October 13, 2025 • 34 mins
The waiting room tells the story before we do: patients are traveling, paying more, and asking for three‑on‑six because it feels like teeth—thin, cleanable, and quiet—without carving bone to hide bulk. We sat down with Dr. Randy Roberts and Dr. Logan Lock efor a candid look at FP1‑based full‑arch care, and why a prosthetic‑first plan can upend old assumptions about high smile lines, bone reduction, and “the lab will save it” thinking.
Across a week in their clinic, we watched uncherry‑picked live seats, learned how every extraction and implant becomes a fiducial, and saw why direct‑to‑fixture workflows with internal angle correction make or break access. The mantra is simple but demanding: set the incisal edge first, design ideal teeth, then place implants to serve the prosthetic. That’s how segmented bridges seat fast, phonetics settle quickly, and hygiene stays human. We also walked through high smile line protocols that often avoid macro reduction entirely—suturing tissue to the prosthetic and letting biology re‑establish space—sometimes with nothing more than a subtle 2 mm contour to adjust lip support and display.
For clinicians, this is less about picking a side—FP1 vs FP3—and more about expanding options and matching them to the right patient. Younger arches with good bone and tissue deserve a conversation that preserves structure; complex FP3 remains essential when indications call for it. We compare cost positioning, outline a sane training path that builds from solid FP3 into guided FP1 before extreme anchorage, and share the thousand tiny steps that keep a 30‑minute seat from turning into two hours. Most of all, we talk value: why educated patients don’t want the cheapest full‑arch, they want the thinnest, most natural, and most durable one they can maintain for years.
If this conversation sparks ideas—or challenges your habits—hit follow, share the episode with a colleague, and leave a review with your biggest FP1 question. Your feedback guides future deep dives and live case breakdowns.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:40):
My name is Dr.
Tyler Tilbert, and I'm Dr.
SPEAKER_02 (00:43):
Soren Poppy, and you're listening to the Fixed
Podcast, your source for allthings implant dentistry.
SPEAKER_01 (00:49):
Hello, and welcome to a very special edition of the
Fixed Podcast, one of our firstcrossovers with Dr.
SPEAKER_03 (00:55):
Randy Roberts and the Three on Six Podcast with
Dr.
Logan Lock.
Dr.
Soren Poppy.
SPEAKER_04 (01:02):
Dr.
Caleb Stodd.
Yeah, this guy.
SPEAKER_01 (01:05):
Yeah, so this is Fixed on Six.
And so here we are, you know,the regular Fixed Podcast guys,
and we're we've come out to thiscourse to learn what all the
fuss is about when it comes tothree-on-six.
We've talked a little bit aboutFP1 modalities on our show
before.
We've always been a little bitwary of it, you know, more show
a lot of concern for a lot ofthings that we've already talked
about.
(01:25):
You know, if you got a highsmile line, you got uh you know
implant failures being harder totake care of, um, higher patient
expectations, perhaps, all kindsof things, gum recession.
All these things uh you knowhave really kept us away from
that type of modality for a longtime.
But we've been seeing thisthree-on-six stuff for so long.
Of course, we've had um Dr.
Locke and uh Dr.
Roberts on the show before, andnow we're really getting to see
(01:47):
you know how the sausage ismade, right?
We've been in the clinic, we'vebeen looking at their post ops,
uh, looking at their deliveries,learning the whole surgical
process.
We'll actually be doing surgerytomorrow.
Of course, we're gonna talkabout that eventually.
Um, and uh we're here to share alittle bit about why all the
folks, I mean, we have a verylarge audience of people that
are doing tons of FT3, signs ofimplantology, why they might
need to open their eyes a littlebit to what's going on here.
(02:09):
So I'd really appreciate it,guys, if you could give us a
little bit of background aboutwhat 306 is for those that are
uninitiated and what it's becomeat this point and what it means
potentially for providers.
SPEAKER_03 (02:18):
Okay.
Well, I'll start.
Um, I feel like uh the reasonthat you guys are interested and
potentially um other doctors isreally because the patients are
driving this.
It's something that as we'vebeen doing it and getting good
results, our patients are soexcited and happy that they
found this and that it's at areasonable price.
(02:38):
And they're like, How did I notknow about this?
I almost did the other thing,and there was no coming back
from that.
And when they got this and theyfound out that it was like
having teeth in their mouthagain, and and so they become so
excited about them, like tryingto tell the world, they're like,
No, no, no, you have to do this.
Like this, I didn't know, and Ialmost did that too.
And so we've got thesecheerleaders that are going
(02:59):
around, and a lot of doctorslike you guys are finding out
about it and finding out the theextent of how much patients love
this from the patients.
And it's it's like I've beentrying to tell people I think
it's better for many years, andpeople are like, Dr.
Roberts, we're pretty sureyou're done.
And you know, and maybe they'reright, I don't know.
But but my patients, they andDr.
Locke's patients and the doc andthe three-on-six patients around
(03:21):
the country that are getting itdone from our providers, they're
so excited and so happy aboutwhat they're getting.
SPEAKER_00 (03:27):
We love when we get doctors that come to the course
because patients are pushingthem.
And those are the best kind ofdoctors because they're looking
out for the interests of theirpatients, they hear it in their
offices, and we love to knowthat they're hearing it in their
offices.
And so to uh to get doctors thatcome out because patients are
driving that is a huge testamentto what 3 on 6 is and how much
(03:51):
patients love it, just like Dr.
Roberts said.
SPEAKER_02 (03:53):
Yeah, I think it's uh it's very important for
clinicians to have um justdifferent options for patients,
right?
Um, you know, in our office wedo a lot of FP3, that's kind of
typically what we're doing.
Um, and you know, a lot of thepatients that are coming in to
our offices for the treatment,they are at a place that maybe
they've been in addenture forlike 20 years, and and doing an
(04:14):
FP3 is totally comfortable.
But but those patients who uhmaybe are a little bit younger
in their 40s who um still havethat good bone and they aren't
in a situation where uh you knowthat we need to remove all of
that bone, it's in a wonderfuloption to provide.
Um and ultimately it's gonnacome down to the patient's
decision what their goal is ifthey're looking for for function
(04:35):
or aesthetics or whatnot.
Um, however, being able to offeryou know that treatment to the
patients and give them theoption of, hey, you can have an
FP3, maybe it's a little bitcheaper for you, or if you want
this FP1-based prosthetic, it isgonna be thinner, maybe have uh
less less um like sound whenthey're coming together, feel a
little bit more natural, um, butit will be a little bit more
(04:58):
expensive, and then give thatpatient the choice and let them
decide.
SPEAKER_01 (05:02):
Yeah, I definitely like that it's it's a higher
order of service, right?
And it it also helps set someexpectations, even if someone
does eventually go down the FP3road, yeah, maybe due to
finances, they understand thatthere was a road that they chose
not to go down that may havegiven them that more natural
feel.
They may have not had some ofthe phonetic issues they deal
with.
Um, you know, maybe they itwould have been a little bit
(05:23):
less accommodation.
So at least they're primed tounderstand that they didn't
choose to go that way.
And now that they're they'rechoosing a path where there will
be some more accommodation,yeah.
Maybe they are gonna have somebone removed, right?
Like they they can kind of, youknow, it's allowing them to
choose that path and not justhaving them, you know, face
those sorts of consequenceslater on.
Um and uh, you know, I Idefinitely think that where a
(05:44):
lot of of friction has comeabout in the conversation
between FP3 versus FP1, FP1versus 3 on 6, whatever, comes
from this sort of ether ormentality, the one or the other
is somehow just better foreverybody.
I don't necessarily think that'strue.
And now I will say that I havebeen very impressed and humbled
by some of the cases that youguys have been able to fit in
this three-on-six box becausesome of the ones I've seen I
(06:07):
would never have predicted wouldhave done that.
Um, but you know, I I think thatwe have to see a world where
these two things can coexist andthere are appropriate situations
for different patients.
Um and there is also a financialreality of it as well.
Like, three on six shouldn't beas cheap as all on X.
It shouldn't, because it'sdefinitely not the same thing.
(06:28):
I mean, and frankly, it's justnot um, I mean, all of us know
this is there's just not nearlyas much orchestration that has
to go into doing an all-in-iscase.
Like if you are capable oflaying a flap, finding bone, and
just putting it in relativelythe right spots with the right
sort of timing and things likethat, you can be very successful
in the lab.
We'll do a whole lot of work tomake that case a slam dunk.
With this, that it does not workthat way.
(06:49):
You don't just walk in withoutreally knowing that case.
Um, and you have to know everyextraction, every tooth is going
to be used as a fiducial, everyimplant, every implant size,
where you're trying to come out,exactly what kind of correction
you're getting, because youraccess holes are gonna have to
be money for this to really makesense, you know.
SPEAKER_00 (07:04):
Yeah, you don't give yourself enough credit as far as
the FP3 side of things goes.
Because we, you know, Randy andI see a lot of of cases come in,
and I know and I've seen a lotof what you guys are putting
out, and it's uh on the scale ofFP3 side of things, I think it's
the most stable, the some of thebest stuff that's that's out
there.
I appreciate it.
Um but it is a it's a differentworld, and it's a really
(07:27):
rewarding field to be in.
And you guys, as part of thistraining, we have um been seeing
a lot of live patients, patientsthat came through our last
training, and you've seen thatthere is it's fairly
predictable.
I mean, we had three final seatstoday, and all three of them,
they're not cherry-picked by anystretch of the imagination, and
they uh they look good.
(07:48):
Patients are ecstatic with theresults, and it's something that
can be done predictably if kindof the recipe is followed.
SPEAKER_03 (07:55):
And that's something that a lot of the doctors that
have come through our coursehave said that they've never
seen before, that they got toactually just see the patients
that were on the schedule forthat normal time to just get the
normal work done, right?
Normally doctors are onlycherry-picking patients and
being like, oh, come look atthis patient up.
Yeah, okay, here's the patientthat's on our schedule.
We're going to seat their teethon, or we're gonna take their
scans just because this is whenthey're scheduled for it.
(08:16):
Right.
Yeah.
And so um you got to see threeof those patients um that had
beautiful teeth and beautifultissue, and that have, you know,
and the first two actually werefrom training.
So those are from doctors thatwere just learning, learning how
to do it last time with the witha beautiful result.
SPEAKER_02 (08:32):
I think it's important too because um we got
to see, you know, how you guysmanage certain uh complications,
not necessarily complications,right?
But like um, you know, if abridge isn't seating exactly
properly, like what are theprocesses that you guys are
taking to make sure that seats?
And every dentist, no matterwhat treatment you're doing, but
especially these full mouthcases, you're gonna run into
(08:54):
those little things.
And those little things are whatcan make a you know, like a
seating appointment that'ssupposed to take 30 minutes turn
into like an hour and a half,two hours.
Yeah.
Um, but if you cat catch theselittle like gold nugget tips and
see how you guys are seatingthese segmented bridges, um it
does go a really long way forthe doctors to ensure that
they're feeling comfortable whenthey're doing, you know, not
(09:16):
only their surgery appointment,but also that post-op care.
SPEAKER_01 (09:20):
Yeah.
Yeah, and I think one thing toois uh, you know, especially
talking about the the deliveriesand like how you maneuver these
types of things, not only is itdifferent because you're working
with a segmented bridge, butsomething we've also been able
to see here, which is somewhatfairly new in our spaces, maybe
not new, but it's new again, isthe direct-to-fixture aspect of
it, like taking out themulti-unit.
That's something that I I mean Ihad no clue.
(09:41):
You know, I mean, I I kind ofwent straight into all in X and
and using multi-unit andrestoring at a multi-unit level.
And I do some single unit stuff,some bridges here and there, but
it's never really been my hugeforte.
And now this whole case is isit's F V1 direct-to-fixture.
How do you navigate a full mouthof that?
And for me, that was very, veryintimidating.
I'm seeing how you're able tomake it more predictable.
(10:01):
Um, but I'm also seeing why, youknow, a system like TRI
potentially makes this a wholelot simpler, right?
Especially when it comes to thetiming aspect of things.
That's another thing I was veryconcerned about, is like in how
you make these cases work.
And doing that direct-to-fixturethat has its own internal angle
correction seems to have madethat a little simpler for you
guys.
Um, so that that's I thinkthat's where a lot of us have
(10:22):
been humbled and trying to workthrough that and and learn what
that might look like.
Um, if maybe that is the bestway to do this type of cancer.
Yeah, yeah.
SPEAKER_00 (10:30):
Yeah.
Yeah, we and that's something wework heavily on, and we see so
many of these patients, andRandy does a great job at
putting in the time andresearching different ways to
make the process simpler and tomake the results better and to
get thicker tissue around theimplants.
And he's doing this stuff whileI'm trying to figure out okay,
how do I simplify it so we cantrain the doctors?
(10:52):
And then once I start seeing hispictures, really it's me going
in and be like, oh, this looksreally good.
Like this is starting to, thisis looking better than my cases.
It's time to implement this newthing into what I'm doing and to
what we're pushing out to all ofour doctors.
And I think that's one of thegreat things about 3 on 6 is it
is a constant work in progress,and we are just trying to push
(11:14):
the limits on what we can do asfar as FP1 goes.
And um, we're constantly tryingto make it simpler for our
doctors and more predictable forour patients and on our fan
clubs that are out there thatthey're getting the same result,
you know, in Boise that they'regonna get here in Salt Lake, so
they can stay at home.
SPEAKER_04 (11:31):
I yeah, one yeah, one thing I noticed like my
biggest takeaway from being herewith you guys is you you're not
afraid of innovation, right?
That's what you're talkingabout.
Where we we came and you havemultiple different implant
brands, you have like everysingle type of photogrammetry
unit, you have differentscanners, you have all the
different lasers.
Like, really, if you wanted totour or to go through a museum
(11:52):
of all the different things thathave been involved, like like in
dentistry, then you could walkback here.
I swear that you probably havelike a pedal drill somewhere
back here.
So, um, and I think it takes alot of humility to do that to a
lot of our mentors, right?
Um, as we go through and kind oflearn this, and there's been
evolutions of this throughouttime, they're really stuck in
their way.
And maybe it's not for theworst, but sometimes it's not
(12:14):
for the best.
And you get a lot of, you know,nobody's really accepted when
you're the only one talkingabout something.
And and I bet Randy's had todeal with a lot of that
throughout her career.
Um, but with time and withexperience, you're you're
proving what's possible andyou're pushing limits.
And these limits are better forpatients in a lot of ways.
I know there's a lot of patientsthat I've had that have received
(12:35):
really good treatments given theinformation that I had at the
time.
Um, but there's also some thatcould have benefited from
three-on-six so much more thanjust, you know, doing six
implants and having pterygoidsand stuff like that.
So that that's been my biggesttakeaway is humility,
innovation, never afraid toreassess what you're doing.
And it's not about you.
Like with a lot of a lot ofinstructors out there, it's
(12:57):
actually more about the ego thanit is about the process or the
patient.
And with you guys, I candefinitely feel that it's it's
not about you, it's more aboutyour patients 100%.
I loved seeing that.
SPEAKER_03 (13:06):
Yeah, and we love bringing on doctors like you
guys because we always feel likewe can do better and we can be
better.
And when we bring on awesomedoctors, like you guys are
always also being like, like ourconversation earlier, like with
taxes and stuff like that.
And you're like, we can help youout in these different ways.
And it's like, and also there'sdifferent ways, and also with
the surgeries and differentthings where our doctors help us
out, and we all kind of growtogether.
I feel like this is a a bigfamily, and like you said, we're
(13:28):
we're trying not to have egosand we're just trying to all
work together and figure out howwe can make the best products
that we can for our patients.
SPEAKER_02 (13:35):
Yeah, and ultimately that's what it comes down to is
just um creating the skill sothat we can treat our patients
with the the best possible care,you know.
And when they come to ouroffices, like I see patients all
the time that um, and we talkedabout this a little bit earlier,
Randy, but they go to like thecheapest provider on the block
just because of the cost, andthey just don't understand that.
(13:58):
And it's it's difficult to wetry to put out content on our
YouTube and whatever to portrayto our patients like, hey,
everything is not all the same.
It's not just like you're gonnaget implants placed this the
exact same way every singleplace.
Maybe it feels like that for thefirst year or two, but once
those implants start um, youknow, degrading a little bit,
(14:19):
you're in a situation where thattreatment cost that you saved is
gonna end up costing you a heckof a lot more when you go and
have to have it redone.
Um so it's important forpatients too to uh to listen to
stuff like this, right?
Um, or for us to to give that uheducation to our patients so
they understand that, hey, maybedon't fly to to Mexico or fly,
(14:43):
you know, to to wherever it isto get this treatment done, not
because there isn't greatdoctors there, but because it's
harder to determine what is agood provider and what isn't in
these other countries.
Um and ultimately I know plentyof great providers in these
other areas.
However, if you go to somebodywho's been to like three on six,
(15:04):
been to Orca, been to a lot ofthese courses, you'll know that
you get you're going to a solidclinician that has spent the
time on the weekends where theycould be doing other stuff to
excel and be a better clinician.
SPEAKER_01 (15:15):
Well, I think something that you guys have
done that's so impressive iswhen we first started Smile Now,
we identified that, you know,across the market of all in X
providers, there's a race to thebottom happening.
And I think there's a lot ofassumptions being made about
these patients that reallyaren't fair.
And it's that, you know, they'rethey're bargain vendors, right?
(15:36):
They just they price shop,they're looking for the cheapest
number, they'll go to the sm thelowest number that they can see.
And that's why we're seeing someof these cases that are being
done for eight, ten thousanddollars an arch or something,
and people are going way out ofthe way to just get the cheapest
possible thing.
And we try so hard on ourcontent side to really build
value and make people understandthat it's you know, you you
don't buy a chicken sandwich atWendy's and Chick-fil-A and
(15:58):
expect the same product, right?
And uh what you guys have donehas shown that this patient
base, there is a verysignificant contingent that is
willing to spend more money forvalue.
Yeah, if it's somethingdifferent and they know it's
something unique, they will gofor that.
And they are coming fromliterally all over the world to
come get this done.
And you guys have really shownthe value of what you're doing.
(16:21):
Like, and and these are verywell educated patients, they've
done their research, they're notvaluable, like they they have
really gone through Reddit,through Facebook, they've
learned so much about anthology,right?
Um sometimes.
Sometimes, sometimes they haveto ask the question.
I'm like, hmm, I might need tocheck this in the other room.
And and they do appreciatevalue.
(16:42):
And so I think that it reallybrings a charge to full arts
providers around the country toask themselves how can I convey
value and value what it is thatI do and not just feel like I
just have to keep doing this forless and less money over time,
because that, of course, is aself-limiting belief.
Like that cannot, you know,persevere through our time.
And so, you know, it really soldme that not only is it a value
(17:05):
for provider to come here andlearn how to do this kind of
thing, but patients will seethat and they will value.
And it's it's it's much easierto do that when there's
something like that, right?
When there's something likethree on six that can then vet
and validate you as a doctorthat can provide it.
And two, what I what I'd beensurprised on, and and I think
that a limiting belief that alot of people that see
three-on-six will have is thatsome of this is cherry-picked.
(17:26):
Anybody can take a photo oftheir best case and put it on
Facebook and say, hey, look whatI did, right?
But that is not what's happeninghere.
I mean, you guys have done overa thousand of these.
We've seen these patients comingin and out.
They're not cherry-picked.
We've seen things that maybeweren't totally perfect and they
need to be worked on, but likeyou're getting to this result
and these photos veryparticularly.
I mean, I saw your phone, right?
SPEAKER_00 (17:46):
Yeah, we I we pop up the phone on the screen and it's
I think your case goes the lastweek.
SPEAKER_01 (17:51):
It's very consistent.
And it's, you know, I I thinkDanny Domain said this in one of
his talks over ICY or somethinglike that.
It's like, don't show me yourbest case, show me your last
one.
And I know both of you can showus your last case, and it's
going to match that samequality, the same stuff you post
on Facebook.
So there is a system to do thisfor patients, and there are
patients that do value this.
So that calculus should show youas a provider that there is
(18:13):
something here that you shouldat least give some time.
unknown (18:15):
Yeah.
SPEAKER_03 (18:16):
Well, thank you.
Yeah, it's uh definitely been ajourney to get to where we're at
right now, where we're gettingthese predictable results, and
so many different techniques,like the uh like the one that I
don't know, I feel like I'vegotten so much crap over all
these different things.
I I'll go on different Facebookgroups and I'll say, hey, um,
healing tissue by secondaryintention is really helping me
to grow a lot of tissue.
And everybody's like, what areyou talking about?
(18:37):
I'm like, I'm just saying what Inoticed when I'm doing it this
way.
Yeah.
Right.
And like it's all these peoplegive me so much crap.
I'm like, yeah, I won't sharewhat I'm learning with you guys
if you're all gonna be pissed atme for sharing.
Right.
But I feel like I've gotten somuch of that.
It's been a journey, is what I'msaying.
Yeah.
To get to this point where we'regetting predictable, beautiful
results, and it's required.
Like, I don't know, you've seenthere's probably like a thousand
(18:59):
things that Logan taught youover the week.
So many little tiny things thatall add up to uh one thing,
right?
But if you miss any of thoselittle tiny things, then the
final result is off a littlebit.
And like each one of thosethings makes a little bit of a
difference.
So it's just uh it's it'sawesome to be where we're at
right now, but it's been a longand hard journey to get here for
(19:22):
sure.
SPEAKER_02 (19:22):
And I'll say too, we, you know, something that
we've been very uh cautious ofis when we place our implants,
we want to make sure ourpatients are getting the
thinnest prosthetic possiblewith our FP3 cases.
That's always been a hugephilosophy of ours.
You know, when you have apatient that's class two, like
angling the upper implants backand the lower ones forward to
(19:44):
kind of correct that and makesure that that FP3 they're
getting is incredibly thin.
Um, but we've taken a lot oftime to learn how to angle our
implants properly and do thosethings in our offices.
And something that I see a lotin coming here, we also got a
lot of tips for how you guys dothat to make your prosthetics as
well.
But I think something that a lotof doctors need to improve on is
(20:07):
to think about their implantplacements prosthetically, not
just where maybe there's themost amount of bone, but what's
the most comfort for patientswhile also considering the
amount of bone.
Um, and coming to a course likethis is gonna kind of open their
eyes to the abilities of, youknow, we don't want to be
looting a denture in thispatient's mouth.
(20:28):
They're not paying$40,000,$50,000,$60,000 to just have
this big hunk of zirconia, youknow, stabilizing the mouth.
They're paying for that to havea functional set of teeth, a
body part that's as close towhat they had previously as we
can provide.
So uh that's something that Ithink is really, really
important that I want moreclinicians to really consider
(20:49):
when they're treating thesepatients.
Um, because ultimately, anyclinician that's doing this
procedure, you know, it's it iskind of the visual of all on
four, all on six, three on sixfor the whole um culture.
And we want to make sure thatevery provider that's doing
these does them well.
Um, and taking time to, youknow, come to courses like this
(21:10):
so we can so providers can learnhow to improve and make their
prosthetics thinner for thepatients is gonna go a really
long way, not only for thatclinician's abilities, but also
the industry as a whole, um, toensure that patients understand
that the difference between adenture and a prosthetic is
incredibly valuable, right?
(21:31):
And the difference between uh aset of teeth and that truck they
were gonna buy, right, it's moreimportant to get that set of
teeth.
SPEAKER_03 (21:39):
Um I also feel like it's really important that all
of the doctors who are placingFP3 also can do FP1 so that they
can give that or at least telltheir patients that that that
that's an option.
Yeah.
Because I feel like if theydon't know how to do FP1,
they're not going to give it asan option.
Their only option will be FP3,which means even if they have a
29-year-old with perfect boneand tissue, they say, well, your
(22:00):
teeth need to go.
The option are dentures or FP3,and we're gonna have to chop
away your bone.
And so without even being ableto tell them, there is an option
where we can give you a fullmoth of implants and save your
bone and your tissue.
I feel like that needs tohappen.
I feel like that needs to bepart of the conversation.
And so I I think that if thatpatient finds out that this was
(22:20):
something that exists the dayafter surgery and they're like,
hold on a second, I could havehad that when this happened,
then I think that doctorpotentially is could be in
trouble with that patient.
And so I just feel like it'simportant for doctors to be able
to at least give that as anoption or let at least let them
know that that's uh available inthe market if it's not something
(22:40):
that they're able to do.
SPEAKER_04 (22:41):
Where would, yeah, following up on that, like where
would you rank the way that youguys teach about how to do FP1?
Where would you rank that ifthere was a hierarchy of
difficulty of different types ofimplants, right?
So we have we have justtraditional, um, and then you
have like pterygoid, you havezygomatic, you you have FP3.
Where would you rank what you doin comparison to those?
SPEAKER_00 (23:02):
It's funny watching it because I I've had the um
blessing to watch some reallytalented surgeons do some
insane, some really beautifulFP3 and quad zygos and you guys
with pterygoids, like there'ssome finesse to all of it.
And so I don't know that one isnecessarily um you know,
(23:23):
watching that that is adifficult thing, and you have to
deal with difficultcomplications.
And but I do feel like FP1 has acertain finesse to it.
Um and artistry and it requiresand and a lot of planning and a
little bit more background inall of the things to be able to
accomplish it perfectly.
(23:44):
You know, we talk about umatriumatic extractions and being
able to get the teeth outwithout breaking bone and
starting there.
So we have to start teaching atthe you know, something that
most doctors are very familiarwith, but maybe not as careful
as we have to be in order to getthe best results possible.
And then we go through you knowthe planning and the guides and
how to seed a guide and spendingthe time to do that.
(24:06):
And so there is a there is afinesse to it, and then tissue
management, which is a littlebit more important than FE3 in
most cases.
So um I would put it up there,but I think uh you know,
watching you guys do your workas well, there's that's
complicated too, and you have togo through a lot of training to
be able to do those remoteanchorage to do the kind of
(24:27):
stuff you're doing as well.
SPEAKER_02 (24:28):
I will say that um in my opinion, and kind of going
off of your question, is thatyou know doctors definitely can
provide FP1.
Like if they have good fixed,like all on four based
treatment, I think FP1 is agreat next step.
Um I would prefer to have theability to do FP1 guided in my
office before jumping into likezygomatic and like these crazy
(24:51):
remote anchorage-basedtechniques because you know, a
lot of the reason that doctorsgo to do those remote anchorage
techniques is to open theiroffice up to more potential
patients, right?
But those more potentialpatients that you're opening
your office up to come with alot of headache, a lot of
complications that that providermight not be fully prepared to
(25:13):
um handle.
Whereas going from, you know,just traditional all-in-for FP3
to like guided FP1, that's apretty easy jump.
Um, and it's gonna mean a lotmore care about tissue and
focusing on these things, whichthen is a good um accelerant to
doing like zygo and some ofthese other cases where you
(25:36):
might not think about it, right?
It feels more macro level, butultimately you're gonna have
oral anterior communications,you're gonna have issues with
tissue that you need to solve.
Um, so I feel like it that wouldkind of be what I would
recommend is, you know, like wealways say, get really good at
basic surgery over or regulardentures, then snap-ins, then
(25:57):
your most basic all on four, andmaybe like a little bit more
challenging all-in-for, so youcan solve some of those implant
failures, palatal approach,pterygoids, but then jumping
into FP1 is where I wouldpersonally jump to prior to
getting into like transcinus andzygomatic and some of these
crazy surgical techniques.
SPEAKER_00 (26:16):
Yeah, I think often it's the the biggest one of the
biggest concerns we hear a lotis the complications of FP1
because we're dealing in anaesthetic zone and there's not a
lot that you can hide.
Um but overall the complicationsfor us are fairly minimal.
SPEAKER_02 (26:32):
If you do them, like you said, with all the little
tips.
SPEAKER_00 (26:34):
Yeah, if you do them the right way and you're
preparing yourself for thefuture, then you know some of
our biggest complications are animplant fails, we take it out
and we do a new prosthetic overfive implants instead of six.
Or we take it out and we shiftit and we make a new prosthetic.
SPEAKER_03 (26:49):
Um or the teeth are slightly longer, you know, and
that's I think that's one of thethings that most doctors are
afraid of.
They're like, what if I do itand the teeth are a little bit
longer?
And in my experience, I've had aton of patients whose teeth are
slightly longer in some areasthan others, and and even some
of the ones that I post topeople, and I'm like, um,
they'll say those lookbeautiful, and probably won't
(27:12):
notice that that canine is amillimeter or two longer than
the other canine because it hasa little bit more tissue or
whatever.
And it's not necessarily a hugecomplication because most
people's natural dentition lookslike that.
They don't have perfectly exactsame tissue heights on every
single tooth.
And so if it's slightly off, notthat big of a deal because you
still have all of the advantagesof your teeth being so much
(27:32):
thinner, so much easier toclean.
Um, so for me personally, Ithink that even if like I think
that the doctors should belearning this before doing the
FP3s, just because I think thatworst case scenario, they just
have longer teeth that are stillnarrow that feel more
comfortable.
Like it just might not look asnatural for the doctors doing it
their first time.
(27:53):
Like maybe they'll break offmore of that buckle bone, and
maybe the gums aren't going tolook as perfect.
In my experience, the patientsdon't super care most of the
time that their gums lookperfect, they care that their
smile looks really good, andyour gums don't most of the time
really show all that much.
So making sure, and that's oneof the things that the lab is
taking care of for you, makingsure that the smile looks really
(28:13):
good.
Um, and making sure that thegums look perfect, that's more
on the doctor, and the newerdoctors are probably gonna have
less perfect gums than thedoctors that have more
experience.
Yeah, but even still, I thinkthat that's something that
they'll have to learn, startlearning at some point.
And having that restoration beso much narrower has so many
advantages that I I'd ratherhave them be starting there than
(28:35):
starting with the FP3.
SPEAKER_01 (28:36):
You know, something that I think is uh, you know,
kind of uh the trend, right, isas a person goes through their
progression as a surgeon, isespecially in the FP3 world,
it's always like you're gettingmore advanced as you take cases
on that have less boneavailable, right?
It's always how do I make FP3work when there's less and less?
(28:57):
So, you know, what if we don'thave zone two bone, right?
What if we don't have a wholelot of zone one bone?
What if, what if uh this area issuper thin, you know, whatever.
Let's go to a terrible, let's goto a zygote, let's deal with
less and less and less.
And you know what?
That is a growing problembecause we keep approaching all
these cases with an FP3mentality and we keep hacking a
lot of bone away, right?
Well, what if, though, the moreadvanced thing to learn is what
(29:18):
you do when there's more bone?
Because maybe the answer isn'tjust to get rid of that, right?
So, like one of the main thingswhen I was first learning about
FP1 versus FP3, which is youknow, FV1 is usually just kind
of a it gets glossed over, leaveit to the prostodontist, don't
worry about it, right?
Is what if the other patient hasa high smile line?
And that used to be anindication in my mind you
shouldn't do FP1 because youdon't want the gums to be
(29:39):
visible, right?
We're supposed to hide our work,right?
But one thing I've been sold onwith you guys is that no, you
don't, that does not mean youneed to do FP3.
In fact, that's one of the worstthings you can do because now
you're gonna be removing evenmore.
You're gonna remove 15, 20millimeters to try and make this
case work and try and fit intothe FP3 world.
And so we've seen tons of cases,some of them live today, like in
the chair, that had high smilelines.
(29:59):
And either you preserve that,and this is entirely based off
of patient accritations or whatthey wanted, um, or you reduced
it and actually left some gungon purpose and made it
absolutely beautiful andharmonious without even actually
removing that much bone.
So can you guys talk a littlebit about how 3 on 6 approaches
those high smile line cases, howyou're able to plan for that,
what's the approach like, howmuch bone does get removed, how
(30:21):
does the prosthetic make thatwork?
SPEAKER_00 (30:23):
Yeah, so the way we the way we generally train it, a
lot of it depends on how um howmuch of a gummy smile they have,
how high that smile line is,where the teeth, where we want
the teeth to end up.
But um a lot of doctors come tous and they ask for like.
Like a bone reduction guide,something to help them create
that architecture.
(30:43):
And I often have to steer themaway from doing something as
macro, we talk about micro andmacro, doing something as macro
as that.
Because really, what we try anddo is we use our prosthetics.
Our lab is trained to createpontic sites, to create
natural-looking aesthetics.
We want to use the prosthetic toguide the development of the
(31:04):
bone and the tissue.
So oftentimes in the cases thatwe did, we are removing very,
very little bone or none at all.
Maybe we're just putting theprosthetic right at the bone
level.
And what that does over time,um, as we suture the tissue to
the prosthetic, it's going toallow resorption on its own, and
we get rid of a gummy smilewithout taking a bird in.
(31:28):
It's a guided bone degeneration.
SPEAKER_03 (31:31):
So really we're guided bone loss.
Yeah, that's right.
So really we're shooting for theincisal edge where we want that
to be.
Yeah.
And then we're going up fromthere for what the ideal teeth
shape and length are.
And so we're going to say, okay,this is where I want the incisal
edge, and then the lab will planthe rest of it up from there.
So, and we're using ourinstaresa scan so that we can
know exactly where their smileis with their picture, where it
(31:52):
is in their bones, so that wecan map that all out before we
start.
Um, so then we have our idealteeth, what their ideal shape
and size, and that's going to beadjusted depending on the size
and shape of the patient's mouthand their lips.
And so normally we're going overthat with our patient or with
our lab uh before we'll evenstart placing the implants in
(32:13):
the surgical guide.
So we start with the prosthetic,we start with where the incisal
ledge is, and then we will startwith that design.
Once we know exactly where theteeth are gonna go, then we're
gonna start designing theimplants and so that we can
start knowing exactly whatangulation those implants need
to be in so that they can uh sothat the screws can be coming
out at just the right spot.
SPEAKER_01 (32:31):
And what depth and what depth the implants are to
then guide that, to then raisethat smile line, raise that.
SPEAKER_04 (32:38):
I did I had a periodonist in the military that
taught me um that you can eitherdo clinical crown lengthening
with a burr or you can do it byinvading the biological width.
Yeah.
Right.
And that's what you're talkingabout.
That's essentially.
So you just you just invadethat, you put pressure on the
bone, the the body's gonnarespond accurately, it's gonna
re-establish the biologicalwidth with the like attempting
to get that three millimeters ofgingival tissue.
SPEAKER_00 (32:59):
So Yeah, and we had two of those cases today, your
case and and one of ours fromour training patients uh three
months ago.
And say we didn't we didn't Idon't know if you took a bird of
years, but during the training,we didn't we didn't touch the
bone at all.
And you saw the reduction in howmuch gum she was showing when
she smiled.
It's purely based on theprosthetic alone.
SPEAKER_03 (33:18):
On mine, she had about like six millimeters of
gum showing when she was smilingbeforehand, and I removed about
two millimeters, and on her herbone was coming out pretty far
at a like an angle facially, sotaking off two millimeters
brought it out, uh brought itback and brought it down.
So but anyways, it made a muchmore aesthetic.
SPEAKER_04 (33:38):
I think that case too, because that was kind of
one of those aha moments for me,is is looking at the results
that you were able to obtain onthat case because she had
excessive lip support, right?
And you reduced that twomillimeters from a buccal
lingual or buccal palatal uhdimension.
And then it I think it alsoallowed her lip to relax a
little bit more and it gained alittle bit of length by doing
(34:00):
that.
So she had a little bit lessyeah, yeah, gingival show.
And it that was so beautiful.
She looked amazing.
Um her before and after isprobably one of the most the the
most beautiful ones that youcould see.
SPEAKER_01 (34:13):
So thank you.
My name is Dr.
Tyler Tilbert, and I'm Dr.
SPEAKER_02 (00:43):
Soren Poppy, and you're listening to the Fixed
Podcast, your source for allthings implant dentistry.
SPEAKER_01 (00:49):
Hello, and welcome to a very special edition of the
Fixed Podcast, one of our firstcrossovers with Dr.
SPEAKER_03 (00:55):
Randy Roberts and the Three on Six Podcast with
Dr.
Logan Lock.
Dr.
Soren Poppy.
SPEAKER_04 (01:02):
Dr.
Caleb Stodd.
Yeah, this guy.
SPEAKER_01 (01:05):
Yeah, so this is Fixed on Six.
And so here we are, you know,the regular Fixed Podcast guys,
and we're we've come out to thiscourse to learn what all the
fuss is about when it comes tothree-on-six.
We've talked a little bit aboutFP1 modalities on our show
before.
We've always been a little bitwary of it, you know, more show
a lot of concern for a lot ofthings that we've already talked
about.
(01:25):
You know, if you got a highsmile line, you got uh you know
implant failures being harder totake care of, um, higher patient
expectations, perhaps, all kindsof things, gum recession.
All these things uh you knowhave really kept us away from
that type of modality for a longtime.
But we've been seeing thisthree-on-six stuff for so long.
Of course, we've had um Dr.
Locke and uh Dr.
Roberts on the show before, andnow we're really getting to see
(01:47):
you know how the sausage ismade, right?
We've been in the clinic, we'vebeen looking at their post ops,
uh, looking at their deliveries,learning the whole surgical
process.
We'll actually be doing surgerytomorrow.
Of course, we're gonna talkabout that eventually.
Um, and uh we're here to share alittle bit about why all the
folks, I mean, we have a verylarge audience of people that
are doing tons of FT3, signs ofimplantology, why they might
need to open their eyes a littlebit to what's going on here.
(02:09):
So I'd really appreciate it,guys, if you could give us a
little bit of background aboutwhat 306 is for those that are
uninitiated and what it's becomeat this point and what it means
potentially for providers.
SPEAKER_03 (02:18):
Okay.
Well, I'll start.
Um, I feel like uh the reasonthat you guys are interested and
potentially um other doctors isreally because the patients are
driving this.
It's something that as we'vebeen doing it and getting good
results, our patients are soexcited and happy that they
found this and that it's at areasonable price.
(02:38):
And they're like, How did I notknow about this?
I almost did the other thing,and there was no coming back
from that.
And when they got this and theyfound out that it was like
having teeth in their mouthagain, and and so they become so
excited about them, like tryingto tell the world, they're like,
No, no, no, you have to do this.
Like this, I didn't know, and Ialmost did that too.
And so we've got thesecheerleaders that are going
(02:59):
around, and a lot of doctorslike you guys are finding out
about it and finding out the theextent of how much patients love
this from the patients.
And it's it's like I've beentrying to tell people I think
it's better for many years, andpeople are like, Dr.
Roberts, we're pretty sureyou're done.
And you know, and maybe they'reright, I don't know.
But but my patients, they andDr.
Locke's patients and the doc andthe three-on-six patients around
(03:21):
the country that are getting itdone from our providers, they're
so excited and so happy aboutwhat they're getting.
SPEAKER_00 (03:27):
We love when we get doctors that come to the course
because patients are pushingthem.
And those are the best kind ofdoctors because they're looking
out for the interests of theirpatients, they hear it in their
offices, and we love to knowthat they're hearing it in their
offices.
And so to uh to get doctors thatcome out because patients are
driving that is a huge testamentto what 3 on 6 is and how much
(03:51):
patients love it, just like Dr.
Roberts said.
SPEAKER_02 (03:53):
Yeah, I think it's uh it's very important for
clinicians to have um justdifferent options for patients,
right?
Um, you know, in our office wedo a lot of FP3, that's kind of
typically what we're doing.
Um, and you know, a lot of thepatients that are coming in to
our offices for the treatment,they are at a place that maybe
they've been in addenture forlike 20 years, and and doing an
(04:14):
FP3 is totally comfortable.
But but those patients who uhmaybe are a little bit younger
in their 40s who um still havethat good bone and they aren't
in a situation where uh you knowthat we need to remove all of
that bone, it's in a wonderfuloption to provide.
Um and ultimately it's gonnacome down to the patient's
decision what their goal is ifthey're looking for for function
(04:35):
or aesthetics or whatnot.
Um, however, being able to offeryou know that treatment to the
patients and give them theoption of, hey, you can have an
FP3, maybe it's a little bitcheaper for you, or if you want
this FP1-based prosthetic, it isgonna be thinner, maybe have uh
less less um like sound whenthey're coming together, feel a
little bit more natural, um, butit will be a little bit more
(04:58):
expensive, and then give thatpatient the choice and let them
decide.
SPEAKER_01 (05:02):
Yeah, I definitely like that it's it's a higher
order of service, right?
And it it also helps set someexpectations, even if someone
does eventually go down the FP3road, yeah, maybe due to
finances, they understand thatthere was a road that they chose
not to go down that may havegiven them that more natural
feel.
They may have not had some ofthe phonetic issues they deal
with.
Um, you know, maybe they itwould have been a little bit
(05:23):
less accommodation.
So at least they're primed tounderstand that they didn't
choose to go that way.
And now that they're they'rechoosing a path where there will
be some more accommodation,yeah.
Maybe they are gonna have somebone removed, right?
Like they they can kind of, youknow, it's allowing them to
choose that path and not justhaving them, you know, face
those sorts of consequenceslater on.
Um and uh, you know, I Idefinitely think that where a
(05:44):
lot of of friction has comeabout in the conversation
between FP3 versus FP1, FP1versus 3 on 6, whatever, comes
from this sort of ether ormentality, the one or the other
is somehow just better foreverybody.
I don't necessarily think that'strue.
And now I will say that I havebeen very impressed and humbled
by some of the cases that youguys have been able to fit in
this three-on-six box becausesome of the ones I've seen I
(06:07):
would never have predicted wouldhave done that.
Um, but you know, I I think thatwe have to see a world where
these two things can coexist andthere are appropriate situations
for different patients.
Um and there is also a financialreality of it as well.
Like, three on six shouldn't beas cheap as all on X.
It shouldn't, because it'sdefinitely not the same thing.
(06:28):
I mean, and frankly, it's justnot um, I mean, all of us know
this is there's just not nearlyas much orchestration that has
to go into doing an all-in-iscase.
Like if you are capable oflaying a flap, finding bone, and
just putting it in relativelythe right spots with the right
sort of timing and things likethat, you can be very successful
in the lab.
We'll do a whole lot of work tomake that case a slam dunk.
With this, that it does not workthat way.
(06:49):
You don't just walk in withoutreally knowing that case.
Um, and you have to know everyextraction, every tooth is going
to be used as a fiducial, everyimplant, every implant size,
where you're trying to come out,exactly what kind of correction
you're getting, because youraccess holes are gonna have to
be money for this to really makesense, you know.
SPEAKER_00 (07:04):
Yeah, you don't give yourself enough credit as far as
the FP3 side of things goes.
Because we, you know, Randy andI see a lot of of cases come in,
and I know and I've seen a lotof what you guys are putting
out, and it's uh on the scale ofFP3 side of things, I think it's
the most stable, the some of thebest stuff that's that's out
there.
I appreciate it.
Um but it is a it's a differentworld, and it's a really
(07:27):
rewarding field to be in.
And you guys, as part of thistraining, we have um been seeing
a lot of live patients, patientsthat came through our last
training, and you've seen thatthere is it's fairly
predictable.
I mean, we had three final seatstoday, and all three of them,
they're not cherry-picked by anystretch of the imagination, and
they uh they look good.
(07:48):
Patients are ecstatic with theresults, and it's something that
can be done predictably if kindof the recipe is followed.
SPEAKER_03 (07:55):
And that's something that a lot of the doctors that
have come through our coursehave said that they've never
seen before, that they got toactually just see the patients
that were on the schedule forthat normal time to just get the
normal work done, right?
Normally doctors are onlycherry-picking patients and
being like, oh, come look atthis patient up.
Yeah, okay, here's the patientthat's on our schedule.
We're going to seat their teethon, or we're gonna take their
scans just because this is whenthey're scheduled for it.
(08:16):
Right.
Yeah.
And so um you got to see threeof those patients um that had
beautiful teeth and beautifultissue, and that have, you know,
and the first two actually werefrom training.
So those are from doctors thatwere just learning, learning how
to do it last time with the witha beautiful result.
SPEAKER_02 (08:32):
I think it's important too because um we got
to see, you know, how you guysmanage certain uh complications,
not necessarily complications,right?
But like um, you know, if abridge isn't seating exactly
properly, like what are theprocesses that you guys are
taking to make sure that seats?
And every dentist, no matterwhat treatment you're doing, but
especially these full mouthcases, you're gonna run into
(08:54):
those little things.
And those little things are whatcan make a you know, like a
seating appointment that'ssupposed to take 30 minutes turn
into like an hour and a half,two hours.
Yeah.
Um, but if you cat catch theselittle like gold nugget tips and
see how you guys are seatingthese segmented bridges, um it
does go a really long way forthe doctors to ensure that
they're feeling comfortable whenthey're doing, you know, not
(09:16):
only their surgery appointment,but also that post-op care.
SPEAKER_01 (09:20):
Yeah.
Yeah, and I think one thing toois uh, you know, especially
talking about the the deliveriesand like how you maneuver these
types of things, not only is itdifferent because you're working
with a segmented bridge, butsomething we've also been able
to see here, which is somewhatfairly new in our spaces, maybe
not new, but it's new again, isthe direct-to-fixture aspect of
it, like taking out themulti-unit.
That's something that I I mean Ihad no clue.
(09:41):
You know, I mean, I I kind ofwent straight into all in X and
and using multi-unit andrestoring at a multi-unit level.
And I do some single unit stuff,some bridges here and there, but
it's never really been my hugeforte.
And now this whole case is isit's F V1 direct-to-fixture.
How do you navigate a full mouthof that?
And for me, that was very, veryintimidating.
I'm seeing how you're able tomake it more predictable.
(10:01):
Um, but I'm also seeing why, youknow, a system like TRI
potentially makes this a wholelot simpler, right?
Especially when it comes to thetiming aspect of things.
That's another thing I was veryconcerned about, is like in how
you make these cases work.
And doing that direct-to-fixturethat has its own internal angle
correction seems to have madethat a little simpler for you
guys.
Um, so that that's I thinkthat's where a lot of us have
(10:22):
been humbled and trying to workthrough that and and learn what
that might look like.
Um, if maybe that is the bestway to do this type of cancer.
Yeah, yeah.
SPEAKER_00 (10:30):
Yeah.
Yeah, we and that's something wework heavily on, and we see so
many of these patients, andRandy does a great job at
putting in the time andresearching different ways to
make the process simpler and tomake the results better and to
get thicker tissue around theimplants.
And he's doing this stuff whileI'm trying to figure out okay,
how do I simplify it so we cantrain the doctors?
(10:52):
And then once I start seeing hispictures, really it's me going
in and be like, oh, this looksreally good.
Like this is starting to, thisis looking better than my cases.
It's time to implement this newthing into what I'm doing and to
what we're pushing out to all ofour doctors.
And I think that's one of thegreat things about 3 on 6 is it
is a constant work in progress,and we are just trying to push
(11:14):
the limits on what we can do asfar as FP1 goes.
And um, we're constantly tryingto make it simpler for our
doctors and more predictable forour patients and on our fan
clubs that are out there thatthey're getting the same result,
you know, in Boise that they'regonna get here in Salt Lake, so
they can stay at home.
SPEAKER_04 (11:31):
I yeah, one yeah, one thing I noticed like my
biggest takeaway from being herewith you guys is you you're not
afraid of innovation, right?
That's what you're talkingabout.
Where we we came and you havemultiple different implant
brands, you have like everysingle type of photogrammetry
unit, you have differentscanners, you have all the
different lasers.
Like, really, if you wanted totour or to go through a museum
(11:52):
of all the different things thathave been involved, like like in
dentistry, then you could walkback here.
I swear that you probably havelike a pedal drill somewhere
back here.
So, um, and I think it takes alot of humility to do that to a
lot of our mentors, right?
Um, as we go through and kind oflearn this, and there's been
evolutions of this throughouttime, they're really stuck in
their way.
And maybe it's not for theworst, but sometimes it's not
(12:14):
for the best.
And you get a lot of, you know,nobody's really accepted when
you're the only one talkingabout something.
And and I bet Randy's had todeal with a lot of that
throughout her career.
Um, but with time and withexperience, you're you're
proving what's possible andyou're pushing limits.
And these limits are better forpatients in a lot of ways.
I know there's a lot of patientsthat I've had that have received
(12:35):
really good treatments given theinformation that I had at the
time.
Um, but there's also some thatcould have benefited from
three-on-six so much more thanjust, you know, doing six
implants and having pterygoidsand stuff like that.
So that that's been my biggesttakeaway is humility,
innovation, never afraid toreassess what you're doing.
And it's not about you.
Like with a lot of a lot ofinstructors out there, it's
(12:57):
actually more about the ego thanit is about the process or the
patient.
And with you guys, I candefinitely feel that it's it's
not about you, it's more aboutyour patients 100%.
I loved seeing that.
SPEAKER_03 (13:06):
Yeah, and we love bringing on doctors like you
guys because we always feel likewe can do better and we can be
better.
And when we bring on awesomedoctors, like you guys are
always also being like, like ourconversation earlier, like with
taxes and stuff like that.
And you're like, we can help youout in these different ways.
And it's like, and also there'sdifferent ways, and also with
the surgeries and differentthings where our doctors help us
out, and we all kind of growtogether.
I feel like this is a a bigfamily, and like you said, we're
(13:28):
we're trying not to have egosand we're just trying to all
work together and figure out howwe can make the best products
that we can for our patients.
SPEAKER_02 (13:35):
Yeah, and ultimately that's what it comes down to is
just um creating the skill sothat we can treat our patients
with the the best possible care,you know.
And when they come to ouroffices, like I see patients all
the time that um, and we talkedabout this a little bit earlier,
Randy, but they go to like thecheapest provider on the block
just because of the cost, andthey just don't understand that.
(13:58):
And it's it's difficult to wetry to put out content on our
YouTube and whatever to portrayto our patients like, hey,
everything is not all the same.
It's not just like you're gonnaget implants placed this the
exact same way every singleplace.
Maybe it feels like that for thefirst year or two, but once
those implants start um, youknow, degrading a little bit,
(14:19):
you're in a situation where thattreatment cost that you saved is
gonna end up costing you a heckof a lot more when you go and
have to have it redone.
Um so it's important forpatients too to uh to listen to
stuff like this, right?
Um, or for us to to give that uheducation to our patients so
they understand that, hey, maybedon't fly to to Mexico or fly,
(14:43):
you know, to to wherever it isto get this treatment done, not
because there isn't greatdoctors there, but because it's
harder to determine what is agood provider and what isn't in
these other countries.
Um and ultimately I know plentyof great providers in these
other areas.
However, if you go to somebodywho's been to like three on six,
(15:04):
been to Orca, been to a lot ofthese courses, you'll know that
you get you're going to a solidclinician that has spent the
time on the weekends where theycould be doing other stuff to
excel and be a better clinician.
SPEAKER_01 (15:15):
Well, I think something that you guys have
done that's so impressive iswhen we first started Smile Now,
we identified that, you know,across the market of all in X
providers, there's a race to thebottom happening.
And I think there's a lot ofassumptions being made about
these patients that reallyaren't fair.
And it's that, you know, they'rethey're bargain vendors, right?
(15:36):
They just they price shop,they're looking for the cheapest
number, they'll go to the sm thelowest number that they can see.
And that's why we're seeing someof these cases that are being
done for eight, ten thousanddollars an arch or something,
and people are going way out ofthe way to just get the cheapest
possible thing.
And we try so hard on ourcontent side to really build
value and make people understandthat it's you know, you you
don't buy a chicken sandwich atWendy's and Chick-fil-A and
(15:58):
expect the same product, right?
And uh what you guys have donehas shown that this patient
base, there is a verysignificant contingent that is
willing to spend more money forvalue.
Yeah, if it's somethingdifferent and they know it's
something unique, they will gofor that.
And they are coming fromliterally all over the world to
come get this done.
And you guys have really shownthe value of what you're doing.
(16:21):
Like, and and these are verywell educated patients, they've
done their research, they're notvaluable, like they they have
really gone through Reddit,through Facebook, they've
learned so much about anthology,right?
Um sometimes.
Sometimes, sometimes they haveto ask the question.
I'm like, hmm, I might need tocheck this in the other room.
And and they do appreciatevalue.
(16:42):
And so I think that it reallybrings a charge to full arts
providers around the country toask themselves how can I convey
value and value what it is thatI do and not just feel like I
just have to keep doing this forless and less money over time,
because that, of course, is aself-limiting belief.
Like that cannot, you know,persevere through our time.
And so, you know, it really soldme that not only is it a value
(17:05):
for provider to come here andlearn how to do this kind of
thing, but patients will seethat and they will value.
And it's it's it's much easierto do that when there's
something like that, right?
When there's something likethree on six that can then vet
and validate you as a doctorthat can provide it.
And two, what I what I'd beensurprised on, and and I think
that a limiting belief that alot of people that see
three-on-six will have is thatsome of this is cherry-picked.
(17:26):
Anybody can take a photo oftheir best case and put it on
Facebook and say, hey, look whatI did, right?
But that is not what's happeninghere.
I mean, you guys have done overa thousand of these.
We've seen these patients comingin and out.
They're not cherry-picked.
We've seen things that maybeweren't totally perfect and they
need to be worked on, but likeyou're getting to this result
and these photos veryparticularly.
I mean, I saw your phone, right?
SPEAKER_00 (17:46):
Yeah, we I we pop up the phone on the screen and it's
I think your case goes the lastweek.
SPEAKER_01 (17:51):
It's very consistent.
And it's, you know, I I thinkDanny Domain said this in one of
his talks over ICY or somethinglike that.
It's like, don't show me yourbest case, show me your last
one.
And I know both of you can showus your last case, and it's
going to match that samequality, the same stuff you post
on Facebook.
So there is a system to do thisfor patients, and there are
patients that do value this.
So that calculus should show youas a provider that there is
(18:13):
something here that you shouldat least give some time.
unknown (18:15):
Yeah.
SPEAKER_03 (18:16):
Well, thank you.
Yeah, it's uh definitely been ajourney to get to where we're at
right now, where we're gettingthese predictable results, and
so many different techniques,like the uh like the one that I
don't know, I feel like I'vegotten so much crap over all
these different things.
I I'll go on different Facebookgroups and I'll say, hey, um,
healing tissue by secondaryintention is really helping me
to grow a lot of tissue.
And everybody's like, what areyou talking about?
(18:37):
I'm like, I'm just saying what Inoticed when I'm doing it this
way.
Yeah.
Right.
And like it's all these peoplegive me so much crap.
I'm like, yeah, I won't sharewhat I'm learning with you guys
if you're all gonna be pissed atme for sharing.
Right.
But I feel like I've gotten somuch of that.
It's been a journey, is what I'msaying.
Yeah.
To get to this point where we'regetting predictable, beautiful
results, and it's required.
Like, I don't know, you've seenthere's probably like a thousand
(18:59):
things that Logan taught youover the week.
So many little tiny things thatall add up to uh one thing,
right?
But if you miss any of thoselittle tiny things, then the
final result is off a littlebit.
And like each one of thosethings makes a little bit of a
difference.
So it's just uh it's it'sawesome to be where we're at
right now, but it's been a longand hard journey to get here for
(19:22):
sure.
SPEAKER_02 (19:22):
And I'll say too, we, you know, something that
we've been very uh cautious ofis when we place our implants,
we want to make sure ourpatients are getting the
thinnest prosthetic possiblewith our FP3 cases.
That's always been a hugephilosophy of ours.
You know, when you have apatient that's class two, like
angling the upper implants backand the lower ones forward to
(19:44):
kind of correct that and makesure that that FP3 they're
getting is incredibly thin.
Um, but we've taken a lot oftime to learn how to angle our
implants properly and do thosethings in our offices.
And something that I see a lotin coming here, we also got a
lot of tips for how you guys dothat to make your prosthetics as
well.
But I think something that a lotof doctors need to improve on is
(20:07):
to think about their implantplacements prosthetically, not
just where maybe there's themost amount of bone, but what's
the most comfort for patientswhile also considering the
amount of bone.
Um, and coming to a course likethis is gonna kind of open their
eyes to the abilities of, youknow, we don't want to be
looting a denture in thispatient's mouth.
(20:28):
They're not paying$40,000,$50,000,$60,000 to just have
this big hunk of zirconia, youknow, stabilizing the mouth.
They're paying for that to havea functional set of teeth, a
body part that's as close towhat they had previously as we
can provide.
So uh that's something that Ithink is really, really
important that I want moreclinicians to really consider
(20:49):
when they're treating thesepatients.
Um, because ultimately, anyclinician that's doing this
procedure, you know, it's it iskind of the visual of all on
four, all on six, three on sixfor the whole um culture.
And we want to make sure thatevery provider that's doing
these does them well.
Um, and taking time to, youknow, come to courses like this
(21:10):
so we can so providers can learnhow to improve and make their
prosthetics thinner for thepatients is gonna go a really
long way, not only for thatclinician's abilities, but also
the industry as a whole, um, toensure that patients understand
that the difference between adenture and a prosthetic is
incredibly valuable, right?
(21:31):
And the difference between uh aset of teeth and that truck they
were gonna buy, right, it's moreimportant to get that set of
teeth.
SPEAKER_03 (21:39):
Um I also feel like it's really important that all
of the doctors who are placingFP3 also can do FP1 so that they
can give that or at least telltheir patients that that that
that's an option.
Yeah.
Because I feel like if theydon't know how to do FP1,
they're not going to give it asan option.
Their only option will be FP3,which means even if they have a
29-year-old with perfect boneand tissue, they say, well, your
(22:00):
teeth need to go.
The option are dentures or FP3,and we're gonna have to chop
away your bone.
And so without even being ableto tell them, there is an option
where we can give you a fullmoth of implants and save your
bone and your tissue.
I feel like that needs tohappen.
I feel like that needs to bepart of the conversation.
And so I I think that if thatpatient finds out that this was
(22:20):
something that exists the dayafter surgery and they're like,
hold on a second, I could havehad that when this happened,
then I think that doctorpotentially is could be in
trouble with that patient.
And so I just feel like it'simportant for doctors to be able
to at least give that as anoption or let at least let them
know that that's uh available inthe market if it's not something
(22:40):
that they're able to do.
SPEAKER_04 (22:41):
Where would, yeah, following up on that, like where
would you rank the way that youguys teach about how to do FP1?
Where would you rank that ifthere was a hierarchy of
difficulty of different types ofimplants, right?
So we have we have justtraditional, um, and then you
have like pterygoid, you havezygomatic, you you have FP3.
Where would you rank what you doin comparison to those?
SPEAKER_00 (23:02):
It's funny watching it because I I've had the um
blessing to watch some reallytalented surgeons do some
insane, some really beautifulFP3 and quad zygos and you guys
with pterygoids, like there'ssome finesse to all of it.
And so I don't know that one isnecessarily um you know,
(23:23):
watching that that is adifficult thing, and you have to
deal with difficultcomplications.
And but I do feel like FP1 has acertain finesse to it.
Um and artistry and it requiresand and a lot of planning and a
little bit more background inall of the things to be able to
accomplish it perfectly.
(23:44):
You know, we talk about umatriumatic extractions and being
able to get the teeth outwithout breaking bone and
starting there.
So we have to start teaching atthe you know, something that
most doctors are very familiarwith, but maybe not as careful
as we have to be in order to getthe best results possible.
And then we go through you knowthe planning and the guides and
how to seed a guide and spendingthe time to do that.
(24:06):
And so there is a there is afinesse to it, and then tissue
management, which is a littlebit more important than FE3 in
most cases.
So um I would put it up there,but I think uh you know,
watching you guys do your workas well, there's that's
complicated too, and you have togo through a lot of training to
be able to do those remoteanchorage to do the kind of
(24:27):
stuff you're doing as well.
SPEAKER_02 (24:28):
I will say that um in my opinion, and kind of going
off of your question, is thatyou know doctors definitely can
provide FP1.
Like if they have good fixed,like all on four based
treatment, I think FP1 is agreat next step.
Um I would prefer to have theability to do FP1 guided in my
office before jumping into likezygomatic and like these crazy
(24:51):
remote anchorage-basedtechniques because you know, a
lot of the reason that doctorsgo to do those remote anchorage
techniques is to open theiroffice up to more potential
patients, right?
But those more potentialpatients that you're opening
your office up to come with alot of headache, a lot of
complications that that providermight not be fully prepared to
(25:13):
um handle.
Whereas going from, you know,just traditional all-in-for FP3
to like guided FP1, that's apretty easy jump.
Um, and it's gonna mean a lotmore care about tissue and
focusing on these things, whichthen is a good um accelerant to
doing like zygo and some ofthese other cases where you
(25:36):
might not think about it, right?
It feels more macro level, butultimately you're gonna have
oral anterior communications,you're gonna have issues with
tissue that you need to solve.
Um, so I feel like it that wouldkind of be what I would
recommend is, you know, like wealways say, get really good at
basic surgery over or regulardentures, then snap-ins, then
(25:57):
your most basic all on four, andmaybe like a little bit more
challenging all-in-for, so youcan solve some of those implant
failures, palatal approach,pterygoids, but then jumping
into FP1 is where I wouldpersonally jump to prior to
getting into like transcinus andzygomatic and some of these
crazy surgical techniques.
SPEAKER_00 (26:16):
Yeah, I think often it's the the biggest one of the
biggest concerns we hear a lotis the complications of FP1
because we're dealing in anaesthetic zone and there's not a
lot that you can hide.
Um but overall the complicationsfor us are fairly minimal.
SPEAKER_02 (26:32):
If you do them, like you said, with all the little
tips.
SPEAKER_00 (26:34):
Yeah, if you do them the right way and you're
preparing yourself for thefuture, then you know some of
our biggest complications are animplant fails, we take it out
and we do a new prosthetic overfive implants instead of six.
Or we take it out and we shiftit and we make a new prosthetic.
SPEAKER_03 (26:49):
Um or the teeth are slightly longer, you know, and
that's I think that's one of thethings that most doctors are
afraid of.
They're like, what if I do itand the teeth are a little bit
longer?
And in my experience, I've had aton of patients whose teeth are
slightly longer in some areasthan others, and and even some
of the ones that I post topeople, and I'm like, um,
they'll say those lookbeautiful, and probably won't
(27:12):
notice that that canine is amillimeter or two longer than
the other canine because it hasa little bit more tissue or
whatever.
And it's not necessarily a hugecomplication because most
people's natural dentition lookslike that.
They don't have perfectly exactsame tissue heights on every
single tooth.
And so if it's slightly off, notthat big of a deal because you
still have all of the advantagesof your teeth being so much
(27:32):
thinner, so much easier toclean.
Um, so for me personally, Ithink that even if like I think
that the doctors should belearning this before doing the
FP3s, just because I think thatworst case scenario, they just
have longer teeth that are stillnarrow that feel more
comfortable.
Like it just might not look asnatural for the doctors doing it
their first time.
(27:53):
Like maybe they'll break offmore of that buckle bone, and
maybe the gums aren't going tolook as perfect.
In my experience, the patientsdon't super care most of the
time that their gums lookperfect, they care that their
smile looks really good, andyour gums don't most of the time
really show all that much.
So making sure, and that's oneof the things that the lab is
taking care of for you, makingsure that the smile looks really
(28:13):
good.
Um, and making sure that thegums look perfect, that's more
on the doctor, and the newerdoctors are probably gonna have
less perfect gums than thedoctors that have more
experience.
Yeah, but even still, I thinkthat that's something that
they'll have to learn, startlearning at some point.
And having that restoration beso much narrower has so many
advantages that I I'd ratherhave them be starting there than
(28:35):
starting with the FP3.
SPEAKER_01 (28:36):
You know, something that I think is uh, you know,
kind of uh the trend, right, isas a person goes through their
progression as a surgeon, isespecially in the FP3 world,
it's always like you're gettingmore advanced as you take cases
on that have less boneavailable, right?
It's always how do I make FP3work when there's less and less?
(28:57):
So, you know, what if we don'thave zone two bone, right?
What if we don't have a wholelot of zone one bone?
What if, what if uh this area issuper thin, you know, whatever.
Let's go to a terrible, let's goto a zygote, let's deal with
less and less and less.
And you know what?
That is a growing problembecause we keep approaching all
these cases with an FP3mentality and we keep hacking a
lot of bone away, right?
Well, what if, though, the moreadvanced thing to learn is what
(29:18):
you do when there's more bone?
Because maybe the answer isn'tjust to get rid of that, right?
So, like one of the main thingswhen I was first learning about
FP1 versus FP3, which is youknow, FV1 is usually just kind
of a it gets glossed over, leaveit to the prostodontist, don't
worry about it, right?
Is what if the other patient hasa high smile line?
And that used to be anindication in my mind you
shouldn't do FP1 because youdon't want the gums to be
(29:39):
visible, right?
We're supposed to hide our work,right?
But one thing I've been sold onwith you guys is that no, you
don't, that does not mean youneed to do FP3.
In fact, that's one of the worstthings you can do because now
you're gonna be removing evenmore.
You're gonna remove 15, 20millimeters to try and make this
case work and try and fit intothe FP3 world.
And so we've seen tons of cases,some of them live today, like in
the chair, that had high smilelines.
(29:59):
And either you preserve that,and this is entirely based off
of patient accritations or whatthey wanted, um, or you reduced
it and actually left some gungon purpose and made it
absolutely beautiful andharmonious without even actually
removing that much bone.
So can you guys talk a littlebit about how 3 on 6 approaches
those high smile line cases, howyou're able to plan for that,
what's the approach like, howmuch bone does get removed, how
(30:21):
does the prosthetic make thatwork?
SPEAKER_00 (30:23):
Yeah, so the way we the way we generally train it, a
lot of it depends on how um howmuch of a gummy smile they have,
how high that smile line is,where the teeth, where we want
the teeth to end up.
But um a lot of doctors come tous and they ask for like.
Like a bone reduction guide,something to help them create
that architecture.
(30:43):
And I often have to steer themaway from doing something as
macro, we talk about micro andmacro, doing something as macro
as that.
Because really, what we try anddo is we use our prosthetics.
Our lab is trained to createpontic sites, to create
natural-looking aesthetics.
We want to use the prosthetic toguide the development of the
(31:04):
bone and the tissue.
So oftentimes in the cases thatwe did, we are removing very,
very little bone or none at all.
Maybe we're just putting theprosthetic right at the bone
level.
And what that does over time,um, as we suture the tissue to
the prosthetic, it's going toallow resorption on its own, and
we get rid of a gummy smilewithout taking a bird in.
(31:28):
It's a guided bone degeneration.
SPEAKER_03 (31:31):
So really we're guided bone loss.
Yeah, that's right.
So really we're shooting for theincisal edge where we want that
to be.
Yeah.
And then we're going up fromthere for what the ideal teeth
shape and length are.
And so we're going to say, okay,this is where I want the incisal
edge, and then the lab will planthe rest of it up from there.
So, and we're using ourinstaresa scan so that we can
know exactly where their smileis with their picture, where it
(31:52):
is in their bones, so that wecan map that all out before we
start.
Um, so then we have our idealteeth, what their ideal shape
and size, and that's going to beadjusted depending on the size
and shape of the patient's mouthand their lips.
And so normally we're going overthat with our patient or with
our lab uh before we'll evenstart placing the implants in
(32:13):
the surgical guide.
So we start with the prosthetic,we start with where the incisal
ledge is, and then we will startwith that design.
Once we know exactly where theteeth are gonna go, then we're
gonna start designing theimplants and so that we can
start knowing exactly whatangulation those implants need
to be in so that they can uh sothat the screws can be coming
out at just the right spot.
SPEAKER_01 (32:31):
And what depth and what depth the implants are to
then guide that, to then raisethat smile line, raise that.
SPEAKER_04 (32:38):
I did I had a periodonist in the military that
taught me um that you can eitherdo clinical crown lengthening
with a burr or you can do it byinvading the biological width.
Yeah.
Right.
And that's what you're talkingabout.
That's essentially.
So you just you just invadethat, you put pressure on the
bone, the the body's gonnarespond accurately, it's gonna
re-establish the biologicalwidth with the like attempting
to get that three millimeters ofgingival tissue.
SPEAKER_00 (32:59):
So Yeah, and we had two of those cases today, your
case and and one of ours fromour training patients uh three
months ago.
And say we didn't we didn't Idon't know if you took a bird of
years, but during the training,we didn't we didn't touch the
bone at all.
And you saw the reduction in howmuch gum she was showing when
she smiled.
It's purely based on theprosthetic alone.
SPEAKER_03 (33:18):
On mine, she had about like six millimeters of
gum showing when she was smilingbeforehand, and I removed about
two millimeters, and on her herbone was coming out pretty far
at a like an angle facially, sotaking off two millimeters
brought it out, uh brought itback and brought it down.
So but anyways, it made a muchmore aesthetic.
SPEAKER_04 (33:38):
I think that case too, because that was kind of
one of those aha moments for me,is is looking at the results
that you were able to obtain onthat case because she had
excessive lip support, right?
And you reduced that twomillimeters from a buccal
lingual or buccal palatal uhdimension.
And then it I think it alsoallowed her lip to relax a
little bit more and it gained alittle bit of length by doing
(34:00):
that.
So she had a little bit lessyeah, yeah, gingival show.
And it that was so beautiful.
She looked amazing.
Um her before and after isprobably one of the most the the
most beautiful ones that youcould see.
SPEAKER_01 (34:13):
So thank you.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Are You A Charlotte?
In 1997, actress Kristin Davis’ life was forever changed when she took on the role of Charlotte York in Sex and the City. As we watched Carrie, Samantha, Miranda and Charlotte navigate relationships in NYC, the show helped push once unacceptable conversation topics out of the shadows and altered the narrative around women and sex. We all saw ourselves in them as they searched for fulfillment in life, sex and friendships. Now, Kristin Davis wants to connect with you, the fans, and share untold stories and all the behind the scenes. Together, with Kristin and special guests, what will begin with Sex and the City will evolve into talks about themes that are still so relevant today. "Are you a Charlotte?" is much more than just rewatching this beloved show, it brings the past and the present together as we talk with heart, humor and of course some optimism.