June 16, 2025 • 33 mins
Ready to transform your dental practice into a facial aesthetics powerhouse? This eye-opening conversation reveals how implant dentists are perfectly positioned to tap into the $120 billion facial aesthetics industry—a market 24 times larger than implant dentistry itself.
Dr. Soren Paape and Dr. Tyler Tolbert explore how incorporating PRF (Platelet-Rich Fibrin) treatments can create substantial recurring revenue streams while delivering exceptional results for patients. The discussion unveils the stark contrast between one-time implant cases versus aesthetic patients who typically spend $3,000 annually on treatments, returning every 4-6 months like clockwork.
The conversation takes a fascinating technical turn with the introduction of the "PRF poncho technique"—a game-changing approach that dramatically reduces bacterial infiltration around implants. Learn how this simple yet powerful method creates a protective barrier of leukocyte-rich fibrin that significantly improves long-term implant success rates, especially for immediate placements.
Dental professionals will appreciate the detailed breakdown of PRF processing protocols, including critical insights about tube surface properties, oxygen exposure, and temperature control. The experts share practical tips for optimizing PRF quality, avoiding common mistakes, and efficiently integrating these services into your existing practice flow.
Perhaps most compelling is how these regenerative treatments can be partially delegated to trained dental assistants who are already comfortable with blood and sterile procedures. This creates new career advancement pathways for team members while maximizing practice productivity.
Have you considered how adding facial aesthetics could revolutionize your implant practice? Could the skills you already possess be worth considerably more in this expanding field? Listen now to discover if this could be your practice's next evolution.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren Papi,
and you're listening to theFixed Podcast, your source for
all things implant dentistry.
Why.
Speaker 2 (00:11):
And, honestly, the reason why, before we even
started, I asked you right awayabout it is because I get I mean
, especially this podcast ismainly full arch like implant
dentistry, right, mainly fullarch like implant dentistry,
right.
But we do like a lot of whatI'm doing is, um, the patients
that come in.
They just, they want to lookdifferent.
You know they, they're sick oftheir teeth, they want to
replace their teeth, they wantthem to look nice.
(00:31):
They've been dealing with theseteeth for for so long and they
finally reach a breaking pointwhere they're like, hey, I want
a new set of teeth, right?
Um, I think my teeth are at thepoint now that we can, we can
get to that point.
And a lot of these patients too.
They're older females andthey're like hey, dr Poppy, do
you do Botox?
Can you do my Botox too?
(00:52):
Because they trust me.
I just took out all their teethand did a big surgery on their
mouth and they're like oh, botoxis going to be easy for him to
do.
So I do Botox on my patientsand I think that this would be a
huge practice builder for fullarch clinic, specifically
because that patient already istrusting you, right, and this is
(01:13):
probably why it's so popular inplastics as well, because they
already trust you.
You already did a surgery onthem.
If you can incorporate doing,you know, like a lot of I get a
lot of patients that want thatdon't like the bags under their
eyes, right, so they want theywant to do like under eye
treatment, um, and I would loveto incorporate this into our
offices.
I think it'd be super easypractice builder and a lot of
(01:35):
our, a lot of our assistantsthey are, um, super comfortable
around blood.
That's all.
That's all we do all day.
So adding something like thisin having them pull blood, spin
it and then do some filler withPRF throughout the face probably
would be huge for implantclinics in particular.
Speaker 3 (01:54):
You know, absolutely 100% right.
We have many clinics doing thisand I'll talk a little bit
about Karasetix and what wecreated there.
But if you had to guess thesize and billions of dollars of
implant dentistry, I don't know,you guys know what it is.
Speaker 1 (02:07):
Five, just just to do it.
Oh, is it really?
It's?
Speaker 3 (02:13):
exactly five.
Yeah, it's fine, I probablyheard that somewhere implant
dentistry is a five billiondollar year and all of dentistry
is 25 billion.
Okay, so implants is 20 of whatwe do in dentistry is $25
billion.
Implants is 20% of what we doin dentistry.
It's a faster-growing marketthan dentistry.
It's growing at 9% per year.
Dentistry is growing at about6% per year.
(02:33):
Guess what facial aesthetics is?
Speaker 1 (02:35):
I'm already one for one, so I probably shouldn't
guess I'm going to say 20.
Oh, I thought we were doingpercentages.
Speaker 2 (02:42):
I was going to say $120 billion right after that.
Speaker 1 (02:44):
Actually, that's insane, that's ridiculous.
Speaker 3 (02:54):
So you're talking about a field that's more than
20 times bigger than implantdentistry.
Okay, this is a point that Ialways make and you know I had a
couple of experience with thisand one of the reasons why I've
shifted my practice to be a lotmore heavy on the facial
aesthetic side, for severalreasons.
But when you and this way Itell especially cosmetic
(03:16):
dentists when you do a greatcase okay, let's say you do a
full set of veneers, you do afull arch case, etc.
Yes, it's very profitable,absolutely, I agree, right, I
don't know what you guys.
You do a full arch case, etc.
Yes, it's very profitable,absolutely, I agree, right, I
don't know what you guys chargefor your full arch cases, but
let's say 25, 000 and after allthe expenses, etc, you know your
take home was 10 15k.
Let's say, you know less thecomplications that may happen,
(03:38):
etc.
But this is one time.
You will make that money onetime, if you've done your job
correctly, that should stay inthe mouth for at least 10 years
at least and ideally 15, 20, Iwould say right.
So now you're just doinghygiene on them, not making a
whole lot of money, and that'syour, that's your, you know
(03:59):
recourse to see these patients.
But that same person you justlike you said, is probably, if
they're spending $25,000 to geta full set of veneers done
because they want to look bettera nice full arch case that's
the exact same person that isgoing to spend and Allergan has
done all this research theaverage person in a set expense
(04:20):
$3,000 per year, every year,right.
So that means that over 10years they're also going to
spend $30,000 in facialaesthetics.
And if you can convert thosepeople to go more natural by
doing PRF and lasers and thingsthat don't cost our practice
that much money, right.
(04:40):
And we have a protocol wherewe've developed, actually, where
we combine laser therapy withpure F.
It takes us one hour to perform.
Half of it's done by my dentalassistant.
The blood draws, themicroneedling, et cetera Takes
one hour okay, $1,400.
And we recommend the patient doit twice per year to be more
youthful.
So they're spending $2,800.
(05:00):
It doesn't even cost us $50 todo the treatment.
Half the treatment's being doneby my assistants and I'm
sitting there racking threethousand dollars a year every
year like I work in our practice.
We actually had to hire anotherassociate period honest because
I was getting busier and busierdoing the facial stuff and I
(05:20):
was like man, this is way, way,way easier, way easier and more
profitable yeah, I mean I don'thave to go chasing yeah, that's
the central large case.
Speaker 1 (05:29):
It's brutal.
You guys know what?
Speaker 3 (05:30):
that's like right you gotta.
You know it is right, it's.
It's a war out there.
And the problem is and thething that I hate about
dentistry is a lot of lawsuitsare created because of fights
between dentists, and usuallyit's specialists, usually it's
oral surgeons, right, you makeone mistake and now all of a
sudden, oh, the oral surgeon'spissed off.
(05:53):
Oh, you're a GP and you'restealing all of our big full
arch cases.
We're pissed, let's go create alawsuit.
It's your own freakingcolleague that's putting you
down.
It's brutal out there.
And we're doing all this for $5billion a year industry, right.
So in the facial field, I justsaid like, wow, this is so easy,
like I'm competing againstnurses and PAs because no
(06:14):
plastic surgeons doing Botox,right, they want to do big
surgeries, right, they alwaysdelegate.
So I'm like I'm competingmainly against nurses and PAs.
I've got way more facialanatomy training.
I've done tens of thousands ofinjections in complex places in
the oral cavity.
You guys know, especially youdoing Botox.
Speaker 2 (06:33):
You know how easy.
Speaker 3 (06:34):
Botox is.
It's the easiest thing in theworld, so it's super easy and
it's repeat business.
So I had my schedule startingto go and fill up and the
craziest thing for me was if Idid two treatments a year.
Here's my 10 patients that I'mgoing to treat January 1st
$1,400 each.
That's a $14,000 a day.
(06:55):
It's all profit.
And guess what they all rebookfor July 1st and six months from
now so I don't have to go july1st.
Go find a bunch of new patientsand beg my gp colleagues like
please send me connective tissuegrafts or please send me those
intrabony defects.
I'm really good at all thisstuff I graduated from bernard
switzerland.
Please, please, please, let's gofor dinner, please.
(07:17):
Right, and that's what it'slike.
So when I switch from that tolike holy shit, my schedule is
full.
I was doing one day a month on,just fridays.
Now it's completely full andnow I'm opening two fridays a
month to do it.
And then it was every fridaymonth.
And then at one point I wasmaking so much money for dr
canner's practices with duringcovid, where we were not allowed
(07:37):
to do research anymore becauseof covid, so we had to stop all
these animal projects.
I went and worked four days aweek in private practice and two
days in a perio practice, twodays with dr canner.
Dr canner said dr myron, youare making so much more money in
facial aesthetics than as aperiodontist.
I don't want you to do any moreperio in my practice anymore.
You focus on facial.
I'll go hire anotherperiodontist and I just did
(07:59):
facial aesthetics.
Speaker 2 (08:01):
So I'm definitely going to be very, very I
definitely will be uh, kind ofstarting to work on
incorporating this change.
I do have a question trajectorywe were going to go do some
zygos down in brazil.
Speaker 1 (08:12):
He said screw that, why am I doing?
Speaker 2 (08:15):
why don't you do zygomatic implants?
I am curious when you havethese patients come in like
what's your, what's your generalprotocol?
I mean, you like what?
What exactly are you doing?
Where are you injecting?
Is it patient dependent?
Are you kind of likegeneralizing it for every single
patient?
Like, do they all kind of getthe vampire facial with?
Certain TRF in certain placesand then are you doing Botox on
(08:39):
all these patients.
Is that like an added benefitfor those patients?
What are the fees you'recharging for those?
I'm definitely curious.
Speaker 3 (08:52):
So we always like to do the regenerative protocols
before Botox.
And the reason why is because,let's say, I want to regenerate
tissue.
So let's say, I can seesomebody who's got visible
crow's feet.
I want them to like, make themotions and I want to be
injecting the pure F in theright location.
Right.
If they do Botox first nowthey're paralyzed, I can't tell
where those lines are and Idon't know, I can't inject as
(09:14):
precisely.
So we always do the protocoland then Botox.
After all my patients I see oneweek after the regenerative
protocols see how they're doingand one week after the
regenerative protocol to see howthey're doing.
Speaker 1 (09:30):
And in that follow-up appointment that's when I do
the botox and we charge 12 unitsfor botox, which I think is
probably pretty common acrossthe united states, and, uh,
about 40 50.
In terms of how things are solike with botox, you're
depending on what you're using,I suppose, and a person's
metabolic function, how activethey are.
They probably have anywherefrom two to four months before
they're coming back for moreBotox.
Do you have a longer relapseperiod with some of the more
regenerative protocols or is itstill kind of a similar cycle?
Speaker 3 (09:54):
Six, now we would say six months, which is pretty
common in the regenerative world.
So even most laser companiesrecommend every six months and
puref same thing and this is notcoming from me necessarily.
It's like the micro needlingcompanies that have been done it
, doing these vampire facialsfor years and years.
They always say start with twoor three treatments about a
(10:14):
month apart to get the bodygoing, making some collagen and
then at your facial aestheticscourse do you go over, like um,
the vampire facial.
Speaker 2 (10:23):
Do you go over the where to inject prf and and
botox, all of that stuff thereokay, not, not botox in that
course.
Speaker 3 (10:34):
No, we teach that in a more advanced course.
But if you already do it, youknow, already know where to
inject botox.
Oh yeah, we have an uh.
We have like a series of acouple courses that people kind
of gradually get better andbetter.
The nice thing with the uh prfis, you know, it's so safe that
nobody feels uncomfortable goingback to their mind.
So you actually have peoplebefore botox so yeah, and botox
(10:57):
is very easy, like it's um, yeah, definitely that's.
Speaker 2 (11:01):
That's.
That's really cool.
Uh, I'm definitely impressed bythat um yeah yeah, I actually
the the reason.
Yeah, like one of my assistantsin particular, she has really
really bad bags and that's likea huge concern for her and she
keeps asking me.
She's like, doc, can you pleasedo the prf, please do the prf.
And to me I was like, oh, Idon't know the under eye area,
(11:21):
like I don't really want to messwith that, you know.
Meanwhile, of course, we're inthe full mouth uh but but uh, I
think taking a basic course likethis and like you said, it's
super safe if you're followingthe right protocols and
everything like that is such agame changer for dentists and
it's such an easy value add.
Any single cosmetic case thatyou come into the office.
You could easily be like, hey,you're coming in every six
(11:42):
months anyways for yourfollow-up to get x-rays done.
Let's just quick, put you down,we'll do the full facial.
Maybe we'll even give you alittle bit of a discount if you
accept treatment with us for thefull arch and then go from
there, and then you have acontinual patient that's paying.
You know, at my office I charge250 for the x-rays and
everything, and then and itadded 1400 on top of that that's
(12:04):
really nice continual revenuefor an office.
Speaker 3 (12:09):
Yeah, you know, dr Canary set this up so smartly
because he would tell thehygienists look and actually
gave them bonuses.
But he would say what I want youguys to do is start learning
how to do microneedling with DrMyra.
Okay, because then what I wantyou to do is, if your patients
(12:29):
are coming in every six monthsto do dental hygiene, I want you
to add skin hygiene, and that'sgoing to be a one-hour
appointment.
So these hygienists, what theywould do is if they had an
eight-hour day where they weregoing to do eight patients,
eight hygiene appointments, theycould actually do four patients
and do one hour of dentalhygiene, one hour of skin
hygiene, one hour dental hygienefor the next patient, one hour
(12:50):
of skin hygiene, and he paidthem $10 more an hour to do the
skin hygiene.
So when those hygienists werewith the patients, they were
constantly talking to patientsyes, dr Myron does my Botox, dr
Myron did my microneedling,these are great services, et
cetera.
And then that's how we startedto get it rolling, because the
hygienists are spending so muchtime with the patients and most
(13:12):
of these hygienists want to havethese treatments done
themselves that it's really goodwhen they're just like yeah, he
does me and you know if you'vedone their surgeries already.
Of course it's going to be avery easy sell, yeah.
Speaker 1 (13:22):
That's fantastic, yeah.
So I do kind of want to pull alittle bit back into dentistry
itself, right?
So obviously we've talked a lotabout facial aesthetics, a lot
more than I ever anticipated,and perhaps I was wrong in that,
but I'm glad we did becauseit's actually opened up probably
the next course that Soren isgoing to drag me to, so but but
(13:43):
seriously I do appreciate theperspective and I didn't realize
how transformative that couldbe.
I always just kind of saw it asan adjunct to the dental stuff.
But who knows, I mean, if youget really into it, the dental
stuff can be an adjunct to theuh, to the facial aesthetics.
But, um, so in terms of you know, we talked a lot about what PRF
can do for um you, you alsomentioned soft tissue around
(14:04):
implants, and so my curiosityabout that is is that typically
something where I've alreadyplaced the implant and maybe I
have a soft tissue defect andI'm trying to improve the soft
tissue around that?
Is there something that I canbe doing intraoperatively when
I'm placing the implant atimmediate placement?
I've heard of PRF ponchos andthings like that.
Can you talk aboutintrasurgical application and
(14:24):
then post-surgical recallapplication?
Speaker 3 (14:26):
Yes, okay, yeah.
So it's much better to use itduring surgery.
And exactly for those thatdon't know what the poncho
technique is, it's a greattechnique.
Oh, wow, in fact, if there wasonly one place in all of
dentistry where puref was used,that would be it.
It is my, it is my favorite.
Okay, you take the purefmembrane, you fold it in half,
(14:48):
you take a you know 15 blade andjust punch a little hole
through it and then you put theabutment through the puref.
And when you place it.
Now, you know, especially onimmediates, you know what I try
and uh tell people is likeimmediate implants come with
more risk than delayed implants.
Without a doubt, right, there'sa higher prevalence of early
implant failure and higherprevalence of perimplantitis.
(15:10):
You know, years down the roadand let's say you're just doing
a very simple basic case right,lower first molar, most common
tooth that's extracted.
When this tooth comes out andyou place an immediate in there,
that implant, the defect sizeis like 10 millimeters, let's
say right, and you're placing alittle five or six millimeter
implant, which means that youhave two millimeters, let's say,
(15:32):
of space all around thisimplant for bacteria to get in
there.
Right, so if you did this casedelayed, right?
You'd put the bone graft inmembrane weight when that
implant would be placed.
Let's say you're placing a bonelevel implant, right, the
entire implant is going into thebone and the roughened portion
(15:54):
of the implant is embedded inbone already.
And if you use the tissue levelimplant, the entirety of the
roughened portion of the implantwould be buried in bone and
what would be exposed for thebacteria would be only the
polished surface, which bacteriadon't like as well.
Right, so you're very safethere.
When you do the same thing andyou got this little six
millimeter implant inside thisbig 10 millimeter hole, okay,
(16:17):
you're engaging, obviously, inthe frication area, but all the
space now exists and everysingle when we go to aap
meetings and we discuss thisamong periodontists, everybody
agrees we're going to pack thegaps with allograft, right, so
everybody agrees on the materialto use there.
Yeah, what to do with softtissues?
Man, you get 10, 20 differentanswers from different people.
Everybody.
(16:37):
Everybody says we develop thistechnique, we do it this way, do
we do it that way?
You know, some people say youneed a connective tissue graph.
Some people say unless it'sthis height you need you need a
connective tissue.
If it's like this, you do this.
So there's all kinds of youknow, different ways to do this,
and even if, let's say, youplaced a abutment, uh, you know
(16:59):
an abutment there and youapproximated the tissue as best
you can, or you made a customabutment, etc.
Like the reality is, is that youdon't really have true primary
closure.
Yeah right, like a littlebacteria that is literally five
micron in size.
If you don't think that it canjust go, we's down there.
And then now where's thebacteria?
(17:19):
He's floating around down herein a space where there's two
millimeters of open space.
He can literally go float rightto the roughened portion of an
implant and, boom, he's nowconnected to it, attached to it.
And I tell the residents in theperi department, like, if this
happens, you just started periimplantitis.
There's no going back now, verydifficult to treat.
We don't want bacteria.
(17:40):
And I always tell the residentsthe day you place the implant
is the most important day ofthat implant's life, because the
decisions you make today aregoing to affect what this
person's going to have to livewith for 10, 20, 30 years from
now.
So the guy that invented theponcho technique it was a
brilliant, brilliant idea hesaid well, I don't know, the
(18:01):
goal was just where thisabutment is, whether it's custom
or not.
When you're trying to getapproximation of the tissue, why
don't we just put purefeverywhere around here?
Okay, and by doing so nowyou've put like a super
concentrate of leukocytes aswell.
That's why they call itleukocyte and platelet-rich
fiber, or l-puref, as you guysknow.
(18:21):
Now the bacteria that's tryingto get in there.
That's the worst place thebacteria wants to be, because
that's where uh, you know you'rebetter at fighting infection.
You have more leukocytes there.
So I think the technique isbrilliant and amazingly, it
literally you just need one tube, you can use one tube, balance
it with a tube filled with water, and the tubes cost $1 each.
(18:44):
And if you did that for everyimplant you placed, man, I'm
sure you'd have much betteroutcomes.
Speaker 1 (18:51):
I got to do that.
I want to start doing monday.
Uh, what does the armamentariumlook like?
What is just like a briefdescription of that protocol, to
do just the prf poncho partyeah, so you know all these
companies that have purefequipment.
Speaker 3 (19:06):
Um, they always sell them as a starter package, right
where typically the kits areanywhere from.
You know three thousand bucksroughly, and it'll include the
centrifuge, you know the twotube types to make the solid
puref and the liquid purefbutterfly needles, and then all
of the uh, all of the hand handinstruments the puref box, the
(19:30):
tray, the bowl, the tube holders.
You know everything else that'sincluded.
So literally, when you buy oneof those kits, you get
everything you need, um to start, and the bio puref kits, which
is the ones that we developed inswitzerland.
Those ones actually come withmy online training program.
It's eight hours, it's myactual puref course.
It was just recorded for onlineand it comes with everything.
(19:52):
I mean everything from you knowhow to turn on your machine and
program it, to what is pure F,why it's different than PRP, to
all the clinical indications.
So it's literally our full dayprogram and that's included with
it, as well as a copy of mybook, understanding platelet
rich fibrin.
So you literally get like a lotof information, yeah and uh the
course.
(20:12):
The reason why we did this, youknow, for me, doing a lot of the
research in the space you guyscan imagine.
I want puref to be successfulin everybody's practice, because
when people associate puref,they think of you know, dr myron
, so to speak.
Right, so if everybody's havingbad experiences and it's not
working well, they're going tobe like well, dr myron is full
of shit, right?
So, um, I don't want that.
(20:33):
So we try, and, you know, putas much of uh material in in
these uh uh when they purchasethat, and the course we made it.
It used to be one year only,but we now made it lifetime
access.
So the doctor that has it inhis practice it's lifetime
access, which means that maybeyou hire a new dental assistant
(20:54):
because one of one of them leftyou in three years from now and
you want her to be your purefqueen and do help you with puref
and all your surgeries.
You say three years later.
Speaker 1 (21:02):
I need you to go watch this.
Where can they purchase thatfrom?
Speaker 3 (21:05):
and then they still have access to it so yeah,
that's a bio PRF, yeah, thewebsite's a B I O dash PRFcom.
And yeah, the starter packageand for those that take courses,
that would be a single unitapplication, do you like?
Speaker 2 (21:27):
what are your thoughts on application for for
full arch treatment?
Are you an advocate?
For you know, I see some peoplewho, because a lot of times
we're sedating these patientsanyways, right, so they just
pull, they just draw blood assoon as they get an iv in and
then, um, but like are you anadvocate for layering prf
everywhere prior to closure?
Like, where do you see it beingthe most applicable for full
(21:49):
arch based cases?
Speaker 3 (21:52):
Yes.
So if you're doing bonegrafting adding it to make your
sticky bone keep your particlesthere a little bit better and
then, yes, during closure, wejust literally put pure
membranes everywhere.
The goal is, and what we teachpeople in courses anywhere you
make an incision in surgery, youwant to have, when you go to
close this, you want to have apure membrane laid here.
(22:14):
So if this is my incision,right, I open up, I do this big
bone grafting, place someimplants, put a collagen
membrane or whatever you'reusing.
When I close up, I have amembrane that's here all the way
down.
Okay, and so that if there isbacteria that want to go in
there and try and contaminatewhat you've done because, again
same thing, yes, you haveprimary closure, but it's not,
(22:37):
it's not true, primary closure Alittle bacteria that's five
microns in size can go squeezein there.
So rule of thumb and this is inall fields of medicine ortho,
plastic surgery, et ceteraAnywhere you make an incision
when you close up, there's apuref membrane there.
So even our plastic surgeonsthat do rhinoplasties etc.
Speaker 2 (22:54):
And they make very little incision lines here when
they close that up so you'reusing a puref membrane right
there, solid prf tubes to makethe membranes.
You're using the liquid prftubes to use a sticky bone
correct.
So it coagulates and forms that.
Um, if you're like in thebeginning of a case, at what
point do you really recommendspinning that?
(23:15):
Because I've run into the issueright where maybe I'll spin my
PRF and then it coagulates toomuch prior to getting to using
the sticky bone.
When is kind of like theoptimal timing for like spinning
the solid and liquid PRF?
Speaker 3 (23:37):
Yeah for for like spinning the the solid versus in
liquid prf.
Yeah, so what's you?
You obviously don't have a biosystem because you're you
probably fixed angle, I'massuming.
Yes, is your machine like a 45degree angle?
The tube is going like this.
So when you use a fixed angle,you're actually driving.
When the centrifuge is spinning, you're driving the cells
against the back ball.
Okay, when this thing'sspinning fast, right, the
(23:57):
g-force is pushing the cellstowards the back wall.
But you actually want to clot?
You don't want to clot.
And where does clotting alwaysstart?
On a wall surface.
So by forcing them there, yoursis probably going to stay
liquid for about 15, 20 minutes.
Okay, when you spin ithorizontally, so the tubes they
actually go like this.
(24:17):
There's no more g force that'spushing it against the walls.
Okay, so on a horizontal systemit'll stay liquid for four
hours, probably better for fulllaunch so you got.
You got way more time, and sothat's a modification that was
made.
Another Another thing too that,yeah, yeah, definitely.
Another thing that you can doas well is we've realized
(24:40):
there's three main things thataffect clotting, okay.
So the first being the tubesurface the more hydrophilic it
is, the more water loving.
The faster it clots.
The more hydrophobic, thelonger it's going to stay liquid
loving.
The faster it clots, the morehydrophobic, the longer it's
going to stay liquid.
So, number one if you use umwith the better tubes and you
can get those and use them inyour machine right now at
(25:01):
biopuref you're going to get itto clot faster and you're also
going to get it to stay liquidlonger.
That's number one.
Number two we know and I don'tknow if you're doing this
already oxygen is one of thedrivers of clotting.
So the red top tubes we alwayspop the lids and we want to
expose them to oxygen, even ifit's clotted and I spun, did my
(25:23):
eight minute protocol or 12minutes, whatever you're
spinning at when it's done, evenif it's clotted already, I
still pop the lid and I want toexpose it to air for another
five minutes.
The air, the oxygen, induces itto clot further On the liquid
puref tubes.
Never pop the lids until you'reready to use it.
Okay, the third thing, and thiswill help you out tremendously.
(25:45):
The third thing we realizedthat the conversion of
fibrinogen plus thrombin into afibrin clot is enzymatic and
enzymes don't work well atcolder temperatures.
So we actually created what'scalled a bio cool device.
It's a little like cup shapeddevice and when you put the
tubes in there it keeps theliquid puref tubes between 8 to
(26:06):
10 degrees celsius and then theenzymes can't convert as
efficiently.
So even on our horizontalsystems it'll push from like an
hour that it stays liquid allthe way up to more than four
hours and on a fixed angleyou'll go from 15, 20 minutes to
like an hour and a half.
So that'll give you just bycooling it.
And if you want to make yourclots clot faster and we bought,
(26:28):
we bought this you buy a tinylittle incubator and keep your
incubator set at bodytemperature, 37 degrees Celsius.
That's when enzymes are mosteffective.
So when I have the red toptubes pulled, my team they pull
off the lids, oxygenate the redtop tubes, they put it in the
incubator until we're ready touse it.
That'll make it clot a lot moreeffectively and the clots will
(26:50):
be stronger.
Related to your question ontiming I have my dental
assistants do all of this.
Okay, they do it all 15 minutesbefore any procedure starts for
me.
They're in the room, they'redoing the blood draws, they're
doing the spinning, they do allthat stuff.
Okay, my whole team does allthe blood draws and all the
spinning and we've trained them,obviously, how to do that.
If I have a patient that's onanticoagulant therapy, typically
(27:12):
people will say like, oh,should I do like double spin or
triple spin or spin faster, thisthat a person that's on
anticoagulant therapy will nothave different levels of
platelets and leukocytes or redblood cells.
So if the role of thecentrifuge is to separate cells
based on their density, theprotocol is the same.
The difference is it's going totake them longer to clot.
(27:34):
So what do you need to do?
You need to do three things youneed to make sure you're using
the hydrophilic tubes, you needto pop the lids and instead of
waiting for five minutes, maybewe need to wait for 20 minutes
Okay, but they'll always clot.
And you need to use anincubator, okay, so that's.
That's basically our protocol.
There are little you know, whenyou talked about doing it from
the IV line, we actually sellthem also at biopuref, but there
(27:55):
are little like adapters thatyou can use and then you just do
the blood draws.
We do that all the time insedation.
Okay, you draw that blood justlike you're doing before.
Okay, and don't do.
I hope you're drawing them inone of the vacuets.
Is that how you do it?
Or draw it in like a tube andthen you do it that way?
Yeah, that's the right way todo it.
Some people they'll grab like abig 40 cc syringe and drop 40
(28:17):
cc's that way from the line andthen inject 10 cc's into each
tube.
I tell people try to avoiddoing that because, um, the
proteins the reason how clottingstarts is from the proteins
that are found which will absorbto the surfaces.
So if you fill a 40 cc syringejust by drawing it, some of
(28:38):
those good proteins that areneeded are now binding to the
syringe wall and then you gointo each of the 10 cc tubes.
Speaker 1 (28:45):
What are some other common mistakes that you see,
maybe specific to dentistry, interms of the blood draw, how
things get spun, how it'sprocessed?
I mean, you talked a lot aboutthe sort of post-process and
there were some other thingsthat are affecting the
effectiveness of the PRF.
Speaker 3 (29:01):
Yeah, I would say that there's a lot of people
don't.
Well, there's three thingsreally.
First, people don't understandthe difference between RPM and
RCF, and so there's a G-forceand an RPM, and what happens is,
let's say I have my centrifugeand I'm spinning.
There's a certain amount ofspinning that's going to occur
(29:22):
at a certain G-force.
So let's say I invent a perfectprotocol and my protocol is
designed only for this machine.
So let's say it's 1,000 RPM andit creates a certain G force
that will separate.
If we start to do a machinethat has is like twice the size
and you still spin at a thousandRPM, you're actually going a
lot faster, right, you'reactually going a lot faster this
(29:44):
way.
And so what happens is whathappened.
I don't know is my video stillgoing okay or is?
Speaker 1 (29:52):
it.
Speaker 3 (29:52):
It's getting a little choppy, but it'll be okay um,
so the rotor size from here to abigger size.
You cannot use the same rpm.
You need to specifically designa protocol here and use it
there.
So I see a lot of peoplethey'll go to facebook groups,
let's say, and they'll say hey,uh, I just bought a centrifuge.
What, what's protocol would yourecommend using?
(30:14):
You get all these answers athousand for 10 minutes 1300.
And that's completely incorrectbecause every protocol is
designed specifically for onemachine.
Okay, so that part there isvery, very important.
Um, and then additionally, um,the tubes matter way more than
the centrifuge and people buythe tubes for like a dollar,
right, and that decision youmake with the tubes will matter
(30:35):
much more than the centrifuge.
So those are the two mostcommon errors that I see hey
everyone.
Speaker 2 (30:41):
I apologize for this quick interruption on the
podcast, um, dr myron's videoactually uh, stopped working at
this point, um, due to justrunning out of battery.
So I'm going to try to give youa quick summary of his final
points and then I'll talk alittle bit about how to get in
touch with him or his program.
So the last thing he was reallytalking about was actually
(31:04):
heating PRF, and when we heatPRF it goes from lasting from
two to three months to five tosix months.
Through Bio PRF or PRF-EDU,they actually have a heating
element that you take the PRF,put it in there and it allows
those membranes or solid PRF tolast quite a bit longer.
That was his first point.
(31:25):
The next thing he startedtalking about was I actually
asked him what the biggestchange he's seen in the dental
or blood environment is and hesaid exosomes and what those are
.
There's a lot of futurepotential for these to change
how medications react.
They're something that canprolong certain medications,
(31:48):
let's say insulin.
If a patient needs to takeinsulin every day, it might
change to taking it every weekusing these.
So he thinks it's the biggestthing he's seen in regenerative
medicine and we're reallyexcited for the potential of
this to come.
Finally, he discussed how to getin touch with him and how to
learn a little bit more aboutPRF, and the best thing you can
(32:10):
do is go to PRFEDU or BioPRFonline and he has multiple
courses on there that you couldsign up for and take.
I actually, since recording thepodcast, I went to his course
and it was excellent and wepurchased all this stuff and we
are doing PRF.
We were doing PRF before, butwe're doing a lot more of the
facial PRF stuff in my officeand it's been excellent.
(32:30):
So we wanted to just thank DrMyron again for coming on the
podcast.
Thank you, dr Tolbert, fordoing another wonderful podcast.
If you guys have any questionsfor Dr Myron, you can reach out
to him on Instagram andhopefully, once again, you
enjoyed our podcast.
Thanks again, bye.
My name is Dr Tyler Tolbert and I'm Dr Soren Papi,
and you're listening to theFixed Podcast, your source for
all things implant dentistry.
Why.
Speaker 2 (00:11):
And, honestly, the reason why, before we even
started, I asked you right awayabout it is because I get I mean
, especially this podcast ismainly full arch like implant
dentistry, right, mainly fullarch like implant dentistry,
right.
But we do like a lot of whatI'm doing is, um, the patients
that come in.
They just, they want to lookdifferent.
You know they, they're sick oftheir teeth, they want to
replace their teeth, they wantthem to look nice.
(00:31):
They've been dealing with theseteeth for for so long and they
finally reach a breaking pointwhere they're like, hey, I want
a new set of teeth, right?
Um, I think my teeth are at thepoint now that we can, we can
get to that point.
And a lot of these patients too.
They're older females andthey're like hey, dr Poppy, do
you do Botox?
Can you do my Botox too?
(00:52):
Because they trust me.
I just took out all their teethand did a big surgery on their
mouth and they're like oh, botoxis going to be easy for him to
do.
So I do Botox on my patientsand I think that this would be a
huge practice builder for fullarch clinic, specifically
because that patient already istrusting you, right, and this is
(01:13):
probably why it's so popular inplastics as well, because they
already trust you.
You already did a surgery onthem.
If you can incorporate doing,you know, like a lot of I get a
lot of patients that want thatdon't like the bags under their
eyes, right, so they want theywant to do like under eye
treatment, um, and I would loveto incorporate this into our
offices.
I think it'd be super easypractice builder and a lot of
(01:35):
our, a lot of our assistantsthey are, um, super comfortable
around blood.
That's all.
That's all we do all day.
So adding something like thisin having them pull blood, spin
it and then do some filler withPRF throughout the face probably
would be huge for implantclinics in particular.
Speaker 3 (01:54):
You know, absolutely 100% right.
We have many clinics doing thisand I'll talk a little bit
about Karasetix and what wecreated there.
But if you had to guess thesize and billions of dollars of
implant dentistry, I don't know,you guys know what it is.
Speaker 1 (02:07):
Five, just just to do it.
Oh, is it really?
It's?
Speaker 3 (02:13):
exactly five.
Yeah, it's fine, I probablyheard that somewhere implant
dentistry is a five billiondollar year and all of dentistry
is 25 billion.
Okay, so implants is 20 of whatwe do in dentistry is $25
billion.
Implants is 20% of what we doin dentistry.
It's a faster-growing marketthan dentistry.
It's growing at 9% per year.
Dentistry is growing at about6% per year.
(02:33):
Guess what facial aesthetics is?
Speaker 1 (02:35):
I'm already one for one, so I probably shouldn't
guess I'm going to say 20.
Oh, I thought we were doingpercentages.
Speaker 2 (02:42):
I was going to say $120 billion right after that.
Speaker 1 (02:44):
Actually, that's insane, that's ridiculous.
Speaker 3 (02:54):
So you're talking about a field that's more than
20 times bigger than implantdentistry.
Okay, this is a point that Ialways make and you know I had a
couple of experience with thisand one of the reasons why I've
shifted my practice to be a lotmore heavy on the facial
aesthetic side, for severalreasons.
But when you and this way Itell especially cosmetic
(03:16):
dentists when you do a greatcase okay, let's say you do a
full set of veneers, you do afull arch case, etc.
Yes, it's very profitable,absolutely, I agree, right, I
don't know what you guys.
You do a full arch case, etc.
Yes, it's very profitable,absolutely, I agree, right, I
don't know what you guys chargefor your full arch cases, but
let's say 25, 000 and after allthe expenses, etc, you know your
take home was 10 15k.
Let's say, you know less thecomplications that may happen,
(03:38):
etc.
But this is one time.
You will make that money onetime, if you've done your job
correctly, that should stay inthe mouth for at least 10 years
at least and ideally 15, 20, Iwould say right.
So now you're just doinghygiene on them, not making a
whole lot of money, and that'syour, that's your, you know
(03:59):
recourse to see these patients.
But that same person you justlike you said, is probably, if
they're spending $25,000 to geta full set of veneers done
because they want to look bettera nice full arch case that's
the exact same person that isgoing to spend and Allergan has
done all this research theaverage person in a set expense
(04:20):
$3,000 per year, every year,right.
So that means that over 10years they're also going to
spend $30,000 in facialaesthetics.
And if you can convert thosepeople to go more natural by
doing PRF and lasers and thingsthat don't cost our practice
that much money, right.
(04:40):
And we have a protocol wherewe've developed, actually, where
we combine laser therapy withpure F.
It takes us one hour to perform.
Half of it's done by my dentalassistant.
The blood draws, themicroneedling, et cetera Takes
one hour okay, $1,400.
And we recommend the patient doit twice per year to be more
youthful.
So they're spending $2,800.
(05:00):
It doesn't even cost us $50 todo the treatment.
Half the treatment's being doneby my assistants and I'm
sitting there racking threethousand dollars a year every
year like I work in our practice.
We actually had to hire anotherassociate period honest because
I was getting busier and busierdoing the facial stuff and I
(05:20):
was like man, this is way, way,way easier, way easier and more
profitable yeah, I mean I don'thave to go chasing yeah, that's
the central large case.
Speaker 1 (05:29):
It's brutal.
You guys know what?
Speaker 3 (05:30):
that's like right you gotta.
You know it is right, it's.
It's a war out there.
And the problem is and thething that I hate about
dentistry is a lot of lawsuitsare created because of fights
between dentists, and usuallyit's specialists, usually it's
oral surgeons, right, you makeone mistake and now all of a
sudden, oh, the oral surgeon'spissed off.
(05:53):
Oh, you're a GP and you'restealing all of our big full
arch cases.
We're pissed, let's go create alawsuit.
It's your own freakingcolleague that's putting you
down.
It's brutal out there.
And we're doing all this for $5billion a year industry, right.
So in the facial field, I justsaid like, wow, this is so easy,
like I'm competing againstnurses and PAs because no
(06:14):
plastic surgeons doing Botox,right, they want to do big
surgeries, right, they alwaysdelegate.
So I'm like I'm competingmainly against nurses and PAs.
I've got way more facialanatomy training.
I've done tens of thousands ofinjections in complex places in
the oral cavity.
You guys know, especially youdoing Botox.
Speaker 2 (06:33):
You know how easy.
Speaker 3 (06:34):
Botox is.
It's the easiest thing in theworld, so it's super easy and
it's repeat business.
So I had my schedule startingto go and fill up and the
craziest thing for me was if Idid two treatments a year.
Here's my 10 patients that I'mgoing to treat January 1st
$1,400 each.
That's a $14,000 a day.
(06:55):
It's all profit.
And guess what they all rebookfor July 1st and six months from
now so I don't have to go july1st.
Go find a bunch of new patientsand beg my gp colleagues like
please send me connective tissuegrafts or please send me those
intrabony defects.
I'm really good at all thisstuff I graduated from bernard
switzerland.
Please, please, please, let's gofor dinner, please.
(07:17):
Right, and that's what it'slike.
So when I switch from that tolike holy shit, my schedule is
full.
I was doing one day a month on,just fridays.
Now it's completely full andnow I'm opening two fridays a
month to do it.
And then it was every fridaymonth.
And then at one point I wasmaking so much money for dr
canner's practices with duringcovid, where we were not allowed
(07:37):
to do research anymore becauseof covid, so we had to stop all
these animal projects.
I went and worked four days aweek in private practice and two
days in a perio practice, twodays with dr canner.
Dr canner said dr myron, youare making so much more money in
facial aesthetics than as aperiodontist.
I don't want you to do any moreperio in my practice anymore.
You focus on facial.
I'll go hire anotherperiodontist and I just did
(07:59):
facial aesthetics.
Speaker 2 (08:01):
So I'm definitely going to be very, very I
definitely will be uh, kind ofstarting to work on
incorporating this change.
I do have a question trajectorywe were going to go do some
zygos down in brazil.
Speaker 1 (08:12):
He said screw that, why am I doing?
Speaker 2 (08:15):
why don't you do zygomatic implants?
I am curious when you havethese patients come in like
what's your, what's your generalprotocol?
I mean, you like what?
What exactly are you doing?
Where are you injecting?
Is it patient dependent?
Are you kind of likegeneralizing it for every single
patient?
Like, do they all kind of getthe vampire facial with?
Certain TRF in certain placesand then are you doing Botox on
(08:39):
all these patients.
Is that like an added benefitfor those patients?
What are the fees you'recharging for those?
I'm definitely curious.
Speaker 3 (08:52):
So we always like to do the regenerative protocols
before Botox.
And the reason why is because,let's say, I want to regenerate
tissue.
So let's say, I can seesomebody who's got visible
crow's feet.
I want them to like, make themotions and I want to be
injecting the pure F in theright location.
Right.
If they do Botox first nowthey're paralyzed, I can't tell
where those lines are and Idon't know, I can't inject as
(09:14):
precisely.
So we always do the protocoland then Botox.
After all my patients I see oneweek after the regenerative
protocols see how they're doingand one week after the
regenerative protocol to see howthey're doing.
Speaker 1 (09:30):
And in that follow-up appointment that's when I do
the botox and we charge 12 unitsfor botox, which I think is
probably pretty common acrossthe united states, and, uh,
about 40 50.
In terms of how things are solike with botox, you're
depending on what you're using,I suppose, and a person's
metabolic function, how activethey are.
They probably have anywherefrom two to four months before
they're coming back for moreBotox.
Do you have a longer relapseperiod with some of the more
regenerative protocols or is itstill kind of a similar cycle?
Speaker 3 (09:54):
Six, now we would say six months, which is pretty
common in the regenerative world.
So even most laser companiesrecommend every six months and
puref same thing and this is notcoming from me necessarily.
It's like the micro needlingcompanies that have been done it
, doing these vampire facialsfor years and years.
They always say start with twoor three treatments about a
(10:14):
month apart to get the bodygoing, making some collagen and
then at your facial aestheticscourse do you go over, like um,
the vampire facial.
Speaker 2 (10:23):
Do you go over the where to inject prf and and
botox, all of that stuff thereokay, not, not botox in that
course.
Speaker 3 (10:34):
No, we teach that in a more advanced course.
But if you already do it, youknow, already know where to
inject botox.
Oh yeah, we have an uh.
We have like a series of acouple courses that people kind
of gradually get better andbetter.
The nice thing with the uh prfis, you know, it's so safe that
nobody feels uncomfortable goingback to their mind.
So you actually have peoplebefore botox so yeah, and botox
(10:57):
is very easy, like it's um, yeah, definitely that's.
Speaker 2 (11:01):
That's.
That's really cool.
Uh, I'm definitely impressed bythat um yeah yeah, I actually
the the reason.
Yeah, like one of my assistantsin particular, she has really
really bad bags and that's likea huge concern for her and she
keeps asking me.
She's like, doc, can you pleasedo the prf, please do the prf.
And to me I was like, oh, Idon't know the under eye area,
(11:21):
like I don't really want to messwith that, you know.
Meanwhile, of course, we're inthe full mouth uh but but uh, I
think taking a basic course likethis and like you said, it's
super safe if you're followingthe right protocols and
everything like that is such agame changer for dentists and
it's such an easy value add.
Any single cosmetic case thatyou come into the office.
You could easily be like, hey,you're coming in every six
(11:42):
months anyways for yourfollow-up to get x-rays done.
Let's just quick, put you down,we'll do the full facial.
Maybe we'll even give you alittle bit of a discount if you
accept treatment with us for thefull arch and then go from
there, and then you have acontinual patient that's paying.
You know, at my office I charge250 for the x-rays and
everything, and then and itadded 1400 on top of that that's
(12:04):
really nice continual revenuefor an office.
Speaker 3 (12:09):
Yeah, you know, dr Canary set this up so smartly
because he would tell thehygienists look and actually
gave them bonuses.
But he would say what I want youguys to do is start learning
how to do microneedling with DrMyra.
Okay, because then what I wantyou to do is, if your patients
(12:29):
are coming in every six monthsto do dental hygiene, I want you
to add skin hygiene, and that'sgoing to be a one-hour
appointment.
So these hygienists, what theywould do is if they had an
eight-hour day where they weregoing to do eight patients,
eight hygiene appointments, theycould actually do four patients
and do one hour of dentalhygiene, one hour of skin
hygiene, one hour dental hygienefor the next patient, one hour
(12:50):
of skin hygiene, and he paidthem $10 more an hour to do the
skin hygiene.
So when those hygienists werewith the patients, they were
constantly talking to patientsyes, dr Myron does my Botox, dr
Myron did my microneedling,these are great services, et
cetera.
And then that's how we startedto get it rolling, because the
hygienists are spending so muchtime with the patients and most
(13:12):
of these hygienists want to havethese treatments done
themselves that it's really goodwhen they're just like yeah, he
does me and you know if you'vedone their surgeries already.
Of course it's going to be avery easy sell, yeah.
Speaker 1 (13:22):
That's fantastic, yeah.
So I do kind of want to pull alittle bit back into dentistry
itself, right?
So obviously we've talked a lotabout facial aesthetics, a lot
more than I ever anticipated,and perhaps I was wrong in that,
but I'm glad we did becauseit's actually opened up probably
the next course that Soren isgoing to drag me to, so but but
(13:43):
seriously I do appreciate theperspective and I didn't realize
how transformative that couldbe.
I always just kind of saw it asan adjunct to the dental stuff.
But who knows, I mean, if youget really into it, the dental
stuff can be an adjunct to theuh, to the facial aesthetics.
But, um, so in terms of you know, we talked a lot about what PRF
can do for um you, you alsomentioned soft tissue around
(14:04):
implants, and so my curiosityabout that is is that typically
something where I've alreadyplaced the implant and maybe I
have a soft tissue defect andI'm trying to improve the soft
tissue around that?
Is there something that I canbe doing intraoperatively when
I'm placing the implant atimmediate placement?
I've heard of PRF ponchos andthings like that.
Can you talk aboutintrasurgical application and
(14:24):
then post-surgical recallapplication?
Speaker 3 (14:26):
Yes, okay, yeah.
So it's much better to use itduring surgery.
And exactly for those thatdon't know what the poncho
technique is, it's a greattechnique.
Oh, wow, in fact, if there wasonly one place in all of
dentistry where puref was used,that would be it.
It is my, it is my favorite.
Okay, you take the purefmembrane, you fold it in half,
(14:48):
you take a you know 15 blade andjust punch a little hole
through it and then you put theabutment through the puref.
And when you place it.
Now, you know, especially onimmediates, you know what I try
and uh tell people is likeimmediate implants come with
more risk than delayed implants.
Without a doubt, right, there'sa higher prevalence of early
implant failure and higherprevalence of perimplantitis.
(15:10):
You know, years down the roadand let's say you're just doing
a very simple basic case right,lower first molar, most common
tooth that's extracted.
When this tooth comes out andyou place an immediate in there,
that implant, the defect sizeis like 10 millimeters, let's
say right, and you're placing alittle five or six millimeter
implant, which means that youhave two millimeters, let's say,
(15:32):
of space all around thisimplant for bacteria to get in
there.
Right, so if you did this casedelayed, right?
You'd put the bone graft inmembrane weight when that
implant would be placed.
Let's say you're placing a bonelevel implant, right, the
entire implant is going into thebone and the roughened portion
(15:54):
of the implant is embedded inbone already.
And if you use the tissue levelimplant, the entirety of the
roughened portion of the implantwould be buried in bone and
what would be exposed for thebacteria would be only the
polished surface, which bacteriadon't like as well.
Right, so you're very safethere.
When you do the same thing andyou got this little six
millimeter implant inside thisbig 10 millimeter hole, okay,
(16:17):
you're engaging, obviously, inthe frication area, but all the
space now exists and everysingle when we go to aap
meetings and we discuss thisamong periodontists, everybody
agrees we're going to pack thegaps with allograft, right, so
everybody agrees on the materialto use there.
Yeah, what to do with softtissues?
Man, you get 10, 20 differentanswers from different people.
Everybody.
(16:37):
Everybody says we develop thistechnique, we do it this way, do
we do it that way?
You know, some people say youneed a connective tissue graph.
Some people say unless it'sthis height you need you need a
connective tissue.
If it's like this, you do this.
So there's all kinds of youknow, different ways to do this,
and even if, let's say, youplaced a abutment, uh, you know
(16:59):
an abutment there and youapproximated the tissue as best
you can, or you made a customabutment, etc.
Like the reality is, is that youdon't really have true primary
closure.
Yeah right, like a littlebacteria that is literally five
micron in size.
If you don't think that it canjust go, we's down there.
And then now where's thebacteria?
(17:19):
He's floating around down herein a space where there's two
millimeters of open space.
He can literally go float rightto the roughened portion of an
implant and, boom, he's nowconnected to it, attached to it.
And I tell the residents in theperi department, like, if this
happens, you just started periimplantitis.
There's no going back now, verydifficult to treat.
We don't want bacteria.
(17:40):
And I always tell the residentsthe day you place the implant
is the most important day ofthat implant's life, because the
decisions you make today aregoing to affect what this
person's going to have to livewith for 10, 20, 30 years from
now.
So the guy that invented theponcho technique it was a
brilliant, brilliant idea hesaid well, I don't know, the
(18:01):
goal was just where thisabutment is, whether it's custom
or not.
When you're trying to getapproximation of the tissue, why
don't we just put purefeverywhere around here?
Okay, and by doing so nowyou've put like a super
concentrate of leukocytes aswell.
That's why they call itleukocyte and platelet-rich
fiber, or l-puref, as you guysknow.
(18:21):
Now the bacteria that's tryingto get in there.
That's the worst place thebacteria wants to be, because
that's where uh, you know you'rebetter at fighting infection.
You have more leukocytes there.
So I think the technique isbrilliant and amazingly, it
literally you just need one tube, you can use one tube, balance
it with a tube filled with water, and the tubes cost $1 each.
(18:44):
And if you did that for everyimplant you placed, man, I'm
sure you'd have much betteroutcomes.
Speaker 1 (18:51):
I got to do that.
I want to start doing monday.
Uh, what does the armamentariumlook like?
What is just like a briefdescription of that protocol, to
do just the prf poncho partyeah, so you know all these
companies that have purefequipment.
Speaker 3 (19:06):
Um, they always sell them as a starter package, right
where typically the kits areanywhere from.
You know three thousand bucksroughly, and it'll include the
centrifuge, you know the twotube types to make the solid
puref and the liquid purefbutterfly needles, and then all
of the uh, all of the hand handinstruments the puref box, the
(19:30):
tray, the bowl, the tube holders.
You know everything else that'sincluded.
So literally, when you buy oneof those kits, you get
everything you need, um to start, and the bio puref kits, which
is the ones that we developed inswitzerland.
Those ones actually come withmy online training program.
It's eight hours, it's myactual puref course.
It was just recorded for onlineand it comes with everything.
(19:52):
I mean everything from you knowhow to turn on your machine and
program it, to what is pure F,why it's different than PRP, to
all the clinical indications.
So it's literally our full dayprogram and that's included with
it, as well as a copy of mybook, understanding platelet
rich fibrin.
So you literally get like a lotof information, yeah and uh the
course.
(20:12):
The reason why we did this, youknow, for me, doing a lot of the
research in the space you guyscan imagine.
I want puref to be successfulin everybody's practice, because
when people associate puref,they think of you know, dr myron
, so to speak.
Right, so if everybody's havingbad experiences and it's not
working well, they're going tobe like well, dr myron is full
of shit, right?
So, um, I don't want that.
(20:33):
So we try, and, you know, putas much of uh material in in
these uh uh when they purchasethat, and the course we made it.
It used to be one year only,but we now made it lifetime
access.
So the doctor that has it inhis practice it's lifetime
access, which means that maybeyou hire a new dental assistant
(20:54):
because one of one of them leftyou in three years from now and
you want her to be your purefqueen and do help you with puref
and all your surgeries.
You say three years later.
Speaker 1 (21:02):
I need you to go watch this.
Where can they purchase thatfrom?
Speaker 3 (21:05):
and then they still have access to it so yeah,
that's a bio PRF, yeah, thewebsite's a B I O dash PRFcom.
And yeah, the starter packageand for those that take courses,
that would be a single unitapplication, do you like?
Speaker 2 (21:27):
what are your thoughts on application for for
full arch treatment?
Are you an advocate?
For you know, I see some peoplewho, because a lot of times
we're sedating these patientsanyways, right, so they just
pull, they just draw blood assoon as they get an iv in and
then, um, but like are you anadvocate for layering prf
everywhere prior to closure?
Like, where do you see it beingthe most applicable for full
(21:49):
arch based cases?
Speaker 3 (21:52):
Yes.
So if you're doing bonegrafting adding it to make your
sticky bone keep your particlesthere a little bit better and
then, yes, during closure, wejust literally put pure
membranes everywhere.
The goal is, and what we teachpeople in courses anywhere you
make an incision in surgery, youwant to have, when you go to
close this, you want to have apure membrane laid here.
(22:14):
So if this is my incision,right, I open up, I do this big
bone grafting, place someimplants, put a collagen
membrane or whatever you'reusing.
When I close up, I have amembrane that's here all the way
down.
Okay, and so that if there isbacteria that want to go in
there and try and contaminatewhat you've done because, again
same thing, yes, you haveprimary closure, but it's not,
(22:37):
it's not true, primary closure Alittle bacteria that's five
microns in size can go squeezein there.
So rule of thumb and this is inall fields of medicine ortho,
plastic surgery, et ceteraAnywhere you make an incision
when you close up, there's apuref membrane there.
So even our plastic surgeonsthat do rhinoplasties etc.
Speaker 2 (22:54):
And they make very little incision lines here when
they close that up so you'reusing a puref membrane right
there, solid prf tubes to makethe membranes.
You're using the liquid prftubes to use a sticky bone
correct.
So it coagulates and forms that.
Um, if you're like in thebeginning of a case, at what
point do you really recommendspinning that?
(23:15):
Because I've run into the issueright where maybe I'll spin my
PRF and then it coagulates toomuch prior to getting to using
the sticky bone.
When is kind of like theoptimal timing for like spinning
the solid and liquid PRF?
Speaker 3 (23:37):
Yeah for for like spinning the the solid versus in
liquid prf.
Yeah, so what's you?
You obviously don't have a biosystem because you're you
probably fixed angle, I'massuming.
Yes, is your machine like a 45degree angle?
The tube is going like this.
So when you use a fixed angle,you're actually driving.
When the centrifuge is spinning, you're driving the cells
against the back ball.
Okay, when this thing'sspinning fast, right, the
(23:57):
g-force is pushing the cellstowards the back wall.
But you actually want to clot?
You don't want to clot.
And where does clotting alwaysstart?
On a wall surface.
So by forcing them there, yoursis probably going to stay
liquid for about 15, 20 minutes.
Okay, when you spin ithorizontally, so the tubes they
actually go like this.
(24:17):
There's no more g force that'spushing it against the walls.
Okay, so on a horizontal systemit'll stay liquid for four
hours, probably better for fulllaunch so you got.
You got way more time, and sothat's a modification that was
made.
Another Another thing too that,yeah, yeah, definitely.
Another thing that you can doas well is we've realized
(24:40):
there's three main things thataffect clotting, okay.
So the first being the tubesurface the more hydrophilic it
is, the more water loving.
The faster it clots.
The more hydrophobic, thelonger it's going to stay liquid
loving.
The faster it clots, the morehydrophobic, the longer it's
going to stay liquid.
So, number one if you use umwith the better tubes and you
can get those and use them inyour machine right now at
(25:01):
biopuref you're going to get itto clot faster and you're also
going to get it to stay liquidlonger.
That's number one.
Number two we know and I don'tknow if you're doing this
already oxygen is one of thedrivers of clotting.
So the red top tubes we alwayspop the lids and we want to
expose them to oxygen, even ifit's clotted and I spun, did my
(25:23):
eight minute protocol or 12minutes, whatever you're
spinning at when it's done, evenif it's clotted already, I
still pop the lid and I want toexpose it to air for another
five minutes.
The air, the oxygen, induces itto clot further On the liquid
puref tubes.
Never pop the lids until you'reready to use it.
Okay, the third thing, and thiswill help you out tremendously.
(25:45):
The third thing we realizedthat the conversion of
fibrinogen plus thrombin into afibrin clot is enzymatic and
enzymes don't work well atcolder temperatures.
So we actually created what'scalled a bio cool device.
It's a little like cup shapeddevice and when you put the
tubes in there it keeps theliquid puref tubes between 8 to
(26:06):
10 degrees celsius and then theenzymes can't convert as
efficiently.
So even on our horizontalsystems it'll push from like an
hour that it stays liquid allthe way up to more than four
hours and on a fixed angleyou'll go from 15, 20 minutes to
like an hour and a half.
So that'll give you just bycooling it.
And if you want to make yourclots clot faster and we bought,
(26:28):
we bought this you buy a tinylittle incubator and keep your
incubator set at bodytemperature, 37 degrees Celsius.
That's when enzymes are mosteffective.
So when I have the red toptubes pulled, my team they pull
off the lids, oxygenate the redtop tubes, they put it in the
incubator until we're ready touse it.
That'll make it clot a lot moreeffectively and the clots will
(26:50):
be stronger.
Related to your question ontiming I have my dental
assistants do all of this.
Okay, they do it all 15 minutesbefore any procedure starts for
me.
They're in the room, they'redoing the blood draws, they're
doing the spinning, they do allthat stuff.
Okay, my whole team does allthe blood draws and all the
spinning and we've trained them,obviously, how to do that.
If I have a patient that's onanticoagulant therapy, typically
(27:12):
people will say like, oh,should I do like double spin or
triple spin or spin faster, thisthat a person that's on
anticoagulant therapy will nothave different levels of
platelets and leukocytes or redblood cells.
So if the role of thecentrifuge is to separate cells
based on their density, theprotocol is the same.
The difference is it's going totake them longer to clot.
(27:34):
So what do you need to do?
You need to do three things youneed to make sure you're using
the hydrophilic tubes, you needto pop the lids and instead of
waiting for five minutes, maybewe need to wait for 20 minutes
Okay, but they'll always clot.
And you need to use anincubator, okay, so that's.
That's basically our protocol.
There are little you know, whenyou talked about doing it from
the IV line, we actually sellthem also at biopuref, but there
(27:55):
are little like adapters thatyou can use and then you just do
the blood draws.
We do that all the time insedation.
Okay, you draw that blood justlike you're doing before.
Okay, and don't do.
I hope you're drawing them inone of the vacuets.
Is that how you do it?
Or draw it in like a tube andthen you do it that way?
Yeah, that's the right way todo it.
Some people they'll grab like abig 40 cc syringe and drop 40
(28:17):
cc's that way from the line andthen inject 10 cc's into each
tube.
I tell people try to avoiddoing that because, um, the
proteins the reason how clottingstarts is from the proteins
that are found which will absorbto the surfaces.
So if you fill a 40 cc syringejust by drawing it, some of
(28:38):
those good proteins that areneeded are now binding to the
syringe wall and then you gointo each of the 10 cc tubes.
Speaker 1 (28:45):
What are some other common mistakes that you see,
maybe specific to dentistry, interms of the blood draw, how
things get spun, how it'sprocessed?
I mean, you talked a lot aboutthe sort of post-process and
there were some other thingsthat are affecting the
effectiveness of the PRF.
Speaker 3 (29:01):
Yeah, I would say that there's a lot of people
don't.
Well, there's three thingsreally.
First, people don't understandthe difference between RPM and
RCF, and so there's a G-forceand an RPM, and what happens is,
let's say I have my centrifugeand I'm spinning.
There's a certain amount ofspinning that's going to occur
(29:22):
at a certain G-force.
So let's say I invent a perfectprotocol and my protocol is
designed only for this machine.
So let's say it's 1,000 RPM andit creates a certain G force
that will separate.
If we start to do a machinethat has is like twice the size
and you still spin at a thousandRPM, you're actually going a
lot faster, right, you'reactually going a lot faster this
(29:44):
way.
And so what happens is whathappened.
I don't know is my video stillgoing okay or is?
Speaker 1 (29:52):
it.
Speaker 3 (29:52):
It's getting a little choppy, but it'll be okay um,
so the rotor size from here to abigger size.
You cannot use the same rpm.
You need to specifically designa protocol here and use it
there.
So I see a lot of peoplethey'll go to facebook groups,
let's say, and they'll say hey,uh, I just bought a centrifuge.
What, what's protocol would yourecommend using?
(30:14):
You get all these answers athousand for 10 minutes 1300.
And that's completely incorrectbecause every protocol is
designed specifically for onemachine.
Okay, so that part there isvery, very important.
Um, and then additionally, um,the tubes matter way more than
the centrifuge and people buythe tubes for like a dollar,
right, and that decision youmake with the tubes will matter
(30:35):
much more than the centrifuge.
So those are the two mostcommon errors that I see hey
everyone.
Speaker 2 (30:41):
I apologize for this quick interruption on the
podcast, um, dr myron's videoactually uh, stopped working at
this point, um, due to justrunning out of battery.
So I'm going to try to give youa quick summary of his final
points and then I'll talk alittle bit about how to get in
touch with him or his program.
So the last thing he was reallytalking about was actually
(31:04):
heating PRF, and when we heatPRF it goes from lasting from
two to three months to five tosix months.
Through Bio PRF or PRF-EDU,they actually have a heating
element that you take the PRF,put it in there and it allows
those membranes or solid PRF tolast quite a bit longer.
That was his first point.
(31:25):
The next thing he startedtalking about was I actually
asked him what the biggestchange he's seen in the dental
or blood environment is and hesaid exosomes and what those are
.
There's a lot of futurepotential for these to change
how medications react.
They're something that canprolong certain medications,
(31:48):
let's say insulin.
If a patient needs to takeinsulin every day, it might
change to taking it every weekusing these.
So he thinks it's the biggestthing he's seen in regenerative
medicine and we're reallyexcited for the potential of
this to come.
Finally, he discussed how to getin touch with him and how to
learn a little bit more aboutPRF, and the best thing you can
(32:10):
do is go to PRFEDU or BioPRFonline and he has multiple
courses on there that you couldsign up for and take.
I actually, since recording thepodcast, I went to his course
and it was excellent and wepurchased all this stuff and we
are doing PRF.
We were doing PRF before, butwe're doing a lot more of the
facial PRF stuff in my officeand it's been excellent.
(32:30):
So we wanted to just thank DrMyron again for coming on the
podcast.
Thank you, dr Tolbert, fordoing another wonderful podcast.
If you guys have any questionsfor Dr Myron, you can reach out
to him on Instagram andhopefully, once again, you
enjoyed our podcast.
Thanks again, bye.
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