¶ Implant Dentistry
My name is Dr Tyler Tolbert and I'm Dr Soren Poppy , and you're listening to the Fix Podcast , your source for all things implant dentistry . Hello and welcome back to the Fix Podcast . So you may notice that we are missing someone today .
So Dr Poppy is off on his first vacation in like two or three years down the DR with his beautiful girlfriend and spend some time down there , and I'm back here recording podcasts . But I'm actually having a really good time , and today I have a special guest with us , dr Drew Phillips . So he and I actually have some similar beginnings .
So we both graduated from the Dental College of Georgia . We're some down south Georgia boys that have come out to a different part of the country to do a whole bunch of full arch , and so Dr Phillips here has done , has an incredible body of work . If you're unfamiliar with his work , it's pretty impressive . I suggest you find him on Instagram .
He is a fully remote Anchorage capable full arch doctor and he hasn't been out much longer than I have . What year did you graduate , drew ? I graduated 2019 . Yeah , so not much further uh along the me at all , but uh , so much further clinically . Um . So I've been so impressed with everything you've been able to do .
And , uh , I've been anxious to hear about your clinical progression and how you got into doing what you've been doing for some time and , uh , what better way to do it than you know live on the show ? So I really appreciate you taking some time out and I'm anxious to get it going . Yeah , for sure , awesome , awesome .
So for those that don't know you , could you just kind of give us some description of you know , your background , your general story , how you got to where you are ? Just the overarching view .
Yeah , so it's funny , I'm actually from georgia originally . I uh , I kind of grew up only knowing anything medical . My father is a radiologist and I grew up wanting to be , you know , some sort of surgeon .
You know , originally it was an orthopedic surgeon and , um , you know , I had the opportunity to shadow , you know , basically every surgery there is in the hospital , but anything from like total hip replacements to just simple stuff .
And the thing that they all had in common is that they told me , if they were to do it again , they would be a dermatologist or a dentist . I heard that a lot and I was like , oh , okay , well , you know , dermatology sounds terrible and you know , my , my father , being a physician , is like dermatology is terrible . Don't do it .
I mean , yeah , it's good money , you want to be a pimple popper . Yeah , I mean , it's , it's , it's it's one of those things where it's like you know the diagnosis 99 of the time before you even walk into the room .
So it's like , yeah , they make good money , but like , yeah , it's , I want something more challenging and and something you know , you know , I think that would be more fun . So I started looking into dentistry and , and you know , really enjoyed it . And , uh , my sister as well . My sister graduated dental school two years before me .
Okay , so , uh , she's a pediatric dentist . Uh , here in Boise as well . Um , so I went to college in Florida and then ended up going to dental school , you know , in Augusta . Um , what a wonderful place Augusta is . One one week , one week a year , um , uh , yeah , it's like everyone , everyone's like oh man , augusta , that must be such a cool place .
And I'm like , yeah , one one week a year , it's really cool . The other 51 weeks it's like the city spends like the two weeks before the master is cleaning it up , making it like a really nice place , and then , yeah , the day is over , man , it's all done .
Back to Augusta and I never really spent much time during that period because I would always just like rent out my condo or whatever and then I'd skip town . So I never even really saw it during that you know golden , you know moment . I saw it for what it really was , but uh , but , you know . You know what that's .
That's the crucible that we both went through , and here we are , so I'm appreciative of it you know it's funny , my one of my classmates , he , his house was close to the national and one year he just with dental school . He just like hadn't cut his grass . And they came over and was like , hey man , can we cut your grass ? That ?
That's great , you just hold it out . It's just like , yeah , let them take care of it .
You know they have a vision . They want people to think . But it's great . I go back every year for the master's . It's a good time , so yeah , so I went to dental school , dental College of Georgia , medical College of Georgia , georgia Regents whatever you want to call it , depending on who you ask . Um , you know , dental school was was dental school .
I uh , it was funny . I never made straight a's until I went to dental school oh , really , yeah , I was never a great student . Um , you know , I think in college I had .
I mean , I had a great time in college , but I think my science gpa was like a 3.2 and standard GPA was like maybe a 3.6 , which , compared to , like , my dental school classmates , was like not anywhere near theirs , yeah , but I killed the DAT . It was like I studied for that thing , like it was a job . It was like six days a week , 10 hour days .
It was funny . Like two weeks before the dat , like I I realized like how to take the test . Um , like everything finally clicked and I was like , oh wow , I don't really need to know this information , I just need to know what the wrong answers are going to be . And then I just , yeah , extra right answers , like it's just like a game and um , it's fine .
I've actually helped a lot of people at the dat since . Um and yeah , so I did really well in the dat and um , nice and uh , yeah , so I got into dental school , which I , you know it was like my dad was like hey , drew , like you know you should look at some other options . Um , just kind of like you know , I'd never .
It was one of those things you know it's like , but you know I got really lucky and got in dental school and , um , you know , made the first I think it was like the first test like a biochem test made and made it like a 93 .
On that I was like , oh shit , like maybe I can do this thing because , like , I'll admit , like I went to dental school like my sister you know she had she'd been a straight A her whole life and made one B her first semester of dental school . So it's like well shoot .
If she didn't do it , reality just came crashing down on her .
Yeah , it's like there's no way I'm going to make straight A's . I was like I go through dental school , like when I get in , like my whole mentality is like C's get degrees , like let's just get out dental school .
Um , but uh , but yeah , I ended up doing really well and , um , you know , I worked my ass off in dental school and um , so I ended up graduating and I was valedictorian in my class , um , so you know , everyone was like so I ended up going to a GPR . After that I went to the VA hospital in Salt Lake city . Uh , you know I I had a .
You know I I ranked that number one . Um , you know I had a . You know I I ranked that number one .
Um , you know , there's some other great programs . I was looking at what , uh , what attracted you ?
to that one . So you know , there there's a few things . So the other one I was really interested in was the uh foundry in alabama . Um , you know , the va and san antonio had a really good A few others had really good reputations . The one thing I really liked about Salt Lake City was number one was location . I grew up , you know , we grew up skiing .
We were not like a beach family , we were a ski family . So we were always out in Utah skiing and that was a big drive for me , kind of , I guess , jumping right into , like , my residency after dental school was the thing I loved about the VA in general was the fact that patients didn't have to pay for treatment .
So you know , it's good and bad , right , like I never learned how to sell treatment and how to sell my treatment plans , but I learned how to basically do everything and that the VA in Salt Lake City specifically you , you know we had a different specialist pretty much every day of the week . So you know it was like monday we had endo .
Like every monday afternoon we were doing molar endo . Every monday morning we were doing , oh , wow , you know we had an oral surgeon . Um , you know we had a day with . Thursday was perio , thursday was pros , some tuesdays , I think , we had an oral surgeon . Then on top of that we had , you know , a handful of really good GP attending .
So you know , we really got our hands in in every sort of specialty and learning from those specialists , as well as running from the GPs there which were doing a lot of the same thing . Um , so you know , I'm really thankful for my , my gpr . I think it gave me a little bit of a of a head start . Um , it was cut short with covid , though covid hit .
I think it was like march of that year and I remember I was one of the first hundred and people in utah to get covid . I was like there's the state , I was like the state's like specimen they were calling me like multiple times a day and I'm like guys like I'm . They were calling me like multiple times a day and I'm like guys like I'm fine .
You got to lead the pack . That's just your , that's your whole personality . You gotta . Yeah , it's just like I'm fine .
Guys , like it's not a big deal , uh , I'm just chilling in my house , uber and getting uber eats and um , wow . But but you know , I think the one thing that my gpr probably taught me the most was how to do dentures . I mean , we did a ton of dentures in my GPR . You know we were doing full mouth extractions .
You know we didn't do any full arch in my GPR . Our standard of care was two implants you mandibles for snap denture , complete upper denture , and .
But it taught me a lot because dentures , I think , are like the basic basis for everything and I see so many people , you know I get hit up on instagram pretty frequently with people being like hey man , like how do I , how do I learn how to do this and things like that . And I'm always like go learn dentures .
You know , go work at affordable dentures or something like that . And just like do dentures a year , yeah , yeah , because I mean you can . You could tell me like , hey , man , I want to do veneers , I want to be like Dr Appa . I'm like , okay , go learn dentures , because it all starts with where you put in your incisal edge and the bite .
Dentures is the basis . And , man , we hated dentures in dental school . Everyone hated them . Oh yeah , frigging . I mean Metzler still . You know what's funny about Metzler , actually , and I hope he actually listens to this , or before no way before he was at georgia . Um , I didn't know that .
Yeah , I remember seeing patients and I'd like scroll back , you know , because they're trying to be like what's done ? It's like kurt metzler . I was like , oh shit , what's up man he's a man .
Yeah , I still . You know it's funny in retrospect . You look back on those guys and you're like you know what . You made some core memories for me that you know . Some of it's bittersweet , but you know what it's a memory seriously .
I could still hear thunderstruck for every rpd , uh , practical that I did yeah , I can't say I did any parcels after dental school but um but , yeah , I mean .
So , you know , learning dentures , I think is just an invaluable , an invaluable thing , and and also the other thing it teaches you which I think is invaluable , is like patient management . You know totally , how do you speak to patients , how do you set expectations for these type of patients ?
Um , so , yeah , so my gpr I did you know about a hundred implants , I think , a few immediates , that's fantastic um , those are mostly in the context of an overdenture uh , we did quite a bit of single implants . Okay , um , we did . You know , I did a lot of sinus grafting , really not much like direct sinus grafting , a lot of lateral sinus grafts .
Um , I still remember my
¶ Post-Residency Career Beginnings and CE
first one . I uh my attending lane brown . He , he did once the person needed bilateral and he did one side and I was meant to do the other side and like , right when I was starting , we had a whole bunch of people show up that were like interviewing or visiting for the GPR and I'm sitting there with like four people over my shoulder laying Dr Brown .
He had already left the room . He like went to go do something else . He's like ah , you got it , man , and you know I'm like trying to do this thing .
I got all these people over my shoulder and they're like and you know I'm like trying to do this thing , I got all these people over my shoulder and they're like I dude , I have no idea what I'm doing , and they were like it turned out good , but you know , so we did a lot of that .
Um , the other thing that you know we did was anything we did on the mandible , like you flap down to the mental nerve . So I see a lot of people learning full arch now and they're like everybody wants to make these like little baby flaps . And I'm like you can't see anything , you don't know what you're doing .
I mean , I flap and every now and then the drill comes out , the buckle plate or you know an implant , and I'm like , wow , if I didn't have it flapped , I would have never seen that . You know , um , totally . So . You know , I was never scared to make big flaps because we were forced to . I mean , we were that's great . Um , so , yeah .
So you know , that was my gpr experience . It was really invaluable for me to work with all these special specialists and , um , you know , do a lot of dentures , even though I didn't like it while I was doing it . I look back on it and I'm like , man , I wish I would have done more of these , or , yeah , it's invaluable .
Yeah , yeah . So , like at that time when you were going through the GPR , was your mentality that you were going to be like an omni capable GP , or was there like kind of a what was the end in mind ?
So you know , at a dental school I didn't know what I wanted to do and everyone was like , oh you know , why aren't you going to ortho , or why aren't you going to oral surgery ? And you know , ortho was out from day one . To me that just sounds not fun . And you know good for you to be honest , but it's just not for me .
So you know , GPR for me was just like that . Next step , you know , out of dental school , I thought that I might like endo .
And after like two molar endos , I was like I never want to do this ever again . Um , yeah , I was under no illusions .
Yeah , when I came , my first root canal , my first root canal out of out of residency was like number 19 and broke broke first file ever broke , first patient out of residency . I was like , wow , I think that was the last root canal I ever did .
That's great .
That's great Um but yeah , man , so it was uh . Yeah , I loved it .
Yeah , cool . So so you're coming out of GPR and , um , you know you , you have the sobering reality of breaking off a file and a number 19 and you got all these skills with like dentures and surgery and implants . Um , so what was the next step ? How did you kind of transition from there ?
What was the direction that got you kind of in more in the aim of surgery ?
So I my , you know , my GPR kind of got cut short . You know there was about three to four months where , and so there were , there were some still some things that I wanted to do and learn before I kind of like dove right into whatever I , you know , ended up wanting to do , which I really still didn't know .
I still had this idea in my head that I really liked cosmetic dentistry , and that was not something that I got to do at um the GP , at my GPR , cause it's the VA and we do functional we do functional dentistry , not aesthetic dentistry .
And so I went to go work at an office , uh , in Salt Lake city , um , where I was doing a lot of sedation dentistry and , um , you know we're doing a lot of .
I was doing , you know , probably one to two sedations a day , just whether it was fillings , crowns , implants , things like that , um , um , and I was there about I think five or six months , uh , before I left , um , and I started doing some full arch there .
I probably did maybe 20 , 20 arches while I was there , um , most of them are all under my own sedation too , which is is I would not .
I would never do that again , and were you doing your own conversions as well ?
So there was a . There was like a a quote unquote in-house lab there . So they were kind of doing the conversion . I mean , we were helping , but for the most part they were doing the conversion and then we were restoring .
So I think , like , if I were , you know , going back to , I think you know they wanted me to do something like 20 , like you know , take like 20 patients to finals or something like that .
Before I did my own surgery , which is for sure , the right thing to do is to to learn the prosthetic aspect of it before you start , you know , throwing some implants in . Um , yeah , I remember my first case still , it was uh , uh , it was a double arch .
The owner of the office was supposed to come there and like basically hold my hand through it and 20 minutes before I called him and I was like yo , man , where you at ? and he's like oh you got it , but he's like I'm not gonna make it .
And I was like and then , and then , four people came into the clinic to watch you do it right ? This is what happens thankfully .
thankfully they had assistants there that had done enough of them Like they could probably do it themselves . But , yeah , my first double arch took me pretty much exactly four hours . I still remember it , it's actually not bad .
It's not bad at all .
Yeah , I was super proud of myself .
Yeah .
And I think it healed . Well , I don't , you know , I don't really know . Um , yeah , so I was there and then I uh , I was I wanted to get out of there pretty quickly and was just looking at some different options .
And that's kind of when I was , I was like , okay , do I want to go somewhere where there's like a lot of more of like aesthetic dentistry so I was looking at an office and working at an office in park city or do I just want to go completely something different ? Because this was really my first .
This office I was working on salt lake city was really my first like um experience to full arch and I liked it . You know what they were paying me to do . It was not worth my time , like I could have just been prepping crowns and I would have made more money , but I liked it . I wanted to kind of see where it went .
The office I was looking on park city just really kind of didn't work out , um . So I went to california and was working at an office there that had another in-house lab that was doing a lot of um , like kind of a lot of digital workflow stuff and , oh cool , okay , so I was there .
This would was this like 2020 , 2021 it was like 20 see graduate 2019 .
So this would have been like I think it was like december . I started like december of 2021 . Okay , 20 , yeah , 2021 , um okay , and I , you know I did . I did quite a few surgeries there . I did a ton of sedation , but the the aspect of them having an in-house lab was was huge for me and becoming friends with the lab tech there .
It's a guy I'm still friends with . He's actually out on his own . It's AOX Designs , joseph Rodriguez . He's the man . Him and I are still buddies . We still , you know , talk about cases together . Him and I are still buddies . We still talk about cases together . Him and I created some protocols together . So just learning the digital workflow there was huge .
Is that with Gus Khalil ?
No , it was in my AOX , is it ? What is his name ? No , it's not with Gus . That's actually where I met gus , though oh okay , okay what is his name ?
Joseph rodriguez , okay , um , whatever , but uh , yeah , he was the man , um , and that's where , kind of like , my ce journey started and that's where I became addicted to ce , um , and so I , uh , I took a lot of ce courses that year , um , and that was like my first kind of remote anchorage ce course as well nice , nice .
So you were actually doing the fixed arches prior to really taking the ce courses . It was more just you know experience in residency and then whatever was happening in that first place that you went to , that kind of you know , yeah .
So it was kind of like a c1 do one teach one sort of thing . Got it right like I . I watched a bunch , I restored a bunch and you know I had the basics right . Like I was fine laying a flap , which again is something that like conceptually seems really easy to do . But you watch people that are new at her .
I go and like mentor people and I'm like man , that flap's got to be way bigger .
I mean like yeah , look at we're doing thickness and you can't see anything .
There's blood everywhere yeah , I'm all over the place , yeah you know the basics , I I had the basics of pretty much everything . I was comfortable around the sinus , I was comfortable around the nerve , and so you just kind of have to put it all together and , uh , so yeah , so that's where I started my ce journey .
Um cool , and you know , that was , I guess , my first ce , like remote , remote anchorage as well well , wow , wow , yeah .
So you kind of like we're already kind of going straight to , uh , to some of the more advanced techniques , like right off the bat with your , with your CE . Yeah , that's cool .
Yeah , yeah , it was . Uh , you know , after that I kind of , I guess maybe I took some steps backwards . But you know , remote Anchorage is not something I ever wanted to do and the first course I took was a live patient course with uh , fishy broman um in his office in arizona .
And I remember , yeah , I was already , I had already become friends with him and he was doing a course and I was like , man , do I really need to learn this ? Like this is so out of my league . You know there's no like , like and he's like man , you're young , you're , you're gonna be , you know , you going to see your own cases fail .
I'm like that's the scariest thing to think about . He's like , you know , you should at least learn how to do it , whether you do it or not . And you know I probably took that course too early and I don't think I did any zygos , I probably did a handful of pterygoids , no-transcript okay , yeah , that's .
That's a really big gap yeah , I did the time you learned , at the time you implement . Yeah , I did two in one day . It was a husband wife , they were , uh , it was did you know that they were going to be zygos before you started or was it like a necessity ? okay , yeah , so a little story with that .
They so my parents were still living in georgia and we'd had this , um , the lady that cleaned our house she'd been , you know , she'd she took care of our dogs .
I mean , she'd been there when I was a small child and cool , um , we I don't think anyone my family ever realized they had , like teeth problems and I guess they like saw what I was doing and instagram or whatever , and and went to my parents and was like , hey , like you know , we went to clear choice and we got these .
Uh , yeah , you know , it was like back then clear choice was charging probably like 60 000 plus dollars you know something crazy
¶ Collaborative Zygo and Pterygoid Implant Cases
like that . And I was like , well , you know , like go get a ct . You know , clear choice wasn't gonna share the ct . I was like go get a ct somewhere and and uh , send it to me . And I immediately saw it and I was like clearjoy said they could do standard all on four in this . There's no way , like both of you guys are zygos like 100 .
And I was like , well , you know , I took a zygo course , I'll you know , they're nice people some time ago . Yeah , these people are nice um , yeah , cool , you know , like they've helped us , like , so I did them for free and we did them both in the same day . Um and uh , we did did them at a friend's office in oregon .
Um and uh , from what I know , every they're , you know they're still good . I mean , they see my friend's office in atlanta for cleanings now . Yeah , so that was my first zygote patient was husband and wife .
Wow , that's awesome . So were those were like , um , uh like , was it like a quad zygote or are you doing like a single on one side , or ?
Yeah , so they were both just uh , post-year zygotes . And and you know , look , I didn't even do pterygoids on that case because I mean that took me so freaking long and I was like I was just like I just so they . You know , I've got posterior zygos on both , just two implants on the anterior for both of them . Both of them got four implants in the lower .
You know , one of these days , uh , you know , they'll probably come visit me in in idaho , um , or in oregon , wherever I'm working somewhere , and you know I might go and add some pterygoids to them because I want them to last for the rest of their life . Yeah , ideally .
But yeah , you know , I haven't , I haven't even looked at , like the post-op CBTs , cbcts . I'm sure the , the Zagos are right in the middle of the bone , you know right where they should be , but you split the field goal .
That's great yeah .
Got to start somewhere , I guess . Yeah , no , of course .
Yeah , no , I mean props to you for just kind of going in head first with that . I mean , you know , a lot of people will take , you know , three or four courses . I want to do a few cadaver courses , some live surgery , and then still want to do some over the shoulder , which there's merit to that , of course .
But at the same time , I've noticed that a lot of the people that you know end up teaching these things , um , they can kind of be a little bit of cowboys , you know , if you will , maybe that's kind of a derogative term , but , um , you know , people that are willing to , you know , feel confident in their abilities as soon as they , you know , understand the
full scope of it and understand that you're not really going to know how to do it until you do it , um and as , and I think that kind of , uh , that kind of service for a patient that otherwise wouldn't really be able to , uh , to get something , it would be a standard of care .
I mean , if there's a Zygo patient , why would they get you know , standard all in four ? So , um , yeah , that that was a lot more of these cases , or how did ? How'd you feel about it ?
You know , not , no , um , really , you know , I still like every time I see a Zygo case , I'm not like oh man , I can't wait through this . I'm like ah , really Like that's a good attitude , actually .
Um , that's how it should be .
I mean like I can do them and and you know I will do them , but it's not something that I like go strive to do and like really enjoy because it's it's exhausting , it's high risk . I mean it's high risk for anyone . There's GP , perio , oral surgeon , it doesn't matter who's doing it . Um , and you know , thankfully I've not had any zygos fail .
I haven't had any huge issues from from zygopatients . I mean , honestly , my , my worst complication on a patient I've had is on a lower arch where the guy had the only teeth I had to take out was both canines . The only thing I left and I was like the worst complicate .
It was just like a total massive infection , just hospitalized , like it was just like a total disaster that you know I'm like man , what , what could I have done differently ? And I feel like I did everything right and he's got Zygos on the upper .
I was like really , Like it was , like it was two years ago .
It was the hardest Zygo case I ever did , like I drilled once , couldn't get torque . Drilled again , placed . Couldn't get torque third time on this on , like it was on camera . Well , drilled , again placed . Couldn't get torque Third time on this , like it was I can't remember what left or right side it was like finally got torque .
I'm like man , this is the hardest Zygo case I've ever done .
And I get a complication on the lower . Yeah , the irony it's always the ones you don't see coming . I've definitely found that the ones that I worry about tend to work out and then the ones I wasn't worried about just totally disregarded . Those are the sneaky ones , oh yeah .
The cases where you load it , it's like 180 centimeters composite torque value and it's like everyone just go home and say your prayers and they heal a mate . No problem , no problem whatsoever .
Yeah , yeah , no , I totally get that . Okay , so you placed your first Zygos about eight months after that , first course still not feeling entirely psyched about them . What kind of made you want to go a little bit further down the road of of doing more fixed for large and atrophic cases ?
so I started . This is when I started traveling to oregon a lot . Um , so I'd moved to boise . At that point I was , uh , working at an office here covering for a friend's maternity leave .
Um , okay , I was doing that , was traveling to a couple different offices in oregon and you know we didn't stock zygos and we started just getting some cases and , um , I was like , well , I'm kind of forced to do these now . Um so , so , yeah , so I just started doing them and you know I hadn't taken any other course yet .
I remember I went this was years ago now I went to a trans nasal course in Boston . It was just like a one day course . It was like David Zellig and Simon oh .
I was teaching it and uh and it was .
It was a transnasal course .
They talked a little bit about zygos , but it was my first time meeting , you know , like david zellig and simon , oh , um , a lot of the other guys I'd already met before , just through different courses or whatever , and um , I can't remember if one , if one gonzalez , was there or not , but anyway , like you know , again , like that course , like a few weeks
later I did a trans trans nasal . Um , nice , that's been , I think december was two years . Still have not seen that patient for post-op .
But you know . I mean it's fair to assume that things worked out .
Yeah , as far as I know they look great but great . So you know I'd probably done I don't know or so Zygo cases , very few quads , maybe a couple quads . I mean even still like I've only done a couple quads . And so then I loaded up a case . I loaded up three Zygo cases one day and I had Juan come do those cases with me in Oregon at the office .
I was at there . So Juan came and we did three upper arches in one day . So Juan came and we did three upper arches in one day . You know , I think a couple transnasal , a couple zygote , and it was great . I mean it was . You know , anytime you do something with any other doctor , like they're learning from you , you're learning from them .
You know I was learning some zygote stuff from him . I was showing him how I was doing my pterygoids , because I was placing my pterygoids with just standard neoden implants and had , like you know , upper 90 success rate of of every time I placed it .
And you know I wasn't using the Norris that you know , arguably was a better designed pterygoid implant , but I was having great success with just the neoden , like 3.75 by 18 helix , and had great success with it . And , uh , you know know . So I showed him kind of like what I was doing with that .
I was using some osteotomes from salvin , I was using some osteotomes from norris , just kind of figuring out what worked for me and , um , you know , so it was cool , just kind of collaborating with him on that and learning . You know , each of us learning from each other and uh .
So are you kind of like a , are you a drill osteotome hybrid type of guy , is it ?
I mean , I keep changing my ways of things . Um , you know , so I I love the Norris , uh , the like the 2.0 sharp osteotome , which I think , uh , I think the SIN one is almost identical to that . Now , Um , you can also get it from like GDT for like 90 bucks as well , and so I at least just try to push with that till I can feel something hard .
Sometimes it's hard already , and you know , when I have that I'm like great , like almost doesn't matter what I do now , like we're going to get to work . We're good to go .
So I'll push with that until I feel something hard and then I will just take like a standard spade drill and go really slow and just feel until I , you know , I perforate the plate and if something doesn't feel right at that point I can kind of redirect , redirect , right , um , and then I have a I believe it's 2.7 millimeter osseotome from salvin that I got .
Uh , my my friend , uh , shivane gupta is an oral surgeon in atlanta told me about that , so I bought it back now and , uh , so I got that and you know basically that if I can get that down to like 12 to 14 millimeters , like I go straight to placing the implant . If , if it won't go in , then I'll pick up a 3.5 drill and go a little bit more .
But you know what's awesome about that neodym helix is , you know you open up , you know a cortical plate with the two millimeter drill , like you can almost guarantee yourself that it's going to grab and go in there . Yeah , yeah , you know , every now and then it would .
You know an implant would hit it and it would spin , and pretty simple , just pick up the 3.5 drill and just , you know , I leave it on like the 40 newton centimeter or 40 , I mean uh rpm speed and just barely open it where you can kind of feel every turn and just cutting just to open it up enough , and I see , um , and yeah , I mean , as long as I'm
in the right spot , like my success rate is is really high with my pterygoids .
Great , yeah , fantastic , okay , awesome . So that's the . So that's your pterygoid . You know general routine there . So anything special would you say about your zygotechnique ? I mean , would you say that's kind of like a you know ? I guess the way I should put it is what kind of school of thought do you generally have in terms of your approaches ?
I go to surgical approach with it . So I have kind of like , uh , you know , I guess , jumping off of CE and we can go back to see if you want some other ones . But like my general approach , like I guess , like kind of in my head , like my algorithm of like how I'm going to approach each case , kind of like jumping into like Patsy protocol , if
¶ Implant Placement Strategy and Techniques
you will . So for me it all comes down to like where the sinuses are Right and so that you know , like where the sinuses are , does it dictates , like where my you know where my teraglute implant starts . It dictates , you know , am I going to do a Zygo ? It dictates like how my front four implants are going to be .
So you know , my train of thought is , if I can get you know , first of all , we don't want cantilevers , if at all possible , right . So if I can get an implant at first premolar and a pterygoid , I don't need a Zygo . I feel like that spread is fine . Um , you know , if I can get one at second premolar , great .
And you can argue that on those cases , a one-tooth cantilever for a molar is okay . I mean , you know , we don't like , we don't like cantilevers . However , clear choice has been doing that for forever , oh , that's the vast majority of cases um you know , and and I have cherry boys under my belt so , yeah , I do them for most cases now .
But you know , look at what clear choice has done . I mean , they've done more than anyone else and like their standard of care is just four implants giving them a one tooth cantilever . And you know the people I know that have been there for a long time so they have great success with that .
Um , so yeah , so my , my kind of algorithm is like , if I can get like first premolar and a pterygoid , I don't need a Zygo . If I can get , you know , first premolar and I don't get a pterygoid , you know I need as I go . Um , you know , anterior is whatever .
Um , you know , there are some cases now where it's like I've done things you know where I would need a quad and I've done you know whether it's like transnasal implants . I have one case again all these cool cases I've done , people refuse to come back for post-ops .
So I have a case where I had , uh , I mean , I had like , I think like six millimeters maybe it was like five , like you know , under the nose , and I did pterygoids , uh , two like first molar zygos , and then I placed three helix short right in the anterior and it was all cortical bone . So it wasn't like your standard . I's cortical bone .
I'm like this bone's not going to talk to dr molinari about it and he's like , yeah , that's a great idea . So I placed , you know , two like in about the lateral spot and one in the nasal palatine just those new those , my first helix short implants I placed and got great torque . It was all cortical bone again . I probably did that .
I was like , right after the helix Short came out Again , still haven't seen that patient pack . It's like all the cool stuff , I don't see anything . Yeah , that's brilliant , awesome , awesome difference and you know , doing a half-ass flap or just being able to see everything . Um , you know the one thing , when it came to my flap that you know I learned from .
So I I took a um alex avonis course in uh in brazil with um dan rosen and dennis smiler . It was funny . I again , I was never planning on taking that course and I had a buddy perry donis was going to go and I was like , yeah , man , I'll go with you , and I think he had a family emergency , ended up not being able to go , and so I went .
I had a great time . Um , and one thing Alex Savonia is like he was always getting me to flap like more , like posterior on the arch , which like really opens it up a lot more than just trying to like only where the implant goes and uh , so you know , again , like bigger flaps , I don't really use any of like the special uh Zyger retractors .
¶ Dental Instrument Preferences and Training Locations
I use a Minnesota . I have a pretty cool Minnesota . I don't know the name of it . Um , it's a Minnesota with more of a handle . Um , there's a . I think they make one that's like an ergo Minnesota . It's not that , it's a little different .
I've seen this . Yeah , I saw it at Clark Damon's course .
I think it's just a longer , it's just a longer Minnesota basically , and I I love that thing . Um , okay , I have like another instrument . Um , salvin makes one . I think they call it like the zaga three . I think nester uh posted about it today .
I I got one from like uh h and h instruments , um , just basically the shape of like a molt nine but it's just like three times the size and for me it's really good for this blunt dissection . Just a spoon , um , yeah , it's just like a big spoon and uh , yeah , so you know just different things . And um , you know , the brazil course was great .
Uh , brazil is my favorite place I think I've ever been . Um , I love brazil . Yeah , it's great everything about it um . I've been back I think like I've been back . I went back this year for another course too .