February 24, 2025 • 39 mins
What happens when a determined dental student ignores early academic struggles to become an expert in full arch dentistry? Meet Dr. Drew Phillips, our guest with an extraordinary journey through the dental world beginning from his roots in the Dental College of Georgia. In this episode of the Fixed Podcast, Dr. Phillips takes us through his transition from aspiring surgeon to a leading figure in implant dentistry, sharing how the influence of his father's medical career and a remarkable performance on the dental admissions test paved his path.
Join us as I recount my own experiences in a General Practice Residency, highlighting the intense pressures of performing under professional scrutiny and the critical lessons learned about surgical visibility. From Salt Lake City's sedation dentistry to the complex world of advanced implant cases, our discussion uncovers the thrilling, yet challenging, leap from residency to specialized surgical fields. With anecdotes of managing unexpected complications, like being left to tackle a double arch case solo, the episode emphasizes the importance of understanding prosthetic aspects before advancing in implant surgery.
Together with Dr. Phillips, we explore the intricate decision-making process in implant placement, discussing the nuances of sinus positioning, implant types, and the strategic use of cantilevers. Listen in to discover our favorite dental instruments and the invaluable insights gained from international courses with experts worldwide, including a memorable training experience in Brazil. This episode promises an enlightening look into the dynamic and rewarding world of implant dentistry, offering both seasoned professionals and aspiring dentists a glimpse into the complexities and satisfactions of the field.
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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
Poppy, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
Hello and welcome back to theFix Podcast.
So you may notice that we aremissing someone today.
So Dr Poppy is off on his firstvacation in like two or three
(00:24):
years down the DR with hisbeautiful girlfriend and spend
some time down there, and I'mback here recording podcasts.
But I'm actually having areally good time, and today I
have a special guest with us, drDrew Phillips.
So he and I actually have somesimilar beginnings.
So we both graduated from theDental College of Georgia.
We're some down south Georgiaboys that have come out to a
(00:47):
different part of the country todo a whole bunch of full arch,
and so Dr Phillips here has done, has an incredible body of work
.
If you're unfamiliar with hiswork, it's pretty impressive.
I suggest you find him onInstagram.
He is a fully remote Anchoragecapable full arch doctor and he
hasn't been out much longer thanI have.
(01:11):
What year did you graduate, drew?
I graduated 2019.
Yeah, so not much further uhalong the me at all, but uh, so
much further clinically.
Um.
So I've been so impressed witheverything you've been able to
do.
And, uh, I've been anxious tohear about your clinical
progression and how you got intodoing what you've been doing
for some time and, uh, whatbetter way to do it than you
know live on the show?
So I really appreciate youtaking some time out and I'm
anxious to get it going.
(01:31):
Yeah, for sure, awesome,awesome.
So for those that don't knowyou, could you just kind of give
us some description of you know, your background, your general
story, how you got to where youare?
Just the overarching view.
Dr. Drew Phillips (01:40):
Yeah, so it's funny, I'm actually from
georgia originally.
I uh, I kind of grew up onlyknowing anything medical.
My father is a radiologist andI grew up wanting to be, you
know, some sort of surgeon.
You know, originally it was anorthopedic surgeon and, um, you
know, I had the opportunity toshadow, you know, basically
(02:01):
every surgery there is in thehospital, but anything from like
total hip replacements to justsimple stuff.
And the thing that they all hadin common is that they told me,
if they were to do it again,they would be a dermatologist or
a dentist.
I heard that a lot and I waslike, oh, okay, well, you know,
dermatology sounds terrible andyou know, my, my father, being a
(02:23):
physician, is like dermatologyis terrible.
Don't do it.
I mean, yeah, it's good money,you want to be a pimple popper.
Yeah, I mean, it's, it's, it'sit's one of those things where
it's like you know the diagnosis99 of the time before you even
walk into the room.
So it's like, yeah, they makegood money, but like, yeah, it's
, I want something morechallenging and and something
you know, you know, I think thatwould be more fun.
(02:44):
So I started looking intodentistry and, and you know,
really enjoyed it.
And, uh, my sister as well.
My sister graduated dentalschool two years before me.
Okay, so, uh, she's a pediatricdentist.
Uh, here in Boise as well.
Um, so I went to college inFlorida and then ended up going
to dental school, you know, inAugusta.
Um, what a wonderful placeAugusta is.
(03:08):
One one week, one week a year,um, uh, yeah, it's like everyone
, everyone's like oh man,augusta, that must be such a
cool place.
And I'm like, yeah, one oneweek a year, it's really cool.
The other 51 weeks it's likethe city spends like the two
weeks before the master iscleaning it up, making it like a
really nice place, and then,yeah, the day is over, man, it's
(03:29):
all done.
Dr. Tyler Tolbert (03:30):
Back to Augusta and I never really spent
much time during that periodbecause I would always just like
rent out my condo or whateverand then I'd skip town.
So I never even really saw itduring that you know golden, you
know moment.
I saw it for what it really was, but uh, but, you know.
You know what that's.
Dr. Drew Phillips (03:46):
That's the crucible that we both went
through, and here we are, so I'mappreciative of it you know
it's funny, my one of myclassmates, he, his house was
close to the national and oneyear he just with dental school.
He just like hadn't cut hisgrass.
And they came over and was like, hey man, can we cut your grass
?
That?
Dr. Tyler Tolbert (04:03):
That's great, you just hold it out.
It's just like, yeah, let themtake care of it.
Dr. Drew Phillips (04:06):
You know they have a vision.
They want people to think.
But it's great.
I go back every year for themaster's.
It's a good time, so yeah, so Iwent to dental school, dental
College of Georgia, medicalCollege of Georgia, georgia
Regents whatever you want tocall it, depending on who you
(04:26):
ask.
Um, you know, dental school waswas dental school.
I uh, it was funny.
I never made straight a's untilI went to dental school oh,
really, yeah, I was never agreat student.
Um, you know, I think in collegeI had.
I mean, I had a great time incollege, but I think my science
gpa was like a 3.2 and standardGPA was like maybe a 3.6, which,
(04:48):
compared to, like, my dentalschool classmates, was like not
anywhere near theirs, yeah, butI killed the DAT.
It was like I studied for thatthing, like it was a job.
It was like six days a week, 10hour days.
It was funny.
Like two weeks before the dat,like I I realized like how to
(05:09):
take the test.
Um, like everything finallyclicked and I was like, oh wow,
I don't really need to know thisinformation, I just need to
know what the wrong answers aregoing to be.
And then I just, yeah, extraright answers, like it's just
like a game and um, it's fine.
I've actually helped a lot ofpeople at the dat since.
Um and yeah, so I did reallywell in the dat and um, nice and
(05:30):
uh, yeah, so I got into dentalschool, which I, you know it was
like my dad was like hey, drew,like you know you should look
at some other options.
Um, just kind of like you know,I'd never.
It was one of those things youknow it's like, but you know I
got really lucky and got indental school and, um, you know,
made the first I think it waslike the first test like a
(05:52):
biochem test made and made itlike a 93.
On that I was like, oh shit,like maybe I can do this thing
because, like, I'll admit, likeI went to dental school like my
sister you know she had she'dbeen a straight A her whole life
and made one B her firstsemester of dental school.
So it's like well shoot.
Dr. Tyler Tolbert (06:08):
If she didn't do it, reality just came
crashing down on her.
Dr. Drew Phillips (06:11):
Yeah, it's like there's no way I'm going to
make straight A's.
I was like I go through dentalschool, like when I get in, like
my whole mentality is like C'sget degrees, like let's just get
out dental school.
Um, but uh, but yeah, I endedup doing really well and, um,
you know, I worked my ass off indental school and um, so I
ended up graduating and I wasvaledictorian in my class, um,
(06:34):
so you know, everyone was likeso I ended up going to a GPR.
After that I went to the VAhospital in Salt Lake city.
Uh, you know I I had a.
You know I I ranked that numberone.
Um, you know I had a.
You know I I ranked that numberone.
Dr. Tyler Tolbert (06:48):
Um, you know, there's some other great
programs.
I was looking at what, uh, whatattracted you?
Dr. Drew Phillips (06:50):
to that one.
So you know, there there's afew things.
So the other one I was reallyinterested in was the uh foundry
in alabama.
Um, you know, the va and sanantonio had a really good A few
others had really goodreputations.
The one thing I really likedabout Salt Lake City was number
one was location.
I grew up, you know, we grew upskiing.
(07:13):
We were not like a beach family, we were a ski family.
So we were always out in Utahskiing and that was a big drive
for me, kind of, I guess,jumping right into, like, my
residency after dental schoolwas the thing I loved about the
VA in general was the fact thatpatients didn't have to pay for
treatment.
So you know, it's good and bad,right, like I never learned how
(07:35):
to sell treatment and how tosell my treatment plans, but I
learned how to basically doeverything and that the VA in
Salt Lake City specifically you,you know we had a different
specialist pretty much every dayof the week.
So you know it was like mondaywe had endo.
Like every monday afternoon wewere doing molar endo.
Every monday morning we weredoing, oh, wow, you know we had
(07:56):
an oral surgeon.
Um, you know we had a day with.
Thursday was perio, thursdaywas pros, some tuesdays, I think
, we had an oral surgeon.
Then on top of that we had, youknow, a handful of really good
GP attending.
So you know, we really got ourhands in in every sort of
specialty and learning fromthose specialists, as well as
(08:17):
running from the GPs there whichwere doing a lot of the same
thing.
Um, so you know, I'm reallythankful for my, my gpr.
I think it gave me a little bitof a of a head start.
Um, it was cut short with covid, though covid hit.
I think it was like march ofthat year and I remember I was
one of the first hundred andpeople in utah to get covid.
(08:39):
I was like there's the state, Iwas like the state's like
specimen they were calling melike multiple times a day and
I'm like guys like I'm.
They were calling me likemultiple times a day and I'm
like guys like I'm fine.
Dr. Tyler Tolbert (08:47):
You got to lead the pack.
That's just your, that's yourwhole personality.
You gotta.
Yeah, it's just like I'm fine.
Dr. Drew Phillips (08:53):
Guys, like it's not a big deal, uh, I'm
just chilling in my house, uberand getting uber eats and um,
wow.
But but you know, I think theone thing that my gpr probably
taught me the most was how to dodentures.
I mean, we did a ton ofdentures in my GPR.
You know we were doing fullmouth extractions.
(09:18):
You know we didn't do any fullarch in my GPR.
Our standard of care was twoimplants you mandibles for snap
denture, complete upper denture,and.
But it taught me a lot becausedentures, I think, are like the
basic basis for everything and Isee so many people, you know I
get hit up on instagram prettyfrequently with people being
(09:40):
like hey man, like how do I, howdo I learn how to do this and
things like that.
And I'm always like go learndentures.
You know, go work at affordabledentures or something like that
.
And just like do dentures a year, yeah, yeah, because I mean you
can.
You could tell me like, hey,man, I want to do veneers, I
want to be like Dr Appa.
I'm like, okay, go learndentures, because it all starts
(10:06):
with where you put in yourincisal edge and the bite.
Dentures is the basis.
And, man, we hated dentures indental school.
Everyone hated them.
Oh yeah, frigging.
I mean Metzler still.
You know what's funny aboutMetzler, actually, and I hope he
actually listens to this, orbefore no way before he was at
(10:26):
georgia.
Um, I didn't know that.
Yeah, I remember seeingpatients and I'd like scroll
back, you know, because they'retrying to be like what's done?
It's like kurt metzler.
I was like, oh shit, what's upman he's a man.
Dr. Tyler Tolbert (10:37):
Yeah, I still .
You know it's funny inretrospect.
You look back on those guys andyou're like you know what.
You made some core memories forme that you know.
Some of it's bittersweet, butyou know what it's a memory
seriously.
I could still hearthunderstruck for every rpd, uh,
practical that I did yeah, Ican't say I did any parcels
after dental school but um but,yeah, I mean.
Dr. Drew Phillips (10:57):
So, you know, learning dentures, I think is
just an invaluable, aninvaluable thing, and and also
the other thing it teaches youwhich I think is invaluable, is
like patient management.
You know totally, how do youspeak to patients, how do you
set expectations for these typeof patients?
Um, so, yeah, so my gpr I didyou know about a hundred
(11:18):
implants, I think, a fewimmediates, that's fantastic um,
those are mostly in the contextof an overdenture uh, we did
quite a bit of single implants.
Okay, um, we did.
You know, I did a lot of sinusgrafting, really not much like
direct sinus grafting, a lot oflateral sinus grafts.
Um, I still remember my firstone.
(11:39):
I uh my attending lane brown.
He, he did once the personneeded bilateral and he did one
side and I was meant to do theother side and like, right when
I was starting, we had a wholebunch of people show up that
were like interviewing orvisiting for the GPR and I'm
sitting there with like fourpeople over my shoulder laying
(12:00):
Dr Brown.
He had already left the room.
He like went to go do somethingelse.
He's like ah, you got it, man,and you know I'm like trying to
do this thing.
I got all these people over myshoulder and they're like and
you know I'm like trying to dothis thing, I got all these
people over my shoulder andthey're like I dude, I have no
idea what I'm doing, and theywere like it turned out good,
but you know, so we did a lot ofthat.
Um, the other thing that youknow we did was anything we did
(12:21):
on the mandible, like you flapdown to the mental nerve.
So I see a lot of peoplelearning full arch now and
they're like everybody wants tomake these like little baby
flaps.
And I'm like you can't seeanything, you don't know what
you're doing.
I mean, I flap and every nowand then the drill comes out,
the buckle plate or you know animplant, and I'm like, wow, if I
didn't have it flapped, I wouldhave never seen that.
(12:41):
You know, um, totally.
So.
You know, I was never scared tomake big flaps because we were
forced to.
I mean, we were that's great.
Um, so, yeah.
So you know, that was my gprexperience.
It was really invaluable for meto work with all these special
specialists and, um, you know,do a lot of dentures, even
(13:02):
though I didn't like it while Iwas doing it.
I look back on it and I'm like,man, I wish I would have done
more of these, or, yeah, it'sinvaluable.
Dr. Tyler Tolbert (13:10):
Yeah, yeah.
So, like at that time when youwere going through the GPR, was
your mentality that you weregoing to be like an omni capable
GP, or was there like kind of awhat was the end in mind?
Dr. Drew Phillips (13:21):
So you know, at a dental school I didn't know
what I wanted to do andeveryone was like, oh you know,
why aren't you going to ortho,or why aren't you going to oral
surgery?
And you know, ortho was outfrom day one.
To me that just sounds not fun.
And you know good for you to behonest, but it's just not for
me.
So you know, GPR for me wasjust like that.
(13:42):
Next step, you know, out ofdental school, I thought that I
might like endo.
Dr. Tyler Tolbert (13:51):
And after like two molar endos, I was like
I never want to do this everagain.
Um, yeah, I was under noillusions.
Dr. Drew Phillips (13:54):
Yeah, when I came, my first root canal, my
first root canal out of out ofresidency was like number 19 and
broke broke first file everbroke, first patient out of
residency.
I was like, wow, I think thatwas the last root canal I ever
did.
Dr. Tyler Tolbert (14:08):
That's great.
Dr. Drew Phillips (14:08):
That's great Um but yeah, man, so it was uh.
Yeah, I loved it.
Dr. Tyler Tolbert (14:17):
Yeah, cool.
So so you're coming out of GPRand, um, you know you, you have
the sobering reality of breakingoff a file and a number 19 and
you got all these skills withlike dentures and surgery and
implants.
Um, so what was the next step?
How did you kind of transitionfrom there?
What was the direction that gotyou kind of in more in the aim
of surgery?
Dr. Drew Phillips (14:34):
So I my, you know, my GPR kind of got cut
short.
You know there was about threeto four months where, and so
there were, there were somestill some things that I wanted
to do and learn before I kind oflike dove right into whatever I
, you know, ended up wanting todo, which I really still didn't
know.
I still had this idea in myhead that I really liked
(14:55):
cosmetic dentistry, and that wasnot something that I got to do
at um the GP, at my GPR, causeit's the VA and we do functional
we do functional dentistry, notaesthetic dentistry.
And so I went to go work at anoffice, uh, in Salt Lake city,
um, where I was doing a lot ofsedation dentistry and, um, you
(15:19):
know we're doing a lot of.
I was doing, you know, probablyone to two sedations a day,
just whether it was fillings,crowns, implants, things like
that, um, um, and I was thereabout I think five or six months
, uh, before I left, um, and Istarted doing some full arch
there.
I probably did maybe 20, 20arches while I was there, um,
(15:43):
most of them are all under myown sedation too, which is is I
would not.
Dr. Tyler Tolbert (15:48):
I would never do that again, and were you
doing your own conversions aswell?
Dr. Drew Phillips (15:57):
So there was a.
There was like a a quoteunquote in-house lab there.
So they were kind of doing theconversion.
I mean, we were helping, butfor the most part they were
doing the conversion and then wewere restoring.
So I think, like, if I were,you know, going back to, I think
you know they wanted me to dosomething like 20, like you know
(16:17):
, take like 20 patients tofinals or something like that.
Before I did my own surgery,which is for sure, the right
thing to do is to to learn theprosthetic aspect of it before
you start, you know, throwingsome implants in.
Um, yeah, I remember my firstcase still, it was uh, uh, it
was a double arch.
The owner of the office wassupposed to come there and like
basically hold my hand throughit and 20 minutes before I
(16:37):
called him and I was like yo,man, where you at?
and he's like oh you got it, buthe's like I'm not gonna make it
.
Dr. Tyler Tolbert (16:42):
And I was like and then, and then, four
people came into the clinic towatch you do it right?
This is what happens thankfully.
Dr. Drew Phillips (16:49):
thankfully they had assistants there that
had done enough of them Likethey could probably do it
themselves.
But, yeah, my first double archtook me pretty much exactly
four hours.
I still remember it, it'sactually not bad.
Dr. Tyler Tolbert (17:00):
It's not bad at all.
Dr. Drew Phillips (17:01):
Yeah, I was super proud of myself.
Dr. Tyler Tolbert (17:03):
Yeah.
Dr. Drew Phillips (17:04):
And I think it healed.
Well, I don't, you know, Idon't really know.
Um, yeah, so I was there andthen I uh, I was I wanted to get
out of there pretty quickly andwas just looking at some
different options.
And that's kind of when I was,I was like, okay, do I want to
go somewhere where there's likea lot of more of like aesthetic
dentistry so I was looking at anoffice and working at an office
(17:27):
in park city or do I just wantto go completely something
different?
Because this was really myfirst.
This office I was working onsalt lake city was really my
first like um experience to fullarch and I liked it.
You know what they were payingme to do.
It was not worth my time, likeI could have just been prepping
(17:47):
crowns and I would have mademore money, but I liked it.
I wanted to kind of see whereit went.
The office I was looking onpark city just really kind of
didn't work out, um.
So I went to california and wasworking at an office there that
had another in-house lab thatwas doing a lot of um, like kind
of a lot of digital workflowstuff and, oh cool, okay, so I
was there.
Dr. Tyler Tolbert (18:07):
This would was this like 2020, 2021 it was
like 20 see graduate 2019.
Dr. Drew Phillips (18:12):
So this would have been like I think it was
like december.
I started like december of 2021.
Okay, 20, yeah, 2021, um okay,and I, you know I did.
I did quite a few surgeriesthere.
I did a ton of sedation, butthe the aspect of them having an
(18:34):
in-house lab was was huge forme and becoming friends with the
lab tech there.
It's a guy I'm still friendswith.
He's actually out on his own.
It's AOX Designs, josephRodriguez.
He's the man.
Him and I are still buddies.
We still, you know, talk aboutcases together.
Him and I are still buddies.
We still talk about casestogether.
Him and I created someprotocols together.
So just learning the digitalworkflow there was huge.
Dr. Tyler Tolbert (19:00):
Is that with Gus Khalil?
Dr. Drew Phillips (19:02):
No, it was in my AOX, is it?
What is his name?
No, it's not with Gus.
That's actually where I met gus, though oh okay, okay what is
(19:22):
his name?
Joseph rodriguez, okay, um,whatever, but uh, yeah, he was
the man, um, and that's where,kind of like, my ce journey
started and that's where Ibecame addicted to ce, um, and
so I, uh, I took a lot of cecourses that year, um, and that
(19:43):
was like my first kind of remoteanchorage ce course as well
nice, nice.
Dr. Tyler Tolbert (19:47):
So you were actually doing the fixed arches
prior to really taking the cecourses.
It was more just you knowexperience in residency and then
whatever was happening in thatfirst place that you went to,
that kind of you know, yeah.
Dr. Drew Phillips (19:57):
So it was kind of like a c1 do one teach
one sort of thing.
Got it right like I.
I watched a bunch, I restored abunch and you know I had the
basics right.
Like I was fine laying a flap,which again is something that
like conceptually seems reallyeasy to do.
But you watch people that arenew at her.
(20:18):
I go and like mentor people andI'm like man, that flap's got
to be way bigger.
Dr. Tyler Tolbert (20:22):
I mean like yeah, look at we're doing
thickness and you can't seeanything.
Dr. Drew Phillips (20:26):
There's blood everywhere yeah, I'm all over
the place, yeah you know thebasics, I I had the basics of
pretty much everything.
I was comfortable around thesinus, I was comfortable around
the nerve, and so you just kindof have to put it all together
and, uh, so yeah, so that'swhere I started my ce journey.
Um cool, and you know, that was, I guess, my first ce, like
(20:46):
remote, remote anchorage as wellwell, wow, wow, yeah.
Dr. Tyler Tolbert (20:50):
So you kind of like we're already kind of
going straight to, uh, to someof the more advanced techniques,
like right off the bat withyour, with your CE.
Yeah, that's cool.
Dr. Drew Phillips (20:57):
Yeah, yeah, it was.
Uh, you know, after that I kindof, I guess maybe I took some
steps backwards.
But you know, remote Anchorageis not something I ever wanted
to do and the first course Itook was a live patient course
with uh, fishy broman um in hisoffice in arizona.
And I remember, yeah, I wasalready, I had already become
friends with him and he wasdoing a course and I was like,
(21:18):
man, do I really need to learnthis?
Like this is so out of myleague.
You know there's no like, likeand he's like man, you're young,
you're, you're gonna be, youknow, you going to see your own
cases fail.
I'm like that's the scariestthing to think about.
He's like, you know, you shouldat least learn how to do it,
whether you do it or not.
And you know I probably tookthat course too early and I
(21:42):
don't think I did any zygos, Iprobably did a handful of
pterygoids, no-transcript okay,yeah, that's.
That's a really big gap yeah, Idid the time you learned, at the
time you implement.
Yeah, I did two in one day.
(22:03):
It was a husband wife, theywere, uh, it was did you know
that they were going to be zygosbefore you started or was it
like a necessity?
okay, yeah, so a little storywith that.
They so my parents were stillliving in georgia and we'd had
this, um, the lady that cleanedour house she'd been, you know,
she'd she took care of our dogs.
(22:23):
I mean, she'd been there when Iwas a small child and cool, um,
we I don't think anyone myfamily ever realized they had,
like teeth problems and I guessthey like saw what I was doing
and instagram or whatever, andand went to my parents and was
like, hey, like you know, wewent to clear choice and we got
these.
Uh, yeah, you know, it was likeback then clear choice was
(22:46):
charging probably like 60 000plus dollars you know something
crazy like that.
And I was like, well, you know,like go get a ct.
You know, clear choice wasn'tgonna share the ct.
I was like go get a ctsomewhere and and uh, send it to
me.
And I immediately saw it and Iwas like clearjoy said they
could do standard all on four inthis.
There's no way, like both ofyou guys are zygos like 100.
(23:10):
And I was like, well, you know,I took a zygo course, I'll you
know, they're nice people sometime ago.
Yeah, these people are nice um,yeah, cool, you know, like
they've helped us, like, so Idid them for free and we did
them both in the same day.
Um and uh, we did did them at afriend's office in oregon.
Um and uh, from what I know,every they're, you know they're
(23:35):
still good.
I mean, they see my friend'soffice in atlanta for cleanings
now.
Yeah, so that was my firstzygote patient was husband and
wife.
Dr. Tyler Tolbert (23:46):
Wow, that's awesome.
So were those were like, um, uhlike, was it like a quad zygote
or are you doing like a singleon one side, or?
Dr. Drew Phillips (23:55):
Yeah, so they were both just uh, post-year
zygotes.
And and you know, look, Ididn't even do pterygoids on
that case because I mean thattook me so freaking long and I
was like I was just like I justso they.
You know, I've got posteriorzygos on both, just two implants
on the anterior for both ofthem.
Both of them got four implantsin the lower.
You know, one of these days, uh, you know, they'll probably
(24:15):
come visit me in in idaho, um,or in oregon, wherever I'm
working somewhere, and you knowI might go and add some
pterygoids to them because Iwant them to last for the rest
of their life.
Yeah, ideally.
But yeah, you know, I haven't,I haven't even looked at, like
the post-op CBTs, cbcts.
I'm sure the, the Zagos areright in the middle of the bone,
(24:36):
you know right where theyshould be, but you split the
field goal.
Dr. Tyler Tolbert (24:42):
That's great yeah.
Dr. Drew Phillips (24:44):
Got to start somewhere, I guess.
Yeah, no, of course.
Dr. Tyler Tolbert (24:47):
Yeah, no, I mean props to you for just kind
of going in head first with that.
I mean, you know, a lot ofpeople will take, you know,
three or four courses.
I want to do a few cadavercourses, some live surgery, and
then still want to do some overthe shoulder, which there's
merit to that, of course.
But at the same time, I'venoticed that a lot of the people
that you know end up teachingthese things, um, they can kind
(25:07):
of be a little bit of cowboys,you know, if you will, maybe
that's kind of a derogative term, but, um, you know, people that
are willing to, you know, feelconfident in their abilities as
soon as they, you know,understand the full scope of it
and understand that you're notreally going to know how to do
it until you do it, um and as,and I think that kind of, uh,
that kind of service for apatient that otherwise wouldn't
really be able to, uh, to getsomething, it would be a
(25:30):
standard of care.
I mean, if there's a Zygopatient, why would they get you
know, standard all in four?
So, um, yeah, that that was alot more of these cases, or how
did?
How'd you feel about it?
Dr. Drew Phillips (25:40):
You know, not , no, um, really, you know, I
still like every time I see aZygo case, I'm not like oh man,
I can't wait through this.
I'm like ah, really Like that'sa good attitude, actually.
Dr. Tyler Tolbert (25:52):
Um, that's how it should be.
Dr. Drew Phillips (25:53):
I mean like I can do them and and you know I
will do them, but it's notsomething that I like go strive
to do and like really enjoybecause it's it's exhausting,
it's high risk.
I mean it's high risk foranyone.
There's GP, perio, oral surgeon, it doesn't matter who's doing
it.
Um, and you know, thankfullyI've not had any zygos fail.
(26:15):
I haven't had any huge issuesfrom from zygopatients.
I mean, honestly, my, my worstcomplication on a patient I've
had is on a lower arch where theguy had the only teeth I had to
take out was both canines.
The only thing I left and I waslike the worst complicate.
It was just like a totalmassive infection, just
(26:35):
hospitalized, like it was justlike a total disaster that you
know I'm like man, what, whatcould I have done differently?
And I feel like I dideverything right and he's got
Zygos on the upper.
Dr. Tyler Tolbert (26:46):
I was like really, Like it was, like it was
two years ago.
Dr. Drew Phillips (26:51):
It was the hardest Zygo case I ever did,
like I drilled once, couldn'tget torque.
Drilled again, placed.
Couldn't get torque third timeon this on, like it was on
camera.
Well, drilled, again placed.
Couldn't get torque Third timeon this, like it was I can't
remember what left or right sideit was like finally got torque.
I'm like man, this is thehardest Zygo case I've ever done
.
Dr. Tyler Tolbert (27:09):
And I get a complication on the lower.
Yeah, the irony it's always theones you don't see coming.
I've definitely found that theones that I worry about tend to
work out and then the ones Iwasn't worried about just
totally disregarded.
Those are the sneaky ones, ohyeah.
Dr. Drew Phillips (27:21):
The cases where you load it, it's like 180
centimeters composite torquevalue and it's like everyone
just go home and say yourprayers and they heal a mate.
No problem, no problemwhatsoever.
Dr. Tyler Tolbert (27:33):
Yeah, yeah, no, I totally get that.
Okay, so you placed your firstZygos about eight months after
that, first course still notfeeling entirely psyched about
them.
What kind of made you want togo a little bit further down the
road of of doing more fixed forlarge and atrophic cases?
Dr. Drew Phillips (27:49):
so I started.
This is when I startedtraveling to oregon a lot.
Um, so I'd moved to boise.
At that point I was, uh,working at an office here
covering for a friend'smaternity leave.
Um, okay, I was doing that, wastraveling to a couple different
offices in oregon and you knowwe didn't stock zygos and we
(28:09):
started just getting some casesand, um, I was like, well, I'm
kind of forced to do these now.
Um so, so, yeah, so I juststarted doing them and you know
I hadn't taken any other courseyet.
I remember I went this wasyears ago now I went to a trans
(28:31):
nasal course in Boston.
It was just like a one daycourse.
It was like David Zellig andSimon oh.
Dr. Tyler Tolbert (28:36):
I was teaching it and uh and it was.
Dr. Drew Phillips (28:40):
It was a transnasal course.
They talked a little bit aboutzygos, but it was my first time
meeting, you know, like davidzellig and simon, oh, um, a lot
of the other guys I'd alreadymet before, just through
different courses or whatever,and um, I can't remember if one,
if one gonzalez, was there ornot, but anyway, like you know,
again, like that course, like afew weeks later I did a trans
(29:01):
trans nasal.
Um, nice, that's been, I thinkdecember was two years.
Still have not seen thatpatient for post-op.
Dr. Tyler Tolbert (29:09):
But you know.
I mean it's fair to assume thatthings worked out.
Dr. Drew Phillips (29:14):
Yeah, as far as I know they look great but
great.
So you know I'd probably done Idon't know or so Zygo cases,
very few quads, maybe a couplequads.
I mean even still like I'veonly done a couple quads.
And so then I loaded up a case.
I loaded up three Zygo casesone day and I had Juan come do
those cases with me in Oregon atthe office.
(29:35):
I was at there.
So Juan came and we did threeupper arches in one day.
So Juan came and we did threeupper arches in one day.
You know, I think a coupletransnasal, a couple zygote, and
it was great.
I mean it was.
You know, anytime you dosomething with any other doctor,
like they're learning from you,you're learning from them.
You know I was learning somezygote stuff from him.
(29:57):
I was showing him how I wasdoing my pterygoids, because I
was placing my pterygoids withjust standard neoden implants
and had, like you know, upper 90success rate of of every time I
placed it.
And you know I wasn't using theNorris that you know, arguably
was a better designed pterygoidimplant, but I was having great
success with just the neoden,like 3.75 by 18 helix, and had
(30:18):
great success with it.
And, uh, you know know.
So I showed him kind of likewhat I was doing with that.
I was using some osteotomesfrom salvin, I was using some
osteotomes from norris, justkind of figuring out what worked
for me and, um, you know, so itwas cool, just kind of
collaborating with him on thatand learning.
You know, each of us learningfrom each other and uh.
Dr. Tyler Tolbert (30:39):
So are you kind of like a, are you a drill
osteotome hybrid type of guy, isit?
Dr. Drew Phillips (30:44):
I mean, I keep changing my ways of things.
Um, you know, so I I love theNorris, uh, the like the 2.0
sharp osteotome, which I think,uh, I think the SIN one is
almost identical to that.
Now, Um, you can also get itfrom like GDT for like 90 bucks
as well, and so I at least justtry to push with that till I can
(31:09):
feel something hard.
Sometimes it's hard already,and you know, when I have that
I'm like great, like almostdoesn't matter what I do now,
like we're going to get to work.
We're good to go.
So I'll push with that until Ifeel something hard and then I
will just take like a standardspade drill and go really slow
and just feel until I, you know,I perforate the plate and if
something doesn't feel right atthat point I can kind of
(31:31):
redirect, redirect, right, um,and then I have a I believe it's
2.7 millimeter osseotome fromsalvin that I got.
Uh, my my friend, uh, shivanegupta is an oral surgeon in
atlanta told me about that, so Ibought it back now and, uh, so
I got that and you knowbasically that if I can get that
(31:52):
down to like 12 to 14millimeters, like I go straight
to placing the implant.
If, if it won't go in, thenI'll pick up a 3.5 drill and go
a little bit more.
But you know what's awesomeabout that neodym helix is, you
know you open up, you know acortical plate with the two
millimeter drill, like you canalmost guarantee yourself that
(32:12):
it's going to grab and go inthere.
Yeah, yeah, you know, every nowand then it would.
You know an implant would hitit and it would spin, and pretty
simple, just pick up the 3.5drill and just, you know, I
leave it on like the 40 newtoncentimeter or 40, I mean uh rpm
speed and just barely open itwhere you can kind of feel every
turn and just cutting just toopen it up enough, and I see, um
(32:34):
, and yeah, I mean, as long asI'm in the right spot, like my
success rate is is really highwith my pterygoids.
Dr. Tyler Tolbert (32:41):
Great, yeah, fantastic, okay, awesome.
So that's the.
So that's your pterygoid.
You know general routine there.
So anything special would yousay about your zygotechnique?
I mean, would you say that'skind of like a you know?
I guess the way I should put itis what kind of school of
thought do you generally have interms of your approaches?
Dr. Drew Phillips (33:01):
I go to surgical approach with it.
So I have kind of like, uh, youknow, I guess, jumping off of
CE and we can go back to see ifyou want some other ones.
But like my general approach,like I guess, like kind of in my
head, like my algorithm of likehow I'm going to approach each
case, kind of like jumping intolike Patsy protocol, if you will
.
So for me it all comes down tolike where the sinuses are Right
(33:24):
and so that you know, likewhere the sinuses are, does it
dictates, like where my you knowwhere my teraglute implant
starts.
It dictates, you know, am Igoing to do a Zygo?
It dictates like how my frontfour implants are going to be.
So you know, my train of thoughtis, if I can get you know,
first of all, we don't wantcantilevers, if at all possible,
right.
(33:44):
So if I can get an implant atfirst premolar and a pterygoid,
I don't need a Zygo.
I feel like that spread is fine.
Um, you know, if I can get oneat second premolar, great.
And you can argue that on thosecases, a one-tooth cantilever
for a molar is okay.
I mean, you know, we don't like, we don't like cantilevers.
(34:06):
However, clear choice has beendoing that for forever, oh,
that's the vast majority ofcases um you know, and and I
have cherry boys under my beltso, yeah, I do them for most
cases now.
But you know, look at whatclear choice has done.
I mean, they've done more thananyone else and like their
standard of care is just fourimplants giving them a one tooth
cantilever.
And you know the people I knowthat have been there for a long
(34:26):
time so they have great successwith that.
Um, so yeah, so my, my kind ofalgorithm is like, if I can get
like first premolar and apterygoid, I don't need a Zygo.
If I can get, you know, firstpremolar and I don't get a
pterygoid, you know I need as Igo.
Um, you know, anterior iswhatever.
Um, you know, there are somecases now where it's like I've
(34:49):
done things you know where Iwould need a quad and I've done
you know whether it's liketransnasal implants.
I have one case again all thesecool cases I've done, people
refuse to come back for post-ops.
So I have a case where I had,uh, I mean, I had like, I think
like six millimeters maybe itwas like five, like you know,
under the nose, and I didpterygoids, uh, two like first
(35:12):
molar zygos, and then I placedthree helix short right in the
anterior and it was all corticalbone.
So it wasn't like your standard.
I's cortical bone.
I'm like this bone's not goingto talk to dr molinari about it
and he's like, yeah, that's agreat idea.
So I placed, you know, two likein about the lateral spot and
one in the nasal palatine justthose new those, my first helix
short implants I placed and gotgreat torque.
(35:34):
It was all cortical bone again.
I probably did that.
I was like, right after thehelix Short came out Again,
still haven't seen that patientpack.
It's like all the cool stuff, Idon't see anything.
Yeah, that's brilliant, awesome,awesome difference and you know
(36:04):
, doing a half-ass flap or justbeing able to see everything.
Um, you know the one thing,when it came to my flap that you
know I learned from.
So I I took a um alex avoniscourse in uh in brazil with um
dan rosen and dennis smiler.
It was funny.
I again, I was never planningon taking that course and I had
a buddy perry donis was going togo and I was like, yeah, man,
I'll go with you, and I think hehad a family emergency, ended
(36:26):
up not being able to go, and soI went.
I had a great time.
Um, and one thing Alex Savoniais like he was always getting me
to flap like more, likeposterior on the arch, which
like really opens it up a lotmore than just trying to like
only where the implant goes anduh, so you know, again, like
(36:48):
bigger flaps, I don't really useany of like the special uh
Zyger retractors.
I use a Minnesota.
I have a pretty cool Minnesota.
I don't know the name of it.
Um, it's a Minnesota with moreof a handle.
Um, there's a.
I think they make one that'slike an ergo Minnesota.
It's not that, it's a littledifferent.
Dr. Tyler Tolbert (37:06):
I've seen this.
Yeah, I saw it at Clark Damon'scourse.
Dr. Drew Phillips (37:08):
I think it's just a longer, it's just a
longer Minnesota basically, andI I love that thing.
Um, okay, I have like anotherinstrument.
Um, salvin makes one.
I think they call it like thezaga three.
I think nester uh posted aboutit today.
I I got one from like uh h andh instruments, um, just
basically the shape of like amolt nine but it's just like
(37:30):
three times the size and for meit's really good for this blunt
dissection.
Just a spoon, um, yeah, it'sjust like a big spoon and uh,
yeah, so you know just differentthings.
And um, you know, the brazilcourse was great.
Uh, brazil is my favorite placeI think I've ever been.
Um, I love brazil.
Yeah, it's great everythingabout it um.
(37:52):
I've been back I think like I'vebeen back.
I went back this year foranother course too.
My name is Dr Tyler Tolbert and I'm Dr Soren
Poppy, and you're listening tothe Fix Podcast, your source for
all things implant dentistry.
Hello and welcome back to theFix Podcast.
So you may notice that we aremissing someone today.
So Dr Poppy is off on his firstvacation in like two or three
(00:24):
years down the DR with hisbeautiful girlfriend and spend
some time down there, and I'mback here recording podcasts.
But I'm actually having areally good time, and today I
have a special guest with us, drDrew Phillips.
So he and I actually have somesimilar beginnings.
So we both graduated from theDental College of Georgia.
We're some down south Georgiaboys that have come out to a
(00:47):
different part of the country todo a whole bunch of full arch,
and so Dr Phillips here has done, has an incredible body of work
.
If you're unfamiliar with hiswork, it's pretty impressive.
I suggest you find him onInstagram.
He is a fully remote Anchoragecapable full arch doctor and he
hasn't been out much longer thanI have.
(01:11):
What year did you graduate, drew?
I graduated 2019.
Yeah, so not much further uhalong the me at all, but uh, so
much further clinically.
Um.
So I've been so impressed witheverything you've been able to
do.
And, uh, I've been anxious tohear about your clinical
progression and how you got intodoing what you've been doing
for some time and, uh, whatbetter way to do it than you
know live on the show?
So I really appreciate youtaking some time out and I'm
anxious to get it going.
(01:31):
Yeah, for sure, awesome,awesome.
So for those that don't knowyou, could you just kind of give
us some description of you know, your background, your general
story, how you got to where youare?
Just the overarching view.
Dr. Drew Phillips (01:40):
Yeah, so it's funny, I'm actually from
georgia originally.
I uh, I kind of grew up onlyknowing anything medical.
My father is a radiologist andI grew up wanting to be, you
know, some sort of surgeon.
You know, originally it was anorthopedic surgeon and, um, you
know, I had the opportunity toshadow, you know, basically
(02:01):
every surgery there is in thehospital, but anything from like
total hip replacements to justsimple stuff.
And the thing that they all hadin common is that they told me,
if they were to do it again,they would be a dermatologist or
a dentist.
I heard that a lot and I waslike, oh, okay, well, you know,
dermatology sounds terrible andyou know, my, my father, being a
(02:23):
physician, is like dermatologyis terrible.
Don't do it.
I mean, yeah, it's good money,you want to be a pimple popper.
Yeah, I mean, it's, it's, it'sit's one of those things where
it's like you know the diagnosis99 of the time before you even
walk into the room.
So it's like, yeah, they makegood money, but like, yeah, it's
, I want something morechallenging and and something
you know, you know, I think thatwould be more fun.
(02:44):
So I started looking intodentistry and, and you know,
really enjoyed it.
And, uh, my sister as well.
My sister graduated dentalschool two years before me.
Okay, so, uh, she's a pediatricdentist.
Uh, here in Boise as well.
Um, so I went to college inFlorida and then ended up going
to dental school, you know, inAugusta.
Um, what a wonderful placeAugusta is.
(03:08):
One one week, one week a year,um, uh, yeah, it's like everyone
, everyone's like oh man,augusta, that must be such a
cool place.
And I'm like, yeah, one oneweek a year, it's really cool.
The other 51 weeks it's likethe city spends like the two
weeks before the master iscleaning it up, making it like a
really nice place, and then,yeah, the day is over, man, it's
(03:29):
all done.
Dr. Tyler Tolbert (03:30):
Back to Augusta and I never really spent
much time during that periodbecause I would always just like
rent out my condo or whateverand then I'd skip town.
So I never even really saw itduring that you know golden, you
know moment.
I saw it for what it really was, but uh, but, you know.
You know what that's.
Dr. Drew Phillips (03:46):
That's the crucible that we both went
through, and here we are, so I'mappreciative of it you know
it's funny, my one of myclassmates, he, his house was
close to the national and oneyear he just with dental school.
He just like hadn't cut hisgrass.
And they came over and was like, hey man, can we cut your grass
?
That?
Dr. Tyler Tolbert (04:03):
That's great, you just hold it out.
It's just like, yeah, let themtake care of it.
Dr. Drew Phillips (04:06):
You know they have a vision.
They want people to think.
But it's great.
I go back every year for themaster's.
It's a good time, so yeah, so Iwent to dental school, dental
College of Georgia, medicalCollege of Georgia, georgia
Regents whatever you want tocall it, depending on who you
(04:26):
ask.
Um, you know, dental school waswas dental school.
I uh, it was funny.
I never made straight a's untilI went to dental school oh,
really, yeah, I was never agreat student.
Um, you know, I think in collegeI had.
I mean, I had a great time incollege, but I think my science
gpa was like a 3.2 and standardGPA was like maybe a 3.6, which,
(04:48):
compared to, like, my dentalschool classmates, was like not
anywhere near theirs, yeah, butI killed the DAT.
It was like I studied for thatthing, like it was a job.
It was like six days a week, 10hour days.
It was funny.
Like two weeks before the dat,like I I realized like how to
(05:09):
take the test.
Um, like everything finallyclicked and I was like, oh wow,
I don't really need to know thisinformation, I just need to
know what the wrong answers aregoing to be.
And then I just, yeah, extraright answers, like it's just
like a game and um, it's fine.
I've actually helped a lot ofpeople at the dat since.
Um and yeah, so I did reallywell in the dat and um, nice and
(05:30):
uh, yeah, so I got into dentalschool, which I, you know it was
like my dad was like hey, drew,like you know you should look
at some other options.
Um, just kind of like you know,I'd never.
It was one of those things youknow it's like, but you know I
got really lucky and got indental school and, um, you know,
made the first I think it waslike the first test like a
(05:52):
biochem test made and made itlike a 93.
On that I was like, oh shit,like maybe I can do this thing
because, like, I'll admit, likeI went to dental school like my
sister you know she had she'dbeen a straight A her whole life
and made one B her firstsemester of dental school.
So it's like well shoot.
Dr. Tyler Tolbert (06:08):
If she didn't do it, reality just came
crashing down on her.
Dr. Drew Phillips (06:11):
Yeah, it's like there's no way I'm going to
make straight A's.
I was like I go through dentalschool, like when I get in, like
my whole mentality is like C'sget degrees, like let's just get
out dental school.
Um, but uh, but yeah, I endedup doing really well and, um,
you know, I worked my ass off indental school and um, so I
ended up graduating and I wasvaledictorian in my class, um,
(06:34):
so you know, everyone was likeso I ended up going to a GPR.
After that I went to the VAhospital in Salt Lake city.
Uh, you know I I had a.
You know I I ranked that numberone.
Um, you know I had a.
You know I I ranked that numberone.
Dr. Tyler Tolbert (06:48):
Um, you know, there's some other great
programs.
I was looking at what, uh, whatattracted you?
Dr. Drew Phillips (06:50):
to that one.
So you know, there there's afew things.
So the other one I was reallyinterested in was the uh foundry
in alabama.
Um, you know, the va and sanantonio had a really good A few
others had really goodreputations.
The one thing I really likedabout Salt Lake City was number
one was location.
I grew up, you know, we grew upskiing.
(07:13):
We were not like a beach family, we were a ski family.
So we were always out in Utahskiing and that was a big drive
for me, kind of, I guess,jumping right into, like, my
residency after dental schoolwas the thing I loved about the
VA in general was the fact thatpatients didn't have to pay for
treatment.
So you know, it's good and bad,right, like I never learned how
(07:35):
to sell treatment and how tosell my treatment plans, but I
learned how to basically doeverything and that the VA in
Salt Lake City specifically you,you know we had a different
specialist pretty much every dayof the week.
So you know it was like mondaywe had endo.
Like every monday afternoon wewere doing molar endo.
Every monday morning we weredoing, oh, wow, you know we had
(07:56):
an oral surgeon.
Um, you know we had a day with.
Thursday was perio, thursdaywas pros, some tuesdays, I think
, we had an oral surgeon.
Then on top of that we had, youknow, a handful of really good
GP attending.
So you know, we really got ourhands in in every sort of
specialty and learning fromthose specialists, as well as
(08:17):
running from the GPs there whichwere doing a lot of the same
thing.
Um, so you know, I'm reallythankful for my, my gpr.
I think it gave me a little bitof a of a head start.
Um, it was cut short with covid, though covid hit.
I think it was like march ofthat year and I remember I was
one of the first hundred andpeople in utah to get covid.
(08:39):
I was like there's the state, Iwas like the state's like
specimen they were calling melike multiple times a day and
I'm like guys like I'm.
They were calling me likemultiple times a day and I'm
like guys like I'm fine.
Dr. Tyler Tolbert (08:47):
You got to lead the pack.
That's just your, that's yourwhole personality.
You gotta.
Yeah, it's just like I'm fine.
Dr. Drew Phillips (08:53):
Guys, like it's not a big deal, uh, I'm
just chilling in my house, uberand getting uber eats and um,
wow.
But but you know, I think theone thing that my gpr probably
taught me the most was how to dodentures.
I mean, we did a ton ofdentures in my GPR.
You know we were doing fullmouth extractions.
(09:18):
You know we didn't do any fullarch in my GPR.
Our standard of care was twoimplants you mandibles for snap
denture, complete upper denture,and.
But it taught me a lot becausedentures, I think, are like the
basic basis for everything and Isee so many people, you know I
get hit up on instagram prettyfrequently with people being
(09:40):
like hey man, like how do I, howdo I learn how to do this and
things like that.
And I'm always like go learndentures.
You know, go work at affordabledentures or something like that
.
And just like do dentures a year, yeah, yeah, because I mean you
can.
You could tell me like, hey,man, I want to do veneers, I
want to be like Dr Appa.
I'm like, okay, go learndentures, because it all starts
(10:06):
with where you put in yourincisal edge and the bite.
Dentures is the basis.
And, man, we hated dentures indental school.
Everyone hated them.
Oh yeah, frigging.
I mean Metzler still.
You know what's funny aboutMetzler, actually, and I hope he
actually listens to this, orbefore no way before he was at
(10:26):
georgia.
Um, I didn't know that.
Yeah, I remember seeingpatients and I'd like scroll
back, you know, because they'retrying to be like what's done?
It's like kurt metzler.
I was like, oh shit, what's upman he's a man.
Dr. Tyler Tolbert (10:37):
Yeah, I still .
You know it's funny inretrospect.
You look back on those guys andyou're like you know what.
You made some core memories forme that you know.
Some of it's bittersweet, butyou know what it's a memory
seriously.
I could still hearthunderstruck for every rpd, uh,
practical that I did yeah, Ican't say I did any parcels
after dental school but um but,yeah, I mean.
Dr. Drew Phillips (10:57):
So, you know, learning dentures, I think is
just an invaluable, aninvaluable thing, and and also
the other thing it teaches youwhich I think is invaluable, is
like patient management.
You know totally, how do youspeak to patients, how do you
set expectations for these typeof patients?
Um, so, yeah, so my gpr I didyou know about a hundred
(11:18):
implants, I think, a fewimmediates, that's fantastic um,
those are mostly in the contextof an overdenture uh, we did
quite a bit of single implants.
Okay, um, we did.
You know, I did a lot of sinusgrafting, really not much like
direct sinus grafting, a lot oflateral sinus grafts.
Um, I still remember my firstone.
(11:39):
I uh my attending lane brown.
He, he did once the personneeded bilateral and he did one
side and I was meant to do theother side and like, right when
I was starting, we had a wholebunch of people show up that
were like interviewing orvisiting for the GPR and I'm
sitting there with like fourpeople over my shoulder laying
(12:00):
Dr Brown.
He had already left the room.
He like went to go do somethingelse.
He's like ah, you got it, man,and you know I'm like trying to
do this thing.
I got all these people over myshoulder and they're like and
you know I'm like trying to dothis thing, I got all these
people over my shoulder andthey're like I dude, I have no
idea what I'm doing, and theywere like it turned out good,
but you know, so we did a lot ofthat.
Um, the other thing that youknow we did was anything we did
(12:21):
on the mandible, like you flapdown to the mental nerve.
So I see a lot of peoplelearning full arch now and
they're like everybody wants tomake these like little baby
flaps.
And I'm like you can't seeanything, you don't know what
you're doing.
I mean, I flap and every nowand then the drill comes out,
the buckle plate or you know animplant, and I'm like, wow, if I
didn't have it flapped, I wouldhave never seen that.
(12:41):
You know, um, totally.
So.
You know, I was never scared tomake big flaps because we were
forced to.
I mean, we were that's great.
Um, so, yeah.
So you know, that was my gprexperience.
It was really invaluable for meto work with all these special
specialists and, um, you know,do a lot of dentures, even
(13:02):
though I didn't like it while Iwas doing it.
I look back on it and I'm like,man, I wish I would have done
more of these, or, yeah, it'sinvaluable.
Dr. Tyler Tolbert (13:10):
Yeah, yeah.
So, like at that time when youwere going through the GPR, was
your mentality that you weregoing to be like an omni capable
GP, or was there like kind of awhat was the end in mind?
Dr. Drew Phillips (13:21):
So you know, at a dental school I didn't know
what I wanted to do andeveryone was like, oh you know,
why aren't you going to ortho,or why aren't you going to oral
surgery?
And you know, ortho was outfrom day one.
To me that just sounds not fun.
And you know good for you to behonest, but it's just not for
me.
So you know, GPR for me wasjust like that.
(13:42):
Next step, you know, out ofdental school, I thought that I
might like endo.
Dr. Tyler Tolbert (13:51):
And after like two molar endos, I was like
I never want to do this everagain.
Um, yeah, I was under noillusions.
Dr. Drew Phillips (13:54):
Yeah, when I came, my first root canal, my
first root canal out of out ofresidency was like number 19 and
broke broke first file everbroke, first patient out of
residency.
I was like, wow, I think thatwas the last root canal I ever
did.
Dr. Tyler Tolbert (14:08):
That's great.
Dr. Drew Phillips (14:08):
That's great Um but yeah, man, so it was uh.
Yeah, I loved it.
Dr. Tyler Tolbert (14:17):
Yeah, cool.
So so you're coming out of GPRand, um, you know you, you have
the sobering reality of breakingoff a file and a number 19 and
you got all these skills withlike dentures and surgery and
implants.
Um, so what was the next step?
How did you kind of transitionfrom there?
What was the direction that gotyou kind of in more in the aim
of surgery?
Dr. Drew Phillips (14:34):
So I my, you know, my GPR kind of got cut
short.
You know there was about threeto four months where, and so
there were, there were somestill some things that I wanted
to do and learn before I kind oflike dove right into whatever I
, you know, ended up wanting todo, which I really still didn't
know.
I still had this idea in myhead that I really liked
(14:55):
cosmetic dentistry, and that wasnot something that I got to do
at um the GP, at my GPR, causeit's the VA and we do functional
we do functional dentistry, notaesthetic dentistry.
And so I went to go work at anoffice, uh, in Salt Lake city,
um, where I was doing a lot ofsedation dentistry and, um, you
(15:19):
know we're doing a lot of.
I was doing, you know, probablyone to two sedations a day,
just whether it was fillings,crowns, implants, things like
that, um, um, and I was thereabout I think five or six months
, uh, before I left, um, and Istarted doing some full arch
there.
I probably did maybe 20, 20arches while I was there, um,
(15:43):
most of them are all under myown sedation too, which is is I
would not.
Dr. Tyler Tolbert (15:48):
I would never do that again, and were you
doing your own conversions aswell?
Dr. Drew Phillips (15:57):
So there was a.
There was like a a quoteunquote in-house lab there.
So they were kind of doing theconversion.
I mean, we were helping, butfor the most part they were
doing the conversion and then wewere restoring.
So I think, like, if I were,you know, going back to, I think
you know they wanted me to dosomething like 20, like you know
(16:17):
, take like 20 patients tofinals or something like that.
Before I did my own surgery,which is for sure, the right
thing to do is to to learn theprosthetic aspect of it before
you start, you know, throwingsome implants in.
Um, yeah, I remember my firstcase still, it was uh, uh, it
was a double arch.
The owner of the office wassupposed to come there and like
basically hold my hand throughit and 20 minutes before I
(16:37):
called him and I was like yo,man, where you at?
and he's like oh you got it, buthe's like I'm not gonna make it
.
Dr. Tyler Tolbert (16:42):
And I was like and then, and then, four
people came into the clinic towatch you do it right?
This is what happens thankfully.
Dr. Drew Phillips (16:49):
thankfully they had assistants there that
had done enough of them Likethey could probably do it
themselves.
But, yeah, my first double archtook me pretty much exactly
four hours.
I still remember it, it'sactually not bad.
Dr. Tyler Tolbert (17:00):
It's not bad at all.
Dr. Drew Phillips (17:01):
Yeah, I was super proud of myself.
Dr. Tyler Tolbert (17:03):
Yeah.
Dr. Drew Phillips (17:04):
And I think it healed.
Well, I don't, you know, Idon't really know.
Um, yeah, so I was there andthen I uh, I was I wanted to get
out of there pretty quickly andwas just looking at some
different options.
And that's kind of when I was,I was like, okay, do I want to
go somewhere where there's likea lot of more of like aesthetic
dentistry so I was looking at anoffice and working at an office
(17:27):
in park city or do I just wantto go completely something
different?
Because this was really myfirst.
This office I was working onsalt lake city was really my
first like um experience to fullarch and I liked it.
You know what they were payingme to do.
It was not worth my time, likeI could have just been prepping
(17:47):
crowns and I would have mademore money, but I liked it.
I wanted to kind of see whereit went.
The office I was looking onpark city just really kind of
didn't work out, um.
So I went to california and wasworking at an office there that
had another in-house lab thatwas doing a lot of um, like kind
of a lot of digital workflowstuff and, oh cool, okay, so I
was there.
Dr. Tyler Tolbert (18:07):
This would was this like 2020, 2021 it was
like 20 see graduate 2019.
Dr. Drew Phillips (18:12):
So this would have been like I think it was
like december.
I started like december of 2021.
Okay, 20, yeah, 2021, um okay,and I, you know I did.
I did quite a few surgeriesthere.
I did a ton of sedation, butthe the aspect of them having an
(18:34):
in-house lab was was huge forme and becoming friends with the
lab tech there.
It's a guy I'm still friendswith.
He's actually out on his own.
It's AOX Designs, josephRodriguez.
He's the man.
Him and I are still buddies.
We still, you know, talk aboutcases together.
Him and I are still buddies.
We still talk about casestogether.
Him and I created someprotocols together.
So just learning the digitalworkflow there was huge.
Dr. Tyler Tolbert (19:00):
Is that with Gus Khalil?
Dr. Drew Phillips (19:02):
No, it was in my AOX, is it?
What is his name?
No, it's not with Gus.
That's actually where I met gus, though oh okay, okay what is
(19:22):
his name?
Joseph rodriguez, okay, um,whatever, but uh, yeah, he was
the man, um, and that's where,kind of like, my ce journey
started and that's where Ibecame addicted to ce, um, and
so I, uh, I took a lot of cecourses that year, um, and that
(19:43):
was like my first kind of remoteanchorage ce course as well
nice, nice.
Dr. Tyler Tolbert (19:47):
So you were actually doing the fixed arches
prior to really taking the cecourses.
It was more just you knowexperience in residency and then
whatever was happening in thatfirst place that you went to,
that kind of you know, yeah.
Dr. Drew Phillips (19:57):
So it was kind of like a c1 do one teach
one sort of thing.
Got it right like I.
I watched a bunch, I restored abunch and you know I had the
basics right.
Like I was fine laying a flap,which again is something that
like conceptually seems reallyeasy to do.
But you watch people that arenew at her.
(20:18):
I go and like mentor people andI'm like man, that flap's got
to be way bigger.
Dr. Tyler Tolbert (20:22):
I mean like yeah, look at we're doing
thickness and you can't seeanything.
Dr. Drew Phillips (20:26):
There's blood everywhere yeah, I'm all over
the place, yeah you know thebasics, I I had the basics of
pretty much everything.
I was comfortable around thesinus, I was comfortable around
the nerve, and so you just kindof have to put it all together
and, uh, so yeah, so that'swhere I started my ce journey.
Um cool, and you know, that was, I guess, my first ce, like
(20:46):
remote, remote anchorage as wellwell, wow, wow, yeah.
Dr. Tyler Tolbert (20:50):
So you kind of like we're already kind of
going straight to, uh, to someof the more advanced techniques,
like right off the bat withyour, with your CE.
Yeah, that's cool.
Dr. Drew Phillips (20:57):
Yeah, yeah, it was.
Uh, you know, after that I kindof, I guess maybe I took some
steps backwards.
But you know, remote Anchorageis not something I ever wanted
to do and the first course Itook was a live patient course
with uh, fishy broman um in hisoffice in arizona.
And I remember, yeah, I wasalready, I had already become
friends with him and he wasdoing a course and I was like,
(21:18):
man, do I really need to learnthis?
Like this is so out of myleague.
You know there's no like, likeand he's like man, you're young,
you're, you're gonna be, youknow, you going to see your own
cases fail.
I'm like that's the scariestthing to think about.
He's like, you know, you shouldat least learn how to do it,
whether you do it or not.
And you know I probably tookthat course too early and I
(21:42):
don't think I did any zygos, Iprobably did a handful of
pterygoids, no-transcript okay,yeah, that's.
That's a really big gap yeah, Idid the time you learned, at the
time you implement.
Yeah, I did two in one day.
(22:03):
It was a husband wife, theywere, uh, it was did you know
that they were going to be zygosbefore you started or was it
like a necessity?
okay, yeah, so a little storywith that.
They so my parents were stillliving in georgia and we'd had
this, um, the lady that cleanedour house she'd been, you know,
she'd she took care of our dogs.
(22:23):
I mean, she'd been there when Iwas a small child and cool, um,
we I don't think anyone myfamily ever realized they had,
like teeth problems and I guessthey like saw what I was doing
and instagram or whatever, andand went to my parents and was
like, hey, like you know, wewent to clear choice and we got
these.
Uh, yeah, you know, it was likeback then clear choice was
(22:46):
charging probably like 60 000plus dollars you know something
crazy like that.
And I was like, well, you know,like go get a ct.
You know, clear choice wasn'tgonna share the ct.
I was like go get a ctsomewhere and and uh, send it to
me.
And I immediately saw it and Iwas like clearjoy said they
could do standard all on four inthis.
There's no way, like both ofyou guys are zygos like 100.
(23:10):
And I was like, well, you know,I took a zygo course, I'll you
know, they're nice people sometime ago.
Yeah, these people are nice um,yeah, cool, you know, like
they've helped us, like, so Idid them for free and we did
them both in the same day.
Um and uh, we did did them at afriend's office in oregon.
Um and uh, from what I know,every they're, you know they're
(23:35):
still good.
I mean, they see my friend'soffice in atlanta for cleanings
now.
Yeah, so that was my firstzygote patient was husband and
wife.
Dr. Tyler Tolbert (23:46):
Wow, that's awesome.
So were those were like, um, uhlike, was it like a quad zygote
or are you doing like a singleon one side, or?
Dr. Drew Phillips (23:55):
Yeah, so they were both just uh, post-year
zygotes.
And and you know, look, Ididn't even do pterygoids on
that case because I mean thattook me so freaking long and I
was like I was just like I justso they.
You know, I've got posteriorzygos on both, just two implants
on the anterior for both ofthem.
Both of them got four implantsin the lower.
You know, one of these days, uh, you know, they'll probably
(24:15):
come visit me in in idaho, um,or in oregon, wherever I'm
working somewhere, and you knowI might go and add some
pterygoids to them because Iwant them to last for the rest
of their life.
Yeah, ideally.
But yeah, you know, I haven't,I haven't even looked at, like
the post-op CBTs, cbcts.
I'm sure the, the Zagos areright in the middle of the bone,
(24:36):
you know right where theyshould be, but you split the
field goal.
Dr. Tyler Tolbert (24:42):
That's great yeah.
Dr. Drew Phillips (24:44):
Got to start somewhere, I guess.
Yeah, no, of course.
Dr. Tyler Tolbert (24:47):
Yeah, no, I mean props to you for just kind
of going in head first with that.
I mean, you know, a lot ofpeople will take, you know,
three or four courses.
I want to do a few cadavercourses, some live surgery, and
then still want to do some overthe shoulder, which there's
merit to that, of course.
But at the same time, I'venoticed that a lot of the people
that you know end up teachingthese things, um, they can kind
(25:07):
of be a little bit of cowboys,you know, if you will, maybe
that's kind of a derogative term, but, um, you know, people that
are willing to, you know, feelconfident in their abilities as
soon as they, you know,understand the full scope of it
and understand that you're notreally going to know how to do
it until you do it, um and as,and I think that kind of, uh,
that kind of service for apatient that otherwise wouldn't
really be able to, uh, to getsomething, it would be a
(25:30):
standard of care.
I mean, if there's a Zygopatient, why would they get you
know, standard all in four?
So, um, yeah, that that was alot more of these cases, or how
did?
How'd you feel about it?
Dr. Drew Phillips (25:40):
You know, not , no, um, really, you know, I
still like every time I see aZygo case, I'm not like oh man,
I can't wait through this.
I'm like ah, really Like that'sa good attitude, actually.
Dr. Tyler Tolbert (25:52):
Um, that's how it should be.
Dr. Drew Phillips (25:53):
I mean like I can do them and and you know I
will do them, but it's notsomething that I like go strive
to do and like really enjoybecause it's it's exhausting,
it's high risk.
I mean it's high risk foranyone.
There's GP, perio, oral surgeon, it doesn't matter who's doing
it.
Um, and you know, thankfullyI've not had any zygos fail.
(26:15):
I haven't had any huge issuesfrom from zygopatients.
I mean, honestly, my, my worstcomplication on a patient I've
had is on a lower arch where theguy had the only teeth I had to
take out was both canines.
The only thing I left and I waslike the worst complicate.
It was just like a totalmassive infection, just
(26:35):
hospitalized, like it was justlike a total disaster that you
know I'm like man, what, whatcould I have done differently?
And I feel like I dideverything right and he's got
Zygos on the upper.
Dr. Tyler Tolbert (26:46):
I was like really, Like it was, like it was
two years ago.
Dr. Drew Phillips (26:51):
It was the hardest Zygo case I ever did,
like I drilled once, couldn'tget torque.
Drilled again, placed.
Couldn't get torque third timeon this on, like it was on
camera.
Well, drilled, again placed.
Couldn't get torque Third timeon this, like it was I can't
remember what left or right sideit was like finally got torque.
I'm like man, this is thehardest Zygo case I've ever done
.
Dr. Tyler Tolbert (27:09):
And I get a complication on the lower.
Yeah, the irony it's always theones you don't see coming.
I've definitely found that theones that I worry about tend to
work out and then the ones Iwasn't worried about just
totally disregarded.
Those are the sneaky ones, ohyeah.
Dr. Drew Phillips (27:21):
The cases where you load it, it's like 180
centimeters composite torquevalue and it's like everyone
just go home and say yourprayers and they heal a mate.
No problem, no problemwhatsoever.
Dr. Tyler Tolbert (27:33):
Yeah, yeah, no, I totally get that.
Okay, so you placed your firstZygos about eight months after
that, first course still notfeeling entirely psyched about
them.
What kind of made you want togo a little bit further down the
road of of doing more fixed forlarge and atrophic cases?
Dr. Drew Phillips (27:49):
so I started.
This is when I startedtraveling to oregon a lot.
Um, so I'd moved to boise.
At that point I was, uh,working at an office here
covering for a friend'smaternity leave.
Um, okay, I was doing that, wastraveling to a couple different
offices in oregon and you knowwe didn't stock zygos and we
(28:09):
started just getting some casesand, um, I was like, well, I'm
kind of forced to do these now.
Um so, so, yeah, so I juststarted doing them and you know
I hadn't taken any other courseyet.
I remember I went this wasyears ago now I went to a trans
(28:31):
nasal course in Boston.
It was just like a one daycourse.
It was like David Zellig andSimon oh.
Dr. Tyler Tolbert (28:36):
I was teaching it and uh and it was.
Dr. Drew Phillips (28:40):
It was a transnasal course.
They talked a little bit aboutzygos, but it was my first time
meeting, you know, like davidzellig and simon, oh, um, a lot
of the other guys I'd alreadymet before, just through
different courses or whatever,and um, I can't remember if one,
if one gonzalez, was there ornot, but anyway, like you know,
again, like that course, like afew weeks later I did a trans
(29:01):
trans nasal.
Um, nice, that's been, I thinkdecember was two years.
Still have not seen thatpatient for post-op.
Dr. Tyler Tolbert (29:09):
But you know.
I mean it's fair to assume thatthings worked out.
Dr. Drew Phillips (29:14):
Yeah, as far as I know they look great but
great.
So you know I'd probably done Idon't know or so Zygo cases,
very few quads, maybe a couplequads.
I mean even still like I'veonly done a couple quads.
And so then I loaded up a case.
I loaded up three Zygo casesone day and I had Juan come do
those cases with me in Oregon atthe office.
(29:35):
I was at there.
So Juan came and we did threeupper arches in one day.
So Juan came and we did threeupper arches in one day.
You know, I think a coupletransnasal, a couple zygote, and
it was great.
I mean it was.
You know, anytime you dosomething with any other doctor,
like they're learning from you,you're learning from them.
You know I was learning somezygote stuff from him.
(29:57):
I was showing him how I wasdoing my pterygoids, because I
was placing my pterygoids withjust standard neoden implants
and had, like you know, upper 90success rate of of every time I
placed it.
And you know I wasn't using theNorris that you know, arguably
was a better designed pterygoidimplant, but I was having great
success with just the neoden,like 3.75 by 18 helix, and had
(30:18):
great success with it.
And, uh, you know know.
So I showed him kind of likewhat I was doing with that.
I was using some osteotomesfrom salvin, I was using some
osteotomes from norris, justkind of figuring out what worked
for me and, um, you know, so itwas cool, just kind of
collaborating with him on thatand learning.
You know, each of us learningfrom each other and uh.
Dr. Tyler Tolbert (30:39):
So are you kind of like a, are you a drill
osteotome hybrid type of guy, isit?
Dr. Drew Phillips (30:44):
I mean, I keep changing my ways of things.
Um, you know, so I I love theNorris, uh, the like the 2.0
sharp osteotome, which I think,uh, I think the SIN one is
almost identical to that.
Now, Um, you can also get itfrom like GDT for like 90 bucks
as well, and so I at least justtry to push with that till I can
(31:09):
feel something hard.
Sometimes it's hard already,and you know, when I have that
I'm like great, like almostdoesn't matter what I do now,
like we're going to get to work.
We're good to go.
So I'll push with that until Ifeel something hard and then I
will just take like a standardspade drill and go really slow
and just feel until I, you know,I perforate the plate and if
something doesn't feel right atthat point I can kind of
(31:31):
redirect, redirect, right, um,and then I have a I believe it's
2.7 millimeter osseotome fromsalvin that I got.
Uh, my my friend, uh, shivanegupta is an oral surgeon in
atlanta told me about that, so Ibought it back now and, uh, so
I got that and you knowbasically that if I can get that
(31:52):
down to like 12 to 14millimeters, like I go straight
to placing the implant.
If, if it won't go in, thenI'll pick up a 3.5 drill and go
a little bit more.
But you know what's awesomeabout that neodym helix is, you
know you open up, you know acortical plate with the two
millimeter drill, like you canalmost guarantee yourself that
(32:12):
it's going to grab and go inthere.
Yeah, yeah, you know, every nowand then it would.
You know an implant would hitit and it would spin, and pretty
simple, just pick up the 3.5drill and just, you know, I
leave it on like the 40 newtoncentimeter or 40, I mean uh rpm
speed and just barely open itwhere you can kind of feel every
turn and just cutting just toopen it up enough, and I see, um
(32:34):
, and yeah, I mean, as long asI'm in the right spot, like my
success rate is is really highwith my pterygoids.
Dr. Tyler Tolbert (32:41):
Great, yeah, fantastic, okay, awesome.
So that's the.
So that's your pterygoid.
You know general routine there.
So anything special would yousay about your zygotechnique?
I mean, would you say that'skind of like a you know?
I guess the way I should put itis what kind of school of
thought do you generally have interms of your approaches?
Dr. Drew Phillips (33:01):
I go to surgical approach with it.
So I have kind of like, uh, youknow, I guess, jumping off of
CE and we can go back to see ifyou want some other ones.
But like my general approach,like I guess, like kind of in my
head, like my algorithm of likehow I'm going to approach each
case, kind of like jumping intolike Patsy protocol, if you will
.
So for me it all comes down tolike where the sinuses are Right
(33:24):
and so that you know, likewhere the sinuses are, does it
dictates, like where my you knowwhere my teraglute implant
starts.
It dictates, you know, am Igoing to do a Zygo?
It dictates like how my frontfour implants are going to be.
So you know, my train of thoughtis, if I can get you know,
first of all, we don't wantcantilevers, if at all possible,
right.
(33:44):
So if I can get an implant atfirst premolar and a pterygoid,
I don't need a Zygo.
I feel like that spread is fine.
Um, you know, if I can get oneat second premolar, great.
And you can argue that on thosecases, a one-tooth cantilever
for a molar is okay.
I mean, you know, we don't like, we don't like cantilevers.
(34:06):
However, clear choice has beendoing that for forever, oh,
that's the vast majority ofcases um you know, and and I
have cherry boys under my beltso, yeah, I do them for most
cases now.
But you know, look at whatclear choice has done.
I mean, they've done more thananyone else and like their
standard of care is just fourimplants giving them a one tooth
cantilever.
And you know the people I knowthat have been there for a long
(34:26):
time so they have great successwith that.
Um, so yeah, so my, my kind ofalgorithm is like, if I can get
like first premolar and apterygoid, I don't need a Zygo.
If I can get, you know, firstpremolar and I don't get a
pterygoid, you know I need as Igo.
Um, you know, anterior iswhatever.
Um, you know, there are somecases now where it's like I've
(34:49):
done things you know where Iwould need a quad and I've done
you know whether it's liketransnasal implants.
I have one case again all thesecool cases I've done, people
refuse to come back for post-ops.
So I have a case where I had,uh, I mean, I had like, I think
like six millimeters maybe itwas like five, like you know,
under the nose, and I didpterygoids, uh, two like first
(35:12):
molar zygos, and then I placedthree helix short right in the
anterior and it was all corticalbone.
So it wasn't like your standard.
I's cortical bone.
I'm like this bone's not goingto talk to dr molinari about it
and he's like, yeah, that's agreat idea.
So I placed, you know, two likein about the lateral spot and
one in the nasal palatine justthose new those, my first helix
short implants I placed and gotgreat torque.
(35:34):
It was all cortical bone again.
I probably did that.
I was like, right after thehelix Short came out Again,
still haven't seen that patientpack.
It's like all the cool stuff, Idon't see anything.
Yeah, that's brilliant, awesome,awesome difference and you know
(36:04):
, doing a half-ass flap or justbeing able to see everything.
Um, you know the one thing,when it came to my flap that you
know I learned from.
So I I took a um alex avoniscourse in uh in brazil with um
dan rosen and dennis smiler.
It was funny.
I again, I was never planningon taking that course and I had
a buddy perry donis was going togo and I was like, yeah, man,
I'll go with you, and I think hehad a family emergency, ended
(36:26):
up not being able to go, and soI went.
I had a great time.
Um, and one thing Alex Savoniais like he was always getting me
to flap like more, likeposterior on the arch, which
like really opens it up a lotmore than just trying to like
only where the implant goes anduh, so you know, again, like
(36:48):
bigger flaps, I don't really useany of like the special uh
Zyger retractors.
I use a Minnesota.
I have a pretty cool Minnesota.
I don't know the name of it.
Um, it's a Minnesota with moreof a handle.
Um, there's a.
I think they make one that'slike an ergo Minnesota.
It's not that, it's a littledifferent.
Dr. Tyler Tolbert (37:06):
I've seen this.
Yeah, I saw it at Clark Damon'scourse.
Dr. Drew Phillips (37:08):
I think it's just a longer, it's just a
longer Minnesota basically, andI I love that thing.
Um, okay, I have like anotherinstrument.
Um, salvin makes one.
I think they call it like thezaga three.
I think nester uh posted aboutit today.
I I got one from like uh h andh instruments, um, just
basically the shape of like amolt nine but it's just like
(37:30):
three times the size and for meit's really good for this blunt
dissection.
Just a spoon, um, yeah, it'sjust like a big spoon and uh,
yeah, so you know just differentthings.
And um, you know, the brazilcourse was great.
Uh, brazil is my favorite placeI think I've ever been.
Um, I love brazil.
Yeah, it's great everythingabout it um.
(37:52):
I've been back I think like I'vebeen back.
I went back this year foranother course too.
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