Unveiling Three on Six: A Revolutionary Approach to Implant Prosthetics with Dr. Logan Locke: Part 2
November 11, 2024 • 48 mins
Discover the groundbreaking world of implant dentistry with our special guest, Dr. Logan Locke, as he takes us on a journey through the innovative three-on-six dental implant procedure. We'll unravel the complexities behind the surgical techniques, revealing why tooth-borne guides are pivotal for stability and how pre-planning abutment placements can make or break prosthetic integration. Dr. Locke provides a masterclass on the essential role of initial prosthetics in preserving dental architecture and shares his secrets on using negative bone reduction guides for the best outcomes.
As we navigate the landscape of full-arch dental implants, we examine the nuances of occlusal schemes in both three-on-six and all-on-six approaches. Dr. Locke offers insights from the recent ICOI meeting, sparking a conversation about the exciting potential of FP1 approaches in situations usually reserved for FP3 solutions. We highlight the importance of canine guidance and solid posterior contacts for achieving ideal occlusal results. Plus, our discussion emphasizes the need for practitioners to refine their skills in GBR and tissue grafting to tackle complex cases while maintaining aesthetics and functionality.
In our final segment, we tackle the transition from FP3 to FP1 prosthetics, exploring the benefits and challenges involved. Dr. Locke delves into the durability of zirconia implants and the hygiene advantages of FP1 prosthetics. With a focus on advancing the three-on-six approach, we discuss the potential for this method to revolutionize full-arch restorations and call for innovation from implant companies to support its mainstream adoption. Join us as we champion the democratization of these cutting-edge techniques, ensuring more providers can offer them to patients seeking lasting, comfortable solutions.
As we navigate the landscape of full-arch dental implants, we examine the nuances of occlusal schemes in both three-on-six and all-on-six approaches. Dr. Locke offers insights from the recent ICOI meeting, sparking a conversation about the exciting potential of FP1 approaches in situations usually reserved for FP3 solutions. We highlight the importance of canine guidance and solid posterior contacts for achieving ideal occlusal results. Plus, our discussion emphasizes the need for practitioners to refine their skills in GBR and tissue grafting to tackle complex cases while maintaining aesthetics and functionality.
In our final segment, we tackle the transition from FP3 to FP1 prosthetics, exploring the benefits and challenges involved. Dr. Locke delves into the durability of zirconia implants and the hygiene advantages of FP1 prosthetics. With a focus on advancing the three-on-six approach, we discuss the potential for this method to revolutionize full-arch restorations and call for innovation from implant companies to support its mainstream adoption. Join us as we champion the democratization of these cutting-edge techniques, ensuring more providers can offer them to patients seeking lasting, comfortable solutions.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
My name is Dr Tyler Tolbert and I'm Dr Soren Poppe,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
My name is Dr Tyler Tolbert andI'm Dr.
Speaker 2 (00:12):
Soren Poppe and you're listening to.
Speaker 1 (00:14):
The Fix Podcast, we were talking with Dr Logan Locke
all about three on six, andwe're just continuing that
conversation this week, gettinginto the nuts and bolts exactly
what is necessary, the skillsand armamentarium needed to do
cases like this, and how you twocan become a provider.
Hope you guys enjoy.
Yeah, that's great.
That's great.
So in terms of so I'm kind ofgoing back to the surgical
approach and things.
(00:34):
So a lot of these patients arestill very dentate.
They still have most of theirteeth.
I'm assuming that there's atooth born guide that's going to
maybe locate some pins that youcan put in.
Then you're doing the atriomaticextraction, and then there's a
pin-retained or bone-retainedguide that then will fully guide
the sixth placement as well,and then is there anything else
(00:55):
on top.
I mean, that's just kind of atraditional fully guided
approach, right.
Or is there any other nuancethere?
Speaker 3 (01:00):
No, that's essentially what we're doing.
We try and have everythingtooth-borne.
If we can Try and stay awayfrom tissue-supported guides.
Occasionally we have to hop onone of those.
We'll have guides that help pinplacement before we extract and
then the same pins go into thespots after we extract.
Anything that we can do to geta stable guide is really
(01:23):
necessary.
All of the abutment placementis all pre-planned so that we
know we're not coming out of anembrasure.
Yeah, obviously, the wax up.
Everything is done prior to thepatient stepping in the chair
so that we can immediatelyconvert and and screw in that
prosthetic while they're asleep.
So they're waking up with their, their single piece cross arch,
(01:44):
cross arch stability.
You know we're getting all thatuh right off the bat, but it is
a it's a thinner prosthetic andso we we really have to drive
home the soft food diet, makingsure they're not chomping on it,
because that's something thatcan can fracture.
But materials are gettingreally awesome there.
You know, the more and more wedive into this, the better the
results we're getting because ofthe materials and the
(02:06):
technology that's coming out.
Speaker 1 (02:08):
Yeah, I'm curious too .
So it kind of sounds like theinitial surgical phase is almost
indistinguishable from thetypical FP1 that you know people
see around where you know it'sguided and usually there's like
a scalloping guide for you knowdoing some bone reduction but
plasty I guess just just shapingthings.
Yeah, do you guys do some ofthat sometimes?
(02:30):
Or like, what's really thedifference between, like a
traditional full arch fp1 and asurgical three on six, if that
question makes sense?
Speaker 3 (02:39):
really there's.
There should be no difference.
Initially, the main thing isusing a lab that basically, this
is all they do, and so they.
We have trained our labtechnicians and their designs to
create pontic sites how we havefound they work best, and
(02:59):
because that initial prostheticwe have found is the key to
everything developing thereafter.
If you don't get an immediateprosthetic on, if you cover your
implants and come in threemonths, it's all gone.
You're losing it.
And so that in order tomaintain or create that
architecture, yeah, we can dobone scalping guides.
I like to think of my prostheticas kind of a negative bone
(03:20):
reduction guide, so I don'tgenerally use a scalloping guide
, even in super gummy patients.
Basically, what we'll do isthat the implants are already
planned at the depth they'resupposed to be.
So let's say we have a reallygummy smile.
We know we're going to removethree or four millimeters of
bone.
To get away from that, we'llplan the implants at depth.
(03:43):
I'll put my MUAs on, I'll scanwithout having removed any bone
and then I will use theprosthetic which is then
designed with my wax up so theyknow exactly how long my teeth
should be.
They know where the ponticsites should be.
They're not referencing reallythe tissue data at all.
Oh, okay, and then I'm going to, as I see that prosthetic and
(04:03):
get it to um to engage with theMUAs.
I know where I need to removebone in order to create those
pontic sites.
So the uh, the initialprosthetic we use as a kind of a
negative bone reduction guidein that case.
Speaker 1 (04:19):
Wow, okay, okay.
So from what I picked up therecause earlier I was wondering
about, you know, we mentionedgetting the uh prosthetics to be
some distance from the bonewhich is being left exposed to
grow in that KG and I'm like,well, how are you able to scan
this, cause you know, in ourworkflows we're always scanning
soft tissue after.
How are you able to scan tissueversus bone and plan this
prosthetic?
(04:39):
But that's not even a thing,because it's already pre-planned
.
Speaker 3 (04:41):
It's pre-planned.
So you know we have to dealwith zenith points and how tall
are your centrals compared toyour laterals and your canines?
Are you getting them at theproper depth or the MUAs Getting
them to where?
When I initially started doingthese cases, almost always my
laterals were longer than mycentrals, just because that's
where I was placing my implantsand I wasn't thinking through
(05:04):
these things through the design.
So now that we have a labtrained, they can create,
basically, and you're, you'reusing photogrammetry, you're,
you're scanning, but it's abloody field, we're not suturing
before we scan anything.
So, um, they're going to kindof blindly create these pontic
sites.
And now you're, you'regenerally guiding them through
(05:25):
this design as they uh, theycall us during the surgery once
they've got the uh, the designtransferred.
And, uh, before we print it andwe can make any sort of
adjustments we want, um, if weknow there's a piece of bone
that's really high and we don'twant to take it down and they've
got the pontics too deep, youknow, all that kind of stuff can
(05:46):
be, can be changed during thesurgery.
But for the most part they'redesigning these cases in a way
that aesthetically looks thebest and so really, our bone
reduction comes down to.
What does that prostheticrequire in order to get that
ideal spacing?
that ideal tooth shape and size.
Speaker 1 (06:06):
Yeah, no, that makes sense.
So it's like aesthetics first,then prosthetics, and then
eventually we're getting to planthe implant.
It's like the last thing thatcomes in the conversation.
Speaker 3 (06:13):
Okay.
Speaker 1 (06:14):
Okay, yeah, no, I mean, that's, that's a beautiful
workflow.
I can really appreciate wherethat's coming from.
That's awesome.
You want to?
Speaker 3 (06:19):
mention this but I just wanted to clarify are are
you guys, when you're using yourguides, are you doing tooth
toothborne guides?
Are you keeping a couple teeth?
Okay, yeah, we, we generallytry and do everything toothborne
and um.
Really those teeth become ourum when we take all of our scans
, that those teeth we leaveduring the whole scanning phase
(06:41):
uh, so that they can merge thefiles from the from pre-surgery
to post post implant placement.
Speaker 2 (06:49):
Do you have a preference on which?
What teeth you're typically solike?
Let's say a patient comes inright and like your perfect case
.
I'm just curious what it wouldlook like as far as what teeth
are you leaving, what teeth areyou removing?
And then what you've mentioneda couple of times, but what
teeth are you placing thoseimplants into?
Uh to get kind of that initialum stability and then a good
(07:10):
support for the the truth bornguide yeah.
Speaker 3 (07:14):
So I would say, uh, the majority of cases we are
leaving.
So implant positioning for ususually goes first molar slash,
second premolar, where we'reangling with the sinus Canines,
laterals.
That's generally ourpositioning for our implants.
So that usually leaves someform of centrals that we can
leave for the guide and usuallywe can leave a premolar on each
(07:37):
side.
We try and get three points ofstability, not only for the
guide but also for merging scans.
Three points of stability notonly for the guide but also for
merging scans.
Um, so, honestly, my uh, ourdesigners know I will do
whatever it takes to leave evena portion of a tooth in place.
(07:57):
Uh, for the surgery because ourscans.
I don't like to place, um, youknow, screws to align scans.
I like to avoid those things ifI can and all possible, and I
like a really stable guide.
So I'll cut a tooth in half andleave half the tooth for um
placement of the of the guidesand um for future scanning.
I'll do whatever I can to tohave that stability because it
(08:18):
means so much um when you'redealing with, you know, half a
millimeter for an embrasurespace.
Speaker 1 (08:28):
Yeah, oh.
So in other words, the some ofthe teeth could actually would
have to remain somewhat intactin order for the guide to stay
seated while you're placing theimplants.
Is that correct?
Speaker 3 (08:38):
Yeah, yeah, I'll leave as many teeth in as I can
during surgery, cause that'swhat the guy that's going to be
seated on, and then I will place, I'll put all of my MUAs on Um.
Well, I use um micron mapperfor the most part.
Now we have an.
I can as well Um, but I'llplace my scan bodies, we'll do
our scans with those teeth stillin Um and then once I've got,
(09:00):
you know, we try and we try andteach bottlenecks in surgery.
This is a long, it's a longsurgery, no matter what how you
do it.
Yeah, and so I'll leave allthose, the rest of the upper
extractions, till the very end,after I've got my lower printing
, and so we can get that big.
Our biggest bottleneck, Ishould say, during the surgery
(09:20):
is getting those scans into ourlab so they can then get them
back to us to print.
So once that lowers printing,then we're finishing up, we're
doing our, our final extractions, we're grafting or anything
else that we need to at thatpoint.
Speaker 1 (09:34):
So is that to say that the approach is usually low
, lowers first and then upper?
Speaker 3 (09:38):
No, I don't.
We have one of our providersthat does, just because he hates
tongue swelling up over thecourse of four or five hours.
Speaker 2 (09:46):
So we have.
Speaker 3 (09:48):
Dr Weisenberg, who's here with us.
He does his lowers first.
For the most part I'm just acreature of habit and we used to
do all of these when weinitially started doing them.
We were free handing them, wewere doing some entertained and
so you know I was relying on Iwould mark up their face before
they went to sleep.
I'm trying to use a fox planeand put my allotragus and I'm
(10:10):
trying to keep all these thingsbecause then I have a pre-made
prosthetic and I have to try anduse my implant placement and
get that prosthetic in thecorrect position.
Cement retained during surgerywas really really hard.
Um, cement retained duringsurgery was really really hard,
but it it honestly it makes itmakes for a good surgeon because
you learn how to, how to do allthat stuff in the beginning.
(10:30):
So, um, so yeah, now witheverything pre-planned and
you're you know, we can remove alot of that difficulty from the
providers.
We can remove a lot of thatnecessary skills, I guess,
because the lab is just can, cantake all that information and
they can put it into theprosthetic without you telling
them to.
Speaker 1 (10:51):
Yeah, that makes sense.
And what kind of um I think youmentioned when you first
started, you guys were usinghigh-tech implants and then you
would switch eventually toneodymium CM.
Is there like a particularsystem you guys recommend for
this.
What kind of nuances make itideal?
Speaker 3 (11:06):
Yeah, so we had, uh, we were using neoden CM.
I won't speak on neoden CMbecause I I have PTSD from
neoden CM.
You're not the only one Um sothey uh, when we started seeing
complications from that, um, wehad a.
We had a really well-knownprosthodontist that was with us
(11:27):
at kind of the beginnings whenwe were trying to make this
trainable Dr Child.
He's an awesome prosthodontist,we love having him, and he
basically came on.
He had a really goodrelationship with BioHorizons.
He liked having having multipleplatforms.
So we said, great, we're gonna,we're gonna switch over.
So currently we're usingbiohorizons for all of our cases
(11:50):
.
Um, we just switched to theirnew conical, deep conical.
We do see, you know, that's oneof the things I loved about
neodent those suckers can holdbone really, really well.
We like the internal connection, um, of course.
But so the new biohorizons DeepConical has been good for us so
far and that's what we'recurrently using.
Speaker 1 (12:10):
Mad Fientist.
And why do you guys like beingable to use different platforms?
Because in general like atleast in the FP3 world like
people want a universal platform, it keeps their stock a lot
easier.
They're getting switch and swap.
So what do you like abouthaving different?
Speaker 3 (12:23):
ones bashing neoda, because I think, of course, I
think gm is a great implant and,uh, I think it's very similar
to what we now use with withbiohorizons.
But, um, we were having thosestupid cm abutments were
fracturing, and so really we wewanted a wider platform for
(12:43):
molar areas because we wereworried about the, the strength
of that platform, um, so nowthat you know there's a lot of
time behind GM, now with thisdeep conical, with bio horizons,
I think the, I think the datais out there to support that
it's.
You know, we're okay usingthose thinner, thinner platforms
(13:06):
.
Bio horizons does have have twowith their new deep conical
versus GM's one.
So I I can get a little bit ofa wider platform in the
posterior, which I prefer, um,but we, you know it's that's
kind of where that, that whatdrove us to a multi-platform,
was just seeing fractures in inabundance in a CM.
Speaker 1 (13:26):
Got it, got it, and so, in terms of, you know,
always keep coming back toprosthetics, of course.
So, in terms of occlusalschemes, is there any way that
people should be thinking aboutall excuse me three on six
versus an all on six in terms ofwhat you're looking to do
occlusally?
Speaker 3 (13:51):
the most part what we train.
We do train.
We try and get canine guidancein all of our cases.
Uh, solid posterior contacts.
If if we're talking about, youknow, bite paper, I want it
lightly dragging in the anteriorso we keep that too much
pressure off of the vertices inthe anterior, but just a solid,
occlusal, spread out contact inthe posterior.
Canine guidance.
Speaker 1 (14:11):
Okay, and then I'm curious too about what are some
of the big contraindications fordoing a three on six.
Let's say you have, like somereally severe class correction
or something like that.
Fp3 gives a whole lot offlexibility with regards to
trying to correct a bite or jumpa class three or something like
that.
Are you still able toaccomplish that with three on
six or?
Speaker 3 (14:28):
does that?
Speaker 1 (14:28):
kind of swing you a different way.
Speaker 3 (14:30):
No, generally.
Generally we can correct mostof those things.
Um, as far as contraindications, our biggest one is just you
know that they've already gotsevere bone loss.
They've been at dentures for 10to 20 years.
Then it's.
It becomes a little bit morecomplicated for most patients.
We still do a lot of um denture.
We take a lot of denturepatients into an fp1.
(14:50):
But um, yeah, most of the timethey if, if they've got really
solid tissue um and really goodbone underneath, we can still do
an fp1 on it.
But um, that's our biggestcontraindication.
It's just bone loss to thepoint where now we've got we
can't fit six implants in or itbecomes too much to try and
segment the thing.
(15:14):
So, otherwise, for the most partwe're trying to get them in an
FP1, if we can.
Speaker 2 (15:18):
On those patients that are denture to FP1, are you
guys free handing those ones?
Are you kind of like?
Speaker 3 (15:26):
We'll do a tissue-borne guide.
We'll do a tissue-borne guide.
I always when I train those, Itell all of our licensees to be
cautious with it.
Yeah, so I train a coupletechniques of how to use them to
(15:46):
hopefully have them become asaccurate as possible, but for me
I like to use them kind of as apilot drill and then I'll
usually freehand after that.
Speaker 1 (15:53):
Okay, yeah, that makes sense.
And how does the ponic shapinggo when you're dealing with a
fully edentulous case Like?
How do you end up getting allthat scalloping and forming
those pseudopapillae?
Speaker 3 (16:03):
Yeah, so the main thing you're going to, we take a
lot of the tissue from thepalate and we're going to
transfer it all to the buckle ofthe prosthetic.
That's going to help us developthe good tissue there on the
buckle.
As far as the bone, like I said, I don't generally do a
scalping guide.
I will use, if needed, the theprosthetic as a negative bone
(16:28):
reduction guide.
If I need to create some,usually it's like eight and nine
.
I need to be longer than sevento ten.
So I'll usually try and createa little bit of, a little bit of
a pocket for eight and nine tosit into so that we get the
correct Zenith points, becauseit does look funky if you've got
seven to ten, looking longerthan eight and nine, if they're
smiling really big, so that'ssomething.
(16:51):
But honestly, you could uh, youcould do the case without
removing the bone, and theprosthetic would just probably
seat right against the bone onon eight and nine and that's
going to cause some resorption,just in that you're going to get
of itself, it's going toremodel and, uh, it's going to
create the pontic site on itsown wow, wow, no, that's that's
great.
Speaker 1 (17:11):
That's great, yeah, I mean I'm so.
I mean we just got back fromthe ICOI meeting in Orlando and
FP1 was like a really bigconversation going on there and
that's a whole notherconversation for a different day
about you know the ICOI andwhat they teach versus what you
will mostly see domestically andthings like that.
But that you know the ISOI andwhat they teach versus what you
(17:34):
will mostly see domestically andthings like that.
Um, but that was one thing thatthat really did amaze me is so
many cases.
I looked at him I was like,well, they have to do that FP3,
um, because there just wasn'tenough tooth.
Um, it wasn't enough, uh, youknow architecture to create that
tissue born uh, sorry, nottissue born, but create all that
.
Really impressed.
And and uh, there were justcases that I would you kind of
said that allude to this earlierthere are cases that I, with my
(17:55):
FP3 trained eyes, would neverthink that you could approach
from an FD1 perspective.
But you know there are ways ifyou want to endeavor to do that.
Speaker 3 (18:02):
Yeah, there's, there's ways for.
For most patients, I would sayit's.
You know it's not everyone,it's not indicated for everyone,
but there's a lot you can do tomake these things look and and
uh and feel really, really goodand it's.
It's a fun procedure to do.
It's it's complicated, which Ilike.
I like doing these hard littlethings and uh, so it's something
(18:24):
I find a lot of joy in and uh,yeah there's.
It kind of requires a littlebit of everything.
It requires I.
I tell guys all the time youknow, go do your your GBR
courses, go do your tissuegrafting courses.
You got to get this stuff inbecause you're going to use it
all.
You just you kind of have to inorder to do FP1.
Speaker 1 (18:44):
Yeah, and, and I forgot to ask you, so the uh,
when you're talking about movingpalatal tissue over to the
buckle, is that usually like aVIP graft, like the vascularized
interpositional pedicle, or isit like you're taking the whole
thing full thickness?
Speaker 3 (18:57):
I'll take the whole thing over, okay, no, I'm going
to take the whole thing over.
I'm going to leave it bareunderneath the prosthetic and
bunch up the KG on the facial ofthe prosthetic and just let it
fill in.
Speaker 2 (19:13):
Very nice.
Yeah, I used to see.
It's similar to what we do with.
We'll do the same thing Use atissue punch to punch our
multi-units in and then pull thehole in front of the tissue.
Speaker 3 (19:25):
I think that's essentially kind of what you're
doing right.
Very similar to that.
Yeah, when I was taking my FP3courses years ago, I remember
seeing pictures of this guy.
I can't remember what his namewas, but he would essentially do
these FP3s and he would justleave the lower completely
flapped, one suture or anything,and he was like look at all
this awesome tissue I'm getting.
It sounded painful, like crazy.
(19:51):
Yeah, I know Danny does that alittle bit like yeah, crazy.
But I mean, you're essentiallydoing something like that to a
lesser degree.
Um, cause we still suture andtissue glue or whatever we want
to do to keep that prosthetic,uh, the tissue up against the
prosthetic, but, um, you know,allowing that secondary
intention for that, that tissueto creep in and and get
underneath the prosthetic it, itcan create some really good
thick tissue.
Speaker 1 (20:09):
Yeah, and I'm curious too, like following the surgery
itself.
You know, typically at least, Imean, everyone's a little bit
different in how they like to doit, but in the FP3 world people
will have the procedure, maybesee the patient back the next
day, some will do one week andthen there's usually like a
three week check to see how thesoft tissue is doing, maybe they
move to a water pick orsomething like that, that
waiting 10 to 12 weeks and thentaking new records and making
(20:31):
new fp3.
How does that restorativeprocess and sort of the
post-operative process differ um?
For a three on six, if it does.
Speaker 3 (20:38):
Yeah, I mean it's.
It's fairly similar.
So we, uh, for the most partwe're seeing our patients 24
hours after surgery um,basically just to dial in the
bite any aesthetic issues, andthen we generally don't see them
again for three months.
So we, at that point they callus if they need us but, like I
(21:00):
said, most of our patientstravel in from out of the
country, so it's see them 24hours after they hop on a plane,
they fly back to their homesand we see them in three months
where we will redo our scans,take our tissue data and tighten
up anything that we need tomake all of our aesthetic
adjustments.
We make them a second set oftemporaries and we can do second
(21:25):
temps and finals here at thisoffice because we are close to
the lab.
We can have that done withinseven days, but today.
Otherwise, if they're close, wetry and I try and have them
stay in their second temps for acouple weeks to try them out
yeah, so they basically areflying in three times.
Speaker 2 (21:45):
Is that correct?
Speaker 3 (21:48):
twice well sometimes three times yeah, a lot of times
people, guys, uh, people bringtheir families out for their
week-long appointment.
They'll they'll make a vacation, they'll come ski and they'll
you know, they'll visit utah andmake it fun and uh, so we can
see their, their finals withinthat same uh visit.
Otherwise they get their secondtemps, they home, they fly back
(22:10):
in whenever we decide they'rethey're ready to go with their
finals.
Speaker 1 (22:14):
Okay, okay, that makes sense, and I'm curious too
and maybe we haven't been doingthis long enough for you to see
this but have you ever had apatient that received a three on
six and, due to whatevercircumstances, then had to
change to an all an X and, if so, what's kind of been their
feedback about what they thinkin terms of how everything feels
(22:34):
and the maintenance of it?
Like, what's been kind of thefeedback we've seen?
Speaker 3 (22:37):
I haven't had to transition anyone yet to an
all-on-X.
That's good.
Yeah, you know most of our.
I'm trying to think if there'sanyone that has come through
that's even close to that.
Yet I don't think so.
I mean, honestly, it's a littlebit of an exposed abutment is
about as bad as we're seeingcurrently.
(22:59):
Um, obviously you're going tohave some, you can get some
implant failures and stuff, butwe can work around them.
So I haven't had to transitionanyone yet.
I did just transition.
Someone went down to Cancun um,got an fp3.
Actually it was fairly welldone.
I actually don't.
They didn't remove enough bone,in my opinion, for the fp3,
which worked in my favor.
He came back, he hated it, um,and so within three weeks we
(23:24):
transitioned him to it from anfp3 to an fp1.
That's um, that was last month,I believe.
Uh, cool guy.
But um, yeah, yeah, yeah,that's.
I haven't had to transitionanyone yet.
But I, I assume at some pointwe, we probably will.
I mean, yeah, I think 20 yearsfrom now, we might, we might be
saying something different anduh, and we're, we're ready to do
(23:46):
that if need be.
But I think we've bought thesepatients a lot of time.
Speaker 1 (23:50):
Yeah, and are you able to do a decent amount of
lower three on sixes, or is thisalmost mostly uppers?
Or if you are doing lowers,what are some of the nuances
there that make that possible,cause I know that can be
challenging.
Speaker 3 (24:00):
Yeah, we're still doing it.
We do a lot um, equally as muchon the lower um, because a lot
of times that the teeth areshorter, you generally need a
larger prosthetic space.
You generally need more bonereduction in order to get a
thicker prosthetic.
For us I can have sixmillimeters of restorative space
and I'm good, I'm not seeingfractures.
(24:22):
Honestly, our fracture ratewith these zirconia implants is
close to zero.
Like, if you segment and you'regetting you know three to four
unit bridges, they net thezirconia does not break it's,
it's really really strong.
Now, if you're getting longerspan bridges then, yeah, you can
see some fracture over time.
But, um, even on the lower,with minimal, minimal
(24:44):
restorative space, uh, wherewe've got really strong
prosthetics.
Speaker 1 (24:49):
So it seems like there's kind of an inverse
mentality.
So, like when you first do thesurgery, we're more concerned
about the cross arch stabilityand making sure the implants
integrate, so we need everythingto be connected.
But once those are healed andwe go to the prosthetic phase,
everything changes.
Now we want them all segmentedand that's going to be better
support for the actual zirconiaprosthesis long term yeah, yeah,
better support for theprosthetic.
Speaker 3 (25:09):
Um, easier to clean?
I mean they can floss inbetween the bridges.
That's one of the main thingswe talk about is how you know if
we're talking about hygiene.
We've done a lot ofmeasurements just on our own
FP3s versus our standard threeon six.
Versus our standard three onsix.
(25:35):
You're taking the position,basically the area that's going
to build up food and debris.
You're taking that from an FP3,which is fairly hidden up there
, harder for them to access, andyou're bringing it down to the
tissue level.
So generally, they can see ifthey've got crap piled up on
their teeth, they're going to beable to see it.
Crap piled up on their teeth,they're going to be able to see
it.
Um, your your prosthetic totissue contacts.
(25:55):
If we're looking at thicknessof how much space can gather
stuff, so let's say, in an FPthree, your average is cause as
we.
You know, as you go down, ourbone is a triangle.
So as we go down on thattriangle we're getting wider and
wider area to pack stuff.
You know, and that prostheticon an FP3 can be fairly thick.
Ours we're getting small ponticsites, so the area where they
(26:20):
can pack food and debris is muchsmaller, it's more visible.
They can floss in betweenbridges, they can floss under
them Super easy.
Water pickiene on these thingsis just night and day over what
we've seen in our own FP3 cases.
I mean, we don't remove themonce a year.
We want to you know there'swhether or not the research is
(26:42):
good, that the tissue can adaptand adhere to the zirconia.
We don't want to, most of thetime, mess with any of that, any
of our papilla that we'vedeveloped over years.
We we want to leave it in therein place, and so we don't
remove our prosthetics.
They're easy to clean with justa regular cleaning.
Our hygienists have no issuedoing that, and you know you're.
(27:05):
We're getting a lot lessunderneath these bridges than
even our own FP3 cases which wefeel like we do a good job with
our fp3s.
Speaker 1 (27:12):
But you know, suckers are hard to clean yeah, I love
those posts when, uh, you takeoff like an fp1 or single crown
or whatever and it's got thatultra polished uh zirconia and
they're, they're taking it offand it just takes tissue with it
because it literally justactually formed a biological
seal, which is crazy.
Um.
But uh, also I'm curious too.
So, uh, the screws that youguys are using to retain these,
(27:33):
um, is it just like the typical,like I mean like a desk screw,
or are we using like powerballvortex, whatever?
Speaker 3 (27:40):
we have some guys using vortex.
We use desks almost exclusivelyright now.
Um, really, our long-term goal,everything is made for fp3.
Currently, it's all yeahmulti-units.
Everything is fp3 and um I.
There is a lot that we could dowith stuff that was created
(28:00):
specifically for fp1.
We would love, uh, to have awider and a longer prosthetic
screw that was actually designedfor a direct-to-connection.
Most of these screws are stilldesigned for titanium copings,
yeah, and the MUAs are designedfor FP3, which has a ton of
(28:22):
variance in angulation.
We because we're going betweentwo units or two implants, we
don't have a ton of degrees ofvariation we could have a longer
MUA.
That would.
That would allow a much morestable prosthetic over time.
So you know, there are a lot ofthings that we're working on to
hopefully advance FP1 and getthose, those parts and those
(28:47):
materials that I think wouldwould benefit patients long term
, because and I think we wouldbenefit patients longterm
because and I think we'll startto see we're seeing a lot more
FP1 come around.
When we first started doing this, I mean you had guys doing it,
but they were kind of off in thedistance and you won't hear
about it.
Now there's more FP1 courses.
Since we, since we, starteddoing this, there's more talk of
(29:08):
FP1.
I think it's coming back aroundto where you'll see more and
more guys doing it, which Ithink is good, um, but I think
we need the implant companies tostep up and start creating
parts that that adapt with thetechnology of where it is today
and give us stuff that we can wecan use that, uh, that address
some of the challenges with fp1yeah, we definitely, like tyler
(29:30):
was saying earlier, wedefinitely saw it a ton at the
conference that we were atalmost to the point of going the
opposite direction with FP3 andrecommending FP1 on a lot of
cases.
Speaker 2 (29:44):
What would you know?
I think this is something thatour listeners always love to
just hear from whoever we haveon the podcast.
But do you have any particularCE that you love?
Maybe any recommendations forbooks, learning this material?
A lot of our listeners arepeople who aren't doing Full
(30:05):
Arch and they want to get intoit right.
So if you have a couple of goodbooks, a couple of good courses
, I know you guys obviously havea course, but it sounds like
before somebody comes to yourcourse, it's probably good to
get a good idea of like doingfull arch, doing surgery and
stuff like that.
Speaker 3 (30:22):
Yeah, for sure, we, most of the the.
I have a lot of dentists thatreach out to me fresh out of
school.
I send most of them to implantpathway.
It seems like they do a greatjob.
As far as getting guys going, Ilove, no, I'm going to.
I'm going to forget their names, but there are two guys that I
(30:45):
I kind of just started followingthrough Instagram Dr Matthew
Fien and Israel.
He's out of DC, dc Implants ishis Instagram handle.
They have a set of GBR coursesand tissue grafting courses that
they're the favorite coursesI've ever done, really Tons of
(31:08):
good experience, and I thinkthey really catapulted me into
doing more of this and feelingmore confident that I could
build bone and build tissue anddo that kind of stuff.
So, um, their courses, uh, Ican't remember what their group
is called, um, but try to add tothe show notes.
Speaker 2 (31:28):
We'll figure it out and try to add it.
Speaker 3 (31:30):
Yeah, yeah, I'll look it up, but those guys are
awesome and they're postingamazing cases on Instagram, a
lot of single units and I tryand look at what guys are doing
for a single unit, you know,someone loses number eight and
uh, israel, that dude man, he,he can make it look like they
(31:52):
never lost a dang thing with theway he develops tissue and, uh,
his implant placement,everything that he does looks so
awesome.
So I kind of I try and take whathe's done and anything that we
can do to incorporate that intoour FD1, because we're
essentially just trying to dothat at a larger scale.
Um, so these guys that arereally, um, leading the field in
, uh, implant dentistry and intissue, uh, these are two
(32:15):
periodontists and we try andincorporate that stuff into what
we teach okay, great, yeah,we'll try to add those to the
show notes and those.
Speaker 2 (32:21):
Those are excellent.
Um, just talking about that, itkind of goes into a new
fixation that I've been having.
As far as you know, we do, likeI said, a lot of all in four
stuff and a lot of immediateload and I feel like that's.
It's pretty straightforwardonce you kind of get that down.
And now I'm trying to figure outI'm getting more into like just
immediate loaded singles,immediate loaded bridges you
(32:44):
know, really like trying tomanipulate the tissue properly
so we can do these cases with apredictable result and without
having to put a patient in likea flipper for three months and
then come back, have to like tryto figure out how to get the
tissue to stay where you want it.
Um, and you know it's notalways possible, right, because
I feel like it's much harder toget uh good torque on your
(33:07):
implants when you're just doinglike one tooth or even a bridge,
versus when you have a cleanslate and you have multiple
places to place them.
But what are you guys doing inyour office as far as, like,
single implant goes and like,are you immediately loading
those?
Are you printing them onto atie base?
Like how are you guys doingthat?
Speaker 3 (33:26):
yeah well, uh, we've done quite a few recently where
I'll put an mua on and uh haveour lab quickly design some form
of tissue shape on a single,yeah, on a single nice, yeah,
then eventually I'll take, I'lltake the mua, because with the
mua I can use photogrammetry, um, yeah and uh, which is a huge
(33:47):
benefit, and I can, you know,have them create whatever I want
from there.
But, um, I've done, I've doneas much as using the.
I cut off the fingertip of theglove and stick the, or stick a,
an uh, an old abutment that Ihad sterilized, stick that
through and push some, somecomposite into, into and shape
it myself to create tissue,tissue healers.
(34:09):
I don't do in the anteriorfront four, I'll immediately
load it without any issue,keeping it out of occlusion.
Beyond that, I still don'timmediately load uh, single
units, um, yeah, are you.
Speaker 2 (34:23):
And the front four, I mean, yeah, I think the front
four are the ones that are themost important that I'm kind of
referencing, because those arethe ones that patients don't
want to be wearing a flipper for, and and usually the like I
don't know, the flippers neverlook like amazing up there,
cause you kind of have no yeah,so are you?
Are you typically?
(34:52):
Always?
always doing so and that, andit's funny because I actually
have a case coming up and I wasthinking about doing just that,
doing like I'm putting amulti-unit on and and trying to
print a crown right to thatmulti-unit.
Um, I did a case last weekwhere it was uh, seven to ten.
We did a direct to multi-unitbridge and it worked awesome.
It looked so good after and Iwas really really you just did a
third of a three on six.
Speaker 3 (35:05):
Dude, you're, you're in.
Speaker 1 (35:06):
Yeah, yeah, he's gonna be a licensee.
You're already there.
You might as well sign up nowmaybe well, but what?
Speaker 2 (35:14):
uh okay, oh, I just want to finish a thought, so um
when you aren't doing printed tomulti on those anteriors, how
do you, how are you doing them?
Are you doing printed to tiebase?
Are you are you kind ofdesigning the crown yourself for
those single anteriors?
Speaker 3 (35:31):
Oh, yeah, for the most part, I've done a lot where
I will use their own naturaltooth.
If I'm just taking it out,which is generally the case,
right, we're trying to keep andpreserve everything I'll use
just a regular use, uh, just a,a regular um.
So, yeah, just a tie base orsomething like that, and I will
(35:52):
cut everything but the facialoff of the tooth and I'll, you
know, create the shell and thenI'll pick it up that way, take
it off, unscrew it, shape itwith, uh, with flowable or
whatever I need to do, polish itup really, really good, and
then, and then go with that.
I know there's's, uh, israelPuterman, same guy, um,
hopefully I didn't botch hisname Um, that runs these courses
(36:13):
, his, his Instagram.
He's got, he's got some specificum, printable tissue healers
that I think look pretty awesome, and I can't remember where he
gets his from.
But I've thought about startingto do kind of exactly what he's
doing, because he gets somecrazy results.
But, yeah, I like, I likecreating my own.
That's generally what I've donejust using whatever they've
(36:36):
already had in there and createa shell and then get the, the
correct form coming out of theimplant so that it develops that
, that that tissue, and we'vegot a lot of experience in in
doing that, so that helps.
Speaker 1 (36:47):
Yeah, great, and I may have been yeah, I may have
misunderstood you a moment ago.
So when you're doing uh likethat interior single and you
mentioned um usingphotogrammetry, so you put the
mua on there, then you put youruh micromapper scan body on
there, you take your micromapperand then that's how you're
printing out uh attempt.
When you go to to finalize that, are you then using that data
(37:09):
to swap to fixture level or doyou just keep it all MUA?
Speaker 3 (37:13):
No, at that point you're getting rotation on the
crown right.
Speaker 2 (37:17):
Right, okay.
Speaker 3 (37:18):
So it doesn't work for a permanent super well.
If it's out of occlusion youcan usually keep it from
rotating or you can sometimesbond it to the teeth on either
side or create something so itwon't rotate.
But I generally would just dothat for an initial tissue
healing type of situation okay,yeah, tissue former, then I'd
put my scan body or myimpression coping on, get a
(37:40):
bunch of um light body in thereso it captures what I've already
created, and uh, and then get ascrew retained crown with a
custom put in cool, yeah, yeah.
Speaker 1 (37:52):
So we've talked a lot about you know what's kind of
taking you from.
You know pre three on six tonow, and now I'm kind of curious
about you know where do you seethis being in?
You know 10 years.
What you mentioned a moment agolike long-term goals, like
where do you kind of see thisconcept going?
Where is the innovation goingto be at?
If you see any room for that?
Speaker 3 (38:14):
Yeah, I think the innovation will come, and we're
pushing BioHorizons, we'repushing implant companies to
help us create things that aremore geared towards FP1.
Like I said, there's so muchtechnology right now.
There's so much that we couldbe doing to make these cases
easier and more predictable.
We just need these guys to comealong and make the parts for it
.
So hopefully, that's where theinnovation comes.
(38:37):
We are continuing to just makeour processes streamlined as we
possibly can.
We want more guys doing it.
We want patients to have optionsto preserve their bone long
term.
We think it's the correct thingto do, um, and so ideally we
get as many doctors providingthree on six as we possibly can.
(38:58):
I think that's what our, ourlong-term goal is.
Um, you know, obviously we wantthat financially, but it also
like I would say% of patientsthat are going through full arch
still have no idea that FP1might be an option for them.
They just don't know that itexists, and so it's only those
(39:21):
that hop on Google and start tosearch for other options that
really end up with us.
So I think if once we can getto the point where patients are
informed that there are options,then it's going to drive more
and more doctors into learninghow to provide FP1 for their,
(39:44):
for their patients, and whetherthat's with us or doing it on
their own, I think it's good fordentistry to have more doctors
doing what we're doing.
Speaker 1 (39:54):
Yeah, no, I totally agree.
I mean there was a time when,you know, people were just doing
one implant per tooth and doingall kinds of crazy grafting and
these hugely staged approachesover years and years and years,
and then all an X or really justall in four at the time kind of
save the day with that andnobody knew about it.
And then, once people knewabout it, there was this massive
, massive wave.
And now you know patients havegeneral awareness around that
(40:16):
and they go around shopping forthe best prices or the best
processes or whatever to get itdone, and it seems like you're
kind of.
You know, in this early phase ofthat three on six, awareness is
starting to happening,providers are starting to pop up
in places, people are havingmore options and, you know,
before you know it, this isgoing to be this.
I mean, we may already be there, but this is becoming this
really emergent thing and that'swhat patients are looking for,
(40:41):
because they do want thatconservatism.
You know, especially if you'reyounger than you know, an fb3 is
probably not going to die withyou no, no, we, we know these
things probably won't.
Speaker 3 (40:50):
We hope they do.
We hope that what we do is iswill last as long as possible,
but I think, sure, of course,giving someone longevity and
options as they move forward.
Um, yeah, I think is isimportant and yeah, it's been.
It's been kind of a weirdprocess.
Just uh, a week or two ago,these YouTube videos start
(41:11):
popping up with three on six andwhy it's awful and it's a cult
and it's really weird stuff andit's weird seeing something that
has been so small and it's beensomething that we just kind of
made here in Utah and a namethat I mean.
we didn't make, fp1, we justmade this little three on six
thing and now to start see itpop up on insurance forms and
(41:35):
and on other doctors, youtubevideos and it's.
It's been a funny, funny thingto see happen in the last couple
of years, but it's uh.
I guess it means we're doingsomething right.
Speaker 1 (41:46):
Yeah, well, I mean, I think it's really cool and you
know, I think we feel umparticularly fortunate to be
talking to uh, the pioneer of uhthree on six, um on our podcast
.
So maybe, uh, you know, once itbecomes this big popular thing
and people are doing theresearch, they'll go and find
our podcasts and and they'll getto learn about the beginnings.
Speaker 3 (42:01):
Hopefully some guys get interested and want to come
out and hang out with us.
I think it's fun.
I think our course is awesome.
We have a Teams chat with allof our providers and everyone's
just posting cases and questions.
I generally stay away fromdental forums because I think
(42:23):
dentists are jerks.
Speaker 2 (42:25):
Yeah, forums, because I think dentists are jerks.
Speaker 3 (42:27):
Um, yeah, just you know they have to nitpick every
little thing that someone elsedoes, um, so I tend to stay away
from those, but, um, we've gota really good forum, awesome
providers, awesome docs.
That's been one of the most funthings for me.
I'm not, I'm not, I'm not asuper well-spoken person, so
getting into this training rolewhere we're teaching doctors how
(42:48):
to do this, and traveling outand meeting their staff, it's
been super fun to just meet alot of like-minded doctors and
get to know them and developfriendships with them and be
able to have a guy down inFlorida that's, in my mind, just
an awesome FP3 provider.
(43:09):
And so in places like you guys,he's doing teragoys and
everything and I love havingsomeone that I can run some
stuff off of.
And then I've got a guy thatswitched from just doing wisdom
teeth in Vegas.
He decided he was done withwisdom teeth and he just wanted
to do FP1.
So he's just a three sixprovider in Vegas and uh, so you
(43:29):
know, being able to meet himand when I have whizzies I need
to do I'm texting him.
What the heck, what am I doing?
Speaker 2 (43:37):
Um, so it's it's.
Speaker 3 (43:39):
It's been a fun thing to to get to know doctors and
and, uh, you know, be in asituation like this and meet you
guys.
It's fun for sure.
Speaker 2 (43:47):
Well, hey, we're honored as well.
And what can people do?
If they are interested in yourcourse or they're interested in,
you know, getting into thethree-on-six, what's the best
way that they can reach out toyou?
You said the other doctor wasit Peyton, or what's the other
doctor's name?
Speaker 3 (44:04):
Randy Roberts.
Randy Roberts.
Speaker 2 (44:06):
Randy Roberts, I'm sorry.
Speaker 3 (44:08):
Michael Weisenberg.
He helps me run the course.
And then Randy Roberts.
He's the one that started thiswhole thing and he's kind of
leading our R&D and what wedevelop as far as progress
moving forward.
Speaker 2 (44:25):
Cool, nice.
So yeah, how would people reachout to?
To kind of get involved, getget over to your course and
start doing the three on six.
Speaker 3 (44:33):
Yeah, if you want to.
So three on sixcom, ourtrainings should be on there.
You're my Instagram.
I try and post a lot of what Icall tissue porn Just really
good scalp tissue.
I like to post that kind ofstuff.
Um, so if you want to see kindof what we're doing, uh, my
Instagram is doc dot lock.
(44:53):
Uh, that's L-O-C-K-E Um, andthey can message me there, they
can text me Um, my number's 8 0,1, 7, 5, 5, 9, 2, 4, 3.
And you're welcome to text me.
I'm happy to send, to send you.
I, whenever I talk to guys andthey're questioning whether or
not they want to come, I just gothrough my camera roll and find
my most recent cases and shootthem over and say this is what
(45:15):
you can do like, this is, thisis what we're we're pushing out,
and, uh, I think for the mostpart it helps them gain the
confidence to come on out.
So welcome to text me and I'llshoot over some cases so you can
see what we're doing, and uh,or message me on Instagram.
That's good too.
Speaker 1 (45:29):
Awesome, awesome, awesome.
Well, we really appreciate youcoming on, dr Locke.
This was a huge learningexperience for uh, dr Poppy and
I and um, you know I'm reallyexcited about what you're doing.
I think you've made a massivecontribution to the full arch
world and you know we alwaystalk about um.
You know how to be conservativein an FB3 case right, like
trying to preserve bone or do amore conservative uh technique
(45:50):
here and there to keep peopleout of zygomatics.
And um, you've you've createdthis whole new intermediary
phase between that um, you know,the natural dentition to the
FB1 and and then, of course, theFB2, fb3.
And you know, I think the thebeauty of it is is you know
we're getting to the point wherewe can really support people
throughout their entire lifecycle and, you know, keep them
in teeth they don't have to comein and out, you know, as long
(46:11):
as possible, and I think that'sa it's a really valuable thing.
I love that you've reallydemocratized what you're doing
and made it very approachablefor other providers.
It'd be very's in the rightplace and uh, I just I feel so
privileged that you came on ourshow.
Speaker 3 (46:27):
I appreciate it, guys .
You guys are awesome.
It's been fun to get to knowyou and uh yeah, hopefully,
hopefully we get to do more ofthis.
Speaker 1 (46:36):
Yes, sir, you got it Well, until next time, thank you
.
Speaker 3 (46:38):
All right, thanks guys.
My name is Dr Tyler Tolbert and I'm Dr Soren Poppe,
and you're listening to the FixPodcast, your source for all
things implant dentistry.
My name is Dr Tyler Tolbert andI'm Dr.
Speaker 2 (00:12):
Soren Poppe and you're listening to.
Speaker 1 (00:14):
The Fix Podcast, we were talking with Dr Logan Locke
all about three on six, andwe're just continuing that
conversation this week, gettinginto the nuts and bolts exactly
what is necessary, the skillsand armamentarium needed to do
cases like this, and how you twocan become a provider.
Hope you guys enjoy.
Yeah, that's great.
That's great.
So in terms of so I'm kind ofgoing back to the surgical
approach and things.
(00:34):
So a lot of these patients arestill very dentate.
They still have most of theirteeth.
I'm assuming that there's atooth born guide that's going to
maybe locate some pins that youcan put in.
Then you're doing the atriomaticextraction, and then there's a
pin-retained or bone-retainedguide that then will fully guide
the sixth placement as well,and then is there anything else
(00:55):
on top.
I mean, that's just kind of atraditional fully guided
approach, right.
Or is there any other nuancethere?
Speaker 3 (01:00):
No, that's essentially what we're doing.
We try and have everythingtooth-borne.
If we can Try and stay awayfrom tissue-supported guides.
Occasionally we have to hop onone of those.
We'll have guides that help pinplacement before we extract and
then the same pins go into thespots after we extract.
Anything that we can do to geta stable guide is really
(01:23):
necessary.
All of the abutment placementis all pre-planned so that we
know we're not coming out of anembrasure.
Yeah, obviously, the wax up.
Everything is done prior to thepatient stepping in the chair
so that we can immediatelyconvert and and screw in that
prosthetic while they're asleep.
So they're waking up with their, their single piece cross arch,
(01:44):
cross arch stability.
You know we're getting all thatuh right off the bat, but it is
a it's a thinner prosthetic andso we we really have to drive
home the soft food diet, makingsure they're not chomping on it,
because that's something thatcan can fracture.
But materials are gettingreally awesome there.
You know, the more and more wedive into this, the better the
results we're getting because ofthe materials and the
(02:06):
technology that's coming out.
Speaker 1 (02:08):
Yeah, I'm curious too .
So it kind of sounds like theinitial surgical phase is almost
indistinguishable from thetypical FP1 that you know people
see around where you know it'sguided and usually there's like
a scalloping guide for you knowdoing some bone reduction but
plasty I guess just just shapingthings.
Yeah, do you guys do some ofthat sometimes?
(02:30):
Or like, what's really thedifference between, like a
traditional full arch fp1 and asurgical three on six, if that
question makes sense?
Speaker 3 (02:39):
really there's.
There should be no difference.
Initially, the main thing isusing a lab that basically, this
is all they do, and so they.
We have trained our labtechnicians and their designs to
create pontic sites how we havefound they work best, and
(02:59):
because that initial prostheticwe have found is the key to
everything developing thereafter.
If you don't get an immediateprosthetic on, if you cover your
implants and come in threemonths, it's all gone.
You're losing it.
And so that in order tomaintain or create that
architecture, yeah, we can dobone scalping guides.
I like to think of my prostheticas kind of a negative bone
(03:20):
reduction guide, so I don'tgenerally use a scalloping guide
, even in super gummy patients.
Basically, what we'll do isthat the implants are already
planned at the depth they'resupposed to be.
So let's say we have a reallygummy smile.
We know we're going to removethree or four millimeters of
bone.
To get away from that, we'llplan the implants at depth.
(03:43):
I'll put my MUAs on, I'll scanwithout having removed any bone
and then I will use theprosthetic which is then
designed with my wax up so theyknow exactly how long my teeth
should be.
They know where the ponticsites should be.
They're not referencing reallythe tissue data at all.
Oh, okay, and then I'm going to, as I see that prosthetic and
(04:03):
get it to um to engage with theMUAs.
I know where I need to removebone in order to create those
pontic sites.
So the uh, the initialprosthetic we use as a kind of a
negative bone reduction guidein that case.
Speaker 1 (04:19):
Wow, okay, okay.
So from what I picked up therecause earlier I was wondering
about, you know, we mentionedgetting the uh prosthetics to be
some distance from the bonewhich is being left exposed to
grow in that KG and I'm like,well, how are you able to scan
this, cause you know, in ourworkflows we're always scanning
soft tissue after.
How are you able to scan tissueversus bone and plan this
prosthetic?
(04:39):
But that's not even a thing,because it's already pre-planned
.
Speaker 3 (04:41):
It's pre-planned.
So you know we have to dealwith zenith points and how tall
are your centrals compared toyour laterals and your canines?
Are you getting them at theproper depth or the MUAs Getting
them to where?
When I initially started doingthese cases, almost always my
laterals were longer than mycentrals, just because that's
where I was placing my implantsand I wasn't thinking through
(05:04):
these things through the design.
So now that we have a labtrained, they can create,
basically, and you're, you'reusing photogrammetry, you're,
you're scanning, but it's abloody field, we're not suturing
before we scan anything.
So, um, they're going to kindof blindly create these pontic
sites.
And now you're, you'regenerally guiding them through
(05:25):
this design as they uh, theycall us during the surgery once
they've got the uh, the designtransferred.
And, uh, before we print it andwe can make any sort of
adjustments we want, um, if weknow there's a piece of bone
that's really high and we don'twant to take it down and they've
got the pontics too deep, youknow, all that kind of stuff can
(05:46):
be, can be changed during thesurgery.
But for the most part they'redesigning these cases in a way
that aesthetically looks thebest and so really, our bone
reduction comes down to.
What does that prostheticrequire in order to get that
ideal spacing?
that ideal tooth shape and size.
Speaker 1 (06:06):
Yeah, no, that makes sense.
So it's like aesthetics first,then prosthetics, and then
eventually we're getting to planthe implant.
It's like the last thing thatcomes in the conversation.
Speaker 3 (06:13):
Okay.
Speaker 1 (06:14):
Okay, yeah, no, I mean, that's, that's a beautiful
workflow.
I can really appreciate wherethat's coming from.
That's awesome.
You want to?
Speaker 3 (06:19):
mention this but I just wanted to clarify are are
you guys, when you're using yourguides, are you doing tooth
toothborne guides?
Are you keeping a couple teeth?
Okay, yeah, we, we generallytry and do everything toothborne
and um.
Really those teeth become ourum when we take all of our scans
, that those teeth we leaveduring the whole scanning phase
(06:41):
uh, so that they can merge thefiles from the from pre-surgery
to post post implant placement.
Speaker 2 (06:49):
Do you have a preference on which?
What teeth you're typically solike?
Let's say a patient comes inright and like your perfect case
.
I'm just curious what it wouldlook like as far as what teeth
are you leaving, what teeth areyou removing?
And then what you've mentioneda couple of times, but what
teeth are you placing thoseimplants into?
Uh to get kind of that initialum stability and then a good
(07:10):
support for the the truth bornguide yeah.
Speaker 3 (07:14):
So I would say, uh, the majority of cases we are
leaving.
So implant positioning for ususually goes first molar slash,
second premolar, where we'reangling with the sinus Canines,
laterals.
That's generally ourpositioning for our implants.
So that usually leaves someform of centrals that we can
leave for the guide and usuallywe can leave a premolar on each
(07:37):
side.
We try and get three points ofstability, not only for the
guide but also for merging scans.
Three points of stability notonly for the guide but also for
merging scans.
Um, so, honestly, my uh, ourdesigners know I will do
whatever it takes to leave evena portion of a tooth in place.
(07:57):
Uh, for the surgery because ourscans.
I don't like to place, um, youknow, screws to align scans.
I like to avoid those things ifI can and all possible, and I
like a really stable guide.
So I'll cut a tooth in half andleave half the tooth for um
placement of the of the guidesand um for future scanning.
I'll do whatever I can to tohave that stability because it
(08:18):
means so much um when you'redealing with, you know, half a
millimeter for an embrasurespace.
Speaker 1 (08:28):
Yeah, oh.
So in other words, the some ofthe teeth could actually would
have to remain somewhat intactin order for the guide to stay
seated while you're placing theimplants.
Is that correct?
Speaker 3 (08:38):
Yeah, yeah, I'll leave as many teeth in as I can
during surgery, cause that'swhat the guy that's going to be
seated on, and then I will place, I'll put all of my MUAs on Um.
Well, I use um micron mapperfor the most part.
Now we have an.
I can as well Um, but I'llplace my scan bodies, we'll do
our scans with those teeth stillin Um and then once I've got,
(09:00):
you know, we try and we try andteach bottlenecks in surgery.
This is a long, it's a longsurgery, no matter what how you
do it.
Yeah, and so I'll leave allthose, the rest of the upper
extractions, till the very end,after I've got my lower printing
, and so we can get that big.
Our biggest bottleneck, Ishould say, during the surgery
(09:20):
is getting those scans into ourlab so they can then get them
back to us to print.
So once that lowers printing,then we're finishing up, we're
doing our, our final extractions, we're grafting or anything
else that we need to at thatpoint.
Speaker 1 (09:34):
So is that to say that the approach is usually low
, lowers first and then upper?
Speaker 3 (09:38):
No, I don't.
We have one of our providersthat does, just because he hates
tongue swelling up over thecourse of four or five hours.
Speaker 2 (09:46):
So we have.
Speaker 3 (09:48):
Dr Weisenberg, who's here with us.
He does his lowers first.
For the most part I'm just acreature of habit and we used to
do all of these when weinitially started doing them.
We were free handing them, wewere doing some entertained and
so you know I was relying on Iwould mark up their face before
they went to sleep.
I'm trying to use a fox planeand put my allotragus and I'm
(10:10):
trying to keep all these thingsbecause then I have a pre-made
prosthetic and I have to try anduse my implant placement and
get that prosthetic in thecorrect position.
Cement retained during surgerywas really really hard.
Um, cement retained duringsurgery was really really hard,
but it it honestly it makes itmakes for a good surgeon because
you learn how to, how to do allthat stuff in the beginning.
(10:30):
So, um, so yeah, now witheverything pre-planned and
you're you know, we can remove alot of that difficulty from the
providers.
We can remove a lot of thatnecessary skills, I guess,
because the lab is just can, cantake all that information and
they can put it into theprosthetic without you telling
them to.
Speaker 1 (10:51):
Yeah, that makes sense.
And what kind of um I think youmentioned when you first
started, you guys were usinghigh-tech implants and then you
would switch eventually toneodymium CM.
Is there like a particularsystem you guys recommend for
this.
What kind of nuances make itideal?
Speaker 3 (11:06):
Yeah, so we had, uh, we were using neoden CM.
I won't speak on neoden CMbecause I I have PTSD from
neoden CM.
You're not the only one Um sothey uh, when we started seeing
complications from that, um, wehad a.
We had a really well-knownprosthodontist that was with us
(11:27):
at kind of the beginnings whenwe were trying to make this
trainable Dr Child.
He's an awesome prosthodontist,we love having him, and he
basically came on.
He had a really goodrelationship with BioHorizons.
He liked having having multipleplatforms.
So we said, great, we're gonna,we're gonna switch over.
So currently we're usingbiohorizons for all of our cases
(11:50):
.
Um, we just switched to theirnew conical, deep conical.
We do see, you know, that's oneof the things I loved about
neodent those suckers can holdbone really, really well.
We like the internal connection, um, of course.
But so the new biohorizons DeepConical has been good for us so
far and that's what we'recurrently using.
Speaker 1 (12:10):
Mad Fientist.
And why do you guys like beingable to use different platforms?
Because in general like atleast in the FP3 world like
people want a universal platform, it keeps their stock a lot
easier.
They're getting switch and swap.
So what do you like abouthaving different?
Speaker 3 (12:23):
ones bashing neoda, because I think, of course, I
think gm is a great implant and,uh, I think it's very similar
to what we now use with withbiohorizons.
But, um, we were having thosestupid cm abutments were
fracturing, and so really we wewanted a wider platform for
(12:43):
molar areas because we wereworried about the, the strength
of that platform, um, so nowthat you know there's a lot of
time behind GM, now with thisdeep conical, with bio horizons,
I think the, I think the datais out there to support that
it's.
You know, we're okay usingthose thinner, thinner platforms
(13:06):
.
Bio horizons does have have twowith their new deep conical
versus GM's one.
So I I can get a little bit ofa wider platform in the
posterior, which I prefer, um,but we, you know it's that's
kind of where that, that whatdrove us to a multi-platform,
was just seeing fractures in inabundance in a CM.
Speaker 1 (13:26):
Got it, got it, and so, in terms of, you know,
always keep coming back toprosthetics, of course.
So, in terms of occlusalschemes, is there any way that
people should be thinking aboutall excuse me three on six
versus an all on six in terms ofwhat you're looking to do
occlusally?
Speaker 3 (13:51):
the most part what we train.
We do train.
We try and get canine guidancein all of our cases.
Uh, solid posterior contacts.
If if we're talking about, youknow, bite paper, I want it
lightly dragging in the anteriorso we keep that too much
pressure off of the vertices inthe anterior, but just a solid,
occlusal, spread out contact inthe posterior.
Canine guidance.
Speaker 1 (14:11):
Okay, and then I'm curious too about what are some
of the big contraindications fordoing a three on six.
Let's say you have, like somereally severe class correction
or something like that.
Fp3 gives a whole lot offlexibility with regards to
trying to correct a bite or jumpa class three or something like
that.
Are you still able toaccomplish that with three on
six or?
Speaker 3 (14:28):
does that?
Speaker 1 (14:28):
kind of swing you a different way.
Speaker 3 (14:30):
No, generally.
Generally we can correct mostof those things.
Um, as far as contraindications, our biggest one is just you
know that they've already gotsevere bone loss.
They've been at dentures for 10to 20 years.
Then it's.
It becomes a little bit morecomplicated for most patients.
We still do a lot of um denture.
We take a lot of denturepatients into an fp1.
(14:50):
But um, yeah, most of the timethey if, if they've got really
solid tissue um and really goodbone underneath, we can still do
an fp1 on it.
But um, that's our biggestcontraindication.
It's just bone loss to thepoint where now we've got we
can't fit six implants in or itbecomes too much to try and
segment the thing.
(15:14):
So, otherwise, for the most partwe're trying to get them in an
FP1, if we can.
Speaker 2 (15:18):
On those patients that are denture to FP1, are you
guys free handing those ones?
Are you kind of like?
Speaker 3 (15:26):
We'll do a tissue-borne guide.
We'll do a tissue-borne guide.
I always when I train those, Itell all of our licensees to be
cautious with it.
Yeah, so I train a coupletechniques of how to use them to
(15:46):
hopefully have them become asaccurate as possible, but for me
I like to use them kind of as apilot drill and then I'll
usually freehand after that.
Speaker 1 (15:53):
Okay, yeah, that makes sense.
And how does the ponic shapinggo when you're dealing with a
fully edentulous case Like?
How do you end up getting allthat scalloping and forming
those pseudopapillae?
Speaker 3 (16:03):
Yeah, so the main thing you're going to, we take a
lot of the tissue from thepalate and we're going to
transfer it all to the buckle ofthe prosthetic.
That's going to help us developthe good tissue there on the
buckle.
As far as the bone, like I said, I don't generally do a
scalping guide.
I will use, if needed, the theprosthetic as a negative bone
(16:28):
reduction guide.
If I need to create some,usually it's like eight and nine
.
I need to be longer than sevento ten.
So I'll usually try and createa little bit of, a little bit of
a pocket for eight and nine tosit into so that we get the
correct Zenith points, becauseit does look funky if you've got
seven to ten, looking longerthan eight and nine, if they're
smiling really big, so that'ssomething.
(16:51):
But honestly, you could uh, youcould do the case without
removing the bone, and theprosthetic would just probably
seat right against the bone onon eight and nine and that's
going to cause some resorption,just in that you're going to get
of itself, it's going toremodel and, uh, it's going to
create the pontic site on itsown wow, wow, no, that's that's
great.
Speaker 1 (17:11):
That's great, yeah, I mean I'm so.
I mean we just got back fromthe ICOI meeting in Orlando and
FP1 was like a really bigconversation going on there and
that's a whole notherconversation for a different day
about you know the ICOI andwhat they teach versus what you
will mostly see domestically andthings like that.
But that you know the ISOI andwhat they teach versus what you
(17:34):
will mostly see domestically andthings like that.
Um, but that was one thing thatthat really did amaze me is so
many cases.
I looked at him I was like,well, they have to do that FP3,
um, because there just wasn'tenough tooth.
Um, it wasn't enough, uh, youknow architecture to create that
tissue born uh, sorry, nottissue born, but create all that
.
Really impressed.
And and uh, there were justcases that I would you kind of
said that allude to this earlierthere are cases that I, with my
(17:55):
FP3 trained eyes, would neverthink that you could approach
from an FD1 perspective.
But you know there are ways ifyou want to endeavor to do that.
Speaker 3 (18:02):
Yeah, there's, there's ways for.
For most patients, I would sayit's.
You know it's not everyone,it's not indicated for everyone,
but there's a lot you can do tomake these things look and and
uh and feel really, really goodand it's.
It's a fun procedure to do.
It's it's complicated, which Ilike.
I like doing these hard littlethings and uh, so it's something
(18:24):
I find a lot of joy in and uh,yeah there's.
It kind of requires a littlebit of everything.
It requires I.
I tell guys all the time youknow, go do your your GBR
courses, go do your tissuegrafting courses.
You got to get this stuff inbecause you're going to use it
all.
You just you kind of have to inorder to do FP1.
Speaker 1 (18:44):
Yeah, and, and I forgot to ask you, so the uh,
when you're talking about movingpalatal tissue over to the
buckle, is that usually like aVIP graft, like the vascularized
interpositional pedicle, or isit like you're taking the whole
thing full thickness?
Speaker 3 (18:57):
I'll take the whole thing over, okay, no, I'm going
to take the whole thing over.
I'm going to leave it bareunderneath the prosthetic and
bunch up the KG on the facial ofthe prosthetic and just let it
fill in.
Speaker 2 (19:13):
Very nice.
Yeah, I used to see.
It's similar to what we do with.
We'll do the same thing Use atissue punch to punch our
multi-units in and then pull thehole in front of the tissue.
Speaker 3 (19:25):
I think that's essentially kind of what you're
doing right.
Very similar to that.
Yeah, when I was taking my FP3courses years ago, I remember
seeing pictures of this guy.
I can't remember what his namewas, but he would essentially do
these FP3s and he would justleave the lower completely
flapped, one suture or anything,and he was like look at all
this awesome tissue I'm getting.
It sounded painful, like crazy.
(19:51):
Yeah, I know Danny does that alittle bit like yeah, crazy.
But I mean, you're essentiallydoing something like that to a
lesser degree.
Um, cause we still suture andtissue glue or whatever we want
to do to keep that prosthetic,uh, the tissue up against the
prosthetic, but, um, you know,allowing that secondary
intention for that, that tissueto creep in and and get
underneath the prosthetic it, itcan create some really good
thick tissue.
Speaker 1 (20:09):
Yeah, and I'm curious too, like following the surgery
itself.
You know, typically at least, Imean, everyone's a little bit
different in how they like to doit, but in the FP3 world people
will have the procedure, maybesee the patient back the next
day, some will do one week andthen there's usually like a
three week check to see how thesoft tissue is doing, maybe they
move to a water pick orsomething like that, that
waiting 10 to 12 weeks and thentaking new records and making
(20:31):
new fp3.
How does that restorativeprocess and sort of the
post-operative process differ um?
For a three on six, if it does.
Speaker 3 (20:38):
Yeah, I mean it's.
It's fairly similar.
So we, uh, for the most partwe're seeing our patients 24
hours after surgery um,basically just to dial in the
bite any aesthetic issues, andthen we generally don't see them
again for three months.
So we, at that point they callus if they need us but, like I
(21:00):
said, most of our patientstravel in from out of the
country, so it's see them 24hours after they hop on a plane,
they fly back to their homesand we see them in three months
where we will redo our scans,take our tissue data and tighten
up anything that we need tomake all of our aesthetic
adjustments.
We make them a second set oftemporaries and we can do second
(21:25):
temps and finals here at thisoffice because we are close to
the lab.
We can have that done withinseven days, but today.
Otherwise, if they're close, wetry and I try and have them
stay in their second temps for acouple weeks to try them out
yeah, so they basically areflying in three times.
Speaker 2 (21:45):
Is that correct?
Speaker 3 (21:48):
twice well sometimes three times yeah, a lot of times
people, guys, uh, people bringtheir families out for their
week-long appointment.
They'll they'll make a vacation, they'll come ski and they'll
you know, they'll visit utah andmake it fun and uh, so we can
see their, their finals withinthat same uh visit.
Otherwise they get their secondtemps, they home, they fly back
(22:10):
in whenever we decide they'rethey're ready to go with their
finals.
Speaker 1 (22:14):
Okay, okay, that makes sense, and I'm curious too
and maybe we haven't been doingthis long enough for you to see
this but have you ever had apatient that received a three on
six and, due to whatevercircumstances, then had to
change to an all an X and, if so, what's kind of been their
feedback about what they thinkin terms of how everything feels
(22:34):
and the maintenance of it?
Like, what's been kind of thefeedback we've seen?
Speaker 3 (22:37):
I haven't had to transition anyone yet to an
all-on-X.
That's good.
Yeah, you know most of our.
I'm trying to think if there'sanyone that has come through
that's even close to that.
Yet I don't think so.
I mean, honestly, it's a littlebit of an exposed abutment is
about as bad as we're seeingcurrently.
(22:59):
Um, obviously you're going tohave some, you can get some
implant failures and stuff, butwe can work around them.
So I haven't had to transitionanyone yet.
I did just transition.
Someone went down to Cancun um,got an fp3.
Actually it was fairly welldone.
I actually don't.
They didn't remove enough bone,in my opinion, for the fp3,
which worked in my favor.
He came back, he hated it, um,and so within three weeks we
(23:24):
transitioned him to it from anfp3 to an fp1.
That's um, that was last month,I believe.
Uh, cool guy.
But um, yeah, yeah, yeah,that's.
I haven't had to transitionanyone yet.
But I, I assume at some pointwe, we probably will.
I mean, yeah, I think 20 yearsfrom now, we might, we might be
saying something different anduh, and we're, we're ready to do
(23:46):
that if need be.
But I think we've bought thesepatients a lot of time.
Speaker 1 (23:50):
Yeah, and are you able to do a decent amount of
lower three on sixes, or is thisalmost mostly uppers?
Or if you are doing lowers,what are some of the nuances
there that make that possible,cause I know that can be
challenging.
Speaker 3 (24:00):
Yeah, we're still doing it.
We do a lot um, equally as muchon the lower um, because a lot
of times that the teeth areshorter, you generally need a
larger prosthetic space.
You generally need more bonereduction in order to get a
thicker prosthetic.
For us I can have sixmillimeters of restorative space
and I'm good, I'm not seeingfractures.
(24:22):
Honestly, our fracture ratewith these zirconia implants is
close to zero.
Like, if you segment and you'regetting you know three to four
unit bridges, they net thezirconia does not break it's,
it's really really strong.
Now, if you're getting longerspan bridges then, yeah, you can
see some fracture over time.
But, um, even on the lower,with minimal, minimal
(24:44):
restorative space, uh, wherewe've got really strong
prosthetics.
Speaker 1 (24:49):
So it seems like there's kind of an inverse
mentality.
So, like when you first do thesurgery, we're more concerned
about the cross arch stabilityand making sure the implants
integrate, so we need everythingto be connected.
But once those are healed andwe go to the prosthetic phase,
everything changes.
Now we want them all segmentedand that's going to be better
support for the actual zirconiaprosthesis long term yeah, yeah,
better support for theprosthetic.
Speaker 3 (25:09):
Um, easier to clean?
I mean they can floss inbetween the bridges.
That's one of the main thingswe talk about is how you know if
we're talking about hygiene.
We've done a lot ofmeasurements just on our own
FP3s versus our standard threeon six.
Versus our standard three onsix.
(25:35):
You're taking the position,basically the area that's going
to build up food and debris.
You're taking that from an FP3,which is fairly hidden up there
, harder for them to access, andyou're bringing it down to the
tissue level.
So generally, they can see ifthey've got crap piled up on
their teeth, they're going to beable to see it.
Crap piled up on their teeth,they're going to be able to see
it.
Um, your your prosthetic totissue contacts.
(25:55):
If we're looking at thicknessof how much space can gather
stuff, so let's say, in an FPthree, your average is cause as
we.
You know, as you go down, ourbone is a triangle.
So as we go down on thattriangle we're getting wider and
wider area to pack stuff.
You know, and that prostheticon an FP3 can be fairly thick.
Ours we're getting small ponticsites, so the area where they
(26:20):
can pack food and debris is muchsmaller, it's more visible.
They can floss in betweenbridges, they can floss under
them Super easy.
Water pickiene on these thingsis just night and day over what
we've seen in our own FP3 cases.
I mean, we don't remove themonce a year.
We want to you know there'swhether or not the research is
(26:42):
good, that the tissue can adaptand adhere to the zirconia.
We don't want to, most of thetime, mess with any of that, any
of our papilla that we'vedeveloped over years.
We we want to leave it in therein place, and so we don't
remove our prosthetics.
They're easy to clean with justa regular cleaning.
Our hygienists have no issuedoing that, and you know you're.
(27:05):
We're getting a lot lessunderneath these bridges than
even our own FP3 cases which wefeel like we do a good job with
our fp3s.
Speaker 1 (27:12):
But you know, suckers are hard to clean yeah, I love
those posts when, uh, you takeoff like an fp1 or single crown
or whatever and it's got thatultra polished uh zirconia and
they're, they're taking it offand it just takes tissue with it
because it literally justactually formed a biological
seal, which is crazy.
Um.
But uh, also I'm curious too.
So, uh, the screws that youguys are using to retain these,
(27:33):
um, is it just like the typical,like I mean like a desk screw,
or are we using like powerballvortex, whatever?
Speaker 3 (27:40):
we have some guys using vortex.
We use desks almost exclusivelyright now.
Um, really, our long-term goal,everything is made for fp3.
Currently, it's all yeahmulti-units.
Everything is fp3 and um I.
There is a lot that we could dowith stuff that was created
(28:00):
specifically for fp1.
We would love, uh, to have awider and a longer prosthetic
screw that was actually designedfor a direct-to-connection.
Most of these screws are stilldesigned for titanium copings,
yeah, and the MUAs are designedfor FP3, which has a ton of
(28:22):
variance in angulation.
We because we're going betweentwo units or two implants, we
don't have a ton of degrees ofvariation we could have a longer
MUA.
That would.
That would allow a much morestable prosthetic over time.
So you know, there are a lot ofthings that we're working on to
hopefully advance FP1 and getthose, those parts and those
(28:47):
materials that I think wouldwould benefit patients long term
, because and I think we wouldbenefit patients longterm
because and I think we'll startto see we're seeing a lot more
FP1 come around.
When we first started doing this, I mean you had guys doing it,
but they were kind of off in thedistance and you won't hear
about it.
Now there's more FP1 courses.
Since we, since we, starteddoing this, there's more talk of
(29:08):
FP1.
I think it's coming back aroundto where you'll see more and
more guys doing it, which Ithink is good, um, but I think
we need the implant companies tostep up and start creating
parts that that adapt with thetechnology of where it is today
and give us stuff that we can wecan use that, uh, that address
some of the challenges with fp1yeah, we definitely, like tyler
(29:30):
was saying earlier, wedefinitely saw it a ton at the
conference that we were atalmost to the point of going the
opposite direction with FP3 andrecommending FP1 on a lot of
cases.
Speaker 2 (29:44):
What would you know?
I think this is something thatour listeners always love to
just hear from whoever we haveon the podcast.
But do you have any particularCE that you love?
Maybe any recommendations forbooks, learning this material?
A lot of our listeners arepeople who aren't doing Full
(30:05):
Arch and they want to get intoit right.
So if you have a couple of goodbooks, a couple of good courses
, I know you guys obviously havea course, but it sounds like
before somebody comes to yourcourse, it's probably good to
get a good idea of like doingfull arch, doing surgery and
stuff like that.
Speaker 3 (30:22):
Yeah, for sure, we, most of the the.
I have a lot of dentists thatreach out to me fresh out of
school.
I send most of them to implantpathway.
It seems like they do a greatjob.
As far as getting guys going, Ilove, no, I'm going to.
I'm going to forget their names, but there are two guys that I
(30:45):
I kind of just started followingthrough Instagram Dr Matthew
Fien and Israel.
He's out of DC, dc Implants ishis Instagram handle.
They have a set of GBR coursesand tissue grafting courses that
they're the favorite coursesI've ever done, really Tons of
(31:08):
good experience, and I thinkthey really catapulted me into
doing more of this and feelingmore confident that I could
build bone and build tissue anddo that kind of stuff.
So, um, their courses, uh, Ican't remember what their group
is called, um, but try to add tothe show notes.
Speaker 2 (31:28):
We'll figure it out and try to add it.
Speaker 3 (31:30):
Yeah, yeah, I'll look it up, but those guys are
awesome and they're postingamazing cases on Instagram, a
lot of single units and I tryand look at what guys are doing
for a single unit, you know,someone loses number eight and
uh, israel, that dude man, he,he can make it look like they
(31:52):
never lost a dang thing with theway he develops tissue and, uh,
his implant placement,everything that he does looks so
awesome.
So I kind of I try and take whathe's done and anything that we
can do to incorporate that intoour FD1, because we're
essentially just trying to dothat at a larger scale.
Um, so these guys that arereally, um, leading the field in
, uh, implant dentistry and intissue, uh, these are two
(32:15):
periodontists and we try andincorporate that stuff into what
we teach okay, great, yeah,we'll try to add those to the
show notes and those.
Speaker 2 (32:21):
Those are excellent.
Um, just talking about that, itkind of goes into a new
fixation that I've been having.
As far as you know, we do, likeI said, a lot of all in four
stuff and a lot of immediateload and I feel like that's.
It's pretty straightforwardonce you kind of get that down.
And now I'm trying to figure outI'm getting more into like just
immediate loaded singles,immediate loaded bridges you
(32:44):
know, really like trying tomanipulate the tissue properly
so we can do these cases with apredictable result and without
having to put a patient in likea flipper for three months and
then come back, have to like tryto figure out how to get the
tissue to stay where you want it.
Um, and you know it's notalways possible, right, because
I feel like it's much harder toget uh good torque on your
(33:07):
implants when you're just doinglike one tooth or even a bridge,
versus when you have a cleanslate and you have multiple
places to place them.
But what are you guys doing inyour office as far as, like,
single implant goes and like,are you immediately loading
those?
Are you printing them onto atie base?
Like how are you guys doingthat?
Speaker 3 (33:26):
yeah well, uh, we've done quite a few recently where
I'll put an mua on and uh haveour lab quickly design some form
of tissue shape on a single,yeah, on a single nice, yeah,
then eventually I'll take, I'lltake the mua, because with the
mua I can use photogrammetry, um, yeah and uh, which is a huge
(33:47):
benefit, and I can, you know,have them create whatever I want
from there.
But, um, I've done, I've doneas much as using the.
I cut off the fingertip of theglove and stick the, or stick a,
an uh, an old abutment that Ihad sterilized, stick that
through and push some, somecomposite into, into and shape
it myself to create tissue,tissue healers.
(34:09):
I don't do in the anteriorfront four, I'll immediately
load it without any issue,keeping it out of occlusion.
Beyond that, I still don'timmediately load uh, single
units, um, yeah, are you.
Speaker 2 (34:23):
And the front four, I mean, yeah, I think the front
four are the ones that are themost important that I'm kind of
referencing, because those arethe ones that patients don't
want to be wearing a flipper for, and and usually the like I
don't know, the flippers neverlook like amazing up there,
cause you kind of have no yeah,so are you?
Are you typically?
(34:52):
Always?
always doing so and that, andit's funny because I actually
have a case coming up and I wasthinking about doing just that,
doing like I'm putting amulti-unit on and and trying to
print a crown right to thatmulti-unit.
Um, I did a case last weekwhere it was uh, seven to ten.
We did a direct to multi-unitbridge and it worked awesome.
It looked so good after and Iwas really really you just did a
third of a three on six.
Speaker 3 (35:05):
Dude, you're, you're in.
Speaker 1 (35:06):
Yeah, yeah, he's gonna be a licensee.
You're already there.
You might as well sign up nowmaybe well, but what?
Speaker 2 (35:14):
uh okay, oh, I just want to finish a thought, so um
when you aren't doing printed tomulti on those anteriors, how
do you, how are you doing them?
Are you doing printed to tiebase?
Are you are you kind ofdesigning the crown yourself for
those single anteriors?
Speaker 3 (35:31):
Oh, yeah, for the most part, I've done a lot where
I will use their own naturaltooth.
If I'm just taking it out,which is generally the case,
right, we're trying to keep andpreserve everything I'll use
just a regular use, uh, just a,a regular um.
So, yeah, just a tie base orsomething like that, and I will
(35:52):
cut everything but the facialoff of the tooth and I'll, you
know, create the shell and thenI'll pick it up that way, take
it off, unscrew it, shape itwith, uh, with flowable or
whatever I need to do, polish itup really, really good, and
then, and then go with that.
I know there's's, uh, israelPuterman, same guy, um,
hopefully I didn't botch hisname Um, that runs these courses
(36:13):
, his, his Instagram.
He's got, he's got some specificum, printable tissue healers
that I think look pretty awesome, and I can't remember where he
gets his from.
But I've thought about startingto do kind of exactly what he's
doing, because he gets somecrazy results.
But, yeah, I like, I likecreating my own.
That's generally what I've donejust using whatever they've
(36:36):
already had in there and createa shell and then get the, the
correct form coming out of theimplant so that it develops that
, that that tissue, and we'vegot a lot of experience in in
doing that, so that helps.
Speaker 1 (36:47):
Yeah, great, and I may have been yeah, I may have
misunderstood you a moment ago.
So when you're doing uh likethat interior single and you
mentioned um usingphotogrammetry, so you put the
mua on there, then you put youruh micromapper scan body on
there, you take your micromapperand then that's how you're
printing out uh attempt.
When you go to to finalize that, are you then using that data
(37:09):
to swap to fixture level or doyou just keep it all MUA?
Speaker 3 (37:13):
No, at that point you're getting rotation on the
crown right.
Speaker 2 (37:17):
Right, okay.
Speaker 3 (37:18):
So it doesn't work for a permanent super well.
If it's out of occlusion youcan usually keep it from
rotating or you can sometimesbond it to the teeth on either
side or create something so itwon't rotate.
But I generally would just dothat for an initial tissue
healing type of situation okay,yeah, tissue former, then I'd
put my scan body or myimpression coping on, get a
(37:40):
bunch of um light body in thereso it captures what I've already
created, and uh, and then get ascrew retained crown with a
custom put in cool, yeah, yeah.
Speaker 1 (37:52):
So we've talked a lot about you know what's kind of
taking you from.
You know pre three on six tonow, and now I'm kind of curious
about you know where do you seethis being in?
You know 10 years.
What you mentioned a moment agolike long-term goals, like
where do you kind of see thisconcept going?
Where is the innovation goingto be at?
If you see any room for that?
Speaker 3 (38:14):
Yeah, I think the innovation will come, and we're
pushing BioHorizons, we'repushing implant companies to
help us create things that aremore geared towards FP1.
Like I said, there's so muchtechnology right now.
There's so much that we couldbe doing to make these cases
easier and more predictable.
We just need these guys to comealong and make the parts for it
.
So hopefully, that's where theinnovation comes.
(38:37):
We are continuing to just makeour processes streamlined as we
possibly can.
We want more guys doing it.
We want patients to have optionsto preserve their bone long
term.
We think it's the correct thingto do, um, and so ideally we
get as many doctors providingthree on six as we possibly can.
(38:58):
I think that's what our, ourlong-term goal is.
Um, you know, obviously we wantthat financially, but it also
like I would say% of patientsthat are going through full arch
still have no idea that FP1might be an option for them.
They just don't know that itexists, and so it's only those
(39:21):
that hop on Google and start tosearch for other options that
really end up with us.
So I think if once we can getto the point where patients are
informed that there are options,then it's going to drive more
and more doctors into learninghow to provide FP1 for their,
(39:44):
for their patients, and whetherthat's with us or doing it on
their own, I think it's good fordentistry to have more doctors
doing what we're doing.
Speaker 1 (39:54):
Yeah, no, I totally agree.
I mean there was a time when,you know, people were just doing
one implant per tooth and doingall kinds of crazy grafting and
these hugely staged approachesover years and years and years,
and then all an X or really justall in four at the time kind of
save the day with that andnobody knew about it.
And then, once people knewabout it, there was this massive
, massive wave.
And now you know patients havegeneral awareness around that
(40:16):
and they go around shopping forthe best prices or the best
processes or whatever to get itdone, and it seems like you're
kind of.
You know, in this early phase ofthat three on six, awareness is
starting to happening,providers are starting to pop up
in places, people are havingmore options and, you know,
before you know it, this isgoing to be this.
I mean, we may already be there, but this is becoming this
really emergent thing and that'swhat patients are looking for,
(40:41):
because they do want thatconservatism.
You know, especially if you'reyounger than you know, an fb3 is
probably not going to die withyou no, no, we, we know these
things probably won't.
Speaker 3 (40:50):
We hope they do.
We hope that what we do is iswill last as long as possible,
but I think, sure, of course,giving someone longevity and
options as they move forward.
Um, yeah, I think is isimportant and yeah, it's been.
It's been kind of a weirdprocess.
Just uh, a week or two ago,these YouTube videos start
(41:11):
popping up with three on six andwhy it's awful and it's a cult
and it's really weird stuff andit's weird seeing something that
has been so small and it's beensomething that we just kind of
made here in Utah and a namethat I mean.
we didn't make, fp1, we justmade this little three on six
thing and now to start see itpop up on insurance forms and
(41:35):
and on other doctors, youtubevideos and it's.
It's been a funny, funny thingto see happen in the last couple
of years, but it's uh.
I guess it means we're doingsomething right.
Speaker 1 (41:46):
Yeah, well, I mean, I think it's really cool and you
know, I think we feel umparticularly fortunate to be
talking to uh, the pioneer of uhthree on six, um on our podcast
.
So maybe, uh, you know, once itbecomes this big popular thing
and people are doing theresearch, they'll go and find
our podcasts and and they'll getto learn about the beginnings.
Speaker 3 (42:01):
Hopefully some guys get interested and want to come
out and hang out with us.
I think it's fun.
I think our course is awesome.
We have a Teams chat with allof our providers and everyone's
just posting cases and questions.
I generally stay away fromdental forums because I think
(42:23):
dentists are jerks.
Speaker 2 (42:25):
Yeah, forums, because I think dentists are jerks.
Speaker 3 (42:27):
Um, yeah, just you know they have to nitpick every
little thing that someone elsedoes, um, so I tend to stay away
from those, but, um, we've gota really good forum, awesome
providers, awesome docs.
That's been one of the most funthings for me.
I'm not, I'm not, I'm not asuper well-spoken person, so
getting into this training rolewhere we're teaching doctors how
(42:48):
to do this, and traveling outand meeting their staff, it's
been super fun to just meet alot of like-minded doctors and
get to know them and developfriendships with them and be
able to have a guy down inFlorida that's, in my mind, just
an awesome FP3 provider.
(43:09):
And so in places like you guys,he's doing teragoys and
everything and I love havingsomeone that I can run some
stuff off of.
And then I've got a guy thatswitched from just doing wisdom
teeth in Vegas.
He decided he was done withwisdom teeth and he just wanted
to do FP1.
So he's just a three sixprovider in Vegas and uh, so you
(43:29):
know, being able to meet himand when I have whizzies I need
to do I'm texting him.
What the heck, what am I doing?
Speaker 2 (43:37):
Um, so it's it's.
Speaker 3 (43:39):
It's been a fun thing to to get to know doctors and
and, uh, you know, be in asituation like this and meet you
guys.
It's fun for sure.
Speaker 2 (43:47):
Well, hey, we're honored as well.
And what can people do?
If they are interested in yourcourse or they're interested in,
you know, getting into thethree-on-six, what's the best
way that they can reach out toyou?
You said the other doctor wasit Peyton, or what's the other
doctor's name?
Speaker 3 (44:04):
Randy Roberts.
Randy Roberts.
Speaker 2 (44:06):
Randy Roberts, I'm sorry.
Speaker 3 (44:08):
Michael Weisenberg.
He helps me run the course.
And then Randy Roberts.
He's the one that started thiswhole thing and he's kind of
leading our R&D and what wedevelop as far as progress
moving forward.
Speaker 2 (44:25):
Cool, nice.
So yeah, how would people reachout to?
To kind of get involved, getget over to your course and
start doing the three on six.
Speaker 3 (44:33):
Yeah, if you want to.
So three on sixcom, ourtrainings should be on there.
You're my Instagram.
I try and post a lot of what Icall tissue porn Just really
good scalp tissue.
I like to post that kind ofstuff.
Um, so if you want to see kindof what we're doing, uh, my
Instagram is doc dot lock.
(44:53):
Uh, that's L-O-C-K-E Um, andthey can message me there, they
can text me Um, my number's 8 0,1, 7, 5, 5, 9, 2, 4, 3.
And you're welcome to text me.
I'm happy to send, to send you.
I, whenever I talk to guys andthey're questioning whether or
not they want to come, I just gothrough my camera roll and find
my most recent cases and shootthem over and say this is what
(45:15):
you can do like, this is, thisis what we're we're pushing out,
and, uh, I think for the mostpart it helps them gain the
confidence to come on out.
So welcome to text me and I'llshoot over some cases so you can
see what we're doing, and uh,or message me on Instagram.
That's good too.
Speaker 1 (45:29):
Awesome, awesome, awesome.
Well, we really appreciate youcoming on, dr Locke.
This was a huge learningexperience for uh, dr Poppy and
I and um, you know I'm reallyexcited about what you're doing.
I think you've made a massivecontribution to the full arch
world and you know we alwaystalk about um.
You know how to be conservativein an FB3 case right, like
trying to preserve bone or do amore conservative uh technique
(45:50):
here and there to keep peopleout of zygomatics.
And um, you've you've createdthis whole new intermediary
phase between that um, you know,the natural dentition to the
FB1 and and then, of course, theFB2, fb3.
And you know, I think the thebeauty of it is is you know
we're getting to the point wherewe can really support people
throughout their entire lifecycle and, you know, keep them
in teeth they don't have to comein and out, you know, as long
(46:11):
as possible, and I think that'sa it's a really valuable thing.
I love that you've reallydemocratized what you're doing
and made it very approachablefor other providers.
It'd be very's in the rightplace and uh, I just I feel so
privileged that you came on ourshow.
Speaker 3 (46:27):
I appreciate it, guys .
You guys are awesome.
It's been fun to get to knowyou and uh yeah, hopefully,
hopefully we get to do more ofthis.
Speaker 1 (46:36):
Yes, sir, you got it Well, until next time, thank you
.
Speaker 3 (46:38):
All right, thanks guys.
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