January 13, 2025 • 40 mins
Unlock the secrets of advanced implant dentistry with insights from Dr. Soren Paape, Dr. Tyler Tolbert, and Dr. Simon Oh. This episode promises to enhance your understanding of the PATZI protocol for six implants and the strategic use of pterygoid implants in the maxilla. We'll discuss the complexities of adapting these techniques to individual patient needs, including nerve lateralization and the critical importance of informed consent. Prepare to gain a comprehensive view of the procedural and financial nuances of advanced implant practices.
Explore the balancing act of treating traveling patients, where we unravel the intricacies of strategic pricing, recovery timelines, and managing expectations. The conversation extends to the ripple effect of influencer marketing in dentistry, particularly how platforms like TikTok are reshaping patient awareness and expectations. Discover how prominent social media personalities impact the perception of dental procedures, fueling curiosity and demand for innovative treatments, and learn how this digital landscape can be both a boon and a challenge for practitioners.
Finally, join us in celebrating the incredible work of ORCA, an organization making strides in global dental care. Listen as Dr. Oh shares ORCA's mission to provide dental services to underserved populations, highlighting their pioneering efforts in Guatemala and upcoming plans for expansion. From revolutionary techniques to opportunities for professional involvement, this episode shines a light on how ORCA is paving the way for accessible dental care worldwide. Get inspired by stories of transformation and the ethical considerations driving these life-changing initiatives.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Tyler Tolbert (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fixed Podcast, your source
for all things implant dentistry.
Soren Paape (00:10):
I have a question going back to what we were
talking about earlier.
You know we were talking aboutpterygoids and traditional
all-in-four, are you?
You know something that me,tyler, our partner Caleb and
some of the other doctors wework with, our partner Caleb and
some of the other doctors wework with we're kind of at a
point now where we are followingat least like the Patsy
protocol, as far as doing siximplants kind of every time that
(00:32):
we can.
You know, on the mandibular ifyou can place straights and in
the upper if you can placepterygoids, we're doing that for
basically every case.
You have a couple offices rightSmart Arches.
Are you guys all kind of doingthat similar approach?
Are you doing standardall-on-four for patients that
get to that first molarocclusion?
Simon Oh (00:51):
you know we encourage pterygoid anchorage for the
maxilla, for sure it's.
It's not the easiest thing tostandardize surgical protocols
because you know it's, everycase is different and there's a
rationale for as long as it'sthought through and the success
rate is good.
You know, that's my requirementreally.
I, uh, you know, for the upper,yeah, six implants is what we
(01:14):
shoot for um, just just becauseof um the bone quality.
You know, like I, I think the,the sort of guidelines we have
are very sort of rudimentary.
You know it's like fourimplants, okay, 130 newton
centimeters of torque composite,okay, and that's really it.
You know, maybe two liters plusof implant length, but there's
(01:38):
not really much more than that.
You know there's.
And what are we up against?
We have differing bonequalities, differing amounts of
cortication of certain areas,differing angles.
You know, arch forms, yeah, Ithink there's a lot more study
that needs to go into it, butfor me my sort of go-to is yeah,
(02:01):
upper patsy.
Tyler Tolbert (02:03):
Lower two is yeah , upper patsy lower uh four plus
two if possible um, withoutrisk injury to the nerve?
Soren Paape (02:11):
you know, yeah, for sure.
Are you doing any nervelateralization for patients that
?
You know, are in a situationwhere they can't even get like a
standard.
Simon Oh (02:18):
Four um, yeah, I mean it.
It really is case dependent.
But yeah, I mean I that that isin in the toolbox.
I don't like to do them justbecause the rate of initial
paresthesia is very high.
It exceeds 80, maybe even 90percent.
(02:39):
I don't remember what thestatistic was, remember what the
statistic was, but that that tome is enough of a risk to sort
of have that conversation of youknow it's.
It all goes back to informedconsent, like would you rather
have risking a nerve injury andmaybe one more tooth on your
prosthesis, or would you ratherhave a more constricted arch and
(02:59):
not have to worry about that?
It's really their call, youknow.
So I don't really know what theanswer is to that.
I don't try to make thosedecisions for them, you know
yeah.
Tyler Tolbert (03:10):
And it's also it's it's kind of difficult to
really prepare a person forparesthesia if they've never had
it.
So it's like you know, is thata problem you really want or not
?
I mean, it's kind of evendifficult to fully inform.
It's just, you know, I thinkit's kind of a case by case
thing where you know someonejust has to have.
You know not that I do this,but I would think in my hands it
(03:31):
would have to be someone towhere I really felt strongly
that a shortened arch is stillgoing to have too much of a
cantilever because that middleframe is just way too interior
and I'm not really going to beable to do what I would even
call an all in four.
Simon Oh (03:49):
No for sure, you never know how somebody is going to
be with paresthesia.
Just from patient experience, Ihave lingual paresthesia for my
wisdom teeth still, oh, wow,okay.
Yeah, I had an OS resident dothem when I was a first-year
dental student and I guess mytongue was numb for several
months and started tricklingback, but it was.
It was maddening at first, likeit was.
It was like I can't stand this,you know, and it's, it doesn't
(04:14):
hurt, you know, it's just likewhat the hell?
So so yeah, I mean that thatexperience to me makes me a
little bit wary of like, but youknow.
Then again, like you know,whether it be iatrogenic or just
from retracting the nerve orsomething, some people do get
numb for some time and they'refine, you know.
(04:36):
So, like I don't know, I haveno clue as to like how somebody
is going to do with that, as tolike how somebody is going to do
with that.
So, if there is a case where anerve lateralization is really
needed, just a very thoroughdiscussion setting expectations.
I think that's the mostimportant thing.
Soren Paape (04:58):
Sure, of course, yeah, definitely.
So I would love to kind of getinto a little bit about maybe
some questions about your office, and you're more than welcome
to share as much as you want andas little as you want.
And then let's jump in and talka little bit about Orca.
Tyler Tolbert (05:14):
For sure.
Soren Paape (05:16):
So the questions I have are I'd love to hear a
little bit about, maybe, thevolume that you're doing that's
just like traditionalall-in-four, the volume that
you're doing more, just liketraditional all-in-four.
The volume that you're doingmore remote anchorage, like
zygomatic implants.
And then I'm curious what youguys charge for zygomatic
implants, like if that'srequired, are patients paying up
(05:38):
front for that?
Are they paying extra when yougo that route for them?
And then I'm curious what youguys do for patients that fly in
for revisions.
Are they paying like full pricefor their cases?
Are you guys so like at myoffice you know we have some
patients that travel andtypically like my incentive to
them is I'll pay for their hoteland their flight as like a
(06:01):
discount to get them to come infor that.
And yeah and yeah, I'm justcurious kind of those specifics
for your practice if you'rewilling to share.
Simon Oh (06:10):
Yeah, sure.
So in terms of like ratio ofconventional to zygomatic,
that's an interesting question.
You know I would always.
My gut tells me probably 10-ishpercent are zygomatic cases,
(06:30):
and that has evolved over timefor a number of reasons.
One, I got better and better atkeeping things conventional,
being very slick, with verylimited bone stock, and so that
made it go down.
But then I started getting alot of referrals for cases that
needed Zygo, so it went back upagain.
(06:52):
So you know, right now I'dprobably say anywhere from 10 to
20%.
And yeah, it's been good.
In terms of, like, travelingpatients, we don't, I don't know
we haven't paid for flights oranything, at least for most, I
(07:17):
forget.
But for most or if not all, Imean I don't think we've offered
to pay for flights or hotels oranything.
And the fee is sort of the fee.
We don't do value-based pricingwhere we see what the market is
(07:37):
charging, we charge the same.
We sort of do a cost pluspricing approach where it's like
we look at our overhead, welook at what the cost of the
procedure is ultimately going tocost us.
You know all those things addedup and then you know some some
to to make a little bit of money, and so that's sort of how we
we we do that.
(07:57):
So it it really depends on, Iguess, what kind of deals we
have with vendors.
But yeah, the fee is a fee.
I mean we don't really discountin terms of like just because
they're traveling, and in factmost of the time the ones that
are traveling to us are the onesthat sort of have the craziest
(08:19):
yeah the hardest.
Yeah, the hardest ones.
So like I also have to thinkabout, like how many years of my
life is this case going to takeoff, you know?
So like I also have to thinkabout, like how many years of my
life is this case going to takeoff, you know, so like.
So, yeah, it's, it's.
It's kind of like a game timedecision.
I guess you could say in termsof like those because those are
(08:41):
extremely complex, you know.
Soren Paape (08:42):
So yeah, that's for those traveling patients.
Do they what?
What kind of do you, whatexpectations you give them?
So like, when they fly in right, let's say they fly in on a
Monday they're doing surgery onTuesday.
You know they get there.
Maybe do your records?
Do your surgery get them in theprosthetic?
(09:04):
Do you send them on the flightthe day after?
Like, how many days do you kindof want them to chill before
they jump on a flight?
What is kind of your protocolas far as that goes?
Simon Oh (09:12):
Yeah, that's a good question.
So I don't advocate for goinghome right away.
On a flight, especially if wehave any kind of sinus
involvement, the pressurechanges can be painful and if
there's an opening it will punchthrough when you go up in the
air.
So if you guys have ever had awater bottle on a flight, the
thing crumples up when you're,you know.
(09:32):
So you expand, you know allthose, all of those things.
Good pressure changes canreally mess up your, your
sinuses.
So, um, I don't advocate forthat.
I usually tell them to plan tostay for a week initially, so
that I can do the surgery or dothe records the day before the
surgery.
Surgery is the next day.
(09:53):
Stay a week so I can see you aweek later, make sure that
things are healing right andthen you can go home.
And then after that, you know,sometimes they can get locally a
CT scan.
I always like to get CAT scansat the stability dip.
So three, four weeks, you knowI like to see what the bone
(10:14):
looks like at that point andthen after that, two months
later, come back for records.
New prototype, that's anotherweek and then, as long as that's
good, come back one more timefor your finals.
Goodbye, you know.
Um, so that's typically, uh,that's usually like three trips,
three trips going off of that.
Soren Paape (10:34):
I'm sorry I'm asking so many specific
questions.
These are just things that I'velike thought of, as, as I've
watched your, your instagram andpeople you've treat um, I know
you've treated some, some prettylike prominent people that have
a good social media presence,prominent people for you guys.
Have you guys seen a goodamount of people coming in from
a lot of views on some of thosevideos and it's something that
(10:59):
we've talked about, like maybedoing a case here and there for
a paper?
You know, like maybe it's itand and, but I'm curious what?
Simon Oh (11:11):
Yeah, no, no, that's a good question, I mean in terms
of, like, the influencers.
You know it has been good, Iwill say that, but, you know it,
it really there's two sides toit, you know, because with sort
of TikTok and the idea of likeauthenticity of your life, which
(11:33):
is like very important toinfluencers, I guess, is it can
be good for them but also kindof bad for people watching
Because, like, if they're havinglike a complication or which is
you know, they're going tobroadcast that, yeah, yeah
they're going to broadcast thatpeople are watching intently
because they're scared, theywant to see what's going on.
That's going to freak them outand that may actually ultimately
(11:55):
prevent them from seeking care.
So, you know, it's kind of acatch-22.
You know, I I think theawareness part of it's good, um,
but I'm not sure in terms oflike this, uh, what, what people
are experiencing, um, and whatkind of decisions are going to
make as a result to it, um, butno, I mean, it has been pretty
(12:17):
good.
You know, um, the, uh, the, the, the, uh, sort of brand
awareness has been positive,good, but you know, it's not
like the end all be all.
You know, I think it's cool andit's cool to help people that
you know have that and hopefully, you know, it provides a
positive message to everybody.
Soren Paape (12:39):
Yeah, definitely.
I mean, it's definitelyspreading awareness, for I think
no matter what, like what wefound in the markets that we're
in, is that some of these biggercompanies, you know, like the
Clear Choices and the Nubias,the people that are pumping
marketing dollars into nationalcommercials and stuff like that.
It's great for the patients whojust didn't know that it was a
(13:03):
possibility, right, the patientswho just didn't know that it
was a possibility, right.
And then they come into youroffice and now that they know
that it's an option, it's coolthat they're able to put that
money out there so that we canhave that awareness that this
procedure exists, becausewithout that it's really tough.
You know most patients I stillhave patients that come in and
(13:24):
they're like, oh my gosh, Ithought that all I could have
was a denture or maybe a snap inright, but the fact that they
can have a fixed prosthetic,they're kind of over the moon
about that and they stillhaven't seen it.
And I mean for us, you know, Isee it every day nonstop.
So it's kind of like crazy tothink that there's so many
people out there that don't evenknow that it's an option.
And that's definitely somethingthat in Tyler's market Tyler's
(13:47):
in Tri-Cities, washington.
I was just about to say, yeah,he just doesn't have a lot of
that awareness, whereas I'm inDenver and Denver's the heart of
Clear Choice, right, clearChoice has been here forever, so
every single person and theirmother knows exactly what an
all-in-four is.
Tyler Tolbert (14:05):
Ever so, every single person and their mother
knows exactly what anall-in-four is I'm in a land
where people assume that youhave to have the teeth pulled
first and then you have to waitand then you have to get the
implants and then you get yourteeth later.
In fact, some people will cometo me and they just got their
teeth extracted with theirinsurance and they come to me
like, okay, I'm going to beready for implants in three
months.
I'm like buddy, you, you killedme.
(14:25):
You could have just got thefree console.
I could have told you all thiswe could have, we could have
gotten it all out of the way.
So, yeah, I mean where you're atin the end, the local marketing
and you know who's, you knowwhat kind of fish have already
kind of exists in that pond,make a big difference in terms
of how some of those consults goand the expectations that come
along with it.
And that's something I'vedefinitely learned um being in a
more you know rural part ofamerica.
It's like there's there's awhole new like re-education that
(14:48):
has to happen.
But you know he has peoplecoming in and they're like so
are you?
You doing an all-in-six, you'redoing pterygoids.
What are you doing like apaloal approach guy and you like
they're listening to hispodcast.
I yeah, it's like why'd you?
Simon Oh (14:58):
miss it were you not exactly, I do I I recently.
Soren Paape (15:11):
I recently had a patient that listened to every
single one of my podcasts andshe just like before I even said
it, she was like quoting stuff.
I was about to say and I'm likeall right, well, are we gonna
do this like you are?
It sounds like you sold, likemy podcast sold you, uh, but it
is.
It's a catch-22, right?
Because because then all of asudden, like if something
happens, that isn't what youwant, it's like oh man, like it,
(15:35):
there's so much more at stakeat that point.
Simon Oh (15:37):
Yeah they're looking for your axial accountability
post make sure you hit the mediawing, but uh, I think I think
that the reason I brought thatup in the first place was just
that make sure you hit the mediawing.
Soren Paape (15:46):
But I think the reason I brought that up in the
first place was just that, goodor bad.
One of the positives of TikTokis spreading awareness for the
fact that these procedures exist.
But there probably isn't alarge population, at least of
the people that I'm treating inmy office.
Most of the people in my officeat that age like aren't really
(16:07):
on TikTok.
Some are, but a majority arenot.
But it's it's good regardlessto to bring that awareness out
there.
Simon Oh (16:15):
Yeah, for sure.
I mean it's going to beinteresting what happens in
January when it gets banned.
I think Apple Store and Androidhave been told to stop putting
it on there January 16th orsomething like that.
I saw that yeah so it's goingto be interesting to see where
short-form video emerges.
Soren Paape (16:35):
to next A lot of teenagers won't be driving
around in lamborghinis anymore.
I know I've been.
Tyler Tolbert (16:42):
I've been working on my tiktok choreo for months
and it's just going to waste.
Soren Paape (16:46):
That was my plan b um, so let's uh, let's talk a
little about orca.
I mean, I would love to to hearyou know what, what the mission
of orca, what people can expect, maybe at what point you'd
recommend people going.
I know that you guys have kindof like the you can just watch
(17:08):
or you can go and actually getyour hands wet.
If you could give us a littleoverview of that.
A lot of our listeners are kindof at the stage where they're
doing a lot of all-in-four butmaybe they aren't getting into
remote Anchorage and they're atthat point now where Orca would
be an option for them.
Simon Oh (17:23):
Yeah for sure, orca is a very sort of unique and
special thing.
I think it's turned intosomething really cool.
It sort of started with justhearing about the problems over
there, so a very common practice.
There's a large population thatlive in villages where they
don't.
(17:43):
They have shoddy electricity,you know, no community, no
internet, stuff like that.
So a very common practice forfor this those sort of
populations, is to, when theyturn to become teenagers, the
parents actually get enoughmoney to send them into the city
, pull all their teeth, put themin dentures, bring them back
(18:04):
because a toothache is like alife ruiner.
You know there's no access tobasic care there.
So like that's sort of what'sgoing on over there.
So, you know, decades later, nobone, you know so.
And then after that, no toolsto help these people because you
know nobody had placed igosdown there.
So, um, they've been sort ofwalking around like this for a
(18:27):
long time.
And so, um, I heard about thisbecause my partner in orca, el
dadrory, um, he, he went downthere to do a singles implant
course.
He met rodrigo Cariaga, who'sthe head of implantology down
there.
He trained up at NYU, did theimplantology fellowship, amazing
people.
So they met each other and theysort of talked and Eldad had
(18:50):
known that I wanted to dosomething overseas to help
people.
I had always heard about CEcourses that were sort of um uh
in it for the for for sort ofthe education only, and then
there's no restorative plan.
You know, like it's crazy, um,you're just basically cutting
people open and leaving it, youknow.
(19:11):
So, like it's, it's crazy to me, and like I'm not having
follow-up, they're havingproblems not getting prosthetics
.
So, um, that sort of um, uhpiqued my interest because this
is at a university, this is atthe top university in Guatemala,
university of FranciscoMarroquin, which is highly
respected.
The facilities are unbelievablethere it's the nicest dental
(19:34):
school I'd ever been to, and sothat really was interesting to
me because, like, okay, itchecks the boxes, needing,
needed or population in need, agreat facility and people that
care, you know, like that, thosewere the sort of basics that I
needed.
So we went down there.
(19:55):
I placed the first zygomaticsin Central America a few years
ago Nice Congrats.
And this patient that had beenedentulous, going trying sinus
lifts over and, over and overwith no results for many, many
years I don't remember thenumber, it was like 30-something
(20:18):
years just no teeth.
I go in there, do a quad, puther in teeth.
She's just like crying, youknow like it's, and so, like
that, that I needed to alsoconvince the school that this
was, you know, because, like,nobody had heard of this before.
So, like, I'm here and do whatyou know, yeah, yeah, exactly, I
(20:39):
was like I have to make surethis case goes well.
What you know, yeah, um, madscientist, yeah, exactly, I was
like I have to make sure thiscase goes well.
You know, like, or else, likethis is gonna be horrible.
So, but we nailed it.
Uh, we got it done.
Uh, german lee, my lab techI've been working with for a
long time, came with me, did theconversion.
Um, we did it in the or undergeneral um, and it went very
smoothly.
Since then, they they were likeokay, okay, we believe in it,
(21:01):
but there's a lot of liability.
So we're like, okay, so theexpense that we take on by doing
this is rather high because wehave to provide for liability
and pay the school, which isfine, though, because I want to
make sure that the patients havereally good follow-up, really
good care afterwards.
(21:21):
So, um, that's sort of what itturned into.
We're like, okay, we can fundthis through education.
So I know a bunch of guys thatare really good at this.
Let's all get together, we'llhave a great time.
Um, we, we do level two, whichis conventional, all on four.
We do that in under anesthesiain the clinics.
(21:46):
It's under moderate sedation,sort of like a practice setting,
and so we do that there.
It's one to one mentorship,which I don't think anybody else
can say.
It's one-to-one mentorship withone of the best people out
there, very experienced, andthey're sort of over your
shoulder.
So it's a very orchestratedthing because we also have a
(22:09):
prosthetic course going on atthe same time so that we can get
everything done as if we're inthe practice at home.
So the prosthetics course isled by Dr Adam Hogan, dr Keith
Klaus, two of the verywell-known guys at this.
We're familiar, yeah, andthey're just great people too.
That's like one of my top rolesis no D-bags.
(22:30):
That's a very important rolefor me.
So we have those guys and theyteach the prosthetics course.
So sorry, I'm kind of all overthe place, but the way that
works chronologically is firstthe digital prosthetics team
with the participants comes inthe weekend before the course
starts.
They take all the records, theprerecords on the patients over
(22:54):
the weekend, design startgetting done and then on Monday
that's when we start.
So level two and three runsimultaneously.
Level two is the conventionalstuff.
So we pre-select these casesmonths before we get there to
make sure it's appropriate.
And we do it one-to-onementorship.
So the digital team will comein place the markers, do the
(23:15):
initial scans, and then thesurgical team will come in place
the implants and do whateversurgery is needed.
And then the surgical team willcome in place the implants and,
you know, do whatever surgeryis needed.
And then the digital team comesback in with photogrammetry.
Sometimes we do segmark withthe CT alignment technique and
do the the the other scans, andthen they get teeth right away.
So that's the protocol on thelevel three side.
(23:39):
It's a little different.
It's, as you know, as you guysknow, it's more invasive.
So full scope, remote anchorage, full scope, so anything from
zygos, pterygoids, transnasals,multiple zygos, multiple, you
know all these things.
So that's run in the operatingroom, it's the OR, so it's run
(24:01):
with one anesthesiologist eachin each room, not like you know
my experience and it's nasalintubation.
We scrub in, we go in.
Again, one-to-one care.
So you're paired up with aparticipant.
The faculty sits at the head,they split the case.
(24:21):
So one side is half, the otherside is half, and from there,
same sort of protocol.
Digital team comes in firstplaces.
A marker scans surgery iscomplete.
Post-operative scans wake up,go and we, we, we do it all day
(24:45):
long, uh, for four days, um anduh.
After that, you know, we, we doa debrief on the last day we
have fun each night.
Soren Paape (24:48):
You know it's.
Simon Oh (24:48):
It's a great time really good sort of very good
spirit, because everybodythere's there for a reason, you
know it's.
It's a purpose-driven sort ofthing.
Um and uh at the end of the thethe course, you know, uh, every
time we go down there, we'reroughly at like the 55 arch uh,
60 arch uh range in terms of howmany we've done that week.
(25:08):
Um and uh, uh, we measure eachtime the amount of edentialism
we stopped.
So, um, each time we go downthere, it's roughly 1200
years200 years of edentulismthat we've ended that week,
which is a pretty cool statistic.
So it's like 20, 30 years eachpatient has not had teeth.
(25:29):
So that's something that we'revery proud of.
We're really excited becausewe're ramping volume up soon.
So the university has seen oursuccess with how many people
we've been helping.
So they're actually building,uh, four additional operating
rooms for us.
So we're going to ramp thingsup in 2026.
(25:49):
Um, so that's really cool.
Um, you know we do this roughlytwice a year.
We're looking into increasingthat frequency.
Um, another thing to note isthat we are never sort of
limited by one vendor, so it'snot one vendor sponsoring the
whole thing, and we did thatbecause we didn't want them to
(26:09):
control, you know, theeducational process, the
protocol, and that way peoplecan sort of see what is actually
best for that clinicalapplication.
So we have many differentvendors that provide supplies,
and these are all people thatactually care.
They care to donate products tohelp these people out and be a
(26:30):
part of something that is sortof beneficial for humanity.
So, you know, and of coursethey get new customers.
Hopefully we want to helpsupport the sponsors too by
helping them, you know.
So you know, and of course they, they get, you know, new
customers.
Hopefully, you know, we want tohelp support the sponsors too by
helping them and so like it's avery sort of symbiotic thing
that we have going on.
It's very um, it's very wellcultivated, I think, because
people involved in it, um, butyeah, in terms of education, we
(26:54):
wanted it to be the besteducational experience and so
like there's there's no judgment, you know, we try to keep it
very, very friendly and thelearning experience to being
optimized.
So that's why we do the Zygosin the OR.
Under general, they areparalyzed, you know, because we
don't want to have to converseabout like hey, you need to give
(27:16):
more local here, or like, hey,they're really feeling it, or
you know.
So we want to be able to talkfreely and not freak the patient
out if somebody is not, youknow, at the right trajectory,
you know.
Tyler Tolbert (27:28):
So it's, it's yeah, exactly yeah, that's all
fat.
Simon Oh (27:34):
Yeah, hopefully not, but yeah, that'd be, that'd be a
bad day.
Luckily, we have never done that, but yeah, our success rates do
measure that we do care aboutthat Patients are being well
taken care of by the residencyprograms, so the prosthodontic
residency program and in fact weare planning to launch the oral
(27:56):
surgery program there becausethey don't have one.
One of the things we do on theside at the university, sort of
through ORCA, is we do a lot ofodd pathology.
So in Guatemala there's notmuch access to like really upper
end oral maxillofacial surgery.
So you know a bunch of myfriends, kathan Patel, steve
Yusupov, zach Brown, which isalso an ORCA instructor, and Joe
(28:22):
Camerata, who's an oral surgeonand plastic surgeon, which is
crazy.
We all go down to sort of cutout these enormous
amyloblastomas, huge tumors.
We did a myxoma of this onegirl.
I have the model right here.
Oh sweet, this was anine-year-old girl.
This is her jaw.
Tyler Tolbert (28:44):
Oh my gosh, geez I think I may have seen this
case.
Simon Oh (28:47):
That's insane, that yeah so, uh, obviously this is
from lack of access to.
Would you ever see this in thestates?
no, no, no chance right like nochance and so like that's the
sort of stuff that goes downdown there.
So, um, on the side we do a lotof these cases because the
faculty they're bringing to ourattention like hey, can we help
this person?
(29:07):
So I'm like, yeah, let's, let'sget all this stuff down, uh,
get all these people down, andwe go to the pediatric uh
hospital.
Uh, do these fibulas in the?
Or we've done a bunch already.
Um, we're looking to get left,left and palate and yeah, it's
sort of become like this thingwhere, like it's just driven
because we want to help thesepeople out, you know, and so
(29:30):
it's been really cool and wehave the resources and
connections to make it happen.
So why not, you know?
So that's sort of the long andshort of it.
With Orca, we're really excitedto see where it goes.
You know, we've gotten a lot ofinterest from other countries.
So we're talking with people inGhana through Tarun Kirpalani,
oral surgeon in New Jersey.
(29:51):
He's an Orca alumni and we hadcontact in Trinidad.
We talked to a team in PuertoRico.
So there's a lot of sort ofinterest there.
So we'll see where it goes.
But you know, again, it's verystrict in terms of what we need
is great follow up, great, youknow, patients that need it and
(30:13):
us being able to do it.
Tyler Tolbert (30:14):
So yeah, yeah, I mean that's amazing.
No-transcript.
Simon Oh (30:47):
You know, I, I think it just sort of goes.
I mean, that's just what I wantto do, and that's sort of the
idea behind smart arches, too,is like okay, like we could
charge 30, 40 000 an arch.
I've heard places in new yorkcharging like 200 grand for a
double.
Oh my god, that dude like areyou serious?
(31:07):
Like oh my god, like that.
Uh, that's like the.
The sort of thing with us islike we've we all found the hack
of digital which reduces ouroverhead, of course, yeah, you
know, it increases success, andso like.
Instead of yeah, I meanvalue-based pricing, higher, you
know, um, we made theinvestment, all these things,
(31:29):
better results, higher price, um, but for us, we actually
lowered it so that we can passit on yeah
Soren Paape (31:35):
more people you know it's, it's a good thing.
Simon Oh (31:37):
Um, you know, I'm also trying to figure out a way to
fund uh charity cases for thattoo.
Uh, dr brie smith, who you guysmay know, he's actually doing
stand-up at at the orchestra,really, oh, really hilarious, um
but uh, but yeah he wassomething called the halo dental
(31:58):
network.
I have heard that, yeah, yeah,they give out or they give
funding or connections forpeople to get their teeth done
by somebody who's willing to bephilanthropic.
And yeah, I've just been tryingto figure out how to get
consistent funding to do that inthe US.
It's just been a challenge.
(32:18):
I did meet some reallyinteresting people that you know
we can really make a differenceif, if, the strategy works out.
But yeah, time will tell.
Tyler Tolbert (32:30):
Sure, sure, yeah.
So we brought up the symposiumthere.
I definitely want to make surethat we talk about that, cause
that's coming up here prettysoon.
I think it was January 17th and18th in Las Vegas.
We're doing the there.
I've seen the lineup.
It's incredibly impressive, thekind of speakers that you've
gotten to come through.
So if you wouldn't mind givingus kind of an elevator pitch of
(32:51):
what people could expect if theyshould attend, yeah, you know,
we, we wanted it to be thesymposium to be a little bit
different.
Simon Oh (33:02):
For one, we wanted to be a little bit different.
You know, a lot of symposiumssort of talk about all the same
stuff the whole time.
You know that like, maybe youpick up one or two good things
every hour.
You know like that's, that'snot very efficient, you know.
So that that kind of botheredme and so we wanted to do
(33:25):
something a little differentwhere we had many different
topics from people in thatindustry, you know, and people
that actually practice thisstuff, and so get perspectives
from all different angles andget perspectives from people
that you normally don't talk to.
So, you know, we have we havethe Prasad with Dr Sven Bone.
(33:49):
You guys don't need to talk tohim.
He's not only a prosthodontist,he's also a mathematician and a
physicist the most credibleperson.
So he's talking about that,about PROS.
We have a slew of oral surgeonsat the top of the industry.
(34:10):
We got Juan, we got Camerrata,we got vichy, we got, you know,
steve yusupov and patel talkingabout microvascular and implants
.
Um, kamrata is talking about,uh, the facial skeleton, um, you
know, as it relates to fuller,and so uh and um, yeah, we have
(34:31):
ent.
So my brother-in-law is afellowship trained rhinologist,
so the guy that we usually he'sthe guy on the other side of the
curtain, you know, the guybehind me you know what I mean.
So, like, he's going to talkabout sinus disease and how to
manage sinusitis with, as itrelates to zygos, what happens
to the oral antral fistula, whatare the actual options.
(34:52):
You know we always hear FESS,but like there are many
different types of sinuplasty,you know.
So he's going to talk aboutthat too.
Anesthesia as well from youknow my anesthesiologist, dr
Goberon.
He worked in cardiac for a verylong time, so he's he's very
well versed in this stuff, um,so yeah, I mean, that's, that's
(35:16):
sort of it.
We wanted to be in a very coolplace which is going to be in
Las Vegas at the Wynn hotel, um,going to be.
There's going to be a lot ofdifferent sponsors, a lot of
great people there that you knowyou can talk to about products,
um, and then after, at the endof each of the days we're going
to, you know, have a great time.
You know, I think a lot of thepeople that sort of come to Orca
events are we're all sort ofintermingled, you know, we all
(35:39):
know who each other are, youknow, but like, maybe not all
that well, and so I think it'llbe a nice experience of not only
education and learning coolstuff, but also networking and
at a cool place, I think,especially in January.
we wanted to be somewhere wherethe climate's kind of, you know,
nice.
I can't stand January, February.
(36:01):
So you guys ever noticed theOrca events are in January and
February.
Tyler Tolbert (36:07):
There's no coincidence.
Simon Oh (36:10):
Yeah, so that's sort of yeah, yeah, that's that's how
that works, but, um, but we'rereally hoping that people have a
great time.
Um, we're, we're looking intothrowing a pretty cool party on
saturday, so, um, and thenfriday, I think there's like a
bowling event going on at night,um, so, yeah, uh, you guys both
coming so, uh, soren's going tobe on vacation.
Tyler Tolbert (36:33):
I don't know what he's thinking.
Soren Paape (36:36):
But yeah.
Tyler Tolbert (36:36):
I definitely intend on coming Tyler and.
Soren Paape (36:38):
Caleb are there.
They're instructed to take lotsof notes and fill me in on what
I'm missing out.
But I saw it like I think youguys post it like probably like
a year ago, maybe eight monthsago, and I was the first one to
post in the group.
I'm like guys, we got to makethis happen and then, of course,
I like forget about it, book myvacation and I'm at the point
(37:00):
now where if I back out of thevacation, my girlfriend would
not be stoked with me.
Simon Oh (37:05):
All right, this is the plan.
We're gonna get an optimistrobot, we're gonna put an ipad
on the head and we're going toget an Optimus robot.
We're going to put an iPad onthe head and you're going to
face the whole time as you walkaround the place We'll call up
Elon, one of those robots he hadat his convention.
Tyler Tolbert (37:22):
That's great.
I'm sure it's going to be areally good time.
Where can people go?
We'll put something in the shownotes to help people figure out
where to sign up for the courseand everything.
Yeah, I'm absolutely stunned bythe lineup.
I've never seen such astar-studded cast of Full Arch
folks.
You've got Dr Ole Jensen, DavidZellig, I mean you've got some
real OGs in here.
This is crazy.
Simon Oh (37:42):
Yeah, no, all the guys .
Tyler Tolbert (37:50):
I mean, I can't even list.
It's all people that deservetheir own sort of you know they
can all have their own symposium.
Simon Oh (37:54):
Yeah, exactly yeah, zellig Oli, yeah, all these guys
are just unbelievable.
Not only speakers andintellectuals, but also people,
you know, like they're goodpeople.
Again, that's like ourrequirement there.
But yeah, I mean you know our,uh, our requirement there, um,
but um, but yeah, I mean, uh,you know, uh, looking forward to
(38:14):
seeing you there.
Uh, so, aaron, you know, hope,uh, hope, you enjoy your time
with your girlfriend.
Soren Paape (38:20):
Uh yeah, it'll be, it's, it's been.
It's been like a couple ofyears since I've gone on a legit
vacation, so, uh, it's, it'llbe good.
I've gone on a legit vacation,so it'll be good.
You know I need it.
Simon Oh (38:31):
I need to take a week off, but I'm very annoyed that
it happens to be on the weekendof Orca.
Soren Paape (38:41):
Well, we'll let you know when the next one is.
Yeah, I'll definitely be there,and Tyler and I will definitely
be at the Orca in Guatemala atsome point as well.
Simon Oh (38:50):
Yeah, oh yeah.
I forgot to mention like, if,if you're not for people that
don't want to go into lifesurgery, you can just come down
and observe, be with us you knowwash stuff, that's also an
option.
So yeah, just you know,orcaglobalcom is the website for
all that stuff, you know.
Tyler Tolbert (39:09):
Perfect, perfect, perfect.
All right.
Well, dr O, thank you so muchfor sparing some time to come on
and talk about your story.
Your impact on not just thedental world but the world and
what you're able to do andtaking what we do and
democratizing it to so manyneedy populations is an amazing
thing.
I'm so happy to hear that it'sgrown so much since even just
(39:31):
the last time we spoke, sothat's really amazing.
I hope everyone you know seesthat.
You know ORCA is really thenexus of you know the people
that are really practicing thisat the top of our field and I
hope people are looking intothat.
You know, hopefully going tothe symposium and you know
they'll might find themselves inGuatemala or Tahiti or wherever
else you were talking aboutgoing with Orca.
(39:52):
So again, thank you so much forcoming on.
We really appreciate it.
We hope to talk to you againsoon and I can't wait to see
where you guys are next.
Simon Oh (40:00):
Yeah, sounds good.
Thanks a lot, guys for havingme and great to be here.
My name is Dr Tyler Tolbert and I'm Dr Soren
Papi, and you're listening tothe Fixed Podcast, your source
for all things implant dentistry.
Soren Paape (00:10):
I have a question going back to what we were
talking about earlier.
You know we were talking aboutpterygoids and traditional
all-in-four, are you?
You know something that me,tyler, our partner Caleb and
some of the other doctors wework with, our partner Caleb and
some of the other doctors wework with we're kind of at a
point now where we are followingat least like the Patsy
protocol, as far as doing siximplants kind of every time that
(00:32):
we can.
You know, on the mandibular ifyou can place straights and in
the upper if you can placepterygoids, we're doing that for
basically every case.
You have a couple offices rightSmart Arches.
Are you guys all kind of doingthat similar approach?
Are you doing standardall-on-four for patients that
get to that first molarocclusion?
Simon Oh (00:51):
you know we encourage pterygoid anchorage for the
maxilla, for sure it's.
It's not the easiest thing tostandardize surgical protocols
because you know it's, everycase is different and there's a
rationale for as long as it'sthought through and the success
rate is good.
You know, that's my requirementreally.
I, uh, you know, for the upper,yeah, six implants is what we
(01:14):
shoot for um, just just becauseof um the bone quality.
You know, like I, I think the,the sort of guidelines we have
are very sort of rudimentary.
You know it's like fourimplants, okay, 130 newton
centimeters of torque composite,okay, and that's really it.
You know, maybe two liters plusof implant length, but there's
(01:38):
not really much more than that.
You know there's.
And what are we up against?
We have differing bonequalities, differing amounts of
cortication of certain areas,differing angles.
You know, arch forms, yeah, Ithink there's a lot more study
that needs to go into it, butfor me my sort of go-to is yeah,
(02:01):
upper patsy.
Tyler Tolbert (02:03):
Lower two is yeah , upper patsy lower uh four plus
two if possible um, withoutrisk injury to the nerve?
Soren Paape (02:11):
you know, yeah, for sure.
Are you doing any nervelateralization for patients that
?
You know, are in a situationwhere they can't even get like a
standard.
Simon Oh (02:18):
Four um, yeah, I mean it.
It really is case dependent.
But yeah, I mean I that that isin in the toolbox.
I don't like to do them justbecause the rate of initial
paresthesia is very high.
It exceeds 80, maybe even 90percent.
(02:39):
I don't remember what thestatistic was, remember what the
statistic was, but that that tome is enough of a risk to sort
of have that conversation of youknow it's.
It all goes back to informedconsent, like would you rather
have risking a nerve injury andmaybe one more tooth on your
prosthesis, or would you ratherhave a more constricted arch and
(02:59):
not have to worry about that?
It's really their call, youknow.
So I don't really know what theanswer is to that.
I don't try to make thosedecisions for them, you know
yeah.
Tyler Tolbert (03:10):
And it's also it's it's kind of difficult to
really prepare a person forparesthesia if they've never had
it.
So it's like you know, is thata problem you really want or not
?
I mean, it's kind of evendifficult to fully inform.
It's just, you know, I thinkit's kind of a case by case
thing where you know someonejust has to have.
You know not that I do this,but I would think in my hands it
(03:31):
would have to be someone towhere I really felt strongly
that a shortened arch is stillgoing to have too much of a
cantilever because that middleframe is just way too interior
and I'm not really going to beable to do what I would even
call an all in four.
Simon Oh (03:49):
No for sure, you never know how somebody is going to
be with paresthesia.
Just from patient experience, Ihave lingual paresthesia for my
wisdom teeth still, oh, wow,okay.
Yeah, I had an OS resident dothem when I was a first-year
dental student and I guess mytongue was numb for several
months and started tricklingback, but it was.
It was maddening at first, likeit was.
It was like I can't stand this,you know, and it's, it doesn't
(04:14):
hurt, you know, it's just likewhat the hell?
So so yeah, I mean that thatexperience to me makes me a
little bit wary of like, but youknow.
Then again, like you know,whether it be iatrogenic or just
from retracting the nerve orsomething, some people do get
numb for some time and they'refine, you know.
(04:36):
So, like I don't know, I haveno clue as to like how somebody
is going to do with that, as tolike how somebody is going to do
with that.
So, if there is a case where anerve lateralization is really
needed, just a very thoroughdiscussion setting expectations.
I think that's the mostimportant thing.
Soren Paape (04:58):
Sure, of course, yeah, definitely.
So I would love to kind of getinto a little bit about maybe
some questions about your office, and you're more than welcome
to share as much as you want andas little as you want.
And then let's jump in and talka little bit about Orca.
Tyler Tolbert (05:14):
For sure.
Soren Paape (05:16):
So the questions I have are I'd love to hear a
little bit about, maybe, thevolume that you're doing that's
just like traditionalall-in-four, the volume that
you're doing more, just liketraditional all-in-four.
The volume that you're doingmore remote anchorage, like
zygomatic implants.
And then I'm curious what youguys charge for zygomatic
implants, like if that'srequired, are patients paying up
(05:38):
front for that?
Are they paying extra when yougo that route for them?
And then I'm curious what youguys do for patients that fly in
for revisions.
Are they paying like full pricefor their cases?
Are you guys so like at myoffice you know we have some
patients that travel andtypically like my incentive to
them is I'll pay for their hoteland their flight as like a
(06:01):
discount to get them to come infor that.
And yeah and yeah, I'm justcurious kind of those specifics
for your practice if you'rewilling to share.
Simon Oh (06:10):
Yeah, sure.
So in terms of like ratio ofconventional to zygomatic,
that's an interesting question.
You know I would always.
My gut tells me probably 10-ishpercent are zygomatic cases,
(06:30):
and that has evolved over timefor a number of reasons.
One, I got better and better atkeeping things conventional,
being very slick, with verylimited bone stock, and so that
made it go down.
But then I started getting alot of referrals for cases that
needed Zygo, so it went back upagain.
(06:52):
So you know, right now I'dprobably say anywhere from 10 to
20%.
And yeah, it's been good.
In terms of, like, travelingpatients, we don't, I don't know
we haven't paid for flights oranything, at least for most, I
(07:17):
forget.
But for most or if not all, Imean I don't think we've offered
to pay for flights or hotels oranything.
And the fee is sort of the fee.
We don't do value-based pricingwhere we see what the market is
(07:37):
charging, we charge the same.
We sort of do a cost pluspricing approach where it's like
we look at our overhead, welook at what the cost of the
procedure is ultimately going tocost us.
You know all those things addedup and then you know some some
to to make a little bit of money, and so that's sort of how we
we we do that.
(07:57):
So it it really depends on, Iguess, what kind of deals we
have with vendors.
But yeah, the fee is a fee.
I mean we don't really discountin terms of like just because
they're traveling, and in factmost of the time the ones that
are traveling to us are the onesthat sort of have the craziest
(08:19):
yeah the hardest.
Yeah, the hardest ones.
So like I also have to thinkabout, like how many years of my
life is this case going to takeoff, you know?
So like I also have to thinkabout, like how many years of my
life is this case going to takeoff, you know, so like.
So, yeah, it's, it's.
It's kind of like a game timedecision.
I guess you could say in termsof like those because those are
(08:41):
extremely complex, you know.
Soren Paape (08:42):
So yeah, that's for those traveling patients.
Do they what?
What kind of do you, whatexpectations you give them?
So like, when they fly in right, let's say they fly in on a
Monday they're doing surgery onTuesday.
You know they get there.
Maybe do your records?
Do your surgery get them in theprosthetic?
(09:04):
Do you send them on the flightthe day after?
Like, how many days do you kindof want them to chill before
they jump on a flight?
What is kind of your protocolas far as that goes?
Simon Oh (09:12):
Yeah, that's a good question.
So I don't advocate for goinghome right away.
On a flight, especially if wehave any kind of sinus
involvement, the pressurechanges can be painful and if
there's an opening it will punchthrough when you go up in the
air.
So if you guys have ever had awater bottle on a flight, the
thing crumples up when you're,you know.
(09:32):
So you expand, you know allthose, all of those things.
Good pressure changes canreally mess up your, your
sinuses.
So, um, I don't advocate forthat.
I usually tell them to plan tostay for a week initially, so
that I can do the surgery or dothe records the day before the
surgery.
Surgery is the next day.
(09:53):
Stay a week so I can see you aweek later, make sure that
things are healing right andthen you can go home.
And then after that, you know,sometimes they can get locally a
CT scan.
I always like to get CAT scansat the stability dip.
So three, four weeks, you knowI like to see what the bone
(10:14):
looks like at that point andthen after that, two months
later, come back for records.
New prototype, that's anotherweek and then, as long as that's
good, come back one more timefor your finals.
Goodbye, you know.
Um, so that's typically, uh,that's usually like three trips,
three trips going off of that.
Soren Paape (10:34):
I'm sorry I'm asking so many specific
questions.
These are just things that I'velike thought of, as, as I've
watched your, your instagram andpeople you've treat um, I know
you've treated some, some prettylike prominent people that have
a good social media presence,prominent people for you guys.
Have you guys seen a goodamount of people coming in from
a lot of views on some of thosevideos and it's something that
(10:59):
we've talked about, like maybedoing a case here and there for
a paper?
You know, like maybe it's itand and, but I'm curious what?
Simon Oh (11:11):
Yeah, no, no, that's a good question, I mean in terms
of, like, the influencers.
You know it has been good, Iwill say that, but, you know it,
it really there's two sides toit, you know, because with sort
of TikTok and the idea of likeauthenticity of your life, which
(11:33):
is like very important toinfluencers, I guess, is it can
be good for them but also kindof bad for people watching
Because, like, if they're havinglike a complication or which is
you know, they're going tobroadcast that, yeah, yeah
they're going to broadcast thatpeople are watching intently
because they're scared, theywant to see what's going on.
That's going to freak them outand that may actually ultimately
(11:55):
prevent them from seeking care.
So, you know, it's kind of acatch-22.
You know, I I think theawareness part of it's good, um,
but I'm not sure in terms oflike this, uh, what, what people
are experiencing, um, and whatkind of decisions are going to
make as a result to it, um, butno, I mean, it has been pretty
(12:17):
good.
You know, um, the, uh, the, the, the, uh, sort of brand
awareness has been positive,good, but you know, it's not
like the end all be all.
You know, I think it's cool andit's cool to help people that
you know have that and hopefully, you know, it provides a
positive message to everybody.
Soren Paape (12:39):
Yeah, definitely.
I mean, it's definitelyspreading awareness, for I think
no matter what, like what wefound in the markets that we're
in, is that some of these biggercompanies, you know, like the
Clear Choices and the Nubias,the people that are pumping
marketing dollars into nationalcommercials and stuff like that.
It's great for the patients whojust didn't know that it was a
(13:03):
possibility, right, the patientswho just didn't know that it
was a possibility, right.
And then they come into youroffice and now that they know
that it's an option, it's coolthat they're able to put that
money out there so that we canhave that awareness that this
procedure exists, becausewithout that it's really tough.
You know most patients I stillhave patients that come in and
(13:24):
they're like, oh my gosh, Ithought that all I could have
was a denture or maybe a snap inright, but the fact that they
can have a fixed prosthetic,they're kind of over the moon
about that and they stillhaven't seen it.
And I mean for us, you know, Isee it every day nonstop.
So it's kind of like crazy tothink that there's so many
people out there that don't evenknow that it's an option.
And that's definitely somethingthat in Tyler's market Tyler's
(13:47):
in Tri-Cities, washington.
I was just about to say, yeah,he just doesn't have a lot of
that awareness, whereas I'm inDenver and Denver's the heart of
Clear Choice, right, clearChoice has been here forever, so
every single person and theirmother knows exactly what an
all-in-four is.
Tyler Tolbert (14:05):
Ever so, every single person and their mother
knows exactly what anall-in-four is I'm in a land
where people assume that youhave to have the teeth pulled
first and then you have to waitand then you have to get the
implants and then you get yourteeth later.
In fact, some people will cometo me and they just got their
teeth extracted with theirinsurance and they come to me
like, okay, I'm going to beready for implants in three
months.
I'm like buddy, you, you killedme.
(14:25):
You could have just got thefree console.
I could have told you all thiswe could have, we could have
gotten it all out of the way.
So, yeah, I mean where you're atin the end, the local marketing
and you know who's, you knowwhat kind of fish have already
kind of exists in that pond,make a big difference in terms
of how some of those consults goand the expectations that come
along with it.
And that's something I'vedefinitely learned um being in a
more you know rural part ofamerica.
It's like there's there's awhole new like re-education that
(14:48):
has to happen.
But you know he has peoplecoming in and they're like so
are you?
You doing an all-in-six, you'redoing pterygoids.
What are you doing like apaloal approach guy and you like
they're listening to hispodcast.
I yeah, it's like why'd you?
Simon Oh (14:58):
miss it were you not exactly, I do I I recently.
Soren Paape (15:11):
I recently had a patient that listened to every
single one of my podcasts andshe just like before I even said
it, she was like quoting stuff.
I was about to say and I'm likeall right, well, are we gonna
do this like you are?
It sounds like you sold, likemy podcast sold you, uh, but it
is.
It's a catch-22, right?
Because because then all of asudden, like if something
happens, that isn't what youwant, it's like oh man, like it,
(15:35):
there's so much more at stakeat that point.
Simon Oh (15:37):
Yeah they're looking for your axial accountability
post make sure you hit the mediawing, but uh, I think I think
that the reason I brought thatup in the first place was just
that make sure you hit the mediawing.
Soren Paape (15:46):
But I think the reason I brought that up in the
first place was just that, goodor bad.
One of the positives of TikTokis spreading awareness for the
fact that these procedures exist.
But there probably isn't alarge population, at least of
the people that I'm treating inmy office.
Most of the people in my officeat that age like aren't really
(16:07):
on TikTok.
Some are, but a majority arenot.
But it's it's good regardlessto to bring that awareness out
there.
Simon Oh (16:15):
Yeah, for sure.
I mean it's going to beinteresting what happens in
January when it gets banned.
I think Apple Store and Androidhave been told to stop putting
it on there January 16th orsomething like that.
I saw that yeah so it's goingto be interesting to see where
short-form video emerges.
Soren Paape (16:35):
to next A lot of teenagers won't be driving
around in lamborghinis anymore.
I know I've been.
Tyler Tolbert (16:42):
I've been working on my tiktok choreo for months
and it's just going to waste.
Soren Paape (16:46):
That was my plan b um, so let's uh, let's talk a
little about orca.
I mean, I would love to to hearyou know what, what the mission
of orca, what people can expect, maybe at what point you'd
recommend people going.
I know that you guys have kindof like the you can just watch
(17:08):
or you can go and actually getyour hands wet.
If you could give us a littleoverview of that.
A lot of our listeners are kindof at the stage where they're
doing a lot of all-in-four butmaybe they aren't getting into
remote Anchorage and they're atthat point now where Orca would
be an option for them.
Simon Oh (17:23):
Yeah for sure, orca is a very sort of unique and
special thing.
I think it's turned intosomething really cool.
It sort of started with justhearing about the problems over
there, so a very common practice.
There's a large population thatlive in villages where they
don't.
(17:43):
They have shoddy electricity,you know, no community, no
internet, stuff like that.
So a very common practice forfor this those sort of
populations, is to, when theyturn to become teenagers, the
parents actually get enoughmoney to send them into the city
, pull all their teeth, put themin dentures, bring them back
(18:04):
because a toothache is like alife ruiner.
You know there's no access tobasic care there.
So like that's sort of what'sgoing on over there.
So, you know, decades later, nobone, you know so.
And then after that, no toolsto help these people because you
know nobody had placed igosdown there.
So, um, they've been sort ofwalking around like this for a
(18:27):
long time.
And so, um, I heard about thisbecause my partner in orca, el
dadrory, um, he, he went downthere to do a singles implant
course.
He met rodrigo Cariaga, who'sthe head of implantology down
there.
He trained up at NYU, did theimplantology fellowship, amazing
people.
So they met each other and theysort of talked and Eldad had
(18:50):
known that I wanted to dosomething overseas to help
people.
I had always heard about CEcourses that were sort of um uh
in it for the for for sort ofthe education only, and then
there's no restorative plan.
You know, like it's crazy, um,you're just basically cutting
people open and leaving it, youknow.
(19:11):
So, like it's, it's crazy to me, and like I'm not having
follow-up, they're havingproblems not getting prosthetics
.
So, um, that sort of um, uhpiqued my interest because this
is at a university, this is atthe top university in Guatemala,
university of FranciscoMarroquin, which is highly
respected.
The facilities are unbelievablethere it's the nicest dental
(19:34):
school I'd ever been to, and sothat really was interesting to
me because, like, okay, itchecks the boxes, needing,
needed or population in need, agreat facility and people that
care, you know, like that, thosewere the sort of basics that I
needed.
So we went down there.
(19:55):
I placed the first zygomaticsin Central America a few years
ago Nice Congrats.
And this patient that had beenedentulous, going trying sinus
lifts over and, over and overwith no results for many, many
years I don't remember thenumber, it was like 30-something
(20:18):
years just no teeth.
I go in there, do a quad, puther in teeth.
She's just like crying, youknow like it's, and so, like
that, that I needed to alsoconvince the school that this
was, you know, because, like,nobody had heard of this before.
So, like, I'm here and do whatyou know, yeah, yeah, exactly, I
(20:39):
was like I have to make surethis case goes well.
What you know, yeah, um, madscientist, yeah, exactly, I was
like I have to make sure thiscase goes well.
You know, like, or else, likethis is gonna be horrible.
So, but we nailed it.
Uh, we got it done.
Uh, german lee, my lab techI've been working with for a
long time, came with me, did theconversion.
Um, we did it in the or undergeneral um, and it went very
smoothly.
Since then, they they were likeokay, okay, we believe in it,
(21:01):
but there's a lot of liability.
So we're like, okay, so theexpense that we take on by doing
this is rather high because wehave to provide for liability
and pay the school, which isfine, though, because I want to
make sure that the patients havereally good follow-up, really
good care afterwards.
(21:21):
So, um, that's sort of what itturned into.
We're like, okay, we can fundthis through education.
So I know a bunch of guys thatare really good at this.
Let's all get together, we'llhave a great time.
Um, we, we do level two, whichis conventional, all on four.
We do that in under anesthesiain the clinics.
(21:46):
It's under moderate sedation,sort of like a practice setting,
and so we do that there.
It's one to one mentorship,which I don't think anybody else
can say.
It's one-to-one mentorship withone of the best people out
there, very experienced, andthey're sort of over your
shoulder.
So it's a very orchestratedthing because we also have a
(22:09):
prosthetic course going on atthe same time so that we can get
everything done as if we're inthe practice at home.
So the prosthetics course isled by Dr Adam Hogan, dr Keith
Klaus, two of the verywell-known guys at this.
We're familiar, yeah, andthey're just great people too.
That's like one of my top rolesis no D-bags.
(22:30):
That's a very important rolefor me.
So we have those guys and theyteach the prosthetics course.
So sorry, I'm kind of all overthe place, but the way that
works chronologically is firstthe digital prosthetics team
with the participants comes inthe weekend before the course
starts.
They take all the records, theprerecords on the patients over
(22:54):
the weekend, design startgetting done and then on Monday
that's when we start.
So level two and three runsimultaneously.
Level two is the conventionalstuff.
So we pre-select these casesmonths before we get there to
make sure it's appropriate.
And we do it one-to-onementorship.
So the digital team will comein place the markers, do the
(23:15):
initial scans, and then thesurgical team will come in place
the implants and do whateversurgery is needed.
And then the surgical team willcome in place the implants and,
you know, do whatever surgeryis needed.
And then the digital team comesback in with photogrammetry.
Sometimes we do segmark withthe CT alignment technique and
do the the the other scans, andthen they get teeth right away.
So that's the protocol on thelevel three side.
(23:39):
It's a little different.
It's, as you know, as you guysknow, it's more invasive.
So full scope, remote anchorage, full scope, so anything from
zygos, pterygoids, transnasals,multiple zygos, multiple, you
know all these things.
So that's run in the operatingroom, it's the OR, so it's run
(24:01):
with one anesthesiologist eachin each room, not like you know
my experience and it's nasalintubation.
We scrub in, we go in.
Again, one-to-one care.
So you're paired up with aparticipant.
The faculty sits at the head,they split the case.
(24:21):
So one side is half, the otherside is half, and from there,
same sort of protocol.
Digital team comes in firstplaces.
A marker scans surgery iscomplete.
Post-operative scans wake up,go and we, we, we do it all day
(24:45):
long, uh, for four days, um anduh.
After that, you know, we, we doa debrief on the last day we
have fun each night.
Soren Paape (24:48):
You know it's.
Simon Oh (24:48):
It's a great time really good sort of very good
spirit, because everybodythere's there for a reason, you
know it's.
It's a purpose-driven sort ofthing.
Um and uh at the end of the thethe course, you know, uh, every
time we go down there, we'reroughly at like the 55 arch uh,
60 arch uh range in terms of howmany we've done that week.
(25:08):
Um and uh, uh, we measure eachtime the amount of edentialism
we stopped.
So, um, each time we go downthere, it's roughly 1200
years200 years of edentulismthat we've ended that week,
which is a pretty cool statistic.
So it's like 20, 30 years eachpatient has not had teeth.
(25:29):
So that's something that we'revery proud of.
We're really excited becausewe're ramping volume up soon.
So the university has seen oursuccess with how many people
we've been helping.
So they're actually building,uh, four additional operating
rooms for us.
So we're going to ramp thingsup in 2026.
(25:49):
Um, so that's really cool.
Um, you know we do this roughlytwice a year.
We're looking into increasingthat frequency.
Um, another thing to note isthat we are never sort of
limited by one vendor, so it'snot one vendor sponsoring the
whole thing, and we did thatbecause we didn't want them to
(26:09):
control, you know, theeducational process, the
protocol, and that way peoplecan sort of see what is actually
best for that clinicalapplication.
So we have many differentvendors that provide supplies,
and these are all people thatactually care.
They care to donate products tohelp these people out and be a
(26:30):
part of something that is sortof beneficial for humanity.
So, you know, and of coursethey get new customers.
Hopefully we want to helpsupport the sponsors too by
helping them, you know.
So you know, and of course they, they get, you know, new
customers.
Hopefully, you know, we want tohelp support the sponsors too by
helping them and so like it's avery sort of symbiotic thing
that we have going on.
It's very um, it's very wellcultivated, I think, because
people involved in it, um, butyeah, in terms of education, we
(26:54):
wanted it to be the besteducational experience and so
like there's there's no judgment, you know, we try to keep it
very, very friendly and thelearning experience to being
optimized.
So that's why we do the Zygosin the OR.
Under general, they areparalyzed, you know, because we
don't want to have to converseabout like hey, you need to give
(27:16):
more local here, or like, hey,they're really feeling it, or
you know.
So we want to be able to talkfreely and not freak the patient
out if somebody is not, youknow, at the right trajectory,
you know.
Tyler Tolbert (27:28):
So it's, it's yeah, exactly yeah, that's all
fat.
Simon Oh (27:34):
Yeah, hopefully not, but yeah, that'd be, that'd be a
bad day.
Luckily, we have never done that, but yeah, our success rates do
measure that we do care aboutthat Patients are being well
taken care of by the residencyprograms, so the prosthodontic
residency program and in fact weare planning to launch the oral
(27:56):
surgery program there becausethey don't have one.
One of the things we do on theside at the university, sort of
through ORCA, is we do a lot ofodd pathology.
So in Guatemala there's notmuch access to like really upper
end oral maxillofacial surgery.
So you know a bunch of myfriends, kathan Patel, steve
Yusupov, zach Brown, which isalso an ORCA instructor, and Joe
(28:22):
Camerata, who's an oral surgeonand plastic surgeon, which is
crazy.
We all go down to sort of cutout these enormous
amyloblastomas, huge tumors.
We did a myxoma of this onegirl.
I have the model right here.
Oh sweet, this was anine-year-old girl.
This is her jaw.
Tyler Tolbert (28:44):
Oh my gosh, geez I think I may have seen this
case.
Simon Oh (28:47):
That's insane, that yeah so, uh, obviously this is
from lack of access to.
Would you ever see this in thestates?
no, no, no chance right like nochance and so like that's the
sort of stuff that goes downdown there.
So, um, on the side we do a lotof these cases because the
faculty they're bringing to ourattention like hey, can we help
this person?
(29:07):
So I'm like, yeah, let's, let'sget all this stuff down, uh,
get all these people down, andwe go to the pediatric uh
hospital.
Uh, do these fibulas in the?
Or we've done a bunch already.
Um, we're looking to get left,left and palate and yeah, it's
sort of become like this thingwhere, like it's just driven
because we want to help thesepeople out, you know, and so
(29:30):
it's been really cool and wehave the resources and
connections to make it happen.
So why not, you know?
So that's sort of the long andshort of it.
With Orca, we're really excitedto see where it goes.
You know, we've gotten a lot ofinterest from other countries.
So we're talking with people inGhana through Tarun Kirpalani,
oral surgeon in New Jersey.
(29:51):
He's an Orca alumni and we hadcontact in Trinidad.
We talked to a team in PuertoRico.
So there's a lot of sort ofinterest there.
So we'll see where it goes.
But you know, again, it's verystrict in terms of what we need
is great follow up, great, youknow, patients that need it and
(30:13):
us being able to do it.
Tyler Tolbert (30:14):
So yeah, yeah, I mean that's amazing.
No-transcript.
Simon Oh (30:47):
You know, I, I think it just sort of goes.
I mean, that's just what I wantto do, and that's sort of the
idea behind smart arches, too,is like okay, like we could
charge 30, 40 000 an arch.
I've heard places in new yorkcharging like 200 grand for a
double.
Oh my god, that dude like areyou serious?
(31:07):
Like oh my god, like that.
Uh, that's like the.
The sort of thing with us islike we've we all found the hack
of digital which reduces ouroverhead, of course, yeah, you
know, it increases success, andso like.
Instead of yeah, I meanvalue-based pricing, higher, you
know, um, we made theinvestment, all these things,
(31:29):
better results, higher price, um, but for us, we actually
lowered it so that we can passit on yeah
Soren Paape (31:35):
more people you know it's, it's a good thing.
Simon Oh (31:37):
Um, you know, I'm also trying to figure out a way to
fund uh charity cases for thattoo.
Uh, dr brie smith, who you guysmay know, he's actually doing
stand-up at at the orchestra,really, oh, really hilarious, um
but uh, but yeah he wassomething called the halo dental
(31:58):
network.
I have heard that, yeah, yeah,they give out or they give
funding or connections forpeople to get their teeth done
by somebody who's willing to bephilanthropic.
And yeah, I've just been tryingto figure out how to get
consistent funding to do that inthe US.
It's just been a challenge.
(32:18):
I did meet some reallyinteresting people that you know
we can really make a differenceif, if, the strategy works out.
But yeah, time will tell.
Tyler Tolbert (32:30):
Sure, sure, yeah.
So we brought up the symposiumthere.
I definitely want to make surethat we talk about that, cause
that's coming up here prettysoon.
I think it was January 17th and18th in Las Vegas.
We're doing the there.
I've seen the lineup.
It's incredibly impressive, thekind of speakers that you've
gotten to come through.
So if you wouldn't mind givingus kind of an elevator pitch of
(32:51):
what people could expect if theyshould attend, yeah, you know,
we, we wanted it to be thesymposium to be a little bit
different.
Simon Oh (33:02):
For one, we wanted to be a little bit different.
You know, a lot of symposiumssort of talk about all the same
stuff the whole time.
You know that like, maybe youpick up one or two good things
every hour.
You know like that's, that'snot very efficient, you know.
So that that kind of botheredme and so we wanted to do
(33:25):
something a little differentwhere we had many different
topics from people in thatindustry, you know, and people
that actually practice thisstuff, and so get perspectives
from all different angles andget perspectives from people
that you normally don't talk to.
So, you know, we have we havethe Prasad with Dr Sven Bone.
(33:49):
You guys don't need to talk tohim.
He's not only a prosthodontist,he's also a mathematician and a
physicist the most credibleperson.
So he's talking about that,about PROS.
We have a slew of oral surgeonsat the top of the industry.
(34:10):
We got Juan, we got Camerrata,we got vichy, we got, you know,
steve yusupov and patel talkingabout microvascular and implants
.
Um, kamrata is talking about,uh, the facial skeleton, um, you
know, as it relates to fuller,and so uh and um, yeah, we have
(34:31):
ent.
So my brother-in-law is afellowship trained rhinologist,
so the guy that we usually he'sthe guy on the other side of the
curtain, you know, the guybehind me you know what I mean.
So, like, he's going to talkabout sinus disease and how to
manage sinusitis with, as itrelates to zygos, what happens
to the oral antral fistula, whatare the actual options.
(34:52):
You know we always hear FESS,but like there are many
different types of sinuplasty,you know.
So he's going to talk aboutthat too.
Anesthesia as well from youknow my anesthesiologist, dr
Goberon.
He worked in cardiac for a verylong time, so he's he's very
well versed in this stuff, um,so yeah, I mean, that's, that's
(35:16):
sort of it.
We wanted to be in a very coolplace which is going to be in
Las Vegas at the Wynn hotel, um,going to be.
There's going to be a lot ofdifferent sponsors, a lot of
great people there that you knowyou can talk to about products,
um, and then after, at the endof each of the days we're going
to, you know, have a great time.
You know, I think a lot of thepeople that sort of come to Orca
events are we're all sort ofintermingled, you know, we all
(35:39):
know who each other are, youknow, but like, maybe not all
that well, and so I think it'llbe a nice experience of not only
education and learning coolstuff, but also networking and
at a cool place, I think,especially in January.
we wanted to be somewhere wherethe climate's kind of, you know,
nice.
I can't stand January, February.
(36:01):
So you guys ever noticed theOrca events are in January and
February.
Tyler Tolbert (36:07):
There's no coincidence.
Simon Oh (36:10):
Yeah, so that's sort of yeah, yeah, that's that's how
that works, but, um, but we'rereally hoping that people have a
great time.
Um, we're, we're looking intothrowing a pretty cool party on
saturday, so, um, and thenfriday, I think there's like a
bowling event going on at night,um, so, yeah, uh, you guys both
coming so, uh, soren's going tobe on vacation.
Tyler Tolbert (36:33):
I don't know what he's thinking.
Soren Paape (36:36):
But yeah.
Tyler Tolbert (36:36):
I definitely intend on coming Tyler and.
Soren Paape (36:38):
Caleb are there.
They're instructed to take lotsof notes and fill me in on what
I'm missing out.
But I saw it like I think youguys post it like probably like
a year ago, maybe eight monthsago, and I was the first one to
post in the group.
I'm like guys, we got to makethis happen and then, of course,
I like forget about it, book myvacation and I'm at the point
(37:00):
now where if I back out of thevacation, my girlfriend would
not be stoked with me.
Simon Oh (37:05):
All right, this is the plan.
We're gonna get an optimistrobot, we're gonna put an ipad
on the head and we're going toget an Optimus robot.
We're going to put an iPad onthe head and you're going to
face the whole time as you walkaround the place We'll call up
Elon, one of those robots he hadat his convention.
Tyler Tolbert (37:22):
That's great.
I'm sure it's going to be areally good time.
Where can people go?
We'll put something in the shownotes to help people figure out
where to sign up for the courseand everything.
Yeah, I'm absolutely stunned bythe lineup.
I've never seen such astar-studded cast of Full Arch
folks.
You've got Dr Ole Jensen, DavidZellig, I mean you've got some
real OGs in here.
This is crazy.
Simon Oh (37:42):
Yeah, no, all the guys .
Tyler Tolbert (37:50):
I mean, I can't even list.
It's all people that deservetheir own sort of you know they
can all have their own symposium.
Simon Oh (37:54):
Yeah, exactly yeah, zellig Oli, yeah, all these guys
are just unbelievable.
Not only speakers andintellectuals, but also people,
you know, like they're goodpeople.
Again, that's like ourrequirement there.
But yeah, I mean you know our,uh, our requirement there, um,
but um, but yeah, I mean, uh,you know, uh, looking forward to
(38:14):
seeing you there.
Uh, so, aaron, you know, hope,uh, hope, you enjoy your time
with your girlfriend.
Soren Paape (38:20):
Uh yeah, it'll be, it's, it's been.
It's been like a couple ofyears since I've gone on a legit
vacation, so, uh, it's, it'llbe good.
I've gone on a legit vacation,so it'll be good.
You know I need it.
Simon Oh (38:31):
I need to take a week off, but I'm very annoyed that
it happens to be on the weekendof Orca.
Soren Paape (38:41):
Well, we'll let you know when the next one is.
Yeah, I'll definitely be there,and Tyler and I will definitely
be at the Orca in Guatemala atsome point as well.
Simon Oh (38:50):
Yeah, oh yeah.
I forgot to mention like, if,if you're not for people that
don't want to go into lifesurgery, you can just come down
and observe, be with us you knowwash stuff, that's also an
option.
So yeah, just you know,orcaglobalcom is the website for
all that stuff, you know.
Tyler Tolbert (39:09):
Perfect, perfect, perfect.
All right.
Well, dr O, thank you so muchfor sparing some time to come on
and talk about your story.
Your impact on not just thedental world but the world and
what you're able to do andtaking what we do and
democratizing it to so manyneedy populations is an amazing
thing.
I'm so happy to hear that it'sgrown so much since even just
(39:31):
the last time we spoke, sothat's really amazing.
I hope everyone you know seesthat.
You know ORCA is really thenexus of you know the people
that are really practicing thisat the top of our field and I
hope people are looking intothat.
You know, hopefully going tothe symposium and you know
they'll might find themselves inGuatemala or Tahiti or wherever
else you were talking aboutgoing with Orca.
(39:52):
So again, thank you so much forcoming on.
We really appreciate it.
We hope to talk to you againsoon and I can't wait to see
where you guys are next.
Simon Oh (40:00):
Yeah, sounds good.
Thanks a lot, guys for havingme and great to be here.
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