Unveiling Three on Six: A Revolutionary Approach to Implant Prosthetics with Dr. Logan Locke: Part 1
October 28, 2024 • 48 mins
Dr. Logan Locke joins us to unravel the innovations behind the three on six FP1 full arch method. Discover how Dr. Locke's journey alongside Dr. Randy Roberts, starting with affordable single implants in Utah, evolved into groundbreaking procedures like all-on-x and the three on six approach. Learn how these segmented arches, supported by six implants, offer both cost and functional advantages over traditional methods, and hear about the early challenges they faced, from milling limitations to achieving cost efficiency.
Explore the strategies Dr. Locke employs to manage implant bridge failures and the solutions necessary for long-term success. We delve into the flexibility of treatment plans, such as transitioning from three on six to two on five designs, and the critical importance of maintaining bone integrity. Special considerations for younger patients are discussed, alongside the potential implications of initial bone removal and the role of FP3 prosthetics. We also touch on advanced solutions like zygomatic implants, which extend the lifespan and effectiveness of dental treatments.
In this episode, we explore the intricacies of prosthetic placement and surgical workflows in dental surgeries. Dr. Locke shares insights on how prosthetics influence bone resorption and tissue development, emphasizing the transition from cement-retained to screw-retained systems. Discover the strategic use of multi-unit abutments to maintain implant integrity, and learn about the challenges and benefits of in-house prosthetic production. With a focus on atraumatic extractions and the importance of avoiding unnecessary bone removal, this episode provides a comprehensive look at the techniques that enhance patient outcomes in implant dentistry.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Tyler (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren Poppy,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
My name is Dr Tyler Tolbert andI'm Dr Soren Poppy, and you're
listening to the Fix Podcast.
Hello and welcome back to theFix Podcast.
We are here with a pioneer inimplant dentistry, dr Logan Lott
(00:21):
.
We are super fortunate thathe's been willing to spare his
time with us and we're going tobe covering some really
interesting concepts, a littlebit different from the typical
fare that Soren and I talk about.
So I think in this episode, youand I are probably going to be
taking a little bit of abackseat, learning about some
interesting surgical andprosthetic concepts and
different ways of thinking aboutand approaching full arch.
(00:42):
So, dr Logan, we reallyappreciate you coming on?
Yeah, happy to be here.
Thanks for having me on, guys,awesome, awesome.
So for those who are not awareof you, those shamed people may
they be, could you help us outjust a little bit and kind of
give us a little?
Logan (01:01):
bit of a story of how you got to where you're at and
where you're at.
Yeah, so, um name's Logan Locke.
Um, I'm on here basicallybecause I'm I've, uh, I've been
with three on six for, uh,basically since its beginning.
Um, my partner, randy Roberts,and myself, um, he, really, he
really started it back in like2016.
(01:22):
Really started it back in like2016.
And I jumped on shortly afterthat.
We started doing the firstcases in our office.
I assume we'll get into threeon six.
I myself, born and raised inUtah, went to Creighton for
dental school and just kind ofgained a passion for implant
(01:45):
dentistry.
There had some really awesomementors.
Can't say enough about how muchthey allowed me to do in dental
school, which I think, aftertalking to a lot of people, I
thought it was normal.
But I think my experience inschool was far different than
most.
And then so came to work for DrRandy Roberts and we just did a
(02:11):
billion low-cost implants andthat's kind of how we got
started with in the full arch asit slowly progressed and and
into attempting FP1, basically.
Tyler (02:23):
Okay, and so what was kind of just the general
landscape back in that time?
So you said a billion low costimplants, what.
What did that look like?
What were most people in yourtown doing at the time?
What was the market?
Logan (02:33):
Yeah, so Utah is a heavily, heavily saturated place
.
Um, it is hard to compete inthis area and so we were running
basically a quantity program.
We were doing implant above andcrown all the way through for
1500 bucks.
Um, we were using, when I firststarted, we were using
(02:55):
high-tech implants, I thinkthey're I don't even know where
they're out of Um, and then weslowly transitioned to neodent
CM.
Um, we were doing most of ourcrowns on a CEREC.
So you know it was.
We did a lot of implants andreally experience-wise, I
(03:17):
couldn't have asked for more,but it had its own challenges
and so, yeah, that's $1,500 allthe way through.
I wouldn't do that right now,but there was, it had its own
challenges and so, yeah, that's1500 bucks all the way through.
I wouldn't do that right now,but Definitely got me some good
experience.
Tyler (03:32):
For sure, for sure, that's awesome and so you know,
being sort of the economy, Iguess single implant guy, were
you approaching full arch at thetime or was there a modality
that you guys were utilizing atthe time For that, or was it
more just like single toothreplacement bridges?
Logan (03:47):
mostly single tooth and implant bridge and uh.
And then I started to dive intoall on x, um, so I took some
courses on that, did quite a fewcases.
Um, that's about around 2017 iswhen uh partner Randy started
doing.
He essentially started doingFP1 with Sarek Bluecam and we
(04:12):
were just.
He had a cousin that needed afull mouth.
He didn't want to remove bone,decided to put some implants in
and after they healed up, we putjust stock abutments on and
scanned them and then wedesigned our own bridges.
They did not look the mostbeautiful at that time but it's.
It functioned and that's kindof how the whole thing began.
Tyler (04:36):
Okay.
So yeah, I'm very naive to theconcept of three on six.
I mean, I've looked at it.
I kind of know it from just abird's eye view, but the basics
that I know is that you wereworking it's a fp1 full arch
method where you have segmentedarches, so it's a total of six
implants and three separaterestorations that are just kind
of butted up at once againstagainst one another in a way
that looks, you know, fluid andlooks like a full arch.
(04:57):
Um, but that's about as far asI go.
So I'm interested to see whatkind of advantages you guys saw
versus all annexes and I lovethat you have that all annex
background.
So what was so attractive aboutthat modality?
Logan (05:07):
The.
The gist of it was, you know,we started to see, once we did
the first cases, we got peoplecoming in and they're like, we
really like this and it wassuper, super challenging at the
time to do us, you know, even afull arch bridge.
We'd try one piece but ourpucks weren't big enough.
(05:28):
Um, the cost to go through alab was incredible.
It was just way too high to tryand have these um fabricated at
the labs that we were using.
Um, they were weaker when theywere one piece, so we'd we'd see
fracture more, more frequently.
We were using Emax at the timebecause it's just what we could
mill out.
(05:48):
Um.
So, yeah, three on six,basically, is a FP1 modality Um,
by no means did we invent FP1,obviously, um.
But the main issues that we sawwe had a younger patient, a
younger patient base coming in,a lot of addiction, completely
(06:10):
broken down dentition and theyneeded full arch.
And the problem that we saw, orthe ethical dilemma I think
that we felt, was the bone room.
We know this stuff isn't goingto last forever, this stuff
(06:31):
isn't going to last forever, um,and so when we were looking at,
you know, 7 to 15, sometimesmillimeters of bone reduction in
order to hide a lip line orcreate a prosthetic space.
In a 28 year old, it just, um,yeah, we decided we wanted to
look at other options.
So so three on six is amodality, an FP1 modality.
It's a way, from start tofinish, to do FP1 slash FP2
(06:54):
consistently and affordably.
So we essentially found that wecouldn't use outside labs
because they weren't proficientenough to get the pontic site
development that we required.
They were way too expensive, sowe were having to charge
patients way too high of feesand so they just didn't want to
do it.
So our barriers were bring thecost of the procedure down,
(07:20):
bring the skill needed down,because it is a tougher
procedure to do, and and make itso that more people could do it
consistently.
And that's kind of where and Iguess the latter part of it is
create something that'smarketable, because no one knows
what fp1 is.
Patients don't understand.
(07:40):
And often I think patientsdon't understand when they're
getting an all-in-x.
They don't understand thatthey're going to have fake gum
tissue, that they're going tohave fake gum tissue, that
they're going to have boneremoval, cause often we just
don't.
That's part of the process.
We don't describe that whenwe're selling patient um, which
I don't think is terrible.
It's just part of the process.
But most of the the people thatcome to see us didn't know that
(08:05):
until they Googled it after aconsult.
Tyler (08:08):
Okay, okay.
So one thing you said there Ican kind of imagine some people
having a little bit of a kneejerk reaction to if they're kind
of very set in the you know allon X uh cross arch stability
world.
As you said, that it was weakerwhen you were doing one piece
all the way across the arch.
So how did segmenting help usout with that?
Logan (08:24):
Yeah, so the I mean the reason we need a prosthetic
space right is for the strengthof the prosthetic, and so that's
part of the reason that we haveto remove bone.
Cross arch stability is iscrucial for the initial
stability and the healing of theimplants.
And we still our initialprosthetic is one piece.
(08:45):
We we want cross arch stability, we want those implants to be
supported during the healingtime and then, um, after that is
, once the implants haveintegrated, that's when we start
to segment, uh, in order togive them, one, a more durable
prosthetic.
And two, we want, we want tostart increasing the load on the
(09:07):
implants.
We looked at a lot of research,for you know, when we look at,
say, an all-on-six, say we'redoing six implants, the research
that we found suggests that theanterior two implants get the
bulk of the load, the posteriortwo implants get the bulk of the
load and really the ones in themiddle are taking much, they're
(09:28):
not providing a ton of extrasupport.
And, uh, we know that implantsdon't do well when there's not a
load against them.
Uh, we've all seen an implantcome in with a healing abutment
after 10 years that never gotrestored.
You're always bone loss, yeah,and so the idea of it's
(09:50):
progressive loading.
I guess Progressive loadingthese implants as they heal is
kind of what drove us Well.
Honestly, the initial part wasthat was as big of a puck as we
had or as big of a block as wecould mill with our CEREC.
That's as big as we could get ofa block as we could mill within
with our seric that's as big aswe're on again.
But then we started, you know,looking into it further and it
was working and and implantswere retaining bone and we were
(10:12):
getting really good scans ofbone density and um bone
deposition and and so webasically it was a accident,
well, not an accident, but kindof lucked into something that we
believe works better long-termand distributes load more evenly
across more implants.
(10:33):
That makes sense.
Soren (10:36):
So a question that I have for you as far as the three on
six goes is I mean, that makessense to me.
I think the first thing Ithought of when I was looking at
3N6, I think the first argumenta lot of people have regarding
it that I've seen is the well,there's no cross-arch stability
for, you know, to get past thatprimary stability portion of the
(10:57):
implant, and if you are gettingthat cross-arch stability,
that's great.
A question I have, though, is,let's say, when we're doing a
fixed prosthetic on four or siximplants and you know what our
philosophy is, we typically dopterygoids in every case, so
we're doing all on six, withfour on the anterior, and where
(11:20):
we see a big benefit to that isif an implant fails down the
line.
Right to that is, if an implantfails down the line right.
Um, we, there's a lot of realestate where we can remove an
implant, place another one andload another temp, or or even,
if they are at the phase ofzirconia, um, mill another
zirconia pretty easily.
Um, how do you guys combat theissue of you know, if you have
(11:44):
three different bridges and oneimplant fails?
I feel like that might be abigger headache for you as the
clinician to then go in there,and you might be kind of limited
with the amount of space andbone that you have to replace
that single implant on thosebridges.
Logan (12:00):
For sure.
Yeah, so I mean, if, if, ifwe're talking, you know, 10
years they're already insegmented bridges.
They come back and an implantsfail.
It's pretty easy for us to beable to take our design and
basically remove one of those,one of those um splits.
So, you know, maybe we turn itinto a two on five um, basically
(12:23):
creating those segments indifferent areas.
Worst case scenario we can turnit into a full arch prosthetic
and you know, at that point yourbiggest weakness is just the
full arch.
You know one big piece ofzirconia.
It tends to fracture morefrequently.
So at that point we'd maybewarn the patient that that's
(12:43):
something that could happen downthe road, being that we're not
having a 12 millimeterrestorative space.
Oftentimes we're in the, youknow, six to eight millimeters.
So, um, so that's kind of theworst case scenario.
But we, we find that, um, itleaves us so much, so many more
opportunities because, yeah,we've got these implants in but
(13:04):
we didn't remove any bone.
We, uh, we kept every ounce ofbone that they had at the
beginning.
We're placing these implants ata prosthetic spot where we're
getting good pontic sitedevelopment and then, let's say,
30 years from now, this suckerfails, we're getting bone loss
and it just doesn't look goodanymore, we'll take the implants
out.
We'll put them in an All-On uh.
(13:26):
Do some pterygoids, we do um.
A lot of our um providers areplacing pterygoids.
They're using those within a uhthree on six slash four on
eight framework where we'rewe're still segmenting against
those pterygoids Um.
So all of the things can stillbe applied.
My belief is that we're givingthem an extended life on what
(13:50):
bone they have, because it's youknow all of this stuff how long
it lasts.
We're going to see theramifications of what we're
doing.
I think 30 years from now.
We'll see what happens with allthese full arch cases.
But if we've got a lot of boneand we can still We'll see what
happens with all these full archcases.
Tyler (14:14):
But if we've got a lot, of bone and we can still go to
an all on X, from a three on six, then great, okay.
So in other words, if you'relosing one of your guys down the
road, this is a long termfailure, like late failure.
Yeah, five, 10 years down theroad you could lose that implant
and you don't necessarily needto be replacing that implant and
just making a new segment.
You're actually now going to,you're going to refabricate a
whole new one that connects twosegments, so that that way you
(14:37):
know it's kind of like youdidn't really lose much at all
because the other implants werealready integrated.
So now you're just sort ofswapping it out, going from
three on six to two on five, ormaybe you started four on eight.
I had to think about that one.
Logan (14:48):
Yeah, you got to think about how many bridges are on
now.
Now, yeah, and if you thinkabout, I mean so, our general
placement of implants, if we canget them straight up and down
in the first molar area, great,but we still angle with the
sinus quite a bit in theposterior.
So let's say three to four touh, we almost always place an
(15:09):
implant in at number six, uh, atour canine sites.
So six and 11 are gettingimplants, and then um seven and
10 generally.
Now, if we had number sevenfail, I'll just put an implant.
We grafted everything.
We graft every single socketthat we take out of.
So usually I have a, let's say,seven fails, I'm going to put
an implant in at eight.
I'll kind of leave her sevenoff of it, and I've still got a
three on six.
So there's still, um, still alot of opportunity to move
(15:33):
things around, um, with whatwe're doing, because we just we
generally keep just a ton ofbone.
Tyler (15:40):
And it's really too like.
Soren (15:42):
I really like that.
Yeah, I was just gonna say Ireally like the idea of it
because, you know, somethingthat we talk a lot about on the
podcast is the fact that, um,you know and, and that primarily
what we are doing is FP3.
Uh, and what ends up happeningis right, you have patients that
go into FP3.
Um, that being said, a lot ofour patients are patients that
come in that you know thatindenture or they've been
(16:07):
missing their posterior teethfor a really long time.
So it's not like a huge jump togo to FP3.
But it sounds like a lot ofyour patients you guys are
marketing towards.
So maybe you're seeing someyounger patients with, you know,
addiction issues or whatever itmay be that's causing that
decay earlier on in their life.
But something we definitelytalk about is the fact that when
(16:28):
we remove that initial bone andwe go to the FP3 style down the
line, if something fails, thenyou're getting into.
You know some of the moreadvanced implant techniques,
like Zygomatic implants.
Yeah, definitely.
You know, even we're kind ofseeing, you know, subs now and
all this other stuff to torepair those defects that they
(16:48):
initially had.
So you know, it's kind of likeyour initial set of teeth is
phase one, fp3 would be phasetwo and then a remote anchorage
is phase three, but you guys arejust adding another phase on it
, which is wonderful for thepotential of the lifespan of
these implants.
Yeah, out of these implants?
(17:11):
Yeah, how do you see like thetissue over time?
Are you losing any of thosepapillas over time?
Are you having any issues withaesthetic concerns?
That's something that has, even,like FP1, has kind of made me
nervous about going into doing alot of FP1 cases is because if
that you know what FP3 allows usto do is it kind of avoids any
of the aesthetic recessionproblems.
Logan (17:29):
Yeah, so I'm curious what you have been seeing over time
and how you combat thoseproblems if you do see them so
the way that we, the way that wedo the case and the way that we
train guys to create really asmuch keratinized tissue as
possible, we're finding more andmore that that's what, that's
(17:52):
what drives the success of theimplant.
So, um, when we're doing an fp1, we're using the pot, the
initial prosthetic, the temps toseparate the keratinized tissue
, let's say, on the upper.
We're going to pull a lot oftissue from the palate the day
of surgery and we're going toleave it.
We're going to leave the bonebasically exposed under the
(18:16):
prosthetic and we're going toallow secondary intention to
fill in that area.
And so we tend to get really,really good KG over time.
Do we still see a little bit ofgold from an abutment showing um
from an mua?
Yeah, we can still.
We can get some of that stuffover time.
We're not seeing most of mypatients.
Papillas remains awesome,assuming that they're cleaning
(18:39):
it.
Um, papillas remains good.
Everything's hidden underneaththe tissue, but occasionally we
have a little MUA exposed.
That's about the extent of theissues that we're seeing and
that's.
You know, for me that's asacrifice I'm willing to explain
to the patient.
You know why they have a littlegold exposed when they pull
(18:59):
their lip up real high.
Soren (19:01):
Yeah, is there anything you do about that, like if it's
an aesthetic zone?
Logan (19:05):
We can, we'll try.
If they're showing it whenthey're smiling, then we'll uh,
we'll get some alloderm in there.
We'll try and cover it up.
We'll uh.
Generally we try and plan ourcases with um with space to drop
down muas.
So we plan our implants fairlydeep, use a longer mua to start,
try and gain the tissue at thatand then, if we need to drop it
down later on, we can can andhide that MUA.
Soren (19:28):
Got it.
Yeah, Are you able to?
I know that I mean, if anythingyou feel uncomfortable sharing,
like, just let us know, we'rehappy to keep it.
I was just curious what yourthe prosthetic work, the
surgical workflow, looks for youguys.
You said that you leave some,some bone under the prosthetic,
which makes sense.
But like, are you guys, isthere like is it two millimeters
(19:50):
that you kind of like givebetween the prosthetic and the
crest of the bone in order forthat tissue to heal in, or what?
What does that kind of looklike?
And then are basically yousuturing under cause.
That's like kind of typical FP1style, right, yeah, so I'm just
curious, kind of what thatsurgical workflow looks for you
guys and um, yeah yeah, so, uh,just a bit.
Logan (20:11):
Once we have our, our implants in, um, for the most
part we're we're uhphotogrammetry and printing same
day.
Our lab for all of ourproviders is basically on.
They get scheduled for the dayof surgery so they can
immediately convert the wax upand we can print it and just go
direct to connection.
We place the prosthetic andoftentimes we are going to allow
(20:37):
the prosthetic to drive anyresorption that may happen.
So a lot of times we see unevenbone.
It's pretty rare for us toremove bone, usually only really
gummy smile, but we'll see theprosthetic up touching the bone.
We usually try and keep it amillimeter and a half to two
millimeters off of the bone.
(20:58):
But we'll let those pontics youknow in the posterior
oftentimes, where it's uneven orwe're switching from let's say
we're switching from twopremolars and two molars to, uh,
one premolar and two molars,that uh, that prosthetic is
going to drive the resorptionand then, as the KG fills, in
underneath it, it's going tocreate that pontic shape and
(21:20):
size that we want and that thick, characterized tissue.
Soren (21:23):
Got it?
Are you?
Are you guys flapping duringyour procedures or typically,
like I'm just curious about thesurgical workflow?
So, is it?
Is it extraction, no, flapimplants kind of go where you
can find that initial bone andthen you just go to the because
that's.
If it's that way, it seems likeit'd be a pretty efficient
surgery yeah, yeah, a lot of thetime we can do it flapless.
Logan (21:46):
Uh, depending on what sort of dentition they're
currently in, um, this is afully guided surgery for the
most part.
So, um, we almost alwaysrequire licensees so that we can
manage the implant placement.
Um, we help them plan the cases, get the guide sent over.
(22:06):
So everything for the most partis guided into place, because
it's such a difficult procedureto get those MUAs and those
scaraxes channels coming out,not out of an embrasure.
So everything's pre-planned.
But, yes, oftentimes we'll flap, like I said on the upper A lot
of times.
If I'm missing posterior teeth,I'm going to pull a lot of that
(22:28):
KG from the palate, I'm going tomove it over to the buckle of
my prosthetic and leave the boneexposed underneath and let that
fill in.
If they've got a full set ofdentition, then we can do the
cases without flapping andbasically our lab is just going
to get those every pontic rightinto the sites where the teeth
(22:49):
were originally.
So you know, we like to say, ifit's, we're treating these
cases exactly as if you had apatient lose seven through 10.
And you know, at that pointwe're not removing bone, we're
not trying to hide a prostheticreally high.
We're going to try and createas natural of a of a papilla and
natural of an appearance as wepossibly can with a bridge from
(23:11):
seven to 10, we're doing, we'redoing the same thing, just all
the way across.
Soren (23:17):
Got it.
That definitely makes sense.
Tyler (23:20):
And it sounds like everything is going to have a an
MUA.
You're not going direct tofixture, it's going to the MUA.
You're not going direct tofixture, it's going to the MUA.
Or do you do some direct tofixture?
I'm just kind of curious aboutsome of the prosthetic nuances
of it.
Logan (23:32):
Yeah, we've tried a few different systems.
So we started off doing all ofthese cement retained.
The first cases that we did, uh, in the first three or four
years probably, we were doingfully cement retained cases um
it.
They turned out reallybeautiful.
Um I still some of my bestcases as far as pontic site and
(23:55):
tissue development came fromthose cement retained cases.
But it was really complicatedand really um it it threw off a
lot of providers that justdidn't want to deal with how
complicated it got.
Yeah, um, now everything we dois basically a direct connection
on muas, um, all screw retained.
We have tried a couple implantsystems out that would go direct
(24:17):
to implant with withimmediately printing and putting
that connection really close tothe bone.
It worries me a little bit so Iprefer to have a little bit of
space with an MUA.
But we can.
That's the other, that's theother part of you know, if you
have an MUA exposed, we canalways put on either custom or
(24:39):
stock abutments for thatspecific bridge and you could
pivot that way as well to dropthat closer to the implant level
.
Tyler (24:46):
It does seem to me that kind of the keystone and being
able to do this and be flexiblewith any type of prosthetic
complications that either happennow or later is that you're
able to make these with your ownlab.
I can imagine if you're verydependent on sending out to
external labs and you're payinga large lab bill for this and
you start having somecomplications and having to
change the schema of this wholethree on six thing.
(25:08):
It can very quickly land youbeing underwater, Would that be?
Logan (25:10):
it.
Yeah, I mean, that was theinitial issue that we had is
they're charging us, howevermany dollars per unit and we're
making this huge bridge so youhave to replace even an
immediately printed case wherethey didn't want to send you the
file or you have to pay extrato get the file so you could
(25:31):
keep printing it in case you hadany issues.
It just became it was too much.
I mean, I remember taking myfirst all in X courses and they,
they would brush over FP one.
You know they, they told usabout the different
classifications and they wouldbrush over FP1,.
You know they told us about thedifferent classifications and
they would say, yeah, if youwant, this is, this is the
unicorn.
It's for only very specificpatients.
(25:51):
It's really complicated and youhave to charge your patients 80
grand per arch and it's likeman, probably never do that,
never do that.
Um, we created our lab in orderto essentially remove that for
ourselves and then it turnedinto removing that for our
(26:12):
licensees.
So you know, for us uh to,let's say, we had to remill, uh,
a full arch.
I think our lab right now nowis charging maybe 300 bucks for
the full arch of zirconia in aremill.
It might be less than that, I'mnot sure.
But as far as our pricing goes,just to kind of give a
(26:32):
framework of things, we deliverbasically the full arch to our
licensees for $5,000 an arch.
That includes the implants, theabutments, the immediate
prosthetic, the secondaryprosthetic, the final zirconia.
So basically your surgery in abox is $5,000.
And that's surgical guide aswell.
(26:55):
So we feel like it's a prettyfair price for everything you
get, especially when it'sincluding the implants and
abutments and uh.
And then, like I said, we wetake those costs and any redos,
remakes, anything like that.
We just lower it as much as wecan so that people aren't
restricted by the cost of thingswow, wow.
Tyler (27:17):
So are all the people that you guys are licensing out
to you, know I?
I assume this means they canmarket three on six and say
there are three on six providers.
They're all going through thelab that you guys developed and
then that's hub and spoke typeof thing.
Logan (27:30):
Yeah, so that's, that's the only thing we require.
Um, uh, we kind of have overthe years it's kind of created
these fan clubs, which is kindof funny on you.
you know, we get these groups onfacebook that yeah just love
that three on six and so thatall we get all these patients
coming into these groups.
And one of the issues that wewe found early on is patients
(27:53):
being afraid that they're goingto get a worse or a different
product than if they came toutah to see us.
And that's one that's one ofthe hurdles that we wanted to
get past, because even still,most of our patients fly in from
out of state searching for this.
So as we started to put theseproviders out, we wanted them to
(28:13):
be delivering the exact samestuff that we were putting out,
so that we could go on there andsay, no, don't come to Utah.
That's your name.
Yeah, stay there.
You're getting the same exactproduct.
So we do require, if you'remarketing three-on-six, use our
lab, use the implants, so thatwe can say, essentially, stay in
Chicago, we've got a greatdoctor there.
Tyler (28:35):
He's doing the exact same stuff.
Okay, okay, so what is kind ofthat sort of curriculum?
So let's say, somebody wants toincorporate doing three on six
and they reach out to you guysand now they want to get into
that world.
A what do they have to do toget involved in it?
And B, once you see that personthat wants to do it, what do
you need to see from them inorder for you to say okay, you,
you're good to do this?
Logan (28:54):
Yeah, so they we hold a training out here in Salt Lake
Um.
It's essentially a four-daytraining.
Wednesday through saturday umheavily wednesdays, didactic
thursday, basically full modelwork um friday, some prep for a
surgery and then saturday wherewe we get each um trainee, uh,
(29:17):
an arch of three on six to do onjust some of our own patients
that couldn't afford it fullprice.
So everyone gets to do a fullarch when they come through our
training.
The cost of the training is$25,000.
Five of that is our one-timelicensing fee, so we don't
charge any licensing fees beyondthat.
(29:37):
That gets you kind of up on ourwebsite as a provider on that.
That gets you kind of up on ourwebsite as a provider From
there.
If we feel like a student needsa little bit more one-on-one
time before we can confidentlyput them up on our website, then
we suggest kind of some furthertraining which we can do.
(29:58):
We've traveled out.
I've traveled out to a lot ofour licensees offices that kind
of want to run it in their ownoffice and I'll help them get
their staff set up and help themrun through the workflow, get
their printers all going, youknow, just make sure
everything's dialed in in theirown space, so they feel
confident doing it.
Tyler (30:17):
And what would you say is kind of like a baseline.
You know I have X amount ofskill.
I'm ready to go do this fourday course and by the end of it
I'm going to be probably readyto go and do some zero ounce X.
Logan (30:28):
Yeah, we, we, we require them to a place.
I think at least 150 implantsis where we just kind of guessed
where we wanted them to be,guessed where we wanted them to
be.
Um, we love getting FP3providers because they're just
so much more used to, uh,surgical complications and so we
(30:49):
have guys that have comethrough that are just amazing
FP3 providers that just addedthis to their workflow.
Um, they charge more for itbecause it's more complicated
and the longer surgery, sure,and they're still doing, you
know, they can place pterygoidssuper easy.
They can, they can doeverything and it makes our
lives a lot easier when theseguys come through and they have
(31:10):
all that experience.
But we've also trained doctors,general dentists that looked at
fp3 said now they didn't feelgreat about, um, some of the
issues with fp3 and, and so thisis their entry into FullArch
and it just requires a littlebit more input on our end and we
feel like we've kind of createda family within this three on
(31:33):
six group where these providersthey'll text me directly, we
walk them through cases, alljump on and help with their
implant planning For their firstfour arches after they've gone
through the training I on andhelp with their implant planning
For their first four archesafter they've gone through the
training.
I basically manage all of theircases, start to finish, to make
sure that the wax ups are doneproperly, that we go through
their implant planning togetherto make sure that they're
(31:56):
thinking of different thingsthat can arise during surgery.
We try and really baby theminto this because it is
complicated and most of themhave just taken it and ran with
it.
Tyler (32:07):
So it's been great to see so is that to say that you know
, after they've had those firstsort of you know cases where
you've been holding handsthrough the planning and
everything you know, they'refeeling confident to go ahead
and do their own implantplanning and their own surgical
guide fabrication.
Like, at what?
At what point are they havingto, uh, coordinate with your lab
(32:27):
?
Is that just when the finalprocess come along for the
second?
No, so they're they're.
Logan (32:31):
They're doing it from the beginning.
So our lab will do.
Does the wax up?
Um, our, we have one umemployee that does all the
implant planning because sheknows how we like them planned
and so she's going to guide allof the surgeons, all of our, our
licensees, through the implantplanning process.
I'm on a team's chat for everysingle one of those, so if any
(32:53):
of them have a question theykind of just tag me in those
things and I can hop in and helpthem with the implant planning.
If it seems like a morecomplicated case, um, we try and
make it.
So we're as available aspossible to help them through
those.
But yeah, after four arches Iguess their their initial arch.
During training we baby themthrough their first four and
then we kind of set them looseand they just ask us if they
(33:15):
need anything from there wow,wow.
Tyler (33:19):
So it might assume and correct me if I'm wrong, because
you have mentioned usingteragoids and things like that.
So in my head when I'm thinkingabout doing you know six
implants and, um, you know whenI've seen most FP1 cases like
this is usually going to be ayounger patient, not necessarily
, but they've got, you know,bone and all the Bedrosian cells
like the.
You've got bone that you canuse all the way back to the
(33:39):
posterior and we're probablyplacing axial implants.
But in some situations we'retilting a little bit like how
how do these usually end uplooking?
Do we have angling implants?
Logan (33:48):
yeah, we, we usually, I would say most cases we have to
angle with the sinus.
Still, um you know these type ofpatients.
At this point they've lost atleast some bone in the posterior
, sure, um?
So we do angle.
I would say what we find ismost a lot of patients that you
(34:12):
maybe wouldn't think arecandidates for fp1 are in fact
candidates, or maybe virgin, toan fp2 type of territory.
But, um, the.
The comments that we get morefrequently than not are I don't
want fake gum tissue, um, and Idon't want any of my bone
removed.
Those are the two main thingspeople come to see us for and um
(34:33):
.
So the, the.
If, if the teeth end up alittle bit longer than a natural
tooth, then it's, it'sgenerally not a concern for most
patients.
Now some, some are going to bepretty picky about it, um, and
then if they're going to be, ifit feels like they're going to
be very picky, then we gothrough the fp3 process as well,
(34:54):
discuss how we can make their,their tissue maybe look a little
bit better if they, if they gothrough that.
But here are the drawbacks wehave to remove a little bit
better if they go through that.
But here are the drawbacks.
We have to remove a little bitof bone.
We have to hide that joint up alittle higher.
So as long as we're providingthat context to patients, then I
think we're in good shape.
But yeah, as far as the implants, the planning goes, I think
(35:15):
you'd be surprised how manypatients are candidates for this
.
And basic framework yeah,we're're in the.
If we can get implants straightup and down in the posterior,
we're going to do it.
If we can't, we'll move topterygoids.
We'll angle with the sinus um,but we almost always have to get
implants in at six and elevenand then we will do seven and
(35:35):
ten is kind of our primary placefor so laterals um.
But we will oftentimes, iflateral um bone isn't great,
we'll place at eight and ninecantilever off laterals um.
But almost never cantilever acanine on the upper okay, um so
I guess that leads to.
(35:56):
One of the trickiest parts ofthis whole thing is, um, just
learning how to do a traumaticextractions, because I think
that's where we see the mostissues with our licensees.
They come in and that caninebuckle plates gone and then pre
it presents a ton of issuesmoving forward.
(36:16):
So we we really harp on atraumatic extractions getting
the teeth out without, um,without destroying the buckle
plate.
Um, we have some doctors thatsocket shield, that do some of
these other techniques to helpkeep that bone in place.
So, um, there's, there's a lotof stuff we can do to help keep
(36:37):
that bone in place.
Do you have any?
Uh?
Soren (36:40):
do you have any tips for people on atriomatic extractions
and kind of you know thingsthat you like to do to try to
prevent and restore that buccalplate?
Logan (36:49):
yeah.
So the main thing that we I usean ash forcep for almost every
anterior extraction yeah, if youcan, if you can figure out
rotational movement and shovingit up into their brain as you're
rotating, you can generally getthe canines out without
(37:10):
removing any bone.
You can get most teeth outwithout removing any bone.
We do eye section canines allthe time.
I will break it into a thousandpieces before I'll let the
buckle plate go.
So that's one of the things wewe focus on.
A lot is okay.
This is how you're going tosection it In order to preserve
(37:32):
the buckle plate.
We will oftentimes we'll useour guide and we'll just.
If there's a root tip left,we'll drill straight straight
through it.
Use that space to pull the restof the tooth out.
There's a root tip left, we'lldrill straight through it.
Use that space to pull the restof the tooth out.
There's a lot of techniquesthat we go through throughout
our course.
That kind of help guide them onhow to prevent bone loss.
Tyler (37:53):
Yeah, yeah, I mean, I think that's one thing that
initially, as you're kind ofwalking us through the surgical
approach here, that's what pingsoff in my head is you know,
when you have, uh, this, youknow, full dentition, you need a
traumatic extraction.
You probably got a bunch ofteeth that are broken off below
the gum line.
Trying to be conservative withyour flap, trying to work with
the surgical guy, trying to makethings come out in one place,
(38:14):
like that's, that's not an easything to do, um, and if you're
primarily an FB3 provider, youdon't worry quite as much about
those things and, frankly, evenif you break off a buckle plate,
you probably still be okay.
Logan (38:24):
You move around a lot of times.
Tyler (38:26):
Yeah, you don't really need that type of architecture.
So this is definitely a muchmore intricate, delicate
procedure, at least as itappears to me.
Logan (38:33):
Yeah, and it will take you longer.
We have a lot of guys that comeout and I think I I talked to a
few that say, well, I've done aton of fp3, I don't need the
training, can I just get going?
And it's like now we gotta haveto come out, we gotta go
through this stuff, because it'sit is more complicated than you
would think and, um, thesurgeries tend to take seven,
(38:54):
eight hours, whereas you can doa.
You know you can do a fullmouth fp3 a lot quicker than
that most fp3 providers can, um,so the cases they're longer,
they it takes more time to dothis and so that's why we
generally tell our providers,you know, charge more for it
when a patient, when a patientcomes in, if you want to sell
(39:15):
them on an fp1, you got to sellthem on what it is and the
difficulty of it, and this iswhy it costs a little bit more
than the FB3, make it worth yourtime, um, because it's a, it's
a longer procedure and you'regoing to be in there for a bit
more time.
Tyler (39:32):
Yeah, yeah what do you typically?
Soren (39:34):
charge for, if you don't mind, for like your uh all on
six or three on six procedure inUtah we're about 25 an arch 22
to 25.
Logan (39:46):
Um, we charge 18 to 20 for our FP3 cases.
So we try and stick about 5,000more per arch.
If we're doing four on eight,so we're just doing more bridges
um more implants than I thinkwe're into the 30 per arch
territory.
Um, we have providers in inchicago, san diego, um florida
(40:09):
that I think charge a decentamount more than that yeah, no,
I mean for your time.
Tyler (40:15):
I think that makes a lot of sense.
So, yeah, I'm kind of, I didn'tmean to cut you off no, you're,
you're good.
Logan (40:21):
Yeah, it's just.
But at the same I don't know.
At this point I have a hardtime with how much we do.
If they're a candidate for FP1,I have a really hard time
telling them that for five grandless the I'll remove the bone.
I do an fp3, so I think they'lljust take that they don't value
(40:43):
it the same way.
Yeah, and so it's a for me.
I try and do what I can to get.
If they're if they're a reallygood candidate got loads of bone
, they're young, then I'll dowhat I can to push them into
that fp1 and all.
Yeah, you know, for me itdoesn't cost much more as far as
lab fees and everything.
It doesn't cost me a ton moreto do an FP1 versus an FP3.
(41:04):
It's only my time and it's justthat initial surgery,
everything thereafter, is fairlysimilar to an FP3 case.
So you know, for me, if I'vegot a young patient, I can
discount it a little bit to getthem in and and help them
preserve a little bit of bone.
Then I'll do that.
Tyler (41:21):
So I'm curious about you know, at the flagship office
that you're working at, whatdoes?
What's the whole infrastructurethat you have?
So you have a ton of ops.
How many providers is there anin-house anesthetist, things
like that?
What kind of volume are youguys looking at per month?
And let me share what you'recomfortable with no, yeah and
share what you're comfortablewith.
Logan (41:42):
We built this office, I believe, about three years ago.
We're pretty close to, kind ofright in the heart of Salt Lake
County, so a pretty goodlocation.
We've got 18 operatories inthis office.
We've got two surgical suites.
We actually regret only makingtwo of those.
That's quite a ratio.
(42:04):
Yeah, well, at the beginning,you know, we didn't know how
much this was going to take off.
Yeah, and so Randy, my partner,he was doing, he kind of
switched a while ago to onlydoing full arch.
I still and I mostly do fullarch right right now.
I still love prepping veneersand I love doing, yeah, root
canals and I'll do all sorts ofstuff.
(42:25):
I like it all.
Um, so we, we have an associatethat does most of the general
dentistry here.
Um, we trained a doctor abouttwo years ago that ended up
staying on with us, uh, drweisenisenberg, and he helps me
with the training.
He's super knowledgeable andhe's been great to have around.
(42:46):
So we've got basically thethree of us Dr Roberts, myself
and Dr Weisenberg that aremostly full arch.
As far as you know, we try andget about two cases a week for
each of us.
It doesn't always happen, butum, yeah, we're, we're doing
quite a bit here and, like Isaid, most of it about half of
(43:06):
it is patients that travel infrom across the country.
Tyler (43:10):
Yeah, yeah, I'm curious about, um, how you guys kind of
got the word out and then youknow cause I, from what little I
do know about three on six.
I do see people asking aboutthree on six and all the other
dental implant groups, um, thatI'm a part of, you know, and a
lot of those.
Most people are talking aboutFP3 and I'm talking about prices
between oh, I went to clearchoice, I went to new via, I
(43:30):
went to so-and-so, um, but uh,every now and then someone will
say, oh, what about three on six?
Yada, yada, yada Right.
So I'm curious, where where'dthat national appeal come from?
And how does that usually workwhen people are traveling in and
then traveling back and kind ofwork that out logistically?
Logan (43:44):
Yeah, it's kind of funny.
It's grown so much in the lastfew years.
I was renewing my uh, my um,malpractice insurance here in
Utah and, uh, I was goingthrough the questionnaire and at
the very end it said do you doall on four, or three on six?
And it was funny to see thatspecific on a malpractice.
(44:05):
You know, it's just in the lasttwo years kind of done this.
We put out a lot of content onYouTube initially.
We still do a decent amount,and so most of our patients,
basically they'll I would say90% of them them come to us
after they've been told bysomeone they need an all on X.
They go on Google and they typein all on X versus, and three
(44:28):
on six is the only other thingto come up, and that's going
back to what we said abouthaving a marketable FP1,
basically, and so a lot of it isjust the content that we put
out.
And then these Facebook groupsstarted and so patients talk
within those groups about whatwe're doing, and so you know, if
(44:51):
someone is searching for analternative to All in X, they
usually find us because of thestuff that we've been putting
out there, usually find usbecause of the stuff that we've
been putting out there.
The idea of starting thislicensing program was well,
don't travel to us, stay whereyou're at.
This is a lot less complicatedif you're close to your house,
(45:11):
and so that was the main goal,and I think we've done a pretty
good job at that, and thesedoctors that are doing a lot of
this are getting a lot ofnotoriety in those Facebook
groups people saying I went todoctor, whatever, and he's doing
awesome cases and they'reshowing their results, and so we
get less and less of thesepatients traveling in from out
of state, which is good, butyeah, I would say online YouTube
(45:33):
videos that kind of thing.
And, yeah, online YouTubevideos that kind of thing.
And yeah, it's, it's funny.
We're starting to see YouTubecontent against us.
Um, guys that think that, uh,what we're doing is crazy, which
is is perfectly fine, but it's,I mean, it's been around
forever.
This isn't something really new.
(45:53):
It's just a way to do itaffordably and predictably in my
mind.
Tyler (45:58):
Well, I think that everything the three of us do
was crazy at one point.
So yeah.
All right guys.
So thank you so much forlistening to part one of our
episode, with Dr Logan Lockediscussing three on six.
So we talked a lot about thecontext of three on six, where
it's coming from and the generalconcepts, but for part two,
next week, we're going to begoing into all the odds and ends
(46:19):
, the nuts and bolts, learninghow to really accomplish this
procedure, how you too can alsobe a provider of three on six.
So stay tuned and thanks forlistening.
My name is Dr Tyler Tolbert and I'm Dr Soren Poppy,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
My name is Dr Tyler Tolbert andI'm Dr Soren Poppy, and you're
listening to the Fix Podcast.
Hello and welcome back to theFix Podcast.
We are here with a pioneer inimplant dentistry, dr Logan Lott
(00:21):
.
We are super fortunate thathe's been willing to spare his
time with us and we're going tobe covering some really
interesting concepts, a littlebit different from the typical
fare that Soren and I talk about.
So I think in this episode, youand I are probably going to be
taking a little bit of abackseat, learning about some
interesting surgical andprosthetic concepts and
different ways of thinking aboutand approaching full arch.
(00:42):
So, dr Logan, we reallyappreciate you coming on?
Yeah, happy to be here.
Thanks for having me on, guys,awesome, awesome.
So for those who are not awareof you, those shamed people may
they be, could you help us outjust a little bit and kind of
give us a little?
Logan (01:01):
bit of a story of how you got to where you're at and
where you're at.
Yeah, so, um name's Logan Locke.
Um, I'm on here basicallybecause I'm I've, uh, I've been
with three on six for, uh,basically since its beginning.
Um, my partner, randy Roberts,and myself, um, he, really, he
really started it back in like2016.
(01:22):
Really started it back in like2016.
And I jumped on shortly afterthat.
We started doing the firstcases in our office.
I assume we'll get into threeon six.
I myself, born and raised inUtah, went to Creighton for
dental school and just kind ofgained a passion for implant
(01:45):
dentistry.
There had some really awesomementors.
Can't say enough about how muchthey allowed me to do in dental
school, which I think, aftertalking to a lot of people, I
thought it was normal.
But I think my experience inschool was far different than
most.
And then so came to work for DrRandy Roberts and we just did a
(02:11):
billion low-cost implants andthat's kind of how we got
started with in the full arch asit slowly progressed and and
into attempting FP1, basically.
Tyler (02:23):
Okay, and so what was kind of just the general
landscape back in that time?
So you said a billion low costimplants, what.
What did that look like?
What were most people in yourtown doing at the time?
What was the market?
Logan (02:33):
Yeah, so Utah is a heavily, heavily saturated place
.
Um, it is hard to compete inthis area and so we were running
basically a quantity program.
We were doing implant above andcrown all the way through for
1500 bucks.
Um, we were using, when I firststarted, we were using
(02:55):
high-tech implants, I thinkthey're I don't even know where
they're out of Um, and then weslowly transitioned to neodent
CM.
Um, we were doing most of ourcrowns on a CEREC.
So you know it was.
We did a lot of implants andreally experience-wise, I
(03:17):
couldn't have asked for more,but it had its own challenges
and so, yeah, that's $1,500 allthe way through.
I wouldn't do that right now,but there was, it had its own
challenges and so, yeah, that's1500 bucks all the way through.
I wouldn't do that right now,but Definitely got me some good
experience.
Tyler (03:32):
For sure, for sure, that's awesome and so you know,
being sort of the economy, Iguess single implant guy, were
you approaching full arch at thetime or was there a modality
that you guys were utilizing atthe time For that, or was it
more just like single toothreplacement bridges?
Logan (03:47):
mostly single tooth and implant bridge and uh.
And then I started to dive intoall on x, um, so I took some
courses on that, did quite a fewcases.
Um, that's about around 2017 iswhen uh partner Randy started
doing.
He essentially started doingFP1 with Sarek Bluecam and we
(04:12):
were just.
He had a cousin that needed afull mouth.
He didn't want to remove bone,decided to put some implants in
and after they healed up, we putjust stock abutments on and
scanned them and then wedesigned our own bridges.
They did not look the mostbeautiful at that time but it's.
It functioned and that's kindof how the whole thing began.
Tyler (04:36):
Okay.
So yeah, I'm very naive to theconcept of three on six.
I mean, I've looked at it.
I kind of know it from just abird's eye view, but the basics
that I know is that you wereworking it's a fp1 full arch
method where you have segmentedarches, so it's a total of six
implants and three separaterestorations that are just kind
of butted up at once againstagainst one another in a way
that looks, you know, fluid andlooks like a full arch.
(04:57):
Um, but that's about as far asI go.
So I'm interested to see whatkind of advantages you guys saw
versus all annexes and I lovethat you have that all annex
background.
So what was so attractive aboutthat modality?
Logan (05:07):
The.
The gist of it was, you know,we started to see, once we did
the first cases, we got peoplecoming in and they're like, we
really like this and it wassuper, super challenging at the
time to do us, you know, even afull arch bridge.
We'd try one piece but ourpucks weren't big enough.
(05:28):
Um, the cost to go through alab was incredible.
It was just way too high to tryand have these um fabricated at
the labs that we were using.
Um, they were weaker when theywere one piece, so we'd we'd see
fracture more, more frequently.
We were using Emax at the timebecause it's just what we could
mill out.
(05:48):
Um.
So, yeah, three on six,basically, is a FP1 modality Um,
by no means did we invent FP1,obviously, um.
But the main issues that we sawwe had a younger patient, a
younger patient base coming in,a lot of addiction, completely
(06:10):
broken down dentition and theyneeded full arch.
And the problem that we saw, orthe ethical dilemma I think
that we felt, was the bone room.
We know this stuff isn't goingto last forever, this stuff
(06:31):
isn't going to last forever, um,and so when we were looking at,
you know, 7 to 15, sometimesmillimeters of bone reduction in
order to hide a lip line orcreate a prosthetic space.
In a 28 year old, it just, um,yeah, we decided we wanted to
look at other options.
So so three on six is amodality, an FP1 modality.
It's a way, from start tofinish, to do FP1 slash FP2
(06:54):
consistently and affordably.
So we essentially found that wecouldn't use outside labs
because they weren't proficientenough to get the pontic site
development that we required.
They were way too expensive, sowe were having to charge
patients way too high of feesand so they just didn't want to
do it.
So our barriers were bring thecost of the procedure down,
(07:20):
bring the skill needed down,because it is a tougher
procedure to do, and and make itso that more people could do it
consistently.
And that's kind of where and Iguess the latter part of it is
create something that'smarketable, because no one knows
what fp1 is.
Patients don't understand.
(07:40):
And often I think patientsdon't understand when they're
getting an all-in-x.
They don't understand thatthey're going to have fake gum
tissue, that they're going tohave fake gum tissue, that
they're going to have boneremoval, cause often we just
don't.
That's part of the process.
We don't describe that whenwe're selling patient um, which
I don't think is terrible.
It's just part of the process.
But most of the the people thatcome to see us didn't know that
(08:05):
until they Googled it after aconsult.
Tyler (08:08):
Okay, okay.
So one thing you said there Ican kind of imagine some people
having a little bit of a kneejerk reaction to if they're kind
of very set in the you know allon X uh cross arch stability
world.
As you said, that it was weakerwhen you were doing one piece
all the way across the arch.
So how did segmenting help usout with that?
Logan (08:24):
Yeah, so the I mean the reason we need a prosthetic
space right is for the strengthof the prosthetic, and so that's
part of the reason that we haveto remove bone.
Cross arch stability is iscrucial for the initial
stability and the healing of theimplants.
And we still our initialprosthetic is one piece.
(08:45):
We we want cross arch stability, we want those implants to be
supported during the healingtime and then, um, after that is
, once the implants haveintegrated, that's when we start
to segment, uh, in order togive them, one, a more durable
prosthetic.
And two, we want, we want tostart increasing the load on the
(09:07):
implants.
We looked at a lot of research,for you know, when we look at,
say, an all-on-six, say we'redoing six implants, the research
that we found suggests that theanterior two implants get the
bulk of the load, the posteriortwo implants get the bulk of the
load and really the ones in themiddle are taking much, they're
(09:28):
not providing a ton of extrasupport.
And, uh, we know that implantsdon't do well when there's not a
load against them.
Uh, we've all seen an implantcome in with a healing abutment
after 10 years that never gotrestored.
You're always bone loss, yeah,and so the idea of it's
(09:50):
progressive loading.
I guess Progressive loadingthese implants as they heal is
kind of what drove us Well.
Honestly, the initial part wasthat was as big of a puck as we
had or as big of a block as wecould mill with our CEREC.
That's as big as we could get ofa block as we could mill within
with our seric that's as big aswe're on again.
But then we started, you know,looking into it further and it
was working and and implantswere retaining bone and we were
(10:12):
getting really good scans ofbone density and um bone
deposition and and so webasically it was a accident,
well, not an accident, but kindof lucked into something that we
believe works better long-termand distributes load more evenly
across more implants.
(10:33):
That makes sense.
Soren (10:36):
So a question that I have for you as far as the three on
six goes is I mean, that makessense to me.
I think the first thing Ithought of when I was looking at
3N6, I think the first argumenta lot of people have regarding
it that I've seen is the well,there's no cross-arch stability
for, you know, to get past thatprimary stability portion of the
(10:57):
implant, and if you are gettingthat cross-arch stability,
that's great.
A question I have, though, is,let's say, when we're doing a
fixed prosthetic on four or siximplants and you know what our
philosophy is, we typically dopterygoids in every case, so
we're doing all on six, withfour on the anterior, and where
(11:20):
we see a big benefit to that isif an implant fails down the
line.
Right to that is, if an implantfails down the line right.
Um, we, there's a lot of realestate where we can remove an
implant, place another one andload another temp, or or even,
if they are at the phase ofzirconia, um, mill another
zirconia pretty easily.
Um, how do you guys combat theissue of you know, if you have
(11:44):
three different bridges and oneimplant fails?
I feel like that might be abigger headache for you as the
clinician to then go in there,and you might be kind of limited
with the amount of space andbone that you have to replace
that single implant on thosebridges.
Logan (12:00):
For sure.
Yeah, so I mean, if, if, ifwe're talking, you know, 10
years they're already insegmented bridges.
They come back and an implantsfail.
It's pretty easy for us to beable to take our design and
basically remove one of those,one of those um splits.
So, you know, maybe we turn itinto a two on five um, basically
(12:23):
creating those segments indifferent areas.
Worst case scenario we can turnit into a full arch prosthetic
and you know, at that point yourbiggest weakness is just the
full arch.
You know one big piece ofzirconia.
It tends to fracture morefrequently.
So at that point we'd maybewarn the patient that that's
(12:43):
something that could happen downthe road, being that we're not
having a 12 millimeterrestorative space.
Oftentimes we're in the, youknow, six to eight millimeters.
So, um, so that's kind of theworst case scenario.
But we, we find that, um, itleaves us so much, so many more
opportunities because, yeah,we've got these implants in but
(13:04):
we didn't remove any bone.
We, uh, we kept every ounce ofbone that they had at the
beginning.
We're placing these implants ata prosthetic spot where we're
getting good pontic sitedevelopment and then, let's say,
30 years from now, this suckerfails, we're getting bone loss
and it just doesn't look goodanymore, we'll take the implants
out.
We'll put them in an All-On uh.
(13:26):
Do some pterygoids, we do um.
A lot of our um providers areplacing pterygoids.
They're using those within a uhthree on six slash four on
eight framework where we'rewe're still segmenting against
those pterygoids Um.
So all of the things can stillbe applied.
My belief is that we're givingthem an extended life on what
(13:50):
bone they have, because it's youknow all of this stuff how long
it lasts.
We're going to see theramifications of what we're
doing.
I think 30 years from now.
We'll see what happens with allthese full arch cases.
But if we've got a lot of boneand we can still We'll see what
happens with all these full archcases.
Tyler (14:14):
But if we've got a lot, of bone and we can still go to
an all on X, from a three on six, then great, okay.
So in other words, if you'relosing one of your guys down the
road, this is a long termfailure, like late failure.
Yeah, five, 10 years down theroad you could lose that implant
and you don't necessarily needto be replacing that implant and
just making a new segment.
You're actually now going to,you're going to refabricate a
whole new one that connects twosegments, so that that way you
(14:37):
know it's kind of like youdidn't really lose much at all
because the other implants werealready integrated.
So now you're just sort ofswapping it out, going from
three on six to two on five, ormaybe you started four on eight.
I had to think about that one.
Logan (14:48):
Yeah, you got to think about how many bridges are on
now.
Now, yeah, and if you thinkabout, I mean so, our general
placement of implants, if we canget them straight up and down
in the first molar area, great,but we still angle with the
sinus quite a bit in theposterior.
So let's say three to four touh, we almost always place an
(15:09):
implant in at number six, uh, atour canine sites.
So six and 11 are gettingimplants, and then um seven and
10 generally.
Now, if we had number sevenfail, I'll just put an implant.
We grafted everything.
We graft every single socketthat we take out of.
So usually I have a, let's say,seven fails, I'm going to put
an implant in at eight.
I'll kind of leave her sevenoff of it, and I've still got a
three on six.
So there's still, um, still alot of opportunity to move
(15:33):
things around, um, with whatwe're doing, because we just we
generally keep just a ton ofbone.
Tyler (15:40):
And it's really too like.
Soren (15:42):
I really like that.
Yeah, I was just gonna say Ireally like the idea of it
because, you know, somethingthat we talk a lot about on the
podcast is the fact that, um,you know and, and that primarily
what we are doing is FP3.
Uh, and what ends up happeningis right, you have patients that
go into FP3.
Um, that being said, a lot ofour patients are patients that
come in that you know thatindenture or they've been
(16:07):
missing their posterior teethfor a really long time.
So it's not like a huge jump togo to FP3.
But it sounds like a lot ofyour patients you guys are
marketing towards.
So maybe you're seeing someyounger patients with, you know,
addiction issues or whatever itmay be that's causing that
decay earlier on in their life.
But something we definitelytalk about is the fact that when
(16:28):
we remove that initial bone andwe go to the FP3 style down the
line, if something fails, thenyou're getting into.
You know some of the moreadvanced implant techniques,
like Zygomatic implants.
Yeah, definitely.
You know, even we're kind ofseeing, you know, subs now and
all this other stuff to torepair those defects that they
(16:48):
initially had.
So you know, it's kind of likeyour initial set of teeth is
phase one, fp3 would be phasetwo and then a remote anchorage
is phase three, but you guys arejust adding another phase on it
, which is wonderful for thepotential of the lifespan of
these implants.
Yeah, out of these implants?
(17:11):
Yeah, how do you see like thetissue over time?
Are you losing any of thosepapillas over time?
Are you having any issues withaesthetic concerns?
That's something that has, even,like FP1, has kind of made me
nervous about going into doing alot of FP1 cases is because if
that you know what FP3 allows usto do is it kind of avoids any
of the aesthetic recessionproblems.
Logan (17:29):
Yeah, so I'm curious what you have been seeing over time
and how you combat thoseproblems if you do see them so
the way that we, the way that wedo the case and the way that we
train guys to create really asmuch keratinized tissue as
possible, we're finding more andmore that that's what, that's
(17:52):
what drives the success of theimplant.
So, um, when we're doing an fp1, we're using the pot, the
initial prosthetic, the temps toseparate the keratinized tissue
, let's say, on the upper.
We're going to pull a lot oftissue from the palate the day
of surgery and we're going toleave it.
We're going to leave the bonebasically exposed under the
(18:16):
prosthetic and we're going toallow secondary intention to
fill in that area.
And so we tend to get really,really good KG over time.
Do we still see a little bit ofgold from an abutment showing um
from an mua?
Yeah, we can still.
We can get some of that stuffover time.
We're not seeing most of mypatients.
Papillas remains awesome,assuming that they're cleaning
(18:39):
it.
Um, papillas remains good.
Everything's hidden underneaththe tissue, but occasionally we
have a little MUA exposed.
That's about the extent of theissues that we're seeing and
that's.
You know, for me that's asacrifice I'm willing to explain
to the patient.
You know why they have a littlegold exposed when they pull
(18:59):
their lip up real high.
Soren (19:01):
Yeah, is there anything you do about that, like if it's
an aesthetic zone?
Logan (19:05):
We can, we'll try.
If they're showing it whenthey're smiling, then we'll uh,
we'll get some alloderm in there.
We'll try and cover it up.
We'll uh.
Generally we try and plan ourcases with um with space to drop
down muas.
So we plan our implants fairlydeep, use a longer mua to start,
try and gain the tissue at thatand then, if we need to drop it
down later on, we can can andhide that MUA.
Soren (19:28):
Got it.
Yeah, Are you able to?
I know that I mean, if anythingyou feel uncomfortable sharing,
like, just let us know, we'rehappy to keep it.
I was just curious what yourthe prosthetic work, the
surgical workflow, looks for youguys.
You said that you leave some,some bone under the prosthetic,
which makes sense.
But like, are you guys, isthere like is it two millimeters
(19:50):
that you kind of like givebetween the prosthetic and the
crest of the bone in order forthat tissue to heal in, or what?
What does that kind of looklike?
And then are basically yousuturing under cause.
That's like kind of typical FP1style, right, yeah, so I'm just
curious, kind of what thatsurgical workflow looks for you
guys and um, yeah yeah, so, uh,just a bit.
Logan (20:11):
Once we have our, our implants in, um, for the most
part we're we're uhphotogrammetry and printing same
day.
Our lab for all of ourproviders is basically on.
They get scheduled for the dayof surgery so they can
immediately convert the wax upand we can print it and just go
direct to connection.
We place the prosthetic andoftentimes we are going to allow
(20:37):
the prosthetic to drive anyresorption that may happen.
So a lot of times we see unevenbone.
It's pretty rare for us toremove bone, usually only really
gummy smile, but we'll see theprosthetic up touching the bone.
We usually try and keep it amillimeter and a half to two
millimeters off of the bone.
(20:58):
But we'll let those pontics youknow in the posterior
oftentimes, where it's uneven orwe're switching from let's say
we're switching from twopremolars and two molars to, uh,
one premolar and two molars,that uh, that prosthetic is
going to drive the resorptionand then, as the KG fills, in
underneath it, it's going tocreate that pontic shape and
(21:20):
size that we want and that thick, characterized tissue.
Soren (21:23):
Got it?
Are you?
Are you guys flapping duringyour procedures or typically,
like I'm just curious about thesurgical workflow?
So, is it?
Is it extraction, no, flapimplants kind of go where you
can find that initial bone andthen you just go to the because
that's.
If it's that way, it seems likeit'd be a pretty efficient
surgery yeah, yeah, a lot of thetime we can do it flapless.
Logan (21:46):
Uh, depending on what sort of dentition they're
currently in, um, this is afully guided surgery for the
most part.
So, um, we almost alwaysrequire licensees so that we can
manage the implant placement.
Um, we help them plan the cases, get the guide sent over.
(22:06):
So everything for the most partis guided into place, because
it's such a difficult procedureto get those MUAs and those
scaraxes channels coming out,not out of an embrasure.
So everything's pre-planned.
But, yes, oftentimes we'll flap, like I said on the upper A lot
of times.
If I'm missing posterior teeth,I'm going to pull a lot of that
(22:28):
KG from the palate, I'm going tomove it over to the buckle of
my prosthetic and leave the boneexposed underneath and let that
fill in.
If they've got a full set ofdentition, then we can do the
cases without flapping andbasically our lab is just going
to get those every pontic rightinto the sites where the teeth
(22:49):
were originally.
So you know, we like to say, ifit's, we're treating these
cases exactly as if you had apatient lose seven through 10.
And you know, at that pointwe're not removing bone, we're
not trying to hide a prostheticreally high.
We're going to try and createas natural of a of a papilla and
natural of an appearance as wepossibly can with a bridge from
(23:11):
seven to 10, we're doing, we'redoing the same thing, just all
the way across.
Soren (23:17):
Got it.
That definitely makes sense.
Tyler (23:20):
And it sounds like everything is going to have a an
MUA.
You're not going direct tofixture, it's going to the MUA.
You're not going direct tofixture, it's going to the MUA.
Or do you do some direct tofixture?
I'm just kind of curious aboutsome of the prosthetic nuances
of it.
Logan (23:32):
Yeah, we've tried a few different systems.
So we started off doing all ofthese cement retained.
The first cases that we did, uh, in the first three or four
years probably, we were doingfully cement retained cases um
it.
They turned out reallybeautiful.
Um I still some of my bestcases as far as pontic site and
(23:55):
tissue development came fromthose cement retained cases.
But it was really complicatedand really um it it threw off a
lot of providers that justdidn't want to deal with how
complicated it got.
Yeah, um, now everything we dois basically a direct connection
on muas, um, all screw retained.
We have tried a couple implantsystems out that would go direct
(24:17):
to implant with withimmediately printing and putting
that connection really close tothe bone.
It worries me a little bit so Iprefer to have a little bit of
space with an MUA.
But we can.
That's the other, that's theother part of you know, if you
have an MUA exposed, we canalways put on either custom or
(24:39):
stock abutments for thatspecific bridge and you could
pivot that way as well to dropthat closer to the implant level
.
Tyler (24:46):
It does seem to me that kind of the keystone and being
able to do this and be flexiblewith any type of prosthetic
complications that either happennow or later is that you're
able to make these with your ownlab.
I can imagine if you're verydependent on sending out to
external labs and you're payinga large lab bill for this and
you start having somecomplications and having to
change the schema of this wholethree on six thing.
(25:08):
It can very quickly land youbeing underwater, Would that be?
Logan (25:10):
it.
Yeah, I mean, that was theinitial issue that we had is
they're charging us, howevermany dollars per unit and we're
making this huge bridge so youhave to replace even an
immediately printed case wherethey didn't want to send you the
file or you have to pay extrato get the file so you could
(25:31):
keep printing it in case you hadany issues.
It just became it was too much.
I mean, I remember taking myfirst all in X courses and they,
they would brush over FP one.
You know they, they told usabout the different
classifications and they wouldbrush over FP1,.
You know they told us about thedifferent classifications and
they would say, yeah, if youwant, this is, this is the
unicorn.
It's for only very specificpatients.
(25:51):
It's really complicated and youhave to charge your patients 80
grand per arch and it's likeman, probably never do that,
never do that.
Um, we created our lab in orderto essentially remove that for
ourselves and then it turnedinto removing that for our
(26:12):
licensees.
So you know, for us uh to,let's say, we had to remill, uh,
a full arch.
I think our lab right now nowis charging maybe 300 bucks for
the full arch of zirconia in aremill.
It might be less than that, I'mnot sure.
But as far as our pricing goes,just to kind of give a
(26:32):
framework of things, we deliverbasically the full arch to our
licensees for $5,000 an arch.
That includes the implants, theabutments, the immediate
prosthetic, the secondaryprosthetic, the final zirconia.
So basically your surgery in abox is $5,000.
And that's surgical guide aswell.
(26:55):
So we feel like it's a prettyfair price for everything you
get, especially when it'sincluding the implants and
abutments and uh.
And then, like I said, we wetake those costs and any redos,
remakes, anything like that.
We just lower it as much as wecan so that people aren't
restricted by the cost of thingswow, wow.
Tyler (27:17):
So are all the people that you guys are licensing out
to you, know I?
I assume this means they canmarket three on six and say
there are three on six providers.
They're all going through thelab that you guys developed and
then that's hub and spoke typeof thing.
Logan (27:30):
Yeah, so that's, that's the only thing we require.
Um, uh, we kind of have overthe years it's kind of created
these fan clubs, which is kindof funny on you.
you know, we get these groups onfacebook that yeah just love
that three on six and so thatall we get all these patients
coming into these groups.
And one of the issues that wewe found early on is patients
(27:53):
being afraid that they're goingto get a worse or a different
product than if they came toutah to see us.
And that's one that's one ofthe hurdles that we wanted to
get past, because even still,most of our patients fly in from
out of state searching for this.
So as we started to put theseproviders out, we wanted them to
(28:13):
be delivering the exact samestuff that we were putting out,
so that we could go on there andsay, no, don't come to Utah.
That's your name.
Yeah, stay there.
You're getting the same exactproduct.
So we do require, if you'remarketing three-on-six, use our
lab, use the implants, so thatwe can say, essentially, stay in
Chicago, we've got a greatdoctor there.
Tyler (28:35):
He's doing the exact same stuff.
Okay, okay, so what is kind ofthat sort of curriculum?
So let's say, somebody wants toincorporate doing three on six
and they reach out to you guysand now they want to get into
that world.
A what do they have to do toget involved in it?
And B, once you see that personthat wants to do it, what do
you need to see from them inorder for you to say okay, you,
you're good to do this?
Logan (28:54):
Yeah, so they we hold a training out here in Salt Lake
Um.
It's essentially a four-daytraining.
Wednesday through saturday umheavily wednesdays, didactic
thursday, basically full modelwork um friday, some prep for a
surgery and then saturday wherewe we get each um trainee, uh,
(29:17):
an arch of three on six to do onjust some of our own patients
that couldn't afford it fullprice.
So everyone gets to do a fullarch when they come through our
training.
The cost of the training is$25,000.
Five of that is our one-timelicensing fee, so we don't
charge any licensing fees beyondthat.
(29:37):
That gets you kind of up on ourwebsite as a provider on that.
That gets you kind of up on ourwebsite as a provider From
there.
If we feel like a student needsa little bit more one-on-one
time before we can confidentlyput them up on our website, then
we suggest kind of some furthertraining which we can do.
(29:58):
We've traveled out.
I've traveled out to a lot ofour licensees offices that kind
of want to run it in their ownoffice and I'll help them get
their staff set up and help themrun through the workflow, get
their printers all going, youknow, just make sure
everything's dialed in in theirown space, so they feel
confident doing it.
Tyler (30:17):
And what would you say is kind of like a baseline.
You know I have X amount ofskill.
I'm ready to go do this fourday course and by the end of it
I'm going to be probably readyto go and do some zero ounce X.
Logan (30:28):
Yeah, we, we, we require them to a place.
I think at least 150 implantsis where we just kind of guessed
where we wanted them to be,guessed where we wanted them to
be.
Um, we love getting FP3providers because they're just
so much more used to, uh,surgical complications and so we
(30:49):
have guys that have comethrough that are just amazing
FP3 providers that just addedthis to their workflow.
Um, they charge more for itbecause it's more complicated
and the longer surgery, sure,and they're still doing, you
know, they can place pterygoidssuper easy.
They can, they can doeverything and it makes our
lives a lot easier when theseguys come through and they have
(31:10):
all that experience.
But we've also trained doctors,general dentists that looked at
fp3 said now they didn't feelgreat about, um, some of the
issues with fp3 and, and so thisis their entry into FullArch
and it just requires a littlebit more input on our end and we
feel like we've kind of createda family within this three on
(31:33):
six group where these providersthey'll text me directly, we
walk them through cases, alljump on and help with their
implant planning For their firstfour arches after they've gone
through the training I on andhelp with their implant planning
For their first four archesafter they've gone through the
training.
I basically manage all of theircases, start to finish, to make
sure that the wax ups are doneproperly, that we go through
their implant planning togetherto make sure that they're
(31:56):
thinking of different thingsthat can arise during surgery.
We try and really baby theminto this because it is
complicated and most of themhave just taken it and ran with
it.
Tyler (32:07):
So it's been great to see so is that to say that you know
, after they've had those firstsort of you know cases where
you've been holding handsthrough the planning and
everything you know, they'refeeling confident to go ahead
and do their own implantplanning and their own surgical
guide fabrication.
Like, at what?
At what point are they havingto, uh, coordinate with your lab
(32:27):
?
Is that just when the finalprocess come along for the
second?
No, so they're they're.
Logan (32:31):
They're doing it from the beginning.
So our lab will do.
Does the wax up?
Um, our, we have one umemployee that does all the
implant planning because sheknows how we like them planned
and so she's going to guide allof the surgeons, all of our, our
licensees, through the implantplanning process.
I'm on a team's chat for everysingle one of those, so if any
(32:53):
of them have a question theykind of just tag me in those
things and I can hop in and helpthem with the implant planning.
If it seems like a morecomplicated case, um, we try and
make it.
So we're as available aspossible to help them through
those.
But yeah, after four arches Iguess their their initial arch.
During training we baby themthrough their first four and
then we kind of set them looseand they just ask us if they
(33:15):
need anything from there wow,wow.
Tyler (33:19):
So it might assume and correct me if I'm wrong, because
you have mentioned usingteragoids and things like that.
So in my head when I'm thinkingabout doing you know six
implants and, um, you know whenI've seen most FP1 cases like
this is usually going to be ayounger patient, not necessarily
, but they've got, you know,bone and all the Bedrosian cells
like the.
You've got bone that you canuse all the way back to the
(33:39):
posterior and we're probablyplacing axial implants.
But in some situations we'retilting a little bit like how
how do these usually end uplooking?
Do we have angling implants?
Logan (33:48):
yeah, we, we usually, I would say most cases we have to
angle with the sinus.
Still, um you know these type ofpatients.
At this point they've lost atleast some bone in the posterior
, sure, um?
So we do angle.
I would say what we find ismost a lot of patients that you
(34:12):
maybe wouldn't think arecandidates for fp1 are in fact
candidates, or maybe virgin, toan fp2 type of territory.
But, um, the.
The comments that we get morefrequently than not are I don't
want fake gum tissue, um, and Idon't want any of my bone
removed.
Those are the two main thingspeople come to see us for and um
(34:33):
.
So the, the.
If, if the teeth end up alittle bit longer than a natural
tooth, then it's, it'sgenerally not a concern for most
patients.
Now some, some are going to bepretty picky about it, um, and
then if they're going to be, ifit feels like they're going to
be very picky, then we gothrough the fp3 process as well,
(34:54):
discuss how we can make their,their tissue maybe look a little
bit better if they, if they gothrough that.
But here are the drawbacks wehave to remove a little bit
better if they go through that.
But here are the drawbacks.
We have to remove a little bitof bone.
We have to hide that joint up alittle higher.
So as long as we're providingthat context to patients, then I
think we're in good shape.
But yeah, as far as the implants, the planning goes, I think
(35:15):
you'd be surprised how manypatients are candidates for this
.
And basic framework yeah,we're're in the.
If we can get implants straightup and down in the posterior,
we're going to do it.
If we can't, we'll move topterygoids.
We'll angle with the sinus um,but we almost always have to get
implants in at six and elevenand then we will do seven and
(35:35):
ten is kind of our primary placefor so laterals um.
But we will oftentimes, iflateral um bone isn't great,
we'll place at eight and ninecantilever off laterals um.
But almost never cantilever acanine on the upper okay, um so
I guess that leads to.
(35:56):
One of the trickiest parts ofthis whole thing is, um, just
learning how to do a traumaticextractions, because I think
that's where we see the mostissues with our licensees.
They come in and that caninebuckle plates gone and then pre
it presents a ton of issuesmoving forward.
(36:16):
So we we really harp on atraumatic extractions getting
the teeth out without, um,without destroying the buckle
plate.
Um, we have some doctors thatsocket shield, that do some of
these other techniques to helpkeep that bone in place.
So, um, there's, there's a lotof stuff we can do to help keep
(36:37):
that bone in place.
Do you have any?
Uh?
Soren (36:40):
do you have any tips for people on atriomatic extractions
and kind of you know thingsthat you like to do to try to
prevent and restore that buccalplate?
Logan (36:49):
yeah.
So the main thing that we I usean ash forcep for almost every
anterior extraction yeah, if youcan, if you can figure out
rotational movement and shovingit up into their brain as you're
rotating, you can generally getthe canines out without
(37:10):
removing any bone.
You can get most teeth outwithout removing any bone.
We do eye section canines allthe time.
I will break it into a thousandpieces before I'll let the
buckle plate go.
So that's one of the things wewe focus on.
A lot is okay.
This is how you're going tosection it In order to preserve
(37:32):
the buckle plate.
We will oftentimes we'll useour guide and we'll just.
If there's a root tip left,we'll drill straight straight
through it.
Use that space to pull the restof the tooth out.
There's a root tip left, we'lldrill straight through it.
Use that space to pull the restof the tooth out.
There's a lot of techniquesthat we go through throughout
our course.
That kind of help guide them onhow to prevent bone loss.
Tyler (37:53):
Yeah, yeah, I mean, I think that's one thing that
initially, as you're kind ofwalking us through the surgical
approach here, that's what pingsoff in my head is you know,
when you have, uh, this, youknow, full dentition, you need a
traumatic extraction.
You probably got a bunch ofteeth that are broken off below
the gum line.
Trying to be conservative withyour flap, trying to work with
the surgical guy, trying to makethings come out in one place,
(38:14):
like that's, that's not an easything to do, um, and if you're
primarily an FB3 provider, youdon't worry quite as much about
those things and, frankly, evenif you break off a buckle plate,
you probably still be okay.
Logan (38:24):
You move around a lot of times.
Tyler (38:26):
Yeah, you don't really need that type of architecture.
So this is definitely a muchmore intricate, delicate
procedure, at least as itappears to me.
Logan (38:33):
Yeah, and it will take you longer.
We have a lot of guys that comeout and I think I I talked to a
few that say, well, I've done aton of fp3, I don't need the
training, can I just get going?
And it's like now we gotta haveto come out, we gotta go
through this stuff, because it'sit is more complicated than you
would think and, um, thesurgeries tend to take seven,
(38:54):
eight hours, whereas you can doa.
You know you can do a fullmouth fp3 a lot quicker than
that most fp3 providers can, um,so the cases they're longer,
they it takes more time to dothis and so that's why we
generally tell our providers,you know, charge more for it
when a patient, when a patientcomes in, if you want to sell
(39:15):
them on an fp1, you got to sellthem on what it is and the
difficulty of it, and this iswhy it costs a little bit more
than the FB3, make it worth yourtime, um, because it's a, it's
a longer procedure and you'regoing to be in there for a bit
more time.
Tyler (39:32):
Yeah, yeah what do you typically?
Soren (39:34):
charge for, if you don't mind, for like your uh all on
six or three on six procedure inUtah we're about 25 an arch 22
to 25.
Logan (39:46):
Um, we charge 18 to 20 for our FP3 cases.
So we try and stick about 5,000more per arch.
If we're doing four on eight,so we're just doing more bridges
um more implants than I thinkwe're into the 30 per arch
territory.
Um, we have providers in inchicago, san diego, um florida
(40:09):
that I think charge a decentamount more than that yeah, no,
I mean for your time.
Tyler (40:15):
I think that makes a lot of sense.
So, yeah, I'm kind of, I didn'tmean to cut you off no, you're,
you're good.
Logan (40:21):
Yeah, it's just.
But at the same I don't know.
At this point I have a hardtime with how much we do.
If they're a candidate for FP1,I have a really hard time
telling them that for five grandless the I'll remove the bone.
I do an fp3, so I think they'lljust take that they don't value
(40:43):
it the same way.
Yeah, and so it's a for me.
I try and do what I can to get.
If they're if they're a reallygood candidate got loads of bone
, they're young, then I'll dowhat I can to push them into
that fp1 and all.
Yeah, you know, for me itdoesn't cost much more as far as
lab fees and everything.
It doesn't cost me a ton moreto do an FP1 versus an FP3.
(41:04):
It's only my time and it's justthat initial surgery,
everything thereafter, is fairlysimilar to an FP3 case.
So you know, for me, if I'vegot a young patient, I can
discount it a little bit to getthem in and and help them
preserve a little bit of bone.
Then I'll do that.
Tyler (41:21):
So I'm curious about you know, at the flagship office
that you're working at, whatdoes?
What's the whole infrastructurethat you have?
So you have a ton of ops.
How many providers is there anin-house anesthetist, things
like that?
What kind of volume are youguys looking at per month?
And let me share what you'recomfortable with no, yeah and
share what you're comfortablewith.
Logan (41:42):
We built this office, I believe, about three years ago.
We're pretty close to, kind ofright in the heart of Salt Lake
County, so a pretty goodlocation.
We've got 18 operatories inthis office.
We've got two surgical suites.
We actually regret only makingtwo of those.
That's quite a ratio.
(42:04):
Yeah, well, at the beginning,you know, we didn't know how
much this was going to take off.
Yeah, and so Randy, my partner,he was doing, he kind of
switched a while ago to onlydoing full arch.
I still and I mostly do fullarch right right now.
I still love prepping veneersand I love doing, yeah, root
canals and I'll do all sorts ofstuff.
(42:25):
I like it all.
Um, so we, we have an associatethat does most of the general
dentistry here.
Um, we trained a doctor abouttwo years ago that ended up
staying on with us, uh, drweisenisenberg, and he helps me
with the training.
He's super knowledgeable andhe's been great to have around.
(42:46):
So we've got basically thethree of us Dr Roberts, myself
and Dr Weisenberg that aremostly full arch.
As far as you know, we try andget about two cases a week for
each of us.
It doesn't always happen, butum, yeah, we're, we're doing
quite a bit here and, like Isaid, most of it about half of
(43:06):
it is patients that travel infrom across the country.
Tyler (43:10):
Yeah, yeah, I'm curious about, um, how you guys kind of
got the word out and then youknow cause I, from what little I
do know about three on six.
I do see people asking aboutthree on six and all the other
dental implant groups, um, thatI'm a part of, you know, and a
lot of those.
Most people are talking aboutFP3 and I'm talking about prices
between oh, I went to clearchoice, I went to new via, I
(43:30):
went to so-and-so, um, but uh,every now and then someone will
say, oh, what about three on six?
Yada, yada, yada Right.
So I'm curious, where where'dthat national appeal come from?
And how does that usually workwhen people are traveling in and
then traveling back and kind ofwork that out logistically?
Logan (43:44):
Yeah, it's kind of funny.
It's grown so much in the lastfew years.
I was renewing my uh, my um,malpractice insurance here in
Utah and, uh, I was goingthrough the questionnaire and at
the very end it said do you doall on four, or three on six?
And it was funny to see thatspecific on a malpractice.
(44:05):
You know, it's just in the lasttwo years kind of done this.
We put out a lot of content onYouTube initially.
We still do a decent amount,and so most of our patients,
basically they'll I would say90% of them them come to us
after they've been told bysomeone they need an all on X.
They go on Google and they typein all on X versus, and three
(44:28):
on six is the only other thingto come up, and that's going
back to what we said abouthaving a marketable FP1,
basically, and so a lot of it isjust the content that we put
out.
And then these Facebook groupsstarted and so patients talk
within those groups about whatwe're doing, and so you know, if
(44:51):
someone is searching for analternative to All in X, they
usually find us because of thestuff that we've been putting
out there, usually find usbecause of the stuff that we've
been putting out there.
The idea of starting thislicensing program was well,
don't travel to us, stay whereyou're at.
This is a lot less complicatedif you're close to your house,
(45:11):
and so that was the main goal,and I think we've done a pretty
good job at that, and thesedoctors that are doing a lot of
this are getting a lot ofnotoriety in those Facebook
groups people saying I went todoctor, whatever, and he's doing
awesome cases and they'reshowing their results, and so we
get less and less of thesepatients traveling in from out
of state, which is good, butyeah, I would say online YouTube
(45:33):
videos that kind of thing.
And, yeah, online YouTubevideos that kind of thing.
And yeah, it's, it's funny.
We're starting to see YouTubecontent against us.
Um, guys that think that, uh,what we're doing is crazy, which
is is perfectly fine, but it's,I mean, it's been around
forever.
This isn't something really new.
(45:53):
It's just a way to do itaffordably and predictably in my
mind.
Tyler (45:58):
Well, I think that everything the three of us do
was crazy at one point.
So yeah.
All right guys.
So thank you so much forlistening to part one of our
episode, with Dr Logan Lockediscussing three on six.
So we talked a lot about thecontext of three on six, where
it's coming from and the generalconcepts, but for part two,
next week, we're going to begoing into all the odds and ends
(46:19):
, the nuts and bolts, learninghow to really accomplish this
procedure, how you too can alsobe a provider of three on six.
So stay tuned and thanks forlistening.
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