications.
(05:19):
And in your recall exam I wouldrecommend that you validate the
torque, that it's maintainedsufficient torque.
Dr. Tyler Tolbert (05:31):
Okay, and that doesn't necessarily involve
replacing the screw.
Dr. Sven Bone (05:33):
You can just do a torque test on the screw.
You can.
I, I have a, you know I, Ithink I I have.
I go back and forth on thisbecause it it does.
It does get a littlecomplicated there as far as how
much actual stress is on thescrew shaft itself, so you can
plastically deform them and thenyou're, you're, you're done.
You know I mean so.
So so I, I would probably do atwo strikes, two to three
(05:56):
strikes rule, like if it's notsufficient torque, you retorque
it, um and then, and then,essentially, if you find it
loose, you know, if it's kind ofnot to spec, uh, you might want
to, you might want to replaceit at that point, or you could
do it one more time and thenreplace it, but I would replace
the screws and you're talkingabout a separate recall
(06:19):
appointment.
Dr. Tyler Tolbert (06:19):
So let's say they're coming in on a.
Do you recommend six month oryearly basis?
Dr. Sven Bone (06:23):
I see my patients annually.
Yeah, we do too.
Yeah, I do, I, unless I.
I mean there's some that Idon't.
But right, but the, the, the,the classes, the, the what's the
protocol?
Yeah, the ones that I'm notreally concerned about.
As far as you know, six months,then a year, then I can space
(06:43):
it out to a year okay, but I dotake radiographs annually of
course always yeah, um, so yeah.
Dr. Tyler Tolbert (06:51):
In other words, you know you, you see
them in the recall, annualrecall.
Uh, you, can you do the torquetest and, let's say it, your
torque wrench, or whateveryou're using, doesn't break
immediately.
You feel it tighten a littlebit.
You should probably notate thatyou have tightened that screw
in particular and so that thenext recall appointment, if that
happens again, you're like okay, that's two strikes, next time
we're going to replace the screw, is that?
(07:12):
Do I follow that?
Dr. Sven Bone (07:13):
yeah, okay, okay, yeah, because the the universe
wants those screws to unwindlike yeah, that's the basic.
You know, uh, you know, I thinkit's the, it's basically the uh
, second law of thermodynamics,right, the entropy is, is, in
this case it's, it's alwaysgoing to tend towards more
(07:35):
disorder, and so so the screwsthey, they will never tighten,
they're not going toself-tighten, they're always
going to loosen there's nomegantropic screw out there
right now.
Dr. Tyler Tolbert (07:46):
Right, it's not going to happen, and so so
you.
Dr. Sven Bone (07:51):
Your assumption is you always have to walk into
this, into a recall is that thescrews have been under cyclic
loading and fatigue and theythey are, are prone to that.
You should assume that they'reloose, okay.
Dr. Tyler Tolbert (08:07):
Very good, and yeah, go ahead.
Dr. Sven Bone (08:09):
Yeah, so, so, so the the key is is is really that
and understanding thoseparameters, like I mean that
that evolved to the Badger screw, the screw that we developed as
, basically as a side project,and, and I was, like you know,
hey, this is, uh, you know, aclass one medical device.
(08:30):
Let's, let's go ahead and and,uh, you know, let's, let's start
with the problem first anddefine our performance
requirements, which is, I think,the opposite of what has been
done traditionally and inengineering.
This is like how you really doit.
One is, you define the problemand you establish your
performance requirements andthen you iterate and design to
(08:53):
those requirements.
So, so, that's, that was thethe prop, that that's the uh
design process that we, that wehave and that, okay, we take so,
so, yeah, we we've kind ofwe've opened up the, the can of
worms that is, prosthetic screws.
Dr. Tyler Tolbert (09:08):
You've, you've done it now.
So, um, you know, I wasthinking, um, and setting up for
this interview, I was kind ofthinking about you know, how do
dentists generally think aboutscrews?
So, you know, every couplemonths nowadays, a new screw
comes out and people are talkingabout it, right, and so usually
the things that people um wantto know about it are uh, does
the screw come loose?
Like what, what screw looseningis coming out, and usually
(09:29):
that's one of the firstmarketable things about it.
It's like, oh, this screw isnever going to come loose, right
?
Um, people want to know, you'reright, people want to know how
much angle correction can I dowith it?
Um, they want to know, uh, youknow, if they're getting into,
especially if they're doing someFP1 stuff, if they've got some
design experience, they'reworried about the size of the
screw channel, yep, and usuallythe end all be all is going to
(09:49):
be price, right?
So, like, is that a prettydecent rundown?
Are there things that are being, you know, tragically
overlooked?
Like, what should people reallybe thinking about when it comes
to?
Dr. Sven Bone (09:59):
screw.
Well, I think there's like kindof ease of use and ease of
manufacturing features, right, Imean, those are very reasonable
.
But I think screw performanceis basically not even talked
about.
Like there's no, right, there'sno like we know exactly.
You know, we have a very, verygood idea of what kind of
(10:24):
clamping force our screwgenerates.
We also know how much stress itgenerates and we also have the
smallest access or screw channelon the market and those are
basic parameters.
That, I think, are, you know,as far as performance parameters
.
Those are very key.
Um, the other thing I would say, um about angle correction is
(10:49):
ideally, you want to on thesurgical side, you really want
to focus your, you want to focusyour attention on implant
timing and, anyway, selection,always, yeah, always, selection,
(11:10):
always, yeah, always.
Um, if you can avoid um angledscrew channels, you should.
I mean that, okay, that wouldbe the.
The ultimate goal is to uh, isto make things less uh on the
manufacturing side.
It's so much easier just to tomachine a.
Dr. Tyler Tolbert (11:22):
Don't rely on angle correction as your as
your fudge factor, and so themain, the main reason for that
being that when you have anangle screw channel that creates
some manufacturing errors, andworkarounds need to happen that
can cause some structuralintegrity or or something else.
Dr. Sven Bone (11:39):
Yeah, I mean generally, you have to remove
more material.
You have to remove morematerial.
There's no question about that.
And and also it's um, it andthat is going to uh, increased
stress, uh, or potential forcrack propagate, uh, initiation
and propagation because ofstress concentrations.
(12:01):
Okay, yeah, and, and so you, sothe you know, it's just you put
a big hole in it.
Basically, yeah, fair enough.
You know, and so so you do wantto minimize that and and
sometimes you have to anglecorrect.
I mean, if I do what I docurrently is I I'll.
If I do have a certain uhabutment that I absolutely need
(12:23):
to angle correct, I usually usea tight base.
I usually use like an anglecorrected tight base.
It's much easier to, I can.
I'm removing a lot of materialand it's not.
It's not ideal, but I canmachine those quite.
You know, we can machine thosepretty precisely Okay.
Dr. Tyler Tolbert (12:43):
So like a custom angle, corrected tight
base.
Dr. Sven Bone (12:46):
It does kind of add some some.
I mean it's not ideal.
So so really, what we shoot foris in in the surgery, really,
really shoot for that.
You know implant timing,emulation selection.
Dr. Tyler Tolbert (13:00):
Yeah, yeah, that's something we stress a lot
when we talk about you knowsurgical nuances and stuff.
And it's something I've I'vespent more time on over time.
Dr. Sven Bone (13:07):
Yeah, and you know, I, I, I teach with Simon O
and Juan Gonzalez and, and youknow that that is what I see
very consistently from fromreally good surgeons is they,
they just they have it nailed,you know, you know they, they're
really, they have it nailed,you know.
You know they're really good atgetting an understanding how to
(13:29):
place multi-unit abutments and,um how to time the implants
correctly.
Dr. Tyler Tolbert (13:35):
Yeah, right, right now, the thing that makes
me most proud from a surgery,it's not torque values.
Uh, it's not my surgery time,it's just access holes, and
wasn't you know straight on Likethat's.
That's pretty much the onlything I want to show in
Instagram posts now.
Dr. Sven Bone (13:48):
Yeah, and I go, I go to all my surgeries and
basically, uh, it's a teameffort.
You know I'm out there to makesure that the, that I'm getting
what I want.
You know what my goals are forthe, for the outcome of the
surgery.
Dr. Tyler Tolbert (14:01):
Yeah, yeah, and something I wanted to throw
your way.
I actually saw it today andwe'll.
I definitely want to come backto screws, because I have more
questions for that, but there isa product coming out, and I
won't say it by name, but I'vekind of thought about this
concept before, definitely notfar enough to ever make a patent
or something like that.
But now that this thisproduct's out here, so there's a
(14:22):
, there's a continuouslyvariable multi-unit right that
kind of has like a ball joint onit and you can sort of unscrew
it, pick whatever angle you wantit's infinite degrees of
freedom and then you can screwit back down.
Uh, do you see any issues withthat biomechanically?
Just just you know off the topof your head, do you?
Do you think of thing like that?
Dr. Sven Bone (14:38):
like we definitely need fatigue analysis
, like cyclic loading andfatigue testing.
On this ability, and then alsoon the digital side, I think
that you certainly could set anangle and if you're doing
(15:02):
photogrammetry data, I thinkthat would um, it should work
well and hopefully that is quitestable um, and then you should
be able to design to that andand yeah, you know it, it, it
could work, I, I, but but Ithink mechanical like it does
need validation, it needs right,you have to put it up, that
(15:23):
kind of scrutiny, scrutiny forsure, cause if it's not stable,
then we're adding a more, uh,mechanical, uh, you know, chaos
into the system, so so so Iwould be, um, I mean, it could
work well.
Yeah, I, I think it just needsto be validated.
Dr. Tyler Tolbert (15:43):
Yeah, it can make our jobs a lot easier if it
works right.
Dr. Sven Bone (15:46):
Yeah, I mean it could.
It could work well.
I think that you could also umget great results with implant
timing and MUA.
Oh, totally, yeah, no, noquestion about it.
Dr. Tyler Tolbert (15:58):
Yeah, that's still a fundamental skill, for
sure, um, but yeah so, so backto uh, back to prostate screws.
So you talked in your um, yourpresentation, a lot about you
know, screw performance and howthat's quantified and the
different things that youactually measure, and I actually
thought it was reallyinteresting.
So you've mentioned clampingforce a few times.
Yeah, um, can you kind of speakto what that really is, how you
(16:22):
measure it, how, let's say,your screw stacks up against
other screws?
You know what's like.
I guess I should ask too, like,what is one of the most
important things that we shouldbe looking at when analyzing
screws?
Like, what's the data thatmatters a lot.
Dr. Sven Bone (16:29):
Yeah, I, I'm.
So.
One is we need, depending onthe like, how much load or force
that the patient is applying.
We need to make sure that we'reour our the preload or or
clamping force, okay, so that'sthe same thing.
(16:50):
That that's applied issufficient to maintain stability
of the bolted joint.
Soing force is a pretty big,important number to know.
Dr. Tyler Tolbert (17:02):
Okay.
Dr. Sven Bone (17:06):
And then on the other parameter, especially on
provisionals that are usuallylike some sort of polymer, right
, this 3D printed or milled PMMA, we also want to look at how
much stress that's applying onthe material and so these
(17:27):
polymers can deform, right, theycan actually yield, and so we
want to try to minimize thestress on those polymers and
also ceramics too.
I mean, zirconia is a very,very tough material.
It's a very strong material andso you might get away with more
(17:47):
on zirconia than you wouldprovisionals, but in general,
that's what you're looking for,that's the kind of that's what
you're looking for.
Okay, the other parameterscould be access hole.
Like you know, for certain,like FP1s, access hole is going
to be more important than like agiant.
(18:09):
You know huge.
You know Zygo case with youknow it's got massive amounts of
material, yeah, yeah.
So but for our, you know, know,as we kind of get into that,
like fp, like small profileprosthesis, you know um, kind of
like small fp3s, uh to fp1 typeof treatments or fp2, which in
(18:35):
reality most of them are um,then then you know, I think
access hole probably would alsobe a parameter to look at Um.
And and then an angle.
I think an angle correctionsolution is it would also be a
good feature to have too.
(18:55):
I think it's not your like.
I said it's, it's, it's, it's a.
To call it a feature is it's?
It's not an anti feature, butit's kinda it's not, it's not
ideal, it's, it's kind of abailout feature.
Dr. Tyler Tolbert (19:10):
I see, okay, yeah, yeah, that makes sense.
Dr. Sven Bone (19:13):
So so the badge, the badger screw, is not angle
corrected because we wanted tofirst start with that, and we do
have a honey badger that'scoming out.
Dr. Tyler Tolbert (19:24):
That just doesn't give a shit.
Dr. Sven Bone (19:31):
So that one is in development now and so we'll be
launching that one, you know,fairly soon too.
But that that's a that's aunique, it is a unique challenge
to to kind of you know.
But but I think we have, we'llhave a really good solution.
Dr. Tyler Tolbert (19:51):
So what are some of the?
So, if we just talk about the,the Badger screw for now, what
are some of the design nuancesthat have really optimized its
clamping force and the screwchannel access?
Dr. Sven Bone (20:04):
Yeah, so it has basically a concave profile and
through a bunch of iterations weended up with that profile
through just basically computeraided engineering.
So so, through this process ofknowing what kind of design
parameters we wanted to to ourperformance goals we wanted to
(20:27):
achieve, that's the.
That was the kind of the fruitsof that.
So, instead of like hey, I'vegot a great idea for a screw,
this is what it kind of lookslike and stuff.
We, we didn't do that.
We, we started with with like,hey, I've got a great idea for a
screw, this is what it kind oflooks like and stuff.
We, we didn't do that.
We, we started with with likeokay, here's the problem.
What is the?
What is a?
There's a big difference inthis, in that, in that approach,
and and so so that's.
(20:49):
I think that's what makes youknow great, you know clever
engineers, so powerful and andand you know and and and so.
So that's, we have a concaveprofile and it is centering by
nature, which is actually a goodthing.
Um, because what I do is um,usually I always have at least
three centering screws in my um,uh, in my uh designs.
(21:15):
So I'll usually place ananterior screw first.
I used to, you know, when I wasdoing these, like early on, I
would like put screws in and tryto retain them and then shove
it up in there and then startscrewing it down.
I do not do that and I wouldn'trecommend that.
So what I do is I put acentering screw in first uh,
(21:38):
usually in the anterior and thenI evaluate.
Um, I look for how muchdisplacement we're off, like in
a zirconia prosthesis.
So I look for.
You want to see a bullseyeright into the, to the threads
of the mua, so I evaluate thatfor the, because I'm looking for
distortions.
Dr. Tyler Tolbert (21:58):
It's kind of like a.
It's like a Sheffield test alittle bit it is.
Dr. Sven Bone (22:01):
And yeah, and passivity is very, very
challenging to judge clinically.
Okay, yeah, yeah absolutelyit's, it's very hard.
Dr. Tyler Tolbert (22:12):
So when you use the term centering, are you
referring to the, the centeringof, like, the screw hole itself,
onto the multi-unit channel?
Yeah, okay.
Dr. Sven Bone (22:20):
Yeah, so the nature of the screw head, as you
clamp it down, causes theprosthesis to center on where
the threads, on the axis of themulti-unit, or at least on the
axis of the threads.
So it causes it to to centerright okay, okay and yeah, and
(22:43):
then, uh, if, if that, if, ifthose look like, if I'm seeing
bullseyes, then we go posterior,posterior, with centering
screws and then if I have like atie base or or, or basically a
like a flat ended screw that hasmore play in it, then, uh, then
I'll seat those, cause I knowthat the prosthesis is is uh,
(23:06):
it's, it's seated.
Yeah, it's centered and so I and, and what I do is I don't, I
don't tighten them Right, yousnug, um, so it's, it's kind of
like a five Newton type type offive Newton centimeter type of
torque, so and so that theprosthesis is at least centered,
(23:27):
and then, and then we startslowly, you know, in a star
pattern, start slowly getting toour store, our torques back.
Dr. Tyler Tolbert (23:31):
Okay, yeah, cause I've definitely had
situations.
I've used a fair number ofscrews, I guess, where you know
I'm usually putting in theanterior first, just because
it's generally the easiest.
And then you know, sometimesyou'll get that snug feeling and
then you go trying to screw insomething else and like it's
just completely off base, likeit's just not hitting, or you
know, maybe you get a couplemore in and one of them just
(23:52):
won't go.
So you have to loosen up theother guys and you get this one
tight and you're just kind ofchasing your tail trying to get
this whole thing to screw in andyou're probably introducing
stress into the situation,especially if it's surgical type
.
Dr. Sven Bone (24:02):
Yeah, and that's somewhat diagnostic, right.
I mean basically hey, there's,you know, I this is not, I'm
fudging right.
Yeah.
Dr. Tyler Tolbert (24:11):
I'm bending the restoration to screw it in
at this point.
Yeah, yeah, and, and so it'sit's so.
Dr. Sven Bone (24:16):
That's, you know, that's a diagnostic, that
that's an indication that, hey,you know, usually, if I do find
that, I will often go back tothe manufacturing part and and
and find root cause, likewhere's the error here?
But but a lot of but, a lot oftimes I don't I, a lot of times
(24:39):
what I'll do is I will tightenit down, you know, and hopefully
everything seats, but I knowthat we're going to have to redo
this.
Dr. Tyler Tolbert (24:49):
It's going to be a problem, but there's an
art to seating Like.
Dr. Sven Bone (24:53):
There is like a.
There's an art to seating youknow what you don't want to.
There is like a.
There's an art to seating youknow the you.
What you don't want to do istake a flat screw and just screw
it down as tight as you can andthen start forcing everything
else that you have to besystematic, but that's what I
found that seems to work well isis I have a centering screw, at
least in the anterior and inthe posterior, and then I can at
(25:15):
least get it lined up.
Dr. Tyler Tolbert (25:17):
Yeah, okay.
Yeah, that's, very good Verygood and as far as um.
So I'm curious about sodifferent screws that will come
out.
They always have some uh,torque value associated with
them.
Um, some of them you torque to10, others 15 others, 20 is a.
Is a screw that can tolerate ahigher torque value when you
screw it in?
Is that inherently better?
Are you going to have betterclamping force from that?
Dr. Sven Bone (25:39):
No, Okay, so it absolutely depends.
When you have a torque wrenchand you torque to 15 newton
centimeters or 20, what doesthat actually mean?
Dr. Tyler Tolbert (25:52):
Right, Right, I don't know.
I don't know what it means.
Dr. Sven Bone (25:57):
So what you have to do is you've got to break it
down into the components.
So this is kind of classicalmechanics type of stuff, newton
stuff.
So when you want to, you know,when you have a force, or in
this case it's a rotationalforce, the torque, we're going
to break it down into the threecomponents.
So one is you've got frictionassociated with the screw head,
(26:18):
the bearing surface friction,and then you have preload,
that's the actual resistance tostretching right.
And then you also have threadfriction.
You have friction on thethreads, and so the way to break
this down is that threadfriction is about five to ten
(26:40):
percent because it's lubricatedalmost all the time.
It's never dry, it's it's, it'slubricated.
So so you can account for maybefive to ten percent of friction
from that.
So we can kind of ignore that.
So the biggest one is the screwhead design, the contact patch,
like how, which is the bearingsurface, and and then the
(27:04):
stretch of the, the preload.
The preload is what we want.
So so you can uh, so basicallythat contact patch, the
resistance, resistance is goingto steal a rob from preload, so
it's going to friction, is goingto take away from you
stretching the screw.
If there was no friction, thenit all be screw stretch If
(27:27):
there's no friction in thesystem it would be all screw
stretch.
So 15 Newton centimeters for onescrew will.
For one screw we'll get one, acertain amount of preload, and
then for another screw it wouldbe a totally different preload.
Dr. Tyler Tolbert (27:44):
Yeah, so I like I usually think in terms of
extremes to simplify a concept.
So you know, if I, if I torquethis to 20, that might just be
telling me that there's a ton offriction, uh, between, like,
the screw interface and thematerial.
It doesn't really tell meanything about how that screw
has actually been stressed andpreloaded.
Dr. Sven Bone (27:59):
Yeah, yeah, got it.
Yeah, if you have a high, ifyou have a screw that has a high
amount of friction on it youmight.
Your clamping force might betoo low for to maintain
stability.
Dr. Tyler Tolbert (28:12):
Okay, okay, yeah.
Dr. Sven Bone (28:14):
Interesting and and so so that's why you, that's
why you really got to know whatwhat that stress is.
And uh, you that's why you gotit, cause stress is a, is a is
amount, is basically a force onthat comp and the amount of area
that's on that contact patch orthe bearing surface.
(28:34):
And then, and then that's whyyou really got to know clamping
force, like what it actuallybrings, and how you can, you can
mechanically test that with,like a load cell.
So so you basically screw theuh, screw the screw down to spec
, and then you see how muchforce is generated on the uh, on
the material.
So you, there's, there are waysto validate that.
Dr. Tyler Tolbert (28:55):
Right, right, okay, that makes sense.
So really, the, the torque inand of itself, I mean that's,
that's a, it's almost like Imean it's rotational, and all we
really care about is the, thedirect vertical force of the
screw onto the material, causethat's what actually keeps it
off.
Dr. Sven Bone (29:09):
The rotational force is kind of irrelevant and
think of, think of preload orclamping force is like a shock
absorber, right, so it is.
It's constantly pulling down onthis thing.
So, so that, so that it canhandle and resist all these, all
these, like you know, you knowthe chewing and rubbing, you
know, whatever the hell they'redoing like you know, like
(29:31):
basically it's like a shockabsorber, and and when that
starts to deplete, when theystart unwinding, then then you
get micro movement of theprosthesis, you get work,
hardening or crack initiation inthe fruit itself, where, on the
platform, all these, like allthese little things that occur
(29:52):
when, when clamping force is isreduced by half.
In fact, if clamping force isreduced by half, in fact, if
clamping force is reduced byhalf, the screw's unwinding.
Dr. Tyler Tolbert (30:00):
Okay, yeah, that makes sense?
That makes sense.
So is um.
Is that to say that the moreclamping force, the merrier um?
Or is it more so?
You know, maybe the um, thedegree by which the clamping
force is reduced over time.
That's more important.
Dr. Sven Bone (30:18):
Yeah, so so, um, that is so.
The more of the clamping force,the merrier is, I think.
I think theoretically, yes, youwant, you want to maximize
clamping force and I think thatis important, but it's
(30:42):
definitely more.
At what cost are you gettingthat for?
Dr. Tyler Tolbert (30:48):
Because we can reduce that bearing surface
friction to a very teeny littlecontact patch, but the
consequence of that is superhigh stress, and so we might so
we might be fracturing andyielding, yes, and deforming our
material yeah, so there'sdefinitely a balance there,
because if I, if I put too muchclamping force in a small area
(31:10):
because I've tried to reducethat friction, to increase the
preload, now I've created awhole another issue of actually
like fracturing material causingcrack propagation.
Okay, this makes sense.
Dr. Sven Bone (31:19):
Yeah.
Dr. Tyler Tolbert (31:19):
Okay, nice.
Dr. Sven Bone (31:20):
Yeah, I hope that .
I mean it's.
It's not that complicated, it'skind of complicated, but not
not too complicated.
Dr. Tyler Tolbert (31:27):
Yeah Right, Right, yeah, I mean it's.
It's more complex than you know.
I screw it into a high numberand that means it's going to
stay right, you know, and that'sthat's.
That's kind of how I thoughtabout it for probably most of my
career.
I think I very recently startedthinking more about it.
Yeah, yeah, I mean yeah.
Dr. Sven Bone (31:42):
I mean, honestly, our job is clinical.
We're not, you know, we don'tthink about, you know, the the,
a lot of the mechanical stuffbehind these things.
We, you know, and it's, it'sthat, that's you know, I mean,
that's why we have engineers,right.
For sure, yeah, absolutely Ourairplanes fly, our cars get us
(32:02):
from A to B.
You know, and and you know,there's a lot of of expertise
that goes behind that.
Dr. Tyler Tolbert (32:09):
And those are considerably more complex than
our restorations, I would assumeso.
Dr. Sven Bone (32:13):
I don't know man Well who am I telling?
There are so many unknowns thatwe have and just in our, it's
actually very, very complicated.
I would say it's.
It's tantalizing for anengineer.
It's complicated enough.
We're not making engine mountbrackets or something like that.
(32:36):
Our problems are actually waymore complicated than we would
realize.
Dr. Tyler Tolbert (32:48):
So I'm curious you talk about a lot of
the testing that you guys aredoing throughout your various
design interfaces.
Have you been testing likeother screws, other materials
and things like that and kind ofseeing how competitors stack up
like are there?
Have there been some surprisesand like design nuances that
people get excited about?
But maybe you know when youactually do the testing.
Dr. Sven Bone (33:06):
Yeah, so mechanical testing is is um's,
it's quite expensive to do itand, and maybe that's one reason
why we don't have a lot of datain it, but most of ours, most
of our testing has beencomputationally so.
So so we, we, we, we definitelyknow what competitors are, what
(33:28):
the performance of thecompetitors, at least from an
analytical point of view, andbut.
But unfortunately, there's nota lot of studies out there,
there's not a lot of likeacademic research on on this.
So so we're, you know, I, I, Idon't, we haven't really I, I, I
(33:56):
don't, we haven't really um, Imean, I think, I think it would
at some.
At some point we'll probably domore rigorous, uh, mechanical
testing, um, but but I thinkright now we're just kind of
really focused on on our screwand making sure that we have the
.
We have the best screw on themarket as performance wise.
Dr. Tyler Tolbert (34:11):
Great, great.
We have the best screw on themarket as performance wise,
great, great.
So, as far as indications forthe Badger screw, what is it
useful in?
I mean I I heard you know FB3obviously we've been talking
about that Is it great for allmaterials or are there certain
limitations of it, or is it auniversal thing?
Dr. Sven Bone (34:27):
I think I mean we have not really optimized it.
I would say it's say it's fortitanium.
I don't know, we haven't reallyit's not the point, for we
haven't optimized itspecifically for titanium.
Dr. Tyler Tolbert (34:45):
We have really optimized it for polymers
and ceramics, like that'sreally kind of what's our focus
on that yeah, yeah, and beingthat there's like a small screw
channel access, I would assumethat's great for fp1 and yes,
you know different applicationsas well okay, yeah, fantastic,
and that's available now andpeople can look up the battery
screw and give it a shot yeah,so so we should by the mid-march
(35:08):
, like early march.
Dr. Sven Bone (35:09):
We're on pre-order status and so okay, so
the what we have now is the.
The latest updates that we haveis that we should be, uh,
shipping in, um, uh, I think,mid-march.
This is when we're anodized.
We're doing a nice anodizingprocess too, and so they're made
(35:33):
.
And the other thing that Ithought was really important
they're made in America.
Dr. Tyler Tolbert (35:39):
There we go, Coming out of Montana.
You know it has to be yeah,yeah, man.
Dr. Sven Bone (35:45):
I was like you know we got to do this Like
let's make these in America,let's, let's have our.
I mean we have awesome, youknow, machine like, basically
industrial machine shops thatthat have.
You know, we're vetted withgreat iso standards.
You know, as far as, like, allthe stuff that we all the boxes
that we want to check ourtolerances are amazing, um yeah
(36:10):
I'm really impressed with themanufacturing.
Dr. Tyler Tolbert (36:14):
Yeah, and you know that's a, that's a whole
nother aspect to you know,choosing screws and really even
implants as well, is that wedon't even really think about is
where are these things gettingmade?
How are they getting made?
To what standard they're beingmade?
I mean, I've never even reallyI barely ever hear anybody even
speak to that.
You know, when they talk aboutdifferent products and options
that are out there.
So that's that's good thatyou've gone through the that
type of rigor to figure that out.
Dr. Sven Bone (36:35):
Yeah, yeah, I mean it's, it's, it's very
important.
I mean the FDA they do have tolike if you make an implant or
an abutment or something likethat, they, there are, you know,
iso standards that have to bemade in order to get it, uh, you
know, cleared.
But but yeah, yeah it's, but,but yeah for for our um, for our
screw.
You know, we, we're super happy.
Dr. Tyler Tolbert (36:57):
That's awesome.
That's awesome.
Well, I congratulate you on oninnovating there and, um, I
definitely feel like you were,you know, uh kind of taking
taking the industry to task, umto you know practice some uh
things that we see in theautomotive industry and
aerospace and hold ourselves toa higher standard and kind of
catch up with the times andother industries, because it's
long overdue.
I mean, full arch is becomingso incredibly ubiquitous and you
(37:20):
know everybody and theircousins trying to do it and if
we're not holding ourselves tothat high of a standard, we're
going to see a lot of problemscoming down the line.
Dr. Sven Bone (37:26):
So yeah, I mean these, these, I mean these go in
patients' mouths.
You know these are people.
Yeah, we really.
Yeah, I mean, I think, I thinkthat, um, I think the industry
in general like that, like likeit's going to get way more
sophisticated, like it should,and I think it will.
You know, yeah, so and and andit's going to be for the benefit
(37:48):
of the patients, it's going tobe the benefit of the clinicians
and on the laboratory side too,I mean everybody.
You know, with moresophisticated tools and
advancements, you know we candefinitely make this.
You know, very costly and riskysurgery and risky treatment.
(38:11):
I think we can make it betterand we should.
We should be the gold standardas far as in medicine.
Hey guys, our stuff lasts like20 years.
Dr. Tyler Tolbert (38:24):
Yeah, that's true.
Dr. Sven Bone (38:25):
So that's our goal, that's our mission Very
good, very good.
So I, I, that's that's our,that's our goal, that's our
mission.
Dr. Tyler Tolbert (38:31):
Very good, very good, yeah.
So to to speak to you, knowyour goals, your missions with
smart tech, with your, with yourlab, with your office, like
what are you know your biggestprofessional goals and ways that
you are looking to impact FullArch, beyond what you're, what
we've already talked about.
Dr. Sven Bone (38:47):
I, you know, I think I love clinical work.
I mean, I love being aclinician.
I think I always do it and so Ithink that's never going to go
away.
But I think I'm most I loveworking with my team of
engineers and I have like threejobs, it feels like, but I'm
(39:09):
always working.
But I really do love the um,the innovation side of things.
So so I, I, um, so I'llprobably definitely uh continue
with with uh, leading teams ofengineers for, for innovation,
and that's awesome and I think I, I have that um, I think what's
(39:29):
very helpful for them is that Ihave, I can live in both worlds
.
So so I understand a lot of thetechnical things that they, that
they work with, but I also havethat, that clinical insight as
well.
Dr. Tyler Tolbert (39:42):
Yeah, yeah, we need people that can be that
bridge.
For sure, you know, hopefullywe'll.
We'll be looking at a future inthe, in the very near future,
where you know we look at all ofour restorations and we know
where their stress points are.
We can, you know, assign thatto every patient and know where
their stress points are.
We can create a model for, um,you know, uh, mitigating
disaster long term and make ourwork last a long time.
(40:02):
And you know there's downstreameffects of that, where the end
user is the dentist, the lab,the patient, everybody benefits.
And so, um, I think you're you,everybody benefits, and so, um,
I think you're, you're reallyon a great path and you're
influencing our field in areally strong way.
Dr. Sven Bone (40:12):
Well, thanks yeah .
Dr. Tyler Tolbert (40:15):
Awesome, um, so this would not be the fixed
podcast if I didn't ask thisquestion.
So, um, I do it for everybody.
So what is your mostcontroversial opinion in full
arch dentistry?
Dr. Sven Bone (40:24):
Oh, my most controversial opinion, uh's see
here.
Dr. Tyler Tolbert (40:34):
You got to upset somebody.
Dr. Sven Bone (40:35):
Right, I know, I think well, you know, I think
the I think we need to.
I think where I'd like to seethings improve is I feel like
(40:58):
there's a lot of noise in thelike on social media and things
like that.
As far as you know, marketingand KOLs and things like that,
and essentially we're kind oflike I'd like to see more
objectivity in the industry andI do feel like we're manipulated
(41:23):
too much, like basically,there's a lot of manipulation
going on and I'd like to see alittle more facts like a little
more like real, rigorous factsand less like nonsense, you know
.
Dr. Tyler Tolbert (41:37):
I think that's fantastic and it
shouldn't be a controversialopinion, but I think it is.
Um, you know, I think we livein a in a social media era,
right, and you know everyone isjust trying to uh, make noise,
uh, for the sake of gettinglistened to.
Um, you know, I I play somewhatof a part in that.
I have a podcast I try topromote and I want people to
hear it.
But I think for us, we want tobring that objectivity and we're
(42:00):
a sponsored show and we talk topeople about their products and
their services.
But ultimately, we do have tohold ourselves to a certain
amount of rigor and show dataand show more than just a
hand-waving argument as to whysomething works and why other
things don't.
And I think that's reallyimportant.
And you know our mission hereis just to help people make
educated decisions and I thinkyou know that should be a
(42:21):
standard throughout the industry.
Dr. Sven Bone (42:22):
So yeah, I think it's just.
It's just the nature of the ofthe industry right now.
It's like how things, how dealsget done, how things are, are
you know how, how things areprogressed, like we we, if we
didn't have that, we wouldn't bewhere we are today.
But that doesn't mean that wecan't improve or get better, you
(42:43):
know, and and so.
So I think we put a lot ofweight on on like opinions and
and I think we're going to get,I believe that we're going to
those opinions are going tomatter, those people with high
EQs, huge social networks,things like that they are
definitely going to be, alwaysbe an important player.
(43:03):
Yeah, you know that's that thatis going to be important, but
but at the same time, I think wecan.
Manufacturers, the you know,innovators their responsibility
is to supply them with real, youknow, valid data so that we can
, all you know, get to from A toB you know, in the right way.
(43:29):
And so it just depends on theagenda Right.
Yeah, so I don't know if that'sthat very controversial because
honestly it's kind of like it'sa fact.
That's just the way it is, yeah.
Dr. Tyler Tolbert (43:42):
Yeah, yeah, I mean, it's the way it should be
, and maybe, uh, maybe, insteadof being a key opinion leader,
we should try to be a keyobjectivity leader.
We should, we should bring data.
Dr. Sven Bone (43:51):
Yeah, I mean it always comes down to opinion,
but but, at the same time, youknow, I think that, like you
know, um, like I like, if we'retalking about like a screw or
something like that, right, okay, like who's going to be a great
opinion leader for a screw,right?
Dr. Tyler Tolbert (44:09):
It's just the guy that screws the stuff in.
Dr. Sven Bone (44:12):
Right, right, yeah, right, I would engineer
over like I would that's who Iwould go to, like like that I
would trust an engineer over umover.
You know somebody that justlike uses them you know, on a
daily basis, like like basis,like like they they may or may.
I mean because we are ouropinions, like like we.
(44:36):
We aren't exactly the bestwitnesses, um you know, of of
whether something is good orwhether something is bad, it's
just it goes back to like ahappy patient isn't necessarily
the best judge of how well youdid.
Dr. Tyler Tolbert (44:53):
Yeah, you know, a five-star Google review
does not tell you how your screwperformed.
No, it doesn't.
Yeah.
Dr. Sven Bone (44:59):
And and and so so we, I think we need to be a
little more uh, you know, youknow objective about, about,
about how how we assess things.
Dr. Tyler Tolbert (45:11):
Yeah, no, I agree, and I think that you know
, when we were talking at thesymposium, you know you kept
bringing up about standards andother industries, right, and
it's like, yeah, we're, we'reinventing screws and like
there's all these new patentscoming out with like different,
you know, dental screws,different implants, all these
things, but the screw in itsform has existed for a very long
time before modern dentistryever existed, right, and there's
(45:31):
people that have really put alot of time and work and
research into screw design.
So there's a lot of things thatcan be learned that have
already been discovered and wedon't need to reinvent the wheel
.
Yeah, and that that was kind ofa Eureka moment for me and I
really appreciated that.
You know you're bringing thatsort of context into into
dentistry and raising thatstandard.
Dr. Sven Bone (45:52):
Yeah, yeah, and I mean, that's just one, that's
just one.
Dr. Tyler Tolbert (45:54):
you know thing, it's a small piece of it.
Dr. Sven Bone (45:54):
Yeah, but there's so many, you know, there's so
many different things and andand also, you know, I think,
true, the.
I think it's also reallyimportant to surround yourself
with mentors, like as you go inyour career, I think.
I think it's really critical,critical to um we also there's a
(46:16):
lot of bro science out there,right.
Dr. Tyler Tolbert (46:21):
I mean, there's a ton of it right, and
and so.
Dr. Sven Bone (46:24):
So, like I think, as you move along in your
career, I think you want to to,you know, get those mentors that
have more sophisticated modelsthat you can learn from, and
feedback as you grow and learn,and, and, and I think I think,
like you know, get we.
(46:45):
We tend to like huddle in ourown little groups and we stay
there and that's how you getstuck right and so so.
So I think it's really importantto reach out to you know, like
a, a surgeon that like sewsheads together yeah, yeah you
know, like, like, get, get thosementors that have, um, you know
(47:08):
, a lot of, uh, differentexperiences than yourself, and,
and, and.
As soon as you feel comfortablein your group, it's time to
move on.
Dr. Tyler Tolbert (47:17):
I like that.
Dr. Sven Bone (47:18):
No, that's good.
Dr. Tyler Tolbert (47:19):
That's good, yeah, and I think too is, you
know, I've always kind of youknow I can I can kind of tell
the history of my own career forthe people that I looked up to
Right, and I think that if you,if you only look to the people
that look how you want to lookright, the people that you're
trying to model yourself after,um, that that's not always the
best way to go about it, becauseyou need to kind of pick apart
(47:39):
all the different components ofwhat you want to be.
Maybe you want to be clinicallyexcellent, maybe you want to be
great in business, you want tobe great in marketing.
If you just model all of thosethings off that one person,
you're going to be a little bitlimited, right?
You need to pick and choosefrom the people that do really
well at all of those things, andthen you can be a composite of
those things and that's what canmake you, um, you know, truly
successful, because you'redrawing from best practices of
all of those things, cause noone is is is really the master
(48:02):
of all trades.
Dr. Sven Bone (48:03):
Yeah, I mean and and also, and also specialize,
like, like focus on, on what youon, on, on, you Like focus on
what you.
You will be a master of none ifyou don't really dedicate your
attention and focus onto a fewthings.
And I think, at least for me,I'm happier if I really focus on
(48:25):
a few things.
Like I don't do veneer, likeI'm not interested in cosmetic
work.
I love taking a hot mess andmaking it, you know, and fixing
it all.
It's awesome.
You know that.
That's.
That's my focus.
I the they have the biggestimpact on patients lives and and
uh, and so I have tons ofstories where that you know,
(48:46):
patients have um been totallychanged, like their careers and
because they were a hot mess andwe got them all straightened up
and and so.
So it's, it's a, it's the mostrewarding thing for me and but
yeah, I'm not doing there's.
I say no to a lot of things,you know you have to get used to
(49:07):
you know if you, if you want to.
At some point every dentistneeds to say no.
They need to learn how to dothat.
Dr. Tyler Tolbert (49:16):
Yeah, no, that's really good, that's
really good.
Yeah, no, I think that's agreat closing note for us.
Is, you know, figuring out howto dive deep and become, you
know, a master of something?
Right, figure out what it isthat you really want to go deep
on and get really into it, andthat's, you know.
That's something that inspiredus to do this show, and it
inspires us to bring people likeyourself on it, and we're just
(49:36):
so honored that you're able tospare your time.
Dr. Sven Bone (49:38):
Well thanks, yeah , no, it's been great.
It's good conversations.
I'm always up for that.
Dr. Tyler Tolbert (49:43):
Awesome, awesome.
Well, this episode willprobably be airing right around
the time that you're opening upa distribution of the Badger
Screw, so hopefully we can getthat synchronized pretty good.
And yeah, I'd just like toreiterate thank you so much for
bringing all your knowledge andexpertise into this conversation
and we look forward tocontinuing the conversation
later.
Yeah, I hope it was helpful.
(50:04):
I really do, I'm certain it was.
It helped me, if nothing else.
But I think our audience isreally going to like it Okay
good deal man.
Dr. Sven Bone (50:11):
Thanks man, All right, Take care.
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
So you mentioned a little bitabout digital technologies and
the improvement that we've hadin record-taking.
A moment ago we were gettinginto CAD design a little bit and
I did want to ask know the therelative inexperience of a lot
(00:25):
of designers that are out there?
Um, what are some of the thingsthat you see in terms of how
arches are being designed?
Um, that is more often going tolead to failure?
Maybe it's getting overlookedum by dentists and they're
getting designed back.
It looks like teeth.
It's screwed in, cool.
You know what are some of thoselike little nuances that should
be looked out for that?
Maybe we're uncovering fromsome of this finite element
(00:45):
analysis.
What are some of those thingsthat people are getting wrong?
They're causing mechanicalstress.
Dr. Sven Bone (00:49):
Yeah, um.
One is um, definitely stressconcentrations and embrasures.
Um, oh, okay, yeah, so, so, um,and the other one is screw
channels.
So so where, where the screwchannels are located and then
also the overall implantdistribution, so where the
(01:19):
platforms are and how well.
The takeaway here is isdefinitely you, when you're
dealing with a high stress area,you really have two options in
CAD software.
You can add material to kind ofreinforce it, sure, or you can
(01:41):
smooth the.
The material so embrasures highpinch points, that's stress.
That's where all those tensorfields are going to like, that's
where all that stress is goingto concentrate in those areas,
and so crack initiation andpropagation will occur at some
(02:02):
of these really high pinchpoints propagation will occur at
some of these really high pinchpoints.
Dr. Tyler Tolbert (02:10):
Okay, so when you mentioned those embrasures,
are you specifically talkingabout the embrasures between
teeth or embrasures elsewhere inthe design.
Dr. Sven Bone (02:13):
Yeah, so embrasures, occlusal embrasures,
lingual embrasures and facialembrasures.
Dr. Tyler Tolbert (02:18):
Okay, okay.
So in areas where that's alittle bit too sharp, we have a
concentration of stresses andthat's where a crack and start
and then it can propagatethroughout the year.
Dr. Sven Bone (02:27):
Dr.
Yeah, and it depends on wherethe prosthesis is loaded, and so
it's hard to guess where that'sgoing to be.
But generally, like on the, Iknow, on my designs I typically
on the lingual and occlusalembrasures.
I tend to smooth those out moreand so that's you know, they're
(02:52):
less noticeable.
That's good, okay, yeah, andthen on the screw channel side,
we're finding that you know,obviously you want to have the
smallest access hole as possible.
I mean, ideally it'd be magic,right, we just like they just
magically stay on.
(03:12):
But we need screws, right, likeprosthetic screws are quite
simple.
You know they have one job todo, and I don't know if you
heard in the Q&A session, butbasically that you know
prosthetic screws have one joband that, and it should be
(03:33):
explained pretty simply becausethat's what they do.
They're meant to torque, theyscrew down and they fasten the
prosthesis to the platform ofthe multi-unit equipment, and
their job is to maintain acertain clamping force for as
(03:53):
long as possible.
And and the second job thatthey have is to, uh, essentially
not over, especially like aceramic or a polymer.
So so their job is to get asmuch clamping force as possible,
um, within the limits of, ofbeing able to, you know, without
(04:15):
popping the, without deformingthe screw.
So you're, you know you'resupposed to clamp it down with
as much clamping force aspossible and put as least, uh,
stress on the material as youcan.
And okay, and so, and and thegoal is to maintain that until
the next like, at least untilthe next uh recall cycle.
(04:38):
So I want people to understandthat too is that everything
fatigues, right, there'smovement and micromotion in all
of our prostheses, because thehuman mouth is a fatigue machine
, basically.
Yeah, constantly, it's meant to,yeah, Going back and forth.
(04:59):
So these prostheses and screwsare cyclic loaded, you know, all
the time.
So these prostheses and screwsare cyclic loaded all the time.
And so the goal with a fixedprosthesis is to get it to at
least the recall without anycomplications.
(05:19):
And in your recall exam I wouldrecommend that you validate the
torque, that it's maintainedsufficient torque.
Dr. Tyler Tolbert (05:31):
Okay, and that doesn't necessarily involve
replacing the screw.
Dr. Sven Bone (05:33):
You can just do a torque test on the screw.
You can.
I, I have a, you know I, Ithink I I have.
I go back and forth on thisbecause it it does.
It does get a littlecomplicated there as far as how
much actual stress is on thescrew shaft itself, so you can
plastically deform them and thenyou're, you're, you're done.
You know I mean so.
So so I, I would probably do atwo strikes, two to three
(05:56):
strikes rule, like if it's notsufficient torque, you retorque
it, um and then, and then,essentially, if you find it
loose, you know, if it's kind ofnot to spec, uh, you might want
to, you might want to replaceit at that point, or you could
do it one more time and thenreplace it, but I would replace
the screws and you're talkingabout a separate recall
(06:19):
appointment.
Dr. Tyler Tolbert (06:19):
So let's say they're coming in on a.
Do you recommend six month oryearly basis?
Dr. Sven Bone (06:23):
I see my patients annually.
Yeah, we do too.
Yeah, I do, I, unless I.
I mean there's some that Idon't.
But right, but the, the, the,the classes, the, the what's the
protocol?
Yeah, the ones that I'm notreally concerned about.
As far as you know, six months,then a year, then I can space
(06:43):
it out to a year okay, but I dotake radiographs annually of
course always yeah, um, so yeah.
Dr. Tyler Tolbert (06:51):
In other words, you know you, you see
them in the recall, annualrecall.
Uh, you, can you do the torquetest and, let's say it, your
torque wrench, or whateveryou're using, doesn't break
immediately.
You feel it tighten a littlebit.
You should probably notate thatyou have tightened that screw
in particular and so that thenext recall appointment, if that
happens again, you're like okay, that's two strikes, next time
we're going to replace the screw, is that?
(07:12):
Do I follow that?
Dr. Sven Bone (07:13):
yeah, okay, okay, yeah, because the the universe
wants those screws to unwindlike yeah, that's the basic.
You know, uh, you know, I thinkit's the, it's basically the uh
, second law of thermodynamics,right, the entropy is, is, in
this case it's, it's alwaysgoing to tend towards more
(07:35):
disorder, and so so the screwsthey, they will never tighten,
they're not going toself-tighten, they're always
going to loosen there's nomegantropic screw out there
right now.
Dr. Tyler Tolbert (07:46):
Right, it's not going to happen, and so so
you.
Dr. Sven Bone (07:51):
Your assumption is you always have to walk into
this, into a recall is that thescrews have been under cyclic
loading and fatigue and theythey are, are prone to that.
You should assume that they'reloose, okay.
Dr. Tyler Tolbert (08:07):
Very good, and yeah, go ahead.
Dr. Sven Bone (08:09):
Yeah, so, so, so the the key is is is really that
and understanding thoseparameters, like I mean that
that evolved to the Badger screw, the screw that we developed as
, basically as a side project,and, and I was, like you know,
hey, this is, uh, you know, aclass one medical device.
(08:30):
Let's, let's go ahead and and,uh, you know, let's, let's start
with the problem first anddefine our performance
requirements, which is, I think,the opposite of what has been
done traditionally and inengineering.
This is like how you really doit.
One is, you define the problemand you establish your
performance requirements andthen you iterate and design to
(08:53):
those requirements.
So, so, that's, that was thethe prop, that that's the uh
design process that we, that wehave and that, okay, we take so,
so, yeah, we we've kind ofwe've opened up the, the can of
worms that is, prosthetic screws.
Dr. Tyler Tolbert (09:08):
You've, you've done it now.
So, um, you know, I wasthinking, um, and setting up for
this interview, I was kind ofthinking about you know, how do
dentists generally think aboutscrews?
So, you know, every couplemonths nowadays, a new screw
comes out and people are talkingabout it, right, and so usually
the things that people um wantto know about it are uh, does
the screw come loose?
Like what, what screw looseningis coming out, and usually
(09:29):
that's one of the firstmarketable things about it.
It's like, oh, this screw isnever going to come loose, right
?
Um, people want to know, you'reright, people want to know how
much angle correction can I dowith it?
Um, they want to know, uh, youknow, if they're getting into,
especially if they're doing someFP1 stuff, if they've got some
design experience, they'reworried about the size of the
screw channel, yep, and usuallythe end all be all is going to
(09:49):
be price, right?
So, like, is that a prettydecent rundown?
Are there things that are being, you know, tragically
overlooked?
Like, what should people reallybe thinking about when it comes
to?
Dr. Sven Bone (09:59):
screw.
Well, I think there's like kindof ease of use and ease of
manufacturing features, right, Imean, those are very reasonable
.
But I think screw performanceis basically not even talked
about.
Like there's no, right, there'sno like we know exactly.
You know, we have a very, verygood idea of what kind of
(10:24):
clamping force our screwgenerates.
We also know how much stress itgenerates and we also have the
smallest access or screw channelon the market and those are
basic parameters.
That, I think, are, you know,as far as performance parameters
.
Those are very key.
Um, the other thing I would say, um about angle correction is
(10:49):
ideally, you want to on thesurgical side, you really want
to focus your, you want to focusyour attention on implant
timing and, anyway, selection,always, yeah, always, selection,
(11:10):
always, yeah, always.
Um, if you can avoid um angledscrew channels, you should.
I mean that, okay, that wouldbe the.
The ultimate goal is to uh, isto make things less uh on the
manufacturing side.
It's so much easier just to tomachine a.
Dr. Tyler Tolbert (11:22):
Don't rely on angle correction as your as
your fudge factor, and so themain, the main reason for that
being that when you have anangle screw channel that creates
some manufacturing errors, andworkarounds need to happen that
can cause some structuralintegrity or or something else.
Dr. Sven Bone (11:39):
Yeah, I mean generally, you have to remove
more material.
You have to remove morematerial.
There's no question about that.
And and also it's um, it andthat is going to uh, increased
stress, uh, or potential forcrack propagate, uh, initiation
and propagation because ofstress concentrations.
(12:01):
Okay, yeah, and, and so you, sothe you know, it's just you put
a big hole in it.
Basically, yeah, fair enough.
You know, and so so you do wantto minimize that and and
sometimes you have to anglecorrect.
I mean, if I do what I docurrently is I I'll.
If I do have a certain uhabutment that I absolutely need
(12:23):
to angle correct, I usually usea tight base.
I usually use like an anglecorrected tight base.
It's much easier to, I can.
I'm removing a lot of materialand it's not.
It's not ideal, but I canmachine those quite.
You know, we can machine thosepretty precisely Okay.
Dr. Tyler Tolbert (12:43):
So like a custom angle, corrected tight
base.
Dr. Sven Bone (12:46):
It does kind of add some some.
I mean it's not ideal.
So so really, what we shoot foris in in the surgery, really,
really shoot for that.
You know implant timing,emulation selection.
Dr. Tyler Tolbert (13:00):
Yeah, yeah, that's something we stress a lot
when we talk about you knowsurgical nuances and stuff.
And it's something I've I'vespent more time on over time.
Dr. Sven Bone (13:07):
Yeah, and you know, I, I, I teach with Simon O
and Juan Gonzalez and, and youknow that that is what I see
very consistently from fromreally good surgeons is they,
they just they have it nailed,you know, you know they, they're
really, they have it nailed,you know.
You know they're really good atgetting an understanding how to
(13:29):
place multi-unit abutments and,um how to time the implants
correctly.
Dr. Tyler Tolbert (13:35):
Yeah, right, right now, the thing that makes
me most proud from a surgery,it's not torque values.
Uh, it's not my surgery time,it's just access holes, and
wasn't you know straight on Likethat's.
That's pretty much the onlything I want to show in
Instagram posts now.
Dr. Sven Bone (13:48):
Yeah, and I go, I go to all my surgeries and
basically, uh, it's a teameffort.
You know I'm out there to makesure that the, that I'm getting
what I want.
You know what my goals are forthe, for the outcome of the
surgery.
Dr. Tyler Tolbert (14:01):
Yeah, yeah, and something I wanted to throw
your way.
I actually saw it today andwe'll.
I definitely want to come backto screws, because I have more
questions for that, but there isa product coming out, and I
won't say it by name, but I'vekind of thought about this
concept before, definitely notfar enough to ever make a patent
or something like that.
But now that this thisproduct's out here, so there's a
(14:22):
, there's a continuouslyvariable multi-unit right that
kind of has like a ball joint onit and you can sort of unscrew
it, pick whatever angle you wantit's infinite degrees of
freedom and then you can screwit back down.
Uh, do you see any issues withthat biomechanically?
Just just you know off the topof your head, do you?
Do you think of thing like that?
Dr. Sven Bone (14:38):
like we definitely need fatigue analysis
, like cyclic loading andfatigue testing.
On this ability, and then alsoon the digital side, I think
that you certainly could set anangle and if you're doing
(15:02):
photogrammetry data, I thinkthat would um, it should work
well and hopefully that is quitestable um, and then you should
be able to design to that andand yeah, you know it, it, it
could work, I, I, but but Ithink mechanical like it does
need validation, it needs right,you have to put it up, that
(15:23):
kind of scrutiny, scrutiny forsure, cause if it's not stable,
then we're adding a more, uh,mechanical, uh, you know, chaos
into the system, so so so Iwould be, um, I mean, it could
work well.
Yeah, I, I think it just needsto be validated.
Dr. Tyler Tolbert (15:43):
Yeah, it can make our jobs a lot easier if it
works right.
Dr. Sven Bone (15:46):
Yeah, I mean it could.
It could work well.
I think that you could also umget great results with implant
timing and MUA.
Oh, totally, yeah, no, noquestion about it.
Dr. Tyler Tolbert (15:58):
Yeah, that's still a fundamental skill, for
sure, um, but yeah so, so backto uh, back to prostate screws.
So you talked in your um, yourpresentation, a lot about you
know, screw performance and howthat's quantified and the
different things that youactually measure, and I actually
thought it was reallyinteresting.
So you've mentioned clampingforce a few times.
Yeah, um, can you kind of speakto what that really is, how you
(16:22):
measure it, how, let's say,your screw stacks up against
other screws?
You know what's like.
I guess I should ask too, like,what is one of the most
important things that we shouldbe looking at when analyzing
screws?
Like, what's the data thatmatters a lot.
Dr. Sven Bone (16:29):
Yeah, I, I'm.
So.
One is we need, depending onthe like, how much load or force
that the patient is applying.
We need to make sure that we'reour our the preload or or
clamping force, okay, so that'sthe same thing.
(16:50):
That that's applied issufficient to maintain stability
of the bolted joint.
Soing force is a pretty big,important number to know.
Dr. Tyler Tolbert (17:02):
Okay.
Dr. Sven Bone (17:06):
And then on the other parameter, especially on
provisionals that are usuallylike some sort of polymer, right
, this 3D printed or milled PMMA, we also want to look at how
much stress that's applying onthe material and so these
(17:27):
polymers can deform, right, theycan actually yield, and so we
want to try to minimize thestress on those polymers and
also ceramics too.
I mean, zirconia is a very,very tough material.
It's a very strong material andso you might get away with more
(17:47):
on zirconia than you wouldprovisionals, but in general,
that's what you're looking for,that's the kind of that's what
you're looking for.
Okay, the other parameterscould be access hole.
Like you know, for certain,like FP1s, access hole is going
to be more important than like agiant.
(18:09):
You know huge.
You know Zygo case with youknow it's got massive amounts of
material, yeah, yeah.
So but for our, you know, know,as we kind of get into that,
like fp, like small profileprosthesis, you know um, kind of
like small fp3s, uh to fp1 typeof treatments or fp2, which in
(18:35):
reality most of them are um,then then you know, I think
access hole probably would alsobe a parameter to look at Um.
And and then an angle.
I think an angle correctionsolution is it would also be a
good feature to have too.
(18:55):
I think it's not your like.
I said it's, it's, it's, it's a.
To call it a feature is it's?
It's not an anti feature, butit's kinda it's not, it's not
ideal, it's, it's kind of abailout feature.
Dr. Tyler Tolbert (19:10):
I see, okay, yeah, yeah, that makes sense.
Dr. Sven Bone (19:13):
So so the badge, the badger screw, is not angle
corrected because we wanted tofirst start with that, and we do
have a honey badger that'scoming out.
Dr. Tyler Tolbert (19:24):
That just doesn't give a shit.
Dr. Sven Bone (19:31):
So that one is in development now and so we'll be
launching that one, you know,fairly soon too.
But that that's a that's aunique, it is a unique challenge
to to kind of you know.
But but I think we have, we'llhave a really good solution.
Dr. Tyler Tolbert (19:51):
So what are some of the?
So, if we just talk about the,the Badger screw for now, what
are some of the design nuancesthat have really optimized its
clamping force and the screwchannel access?
Dr. Sven Bone (20:04):
Yeah, so it has basically a concave profile and
through a bunch of iterations weended up with that profile
through just basically computeraided engineering.
So so, through this process ofknowing what kind of design
parameters we wanted to to ourperformance goals we wanted to
(20:27):
achieve, that's the.
That was the kind of the fruitsof that.
So, instead of like hey, I'vegot a great idea for a screw,
this is what it kind of lookslike and stuff.
We, we didn't do that.
We, we started with with like,hey, I've got a great idea for a
screw, this is what it kind oflooks like and stuff.
We, we didn't do that.
We, we started with with likeokay, here's the problem.
What is the?
What is a?
There's a big difference inthis, in that, in that approach,
and and so so that's.
(20:49):
I think that's what makes youknow great, you know clever
engineers, so powerful and andand you know and and and so.
So that's, we have a concaveprofile and it is centering by
nature, which is actually a goodthing.
Um, because what I do is um,usually I always have at least
three centering screws in my um,uh, in my uh designs.
(21:15):
So I'll usually place ananterior screw first.
I used to, you know, when I wasdoing these, like early on, I
would like put screws in and tryto retain them and then shove
it up in there and then startscrewing it down.
I do not do that and I wouldn'trecommend that.
So what I do is I put acentering screw in first uh,
(21:38):
usually in the anterior and thenI evaluate.
Um, I look for how muchdisplacement we're off, like in
a zirconia prosthesis.
So I look for.
You want to see a bullseyeright into the, to the threads
of the mua, so I evaluate thatfor the, because I'm looking for
distortions.
Dr. Tyler Tolbert (21:58):
It's kind of like a.
It's like a Sheffield test alittle bit it is.
Dr. Sven Bone (22:01):
And yeah, and passivity is very, very
challenging to judge clinically.
Okay, yeah, yeah absolutelyit's, it's very hard.
Dr. Tyler Tolbert (22:12):
So when you use the term centering, are you
referring to the, the centeringof, like, the screw hole itself,
onto the multi-unit channel?
Yeah, okay.
Dr. Sven Bone (22:20):
Yeah, so the nature of the screw head, as you
clamp it down, causes theprosthesis to center on where
the threads, on the axis of themulti-unit, or at least on the
axis of the threads.
So it causes it to to centerright okay, okay and yeah, and
(22:43):
then, uh, if, if that, if, ifthose look like, if I'm seeing
bullseyes, then we go posterior,posterior, with centering
screws and then if I have like atie base or or, or basically a
like a flat ended screw that hasmore play in it, then, uh, then
I'll seat those, cause I knowthat the prosthesis is is uh,
(23:06):
it's, it's seated.
Yeah, it's centered and so I and, and what I do is I don't, I
don't tighten them Right, yousnug, um, so it's, it's kind of
like a five Newton type type offive Newton centimeter type of
torque, so and so that theprosthesis is at least centered,
(23:27):
and then, and then we startslowly, you know, in a star
pattern, start slowly getting toour store, our torques back.
Dr. Tyler Tolbert (23:31):
Okay, yeah, cause I've definitely had
situations.
I've used a fair number ofscrews, I guess, where you know
I'm usually putting in theanterior first, just because
it's generally the easiest.
And then you know, sometimesyou'll get that snug feeling and
then you go trying to screw insomething else and like it's
just completely off base, likeit's just not hitting, or you
know, maybe you get a couplemore in and one of them just
(23:52):
won't go.
So you have to loosen up theother guys and you get this one
tight and you're just kind ofchasing your tail trying to get
this whole thing to screw in andyou're probably introducing
stress into the situation,especially if it's surgical type
.
Dr. Sven Bone (24:02):
Yeah, and that's somewhat diagnostic, right.
I mean basically hey, there's,you know, I this is not, I'm
fudging right.
Yeah.
Dr. Tyler Tolbert (24:11):
I'm bending the restoration to screw it in
at this point.
Yeah, yeah, and, and so it'sit's so.
Dr. Sven Bone (24:16):
That's, you know, that's a diagnostic, that
that's an indication that, hey,you know, usually, if I do find
that, I will often go back tothe manufacturing part and and
and find root cause, likewhere's the error here?
But but a lot of but, a lot oftimes I don't I, a lot of times
(24:39):
what I'll do is I will tightenit down, you know, and hopefully
everything seats, but I knowthat we're going to have to redo
this.
Dr. Tyler Tolbert (24:49):
It's going to be a problem, but there's an
art to seating Like.
Dr. Sven Bone (24:53):
There is like a.
There's an art to seating youknow what you don't want to.
There is like a.
There's an art to seating youknow the you.
What you don't want to do istake a flat screw and just screw
it down as tight as you can andthen start forcing everything
else that you have to besystematic, but that's what I
found that seems to work well isis I have a centering screw, at
least in the anterior and inthe posterior, and then I can at
(25:15):
least get it lined up.
Dr. Tyler Tolbert (25:17):
Yeah, okay.
Yeah, that's, very good Verygood and as far as um.
So I'm curious about sodifferent screws that will come
out.
They always have some uh,torque value associated with
them.
Um, some of them you torque to10, others 15 others, 20 is a.
Is a screw that can tolerate ahigher torque value when you
screw it in?
Is that inherently better?
Are you going to have betterclamping force from that?
Dr. Sven Bone (25:39):
No, Okay, so it absolutely depends.
When you have a torque wrenchand you torque to 15 newton
centimeters or 20, what doesthat actually mean?
Dr. Tyler Tolbert (25:52):
Right, Right, I don't know.
I don't know what it means.
Dr. Sven Bone (25:57):
So what you have to do is you've got to break it
down into the components.
So this is kind of classicalmechanics type of stuff, newton
stuff.
So when you want to, you know,when you have a force, or in
this case it's a rotationalforce, the torque, we're going
to break it down into the threecomponents.
So one is you've got frictionassociated with the screw head,
(26:18):
the bearing surface friction,and then you have preload,
that's the actual resistance tostretching right.
And then you also have threadfriction.
You have friction on thethreads, and so the way to break
this down is that threadfriction is about five to ten
(26:40):
percent because it's lubricatedalmost all the time.
It's never dry, it's it's, it'slubricated.
So so you can account for maybefive to ten percent of friction
from that.
So we can kind of ignore that.
So the biggest one is the screwhead design, the contact patch,
like how, which is the bearingsurface, and and then the
(27:04):
stretch of the, the preload.
The preload is what we want.
So so you can uh, so basicallythat contact patch, the
resistance, resistance is goingto steal a rob from preload, so
it's going to friction, is goingto take away from you
stretching the screw.
If there was no friction, thenit all be screw stretch If
(27:27):
there's no friction in thesystem it would be all screw
stretch.
So 15 Newton centimeters for onescrew will.
For one screw we'll get one, acertain amount of preload, and
then for another screw it wouldbe a totally different preload.
Dr. Tyler Tolbert (27:44):
Yeah, so I like I usually think in terms of
extremes to simplify a concept.
So you know, if I, if I torquethis to 20, that might just be
telling me that there's a ton offriction, uh, between, like,
the screw interface and thematerial.
It doesn't really tell meanything about how that screw
has actually been stressed andpreloaded.
Dr. Sven Bone (27:59):
Yeah, yeah, got it.
Yeah, if you have a high, ifyou have a screw that has a high
amount of friction on it youmight.
Your clamping force might betoo low for to maintain
stability.
Dr. Tyler Tolbert (28:12):
Okay, okay, yeah.
Dr. Sven Bone (28:14):
Interesting and and so so that's why you, that's
why you really got to know whatwhat that stress is.
And uh, you that's why you gotit, cause stress is a, is a is
amount, is basically a force onthat comp and the amount of area
that's on that contact patch orthe bearing surface.
(28:34):
And then, and then that's whyyou really got to know clamping
force, like what it actuallybrings, and how you can, you can
mechanically test that with,like a load cell.
So so you basically screw theuh, screw the screw down to spec
, and then you see how muchforce is generated on the uh, on
the material.
So you, there's, there are waysto validate that.
Dr. Tyler Tolbert (28:55):
Right, right, okay, that makes sense.
So really, the, the torque inand of itself, I mean that's,
that's a, it's almost like Imean it's rotational, and all we
really care about is the, thedirect vertical force of the
screw onto the material, causethat's what actually keeps it
off.
Dr. Sven Bone (29:09):
The rotational force is kind of irrelevant and
think of, think of preload orclamping force is like a shock
absorber, right, so it is.
It's constantly pulling down onthis thing.
So, so that, so that it canhandle and resist all these, all
these, like you know, you knowthe chewing and rubbing, you
know, whatever the hell they'redoing like you know, like
(29:31):
basically it's like a shockabsorber, and and when that
starts to deplete, when theystart unwinding, then then you
get micro movement of theprosthesis, you get work,
hardening or crack initiation inthe fruit itself, where, on the
platform, all these, like allthese little things that occur
(29:52):
when, when clamping force is isreduced by half.
In fact, if clamping force isreduced by half, in fact, if
clamping force is reduced byhalf, the screw's unwinding.
Dr. Tyler Tolbert (30:00):
Okay, yeah, that makes sense?
That makes sense.
So is um.
Is that to say that the moreclamping force, the merrier um?
Or is it more so?
You know, maybe the um, thedegree by which the clamping
force is reduced over time.
That's more important.
Dr. Sven Bone (30:18):
Yeah, so so, um, that is so.
The more of the clamping force,the merrier is, I think.
I think theoretically, yes, youwant, you want to maximize
clamping force and I think thatis important, but it's
(30:42):
definitely more.
At what cost are you gettingthat for?
Dr. Tyler Tolbert (30:48):
Because we can reduce that bearing surface
friction to a very teeny littlecontact patch, but the
consequence of that is superhigh stress, and so we might so
we might be fracturing andyielding, yes, and deforming our
material yeah, so there'sdefinitely a balance there,
because if I, if I put too muchclamping force in a small area
(31:10):
because I've tried to reducethat friction, to increase the
preload, now I've created awhole another issue of actually
like fracturing material causingcrack propagation.
Okay, this makes sense.
Dr. Sven Bone (31:19):
Yeah.
Dr. Tyler Tolbert (31:19):
Okay, nice.
Dr. Sven Bone (31:20):
Yeah, I hope that .
I mean it's.
It's not that complicated, it'skind of complicated, but not
not too complicated.
Dr. Tyler Tolbert (31:27):
Yeah Right, Right, yeah, I mean it's.
It's more complex than you know.
I screw it into a high numberand that means it's going to
stay right, you know, and that'sthat's.
That's kind of how I thoughtabout it for probably most of my
career.
I think I very recently startedthinking more about it.
Yeah, yeah, I mean yeah.
Dr. Sven Bone (31:42):
I mean, honestly, our job is clinical.
We're not, you know, we don'tthink about, you know, the the,
a lot of the mechanical stuffbehind these things.
We, you know, and it's, it'sthat, that's you know, I mean,
that's why we have engineers,right.
For sure, yeah, absolutely Ourairplanes fly, our cars get us
(32:02):
from A to B.
You know, and and you know,there's a lot of of expertise
that goes behind that.
Dr. Tyler Tolbert (32:09):
And those are considerably more complex than
our restorations, I would assumeso.
Dr. Sven Bone (32:13):
I don't know man Well who am I telling?
There are so many unknowns thatwe have and just in our, it's
actually very, very complicated.
I would say it's.
It's tantalizing for anengineer.
It's complicated enough.
We're not making engine mountbrackets or something like that.
(32:36):
Our problems are actually waymore complicated than we would
realize.
Dr. Tyler Tolbert (32:48):
So I'm curious you talk about a lot of
the testing that you guys aredoing throughout your various
design interfaces.
Have you been testing likeother screws, other materials
and things like that and kind ofseeing how competitors stack up
like are there?
Have there been some surprisesand like design nuances that
people get excited about?
But maybe you know when youactually do the testing.
Dr. Sven Bone (33:06):
Yeah, so mechanical testing is is um's,
it's quite expensive to do itand, and maybe that's one reason
why we don't have a lot of datain it, but most of ours, most
of our testing has beencomputationally so.
So so we, we, we, we definitelyknow what competitors are, what
(33:28):
the performance of thecompetitors, at least from an
analytical point of view, andbut.
But unfortunately, there's nota lot of studies out there,
there's not a lot of likeacademic research on on this.
So so we're, you know, I, I, Idon't, we haven't really I, I, I
(33:56):
don't, we haven't really um, Imean, I think, I think it would
at some.
At some point we'll probably domore rigorous, uh, mechanical
testing, um, but but I thinkright now we're just kind of
really focused on on our screwand making sure that we have the
.
We have the best screw on themarket as performance wise.
Dr. Tyler Tolbert (34:11):
Great, great.
We have the best screw on themarket as performance wise,
great, great.
So, as far as indications forthe Badger screw, what is it
useful in?
I mean I I heard you know FB3obviously we've been talking
about that Is it great for allmaterials or are there certain
limitations of it, or is it auniversal thing?
Dr. Sven Bone (34:27):
I think I mean we have not really optimized it.
I would say it's say it's fortitanium.
I don't know, we haven't reallyit's not the point, for we
haven't optimized itspecifically for titanium.
Dr. Tyler Tolbert (34:45):
We have really optimized it for polymers
and ceramics, like that'sreally kind of what's our focus
on that yeah, yeah, and beingthat there's like a small screw
channel access, I would assumethat's great for fp1 and yes,
you know different applicationsas well okay, yeah, fantastic,
and that's available now andpeople can look up the battery
screw and give it a shot yeah,so so we should by the mid-march
(35:08):
, like early march.
Dr. Sven Bone (35:09):
We're on pre-order status and so okay, so
the what we have now is the.
The latest updates that we haveis that we should be, uh,
shipping in, um, uh, I think,mid-march.
This is when we're anodized.
We're doing a nice anodizingprocess too, and so they're made
(35:33):
.
And the other thing that Ithought was really important
they're made in America.
Dr. Tyler Tolbert (35:39):
There we go, Coming out of Montana.
You know it has to be yeah,yeah, man.
Dr. Sven Bone (35:45):
I was like you know we got to do this Like
let's make these in America,let's, let's have our.
I mean we have awesome, youknow, machine like, basically
industrial machine shops thatthat have.
You know, we're vetted withgreat iso standards.
You know, as far as, like, allthe stuff that we all the boxes
that we want to check ourtolerances are amazing, um yeah
(36:10):
I'm really impressed with themanufacturing.
Dr. Tyler Tolbert (36:14):
Yeah, and you know that's a, that's a whole
nother aspect to you know,choosing screws and really even
implants as well, is that wedon't even really think about is
where are these things gettingmade?
How are they getting made?
To what standard they're beingmade?
I mean, I've never even reallyI barely ever hear anybody even
speak to that.
You know, when they talk aboutdifferent products and options
that are out there.
So that's that's good thatyou've gone through the that
type of rigor to figure that out.
Dr. Sven Bone (36:35):
Yeah, yeah, I mean it's, it's, it's very
important.
I mean the FDA they do have tolike if you make an implant or
an abutment or something likethat, they, there are, you know,
iso standards that have to bemade in order to get it, uh, you
know, cleared.
But but yeah, yeah it's, but,but yeah for for our um, for our
screw.
You know, we, we're super happy.
Dr. Tyler Tolbert (36:57):
That's awesome.
That's awesome.
Well, I congratulate you on oninnovating there and, um, I
definitely feel like you were,you know, uh kind of taking
taking the industry to task, umto you know practice some uh
things that we see in theautomotive industry and
aerospace and hold ourselves toa higher standard and kind of
catch up with the times andother industries, because it's
long overdue.
I mean, full arch is becomingso incredibly ubiquitous and you
(37:20):
know everybody and theircousins trying to do it and if
we're not holding ourselves tothat high of a standard, we're
going to see a lot of problemscoming down the line.
Dr. Sven Bone (37:26):
So yeah, I mean these, these, I mean these go in
patients' mouths.
You know these are people.
Yeah, we really.
Yeah, I mean, I think, I thinkthat, um, I think the industry
in general like that, like likeit's going to get way more
sophisticated, like it should,and I think it will.
You know, yeah, so and and andit's going to be for the benefit
(37:48):
of the patients, it's going tobe the benefit of the clinicians
and on the laboratory side too,I mean everybody.
You know, with moresophisticated tools and
advancements, you know we candefinitely make this.
You know, very costly and riskysurgery and risky treatment.
(38:11):
I think we can make it betterand we should.
We should be the gold standardas far as in medicine.
Hey guys, our stuff lasts like20 years.
Dr. Tyler Tolbert (38:24):
Yeah, that's true.
Dr. Sven Bone (38:25):
So that's our goal, that's our mission Very
good, very good.
So I, I, that's that's our,that's our goal, that's our
mission.
Dr. Tyler Tolbert (38:31):
Very good, very good, yeah.
So to to speak to you, knowyour goals, your missions with
smart tech, with your, with yourlab, with your office, like
what are you know your biggestprofessional goals and ways that
you are looking to impact FullArch, beyond what you're, what
we've already talked about.
Dr. Sven Bone (38:47):
I, you know, I think I love clinical work.
I mean, I love being aclinician.
I think I always do it and so Ithink that's never going to go
away.
But I think I'm most I loveworking with my team of
engineers and I have like threejobs, it feels like, but I'm
(39:09):
always working.
But I really do love the um,the innovation side of things.
So so I, I, um, so I'llprobably definitely uh continue
with with uh, leading teams ofengineers for, for innovation,
and that's awesome and I think I, I have that um, I think what's
(39:29):
very helpful for them is that Ihave, I can live in both worlds
.
So so I understand a lot of thetechnical things that they, that
they work with, but I also havethat, that clinical insight as
well.
Dr. Tyler Tolbert (39:42):
Yeah, yeah, we need people that can be that
bridge.
For sure, you know, hopefullywe'll.
We'll be looking at a future inthe, in the very near future,
where you know we look at all ofour restorations and we know
where their stress points are.
We can, you know, assign thatto every patient and know where
their stress points are.
We can create a model for, um,you know, uh, mitigating
disaster long term and make ourwork last a long time.
(40:02):
And you know there's downstreameffects of that, where the end
user is the dentist, the lab,the patient, everybody benefits.
And so, um, I think you're you,everybody benefits, and so, um,
I think you're, you're reallyon a great path and you're
influencing our field in areally strong way.
Dr. Sven Bone (40:12):
Well, thanks yeah .
Dr. Tyler Tolbert (40:15):
Awesome, um, so this would not be the fixed
podcast if I didn't ask thisquestion.
So, um, I do it for everybody.
So what is your mostcontroversial opinion in full
arch dentistry?
Dr. Sven Bone (40:24):
Oh, my most controversial opinion, uh's see
here.
Dr. Tyler Tolbert (40:34):
You got to upset somebody.
Dr. Sven Bone (40:35):
Right, I know, I think well, you know, I think
the I think we need to.
I think where I'd like to seethings improve is I feel like
(40:58):
there's a lot of noise in thelike on social media and things
like that.
As far as you know, marketingand KOLs and things like that,
and essentially we're kind oflike I'd like to see more
objectivity in the industry andI do feel like we're manipulated
(41:23):
too much, like basically,there's a lot of manipulation
going on and I'd like to see alittle more facts like a little
more like real, rigorous factsand less like nonsense, you know
.
Dr. Tyler Tolbert (41:37):
I think that's fantastic and it
shouldn't be a controversialopinion, but I think it is.
Um, you know, I think we livein a in a social media era,
right, and you know everyone isjust trying to uh, make noise,
uh, for the sake of gettinglistened to.
Um, you know, I I play somewhatof a part in that.
I have a podcast I try topromote and I want people to
hear it.
But I think for us, we want tobring that objectivity and we're
(42:00):
a sponsored show and we talk topeople about their products and
their services.
But ultimately, we do have tohold ourselves to a certain
amount of rigor and show dataand show more than just a
hand-waving argument as to whysomething works and why other
things don't.
And I think that's reallyimportant.
And you know our mission hereis just to help people make
educated decisions and I thinkyou know that should be a
(42:21):
standard throughout the industry.
Dr. Sven Bone (42:22):
So yeah, I think it's just.
It's just the nature of the ofthe industry right now.
It's like how things, how dealsget done, how things are, are
you know how, how things areprogressed, like we we, if we
didn't have that, we wouldn't bewhere we are today.
But that doesn't mean that wecan't improve or get better, you
(42:43):
know, and and so.
So I think we put a lot ofweight on on like opinions and
and I think we're going to get,I believe that we're going to
those opinions are going tomatter, those people with high
EQs, huge social networks,things like that they are
definitely going to be, alwaysbe an important player.
(43:03):
Yeah, you know that's that thatis going to be important, but
but at the same time, I think wecan.
Manufacturers, the you know,innovators their responsibility
is to supply them with real, youknow, valid data so that we can
, all you know, get to from A toB you know, in the right way.
(43:29):
And so it just depends on theagenda Right.
Yeah, so I don't know if that'sthat very controversial because
honestly it's kind of like it'sa fact.
That's just the way it is, yeah.
Dr. Tyler Tolbert (43:42):
Yeah, yeah, I mean, it's the way it should be
, and maybe, uh, maybe, insteadof being a key opinion leader,
we should try to be a keyobjectivity leader.
We should, we should bring data.
Dr. Sven Bone (43:51):
Yeah, I mean it always comes down to opinion,
but but, at the same time, youknow, I think that, like you
know, um, like I like, if we'retalking about like a screw or
something like that, right, okay, like who's going to be a great
opinion leader for a screw,right?
Dr. Tyler Tolbert (44:09):
It's just the guy that screws the stuff in.
Dr. Sven Bone (44:12):
Right, right, yeah, right, I would engineer
over like I would that's who Iwould go to, like like that I
would trust an engineer over umover.
You know somebody that justlike uses them you know, on a
daily basis, like like basis,like like they they may or may.
I mean because we are ouropinions, like like we.
(44:36):
We aren't exactly the bestwitnesses, um you know, of of
whether something is good orwhether something is bad, it's
just it goes back to like ahappy patient isn't necessarily
the best judge of how well youdid.
Dr. Tyler Tolbert (44:53):
Yeah, you know, a five-star Google review
does not tell you how your screwperformed.
No, it doesn't.
Yeah.
Dr. Sven Bone (44:59):
And and and so so we, I think we need to be a
little more uh, you know, youknow objective about, about,
about how how we assess things.
Dr. Tyler Tolbert (45:11):
Yeah, no, I agree, and I think that you know
, when we were talking at thesymposium, you know you kept
bringing up about standards andother industries, right, and
it's like, yeah, we're, we'reinventing screws and like
there's all these new patentscoming out with like different,
you know, dental screws,different implants, all these
things, but the screw in itsform has existed for a very long
time before modern dentistryever existed, right, and there's
(45:31):
people that have really put alot of time and work and
research into screw design.
So there's a lot of things thatcan be learned that have
already been discovered and wedon't need to reinvent the wheel
.
Yeah, and that that was kind ofa Eureka moment for me and I
really appreciated that.
You know you're bringing thatsort of context into into
dentistry and raising thatstandard.
Dr. Sven Bone (45:52):
Yeah, yeah, and I mean, that's just one, that's
just one.
Dr. Tyler Tolbert (45:54):
you know thing, it's a small piece of it.
Dr. Sven Bone (45:54):
Yeah, but there's so many, you know, there's so
many different things and andand also, you know, I think,
true, the.
I think it's also reallyimportant to surround yourself
with mentors, like as you go inyour career, I think.
I think it's really critical,critical to um we also there's a
(46:16):
lot of bro science out there,right.
Dr. Tyler Tolbert (46:21):
I mean, there's a ton of it right, and
and so.
Dr. Sven Bone (46:24):
So, like I think, as you move along in your
career, I think you want to to,you know, get those mentors that
have more sophisticated modelsthat you can learn from, and
feedback as you grow and learn,and, and, and I think I think,
like you know, get we.
(46:45):
We tend to like huddle in ourown little groups and we stay
there and that's how you getstuck right and so so.
So I think it's really importantto reach out to you know, like
a, a surgeon that like sewsheads together yeah, yeah you
know, like, like, get, get thosementors that have, um, you know
(47:08):
, a lot of, uh, differentexperiences than yourself, and,
and, and.
As soon as you feel comfortablein your group, it's time to
move on.
Dr. Tyler Tolbert (47:17):
I like that.
Dr. Sven Bone (47:18):
No, that's good.
Dr. Tyler Tolbert (47:19):
That's good, yeah, and I think too is, you
know, I've always kind of youknow I can I can kind of tell
the history of my own career forthe people that I looked up to
Right, and I think that if you,if you only look to the people
that look how you want to lookright, the people that you're
trying to model yourself after,um, that that's not always the
best way to go about it, becauseyou need to kind of pick apart
(47:39):
all the different components ofwhat you want to be.
Maybe you want to be clinicallyexcellent, maybe you want to be
great in business, you want tobe great in marketing.
If you just model all of thosethings off that one person,
you're going to be a little bitlimited, right?
You need to pick and choosefrom the people that do really
well at all of those things, andthen you can be a composite of
those things and that's what canmake you, um, you know, truly
successful, because you'redrawing from best practices of
all of those things, cause noone is is is really the master
(48:02):
of all trades.
Dr. Sven Bone (48:03):
Yeah, I mean and and also, and also specialize,
like, like focus on, on what youon, on, on, you Like focus on
what you.
You will be a master of none ifyou don't really dedicate your
attention and focus onto a fewthings.
And I think, at least for me,I'm happier if I really focus on
(48:25):
a few things.
Like I don't do veneer, likeI'm not interested in cosmetic
work.
I love taking a hot mess andmaking it, you know, and fixing
it all.
It's awesome.
You know that.
That's.
That's my focus.
I the they have the biggestimpact on patients lives and and
uh, and so I have tons ofstories where that you know,
(48:46):
patients have um been totallychanged, like their careers and
because they were a hot mess andwe got them all straightened up
and and so.
So it's, it's a, it's the mostrewarding thing for me and but
yeah, I'm not doing there's.
I say no to a lot of things,you know you have to get used to
(49:07):
you know if you, if you want to.
At some point every dentistneeds to say no.
They need to learn how to dothat.
Dr. Tyler Tolbert (49:16):
Yeah, no, that's really good, that's
really good.
Yeah, no, I think that's agreat closing note for us.
Is, you know, figuring out howto dive deep and become, you
know, a master of something?
Right, figure out what it isthat you really want to go deep
on and get really into it, andthat's, you know.
That's something that inspiredus to do this show, and it
inspires us to bring people likeyourself on it, and we're just
(49:36):
so honored that you're able tospare your time.
Dr. Sven Bone (49:38):
Well thanks, yeah , no, it's been great.
It's good conversations.
I'm always up for that.
Dr. Tyler Tolbert (49:43):
Awesome, awesome.
Well, this episode willprobably be airing right around
the time that you're opening upa distribution of the Badger
Screw, so hopefully we can getthat synchronized pretty good.
And yeah, I'd just like toreiterate thank you so much for
bringing all your knowledge andexpertise into this conversation
and we look forward tocontinuing the conversation
later.
Yeah, I hope it was helpful.
(50:04):
I really do, I'm certain it was.
It helped me, if nothing else.
But I think our audience isreally going to like it Okay
good deal man.
Dr. Sven Bone (50:11):
Thanks man, All right, Take care.
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