Welcome back to part two of the TFAP SPG Pod crossover. Last week we talked about the year end, the wrap up. Happy New Year for all of those listening to this. We're going to talk a little bit more looking forward in SPG specifically but generally in the market of full arched industry and I'm joined once again by CEO and lexicon extraordinaire, Dr. Alex Schur. Steve, how's it going? It's good, man. It's good. We just got done talking about the crazy amount of stuff that happened in one year.
And for me, one year feels like at least three distinct phases, to be honest with you two, which we didn't talk about last year, but almost like the thirds of the year were each very distinctly different. I can't imagine what it feels like to be in the actual third year of this. Like you are because that must feel like a decade. Yeah, it feels like a long time but really it feels like it's all been building to where we are now.
And I don't want to get too woo-woo on you but it just feels like everything has been crescendoing in service of where we are now or where we're going because there's like a fatalism to it almost saying that we had to go through the challenges and also the wins that we've experienced in order to be exactly where we are right now. And so, you know, 2025, the subject of today's recording is going to be just an unbelievable year for us internally, externally.
Everything that we have on the docket and the hopper ready to go. So I'm just very, very glad to be entering 2025. I'd much rather be entering 2025 than any of the prior years. I'll put it that way. Yeah, that's nice. That's a good way to put it. So it's almost like the crescendo is like, you know, very rapid growth.
And then almost like the wave comes back in to consolidate and like power up for like an explosion that's about to happen in 2025 and not necessarily in size but in valuation and potential other investment and just generally kind of everything we've built to this point is going to now come out. Now we've what we've done is we've kind of as best we can knowing how last year went and how long one year is. How best can we actually forecast 2025?
I have goals that I want to kind of get done in the first quarter. And after that, I have general ideas, but it's hard to, you know, really map out a whole year like that in the company that's this dynamic. But one thing that we focused on and we're going to focus on is SPGU and those doctors and SPGU who have taken the time to log back into that network and kind of seen the facelift and the different videos. I'll keep poking people when new more and more new stuff comes out.
But one of the biggest pushes is going to be drum roll, please, the inevitable digitization of SPGU. It's been in the work since I joined in a year ago. And now there's actually a roadmap to get it done, which is really exciting. And I have full confidence by the end of 2025, every office in the network will be fully digital. And I think that is the only way to truly scale past the size rat now for a number of reasons which we can get into.
And I've had a lot of one-on-one conversations with doctors about what this looks like and how and why. It's just it's like a triple win, like maybe even a quadruple win for why to do it this way. Yourself who's done some surgery when you had your own practice and stuff, how much digital stuff did you do? Not necessarily like full arch implants, but crowns, bridges, that kind of stuff. I was just dinking around on the periphery, really.
So I had the scanner to be able to not have to do impressions for crown and bridge. I printed off surgical guides. I played with the full arch surgical guides, but for reasons that I think are well established doing the full arch surgical guides, that's not a one-size-fits-all approach. So I ended up using the surgical guides primarily for tight, lateral incisors and things like that where it's nice to at least have a pilot orientation.
But yeah, I did the digital approach, kind of like the prehistoric version of it back in the day. And what's really interesting in my role now, in my favorite part of my role, honestly, is to get to visit with our practice teams and to do these site visits and SPG focused days, where I get to see some of the differences and similarities and operations between our locations.
And like we talked about in the last episode, we've gotten more centralized and more calibrated on how we operate day in, day out at all of our locations. But one of the major differences is between analog offices and digital offices. You see some obvious differences there on down to the scheduling and the fulfillment times of when someone can come in for records compared to when they're able to come in for their procedure. Like there's a lot of different ripple effects there.
And what I love to see is in our offices that have been digital for a while, there's just relatively fewer steps to the different aspects of care. There's redundancy and that that word can have a negative connotation, but redundancy, meaning patient calls on the phone and says, Hey, I screwed up. I bit down on something hard that I shouldn't have been down on in my temporary broke. Okay, come on in. We'll hit print.
And then you unscrew the broken prosthetic screw in the new one and then about being about a boom, you're good. And that's just one example of the benefits of being digital. But no, I mean, I love the angle. I love the approach. And it's becoming an expectation. We talked last episode about patient expectations.
And our patient expectations are evolving to where they know that, Hey, the quick turnaround time, the instantaneous finals, the delivering your finals same day or same week, isn't necessarily the best way to go in all situations. The inverse can be true, though, where patients can equate digital technology with quality. The more technology you have at your disposal, the more that can be looked upon favorably
by a lot of different patient populations. So I like it from that angle, not to mention the fact that doctors are jazzed about integrating technology. It's becoming an expectation for doctors that are our age, Steve, and also the younger generation of doctors coming out, where the appreciation for analog, I think is there. But I think it's great for fundamentals and for people to learn the ropes and to learn occlusion. But then rubber meets the road.
There's just so many benefits to digital, which honestly you've helped me to see. Yeah, I think I think 2025 is the year where it makes the most sense because some new things have hit the market. Most recently, the shining elite scanner hit the market right when we were previously this, all of our digital offices have the micron mapper and some scanner. One thing that when myself and Matt Ford were sitting down and trying to map this out was like,
we really want every office to have the same thing. We really don't want to have what we have now, which is Columbus has a trios and a micromapper and Denver has a meta and a micromapper and this and that. Sprint Ray versus Frozen versus Form Lab is all these different printers. We really want to pick one and stick with it. But it's hard because in this market, the technology is evolving so fast that there's a fear that you'll pick something and pretty quickly you'll be like,
oh, I've chose the wrong one. And so right when we were about to digitize, what office was it? Maybe Cincinnati or Phoenix or one of the ones that most recently went. We were looking at the prices and then we got word that shining was releasing this new scanner. And we knew full well that scanner is brand new. It's going to have its own bumps, but shining is a solid company with a great running background and how they,
I've had shining equipment and private practice. I had shining equipment, high quality stuff. And when you work with a lot of other companies that are distributing it, there's a lot of training available and inevitably, and it's already happened actually, there's software updates and upgrades to make it more reasonable. Because when this machine came out, it was very clearly, when engineers are designing something versus then it finally gets
in the hands of the surgeon to use it, there's going to be a learning curve. And we're willing to put up with that learning curve because we truly see this as the way to scale digital. The price point is amazing at 20,000 retail. And that gets you what they call introural photogrammetry or IPG and a scanner built in. Whereas before it'd be some sort of scanner, 15, 20,000 and a 30 something thousand dollar photogrammetry unit. And it just became a lot
harder to do that at scale. I mean, how can we either start up offices with that kind of 50 or $60,000 investment versus a $20,000 investment with some printers. Suddenly, we can go much faster. And we know the people who are bringing this to market are not going to let this thing just become a stage two scanner, which is what it was designed for. It was clearly designed.
When it came out, the workflow was kind of locked in the steps you had to do. And you had to scan the pre op teeth just like we normally do, then you had to scan it with the IPG to get the photogrammetry. Then you had to do a merge scan in the mouth every time. And those of us who've done surgery and done photogrammetry know that that is very difficult, if not impossible, and the mandible sometimes, it's just really clunky to do it sometimes on the maxilla.
If you have these large scan bodies in there. And so the traditional way, the way that I still do it is to take a pre op scan with markers, take a photogrammetry scan and then get the photogrammetry out of there, put in new smaller body scan bodies and scan that and let the lab stitch things based on markers or teeth or whatever. And this was forcing you to do it with the with the large
IPG scan bodies. So for a lot of people, that was a that's not going to work. But we knew that there's no way that's going to come to market within a couple months, they're not going to release some sort of new software had already been rumored it launches next month or this month since you're
listening to this in January, where you'll be able to actually separate the two. So you could go the quote unquote old school, which is kind of funny to say, and do the markers and or maybe leave some teeth and get those two scans and then open a second kind of case been for just the photogrammetry and allow your lab and exocad to bring it all together. And then when you do come to a stage two, you can use it how they've originally designed it because it is a very, very seamless workflow.
What does it stitches everything for you without lab having to do it in exocad, which is neat. But knowing that they've already made a jump to be like, okay, we've realized people want to use this in surgeries. And here's how and why and how we can do this. I'm very bullish on that scanner being the scalability scanner for a group like ours. I think it's going to be huge. We've already had a couple successful surgeries in Phoenix. Dr. Miller's been trialing it with their old workflow
too, where you had to scan it. And it does work. There's just nuances to it. It's only going to get better and better and better. So I'm really excited for that. When that came out, we quickly realized, oh, shoot, we can we can digitize even faster than we thought because it's half the price or less. And we've made some really good vendor relations with a lab like Barksdale who helps us with our equipment, you know, acquisitions, and then companies like Digital Arches and Danny Yao,
who helps us with our markers and also distributes the shining for us. So it's really come full circle and it feels like we were just like primed and waiting. And then this opportunity came around and just boom, off to the races. So there's no perfect time to jump in because you can keep waiting for some other signal or some other plateau or some other outside force that makes it feel like the right time to make the move. But this to me, this feels like an example of something where you
know that maybe we're on the early side. But that's the way the winds are moving. That's the way that things are shifting. That's becoming the expectation of the doctors and the patients. And so I think getting out ahead of it and being more proactive than reactive, it behooves us to have that posture. And so yeah, I love the fact that we're that we're moving in that direction and sourcing feedback from our doctor team. There's clearly an eagerness to go this direction.
And I like the fact that we have we have experience as a company in the analog workflow. We have a healthy respect for the analog workflow. I think the analog workflow has helped us to develop a lot of fundamentals. And one piece that I can't remember who I was talking to, but I was talking to one of our doctors about the fact that the analog workflow really did help learn or help teach some
lessons around occlusion to prep before the digital workflow. And so what's your assessment just out of curiosity of best ways to educate on occlusion, like especially for say we have a doctor that opens a practice with us in nine months, and we're going digital straight from the get-go. What are some resources to learn that same occlusion based building around the optimal location and alignment of the teeth to be able to parlay that into the digital workflow?
Yeah, there's, I mean, I think Coase is kind of the place to go to learn and plant occlusion in general. Of course, that's they're booked out a long time and they're quite expensive. But we have some amazing doctors in our group who have taken all of those courses. And I'd like to get them either on an internal podcast or in SPGU and talking about that. And it all comes back to dentures in a way like where we set the teeth. And I took Frank Spear. I was a spear person
because I did Sarah, I can stuff like that. And so in the Spears kind of paradigm, it's kind of like find out where eight and nine need to go for aesthetics. The rest of the teeth just naturally follow that with the curve of the lip and the occlusal plane. And then you kind of make the lower match that. And when it comes to digital stuff, that becomes pretty simple. If we get good
with the photography and our internal scans, and that's if we can get it to look right. Now, usually if the occlusion is like, if there's like para function or there's some sort of occlusal malady, you're going to find out in those 10 weeks because they're probably going to, it's going to get loose. They're going to break it. There's like, I have a patient right now who broke who fractured the her upper at site number 10 twice. And first, I thought, I thought she was
maybe grinding her teeth because she's like, she's like a daytime cleanser. So we like made her a night guard and she got loose once more. We tighten it, then she came in and it was fractured off and she was missing the back half. And I was like, okay, like, there's plenty of signs that I, like red flags that could have seen earlier, but now it's like, okay, clearly, this is a occlusal problem. Now the, the tricky part is with general occlusion, especially if it's upper and lower,
you want like bilateral simultaneous contact. And there's not so much like canine guidance on two bridges. There's kind of like a group function, S, we just want to make sure it excludes when they go into excursives, make sure they're not stuck in their envelope of motion, you know, so if they have a really low angle of opening, we don't want to have a lot of overjet, for instance, overbite. So there's things you can, you'll find out before the final,
because things will be uncomfortable or loose or breaking usually. And so it should be kind of obvious. And I, and I'm no like a occlusal expert by any means. I haven't taken any of those coins classes or like, dives into that, that is like a deep end of a pool that I can't even see the bottom of. And generally, in my experience, you, the patient just can tell you if they're comfortable or not. And in my patient's case, I printed the thing before she came in, because I knew it was
broken. We put in the new upper, uh, she said, she's like, keep saying, I feel like I'm only hitting the left side. And in the end, what happened when she broke it, by the way, she was missing the screw on 14 and the screw was still in 10, but that's where it fractured. So I finally like, clicked that, Oh my God, she's actually not like, Bruxine, she's somehow loosening the screw on 14. And once that's loose, it breaks at 10, because now the cantilever is from 10 to 14.
So that's suddenly the pivot point and snap, you know, crackle pop, there it goes. So I need to stop looking at 10 and be concerned about the thinnest up there. I need to look at 14. What the hell's going on back there? Because she's losing that screw the day before it breaks. Well, you put her in the occlusal paper, tap, tap, there's dots everywhere. And she says she only feels on the left. So I adjust the left. I'm putting in paper and like, timing, bike down a hole and
a point to the left. And it's like lightly contacting in the front, very light in the right, it feels heaviest. She's still saying it's the left. And I'm like, I'm watching this and it's not the left, but I think it's when the paper is not in her mouth. And she kind of tap, tap, tap, she must be hitting and sliding or some sort of other thing. I like obliterated the left side and then made the right side level. And she's like, Oh, that feels so much better. And there was just like,
I just kind of went on her sense. Now this feels better, re-scanned up or lower in the bite and got a new set of T three days later that went in full anatomy again, because I obviously obliterated a lot of anatomy. And she was like, Oh, that just feels like they come together. And now they are actually hitting on both sides. I it's like such a ghost. Occlusion can be such a hard thing to dial in. So I usually just go with what the patient's telling me and trust there. And obviously the
physical science where loosening and stuff like that. So we'll get someone with a little bit more knowledge than me to come on and talk about it in real nuts and bolts. Yeah, I love that angle. And I think we collectively, as a unit, as a doctor team, have so much knowledge and so many best practices that we've acquired to help demystify some of that
gobbledygook because you have all the different schools of thought around occlusion. And I just know that it's it's something that can be very individual to each patient because of just the dynamic nature of all the different joints and tendons and hard tissue soft tissue that plays into it. And it's highly individualized and specialized. So I think the more the more that we build out the the merrier on that. So I'm excited for that effort.
Yeah. Yeah, Sam, I think that digital stuff is just going to make like we talked last episode about you need to build the airplane while you're flying. But you also can't cut corners. So this kind of like these two things where like you have to do everything right, you can't try to rush things.
That being said, digital allows us to get our fulfillment numbers down from like an average that I'm staying some in some practices, you have one off patients here there that are nine months to 12 months before they're going from finals from surgery, where if they have, you know, in the analog way, you do a wax try in and then you send that off to a lab to get a middle PMMA. That takes that's a three week communication. PMMA comes back, something's wrong. They don't
like it bites off. You would just send it back three more weeks. And that's assuming the patient come back in at that time and your schedules coordinate. It can very quickly become this just like a horrible thing. Plus three weeks or four weeks between appointments, you've already forgotten like what your and so does the patient. I mean, I talked to I think it was Mike Sharp or maybe it was Greg who was like this four week turnaround stuff is so tough because you have a
patient who asks for something. And then four weeks later, they come back and they've kind of you fixed what they asked for, but they kind of forgot they asked for that. So now they're asking for something else. And so there's never this like very tight, hey, we're going to make this slide adjustment C and X week kind of thing. Whereas in digital, you'll get the next prototype if that's what you want within within three days. And I schedule everything out with just a week
apart just for to the simple. See you next week. And I know I have in three days on print on day four, I'll have it ready on day five. It just makes that so much faster as far as the turnaround. And then you have little nuances, things like, of course, if something breaks, that becomes an afterthought, you got to find out why it broke. Like in my case, but it's not like get out the master cast be here for four hours, I'll be reflow acrylic. That's on that's a nightmare. I've been
there done that. But little things like midlines off bites open open bites are still a big issue in digital. There's an issue in analog to where they're hitting the heels of the denture just the molars and they're wide open in the front. We'll talk about it in our part two digital arches course in May, but the general rule of thumb is if you don't have a tripod and you just have markers in the back, whether you keep teeth or you put markers in the buckle shelf,
there's obviously a pivot point there. It's a sea salt. And so the lab stitches it extra cancer is good, but it's tilted, you know, five degrees and by the time that hits the back teeth, the front are open by five millimeters. And that's how it happens. So techniques to get some sort of marker in the chin or leave a canine or something like that helps to mitigate that. But sometimes it's unavoidable. You put it in there, you say bike down, you go, Oh shit, they're hitting like on
two points in the back. There's a burr that I designed with my zinger in our 3D adjustment kit that is meant for intra oral gross reduction, because this is so common. Buzz off the back teeth until the front teeth are over overgent over by the correct rescan. Three days later, get yourself a new, whether it's just the lower or it's upper lower and deliver it the one week
follow up, you know, and you can fix that kind of stuff. We had a there's a pod guys, if you go back with page, or maybe we were just talking about, I think it was Aaron Miller and I talking about page's question, which was, how do you get patients comfortable during that healing phase of the analog? Because it doesn't look great. It's bulky, whatever. And it's it's a lot of hand holding an analog because it is this thick acrylic kind of thing versus in digital, it's a little bit thinner.
The holes aren't as big. The teeth are mostly anatomical. There's not big, you know, 10 millimeters circles missing everywhere. And if something is off, like if the midline's off in an acrylic converted denture, you're just like, just bear with me for 10, 12 weeks, you will get there, you know, in the digital, it's like, oh yeah, like don't worry. And one week we're gonna we'll put a new one in. And so you can you're not cutting corners, you just have a technology that allows
you to speed up these kind of minor things. So by the time everything is also integrated, you're going to final and not now starting to fix these little minor annoyances. You've learned everything like by the time you go to final, you've already learned all of the stuff about what you said earlier about the imbalanced bite, the weird hyper occlusion on the left side that the patient felt, but you didn't like imagine trying to figure that out in a
trying appointment with the zirconia. I guess it's a nightmare scenario where in into the actual mouth, it behaves differently than it did on a cast for whatever reason. And so being able to figure that out in acrylic, in into the temp is so valuable. And I think that that just allows us to render a better service to people, because instead of just saying, Hey, we're going to shoehorn you into this quote unquote ideal situation, we're going to customize it based upon your goals,
your musculature, your your whole anatomy. And we're going to find out all of those different specifics and make those refinements along the way while we're trialing out the current prototype that we have. And having a V1.0 V1.1, like being able to make those little adjustments, that's the beauty of this practice model, because if you think about GP, you get a crown on number
19, it's a crown on number 19. And it's not the type of thing that you can really customize to the patient's goals and that nor can you really have the time to justify dinking around with it, and doing prototypes and milliness and milling that. But for full art, we can take the time, we can spend the chair side time with patients strategizing problem solving and rendering a better service to the patients rather than making it so transactional, like things tend to be in the GP
world. Yeah. And I think another thing, the occlusion you're talking about where you know generally in the first couple of weeks, when you have an acrylic converted denture, and you're you do a good job. So your access hole is the second premolar in the lateral and caiser, you no longer have a second premolar or lateral and caiser, you have a flat disk of pink,
you know, hard real material. So when you have them tap, tap, tap, there's like marks on just flat acrylic, it's impossible to actually know what that's going to be with anatomical teeth.
Right. So when you have a printed thing where the hole was literally two millimeters, you actually get the trial, this occlusion way, way, way earlier versus what a good friend of mine, Michelle Caldwell would do is convert them into denture and then build a ramp of composite, like an NTI right into the acrylic lingual part of the, you know, by eight nine and just keep them open so that in 10 weeks when they take their master models, they have a essentially a mounted
CR bite. And then they bring the teeth in versus like, they're just chewing on this flat plane. And then you're going to try in a wax try and for the first time ever give them cuspal inclines. And you know, so that kind of headache is greatly minimized with the digital stuff. And it's more exciting and it's so much faster. I mean, like, I think I've talked out on this podcast with the Barksdale guys and even Cliff from Neodent, kind of what my new workflow is going to be
with like when we're trialing teeth and everything else. And it just is going to be a lot smoother in that regards. Every appointment in my office is one hour long, every appointment minus the surgeries. It doesn't matter. A consults an hour long, a record's appointment's an hour long, a post stops an hour long, a delivery, a final record, everything is one hour. It makes scheduling
so easy that it's just one hour blocks. Because that's how fast you can do it. Dr Miller was talking about a case he did a stage two on where he used to do, he would do the impression over the denture and do the cross mounting so you get a minute, you get a V jig mount that put the teeth back on it would take three hours between him and the lab with the patients sitting there while they like kind of got a master cast mounted in the lab. And he did it with the shining and he said
there was like 40 minutes and got all the information they needed. And like if you take up and these offices that are doing like his office that did, I don't remember how many arches he did like 80, 90 arches. Every time they have a stage two, you just save two hours, it's 180 hours a year in clinical time to breathe or to see other patients or to whatever. I mean, man, that's like four or five full weeks of extra time. So that lowers the stress on the office, on the staff, on the doctor,
on the patients. And then I was talking to Greg and Mike, I had a drive down to LA for an errand for two hours and some people joined me on a phone call. And we were just talking about that kind of idea that a patient should be done within four months. And if you're seeing a patient
for nine months, that's just more patients you are struggling to get into those chairs. And so we're not trying to like rush the patient through, but at the same time, we don't need to be having these long lifespans where we're actually limiting our ability to see more patients.
So there's gonna be like that's the triple or quadruple or sex double win that digital is going to bring into these practices, especially practice like Greg's where he's so busy, he has to send out his immediate dentures to a lab because his lab tech is so busy, they can't keep up because they have wax try-ins. So for him, someone comes in, you mentioned this earlier, records appointment, all right, we got to make a denture. So we have some of the convert, it's gonna be two weeks.
I could, I could ask the lab to expediate things and do it the next day or the same day or something if I had to, you know, like, I had a case recently where patient had no bite, she had an upper denture and lower like four teeth and only one of them was still there, like 26. I mean, so she didn't have a bite and she lives an hour and a half away and they took the initial records. There's no mounting and so I had bark still designed me a bite rim for the lower that stayed open in the
front. So like a big anterior window, imagine like a cast partial that had the lingual bar, right? So it's like has basically a distal extension on both sides and then a little bar on the lingual of the anterior and I put that in, she bites down on it. It's a little high in the back, I take the lab, I buzz down the back, bite down again. Okay, perfect over jit over bite number 26 is the one thing I'm looking at. It's just right behind number nine in her denture and I go,
okay, cool. And we scan the bite and because of this anterior open window, I'm able to align the the upper and lower cast together because I had the time to sit down with barks down and say, hey, she lives an hour and a half away. I really don't want her to come in just to get this bite. So this was all done right before the surgery. So she comes in, she's already on triazolam. I keep the lights really bright to keep her awake and with it. So I get this stable bite,
scan it. Okay. And then the lab knows, hey, we're doing this right now. So they immediately start doing the wax up and the surgery went great. We delivered the lower and the bite was perfect. And it was because of digital that we can do that kind of stuff. And so the one thing that I'm going to we're going to struggle with with digital is it's a lot more
critical thinking than analog is. That is something I don't know. Maybe you can give us a good idea of like maybe some books to encourage our digital doctors to read because I don't really know how to teach critical thinking. I can certainly show examples and how I approached it. But the funny thing is, if I look back, I have a protocol in mind of the major things I need to get. I need to get the video. I need to get a lower and an upper and I need to have some sort of markers that are
going to compare the before and the after. Okay. But there's so many ways in between there, like the patient I just described who doesn't have a bite or the patient who's bites closed or opened or the patient who doesn't have any teeth. So where do you put the markers or like all these little things are critical thinking nuances inside of getting those major points. And that's where it's like, I can show all these examples. But if someone like we talked about
less looking for the cookbook, it's going to be difficult. And so do you have any advice on how to teach critical thinking? Yeah, so the parallel that comes to mind for me is the first time you're by yourself in the woods going camping. You're in a new area. There is no road map that says, take 150 paces northwest and then bare east for along the river. Like you're going to have to
figure out your own path. But there are principles that you can teach that through repetition, you can use to make sure that you don't lose where you are because the name of the game here in digital is don't lose your reference points. Don't lose the bite or you will be a drift. You'll be in open space on the x, y and z axis. And you won't know which way is up or down. That's the problem
that you're trying to solve. And so I think to your point, number one, it's case studies. We have the case studies, we have the case planning, we we debrief at the points where we could have lost where we were in space, but we didn't because we kept our stable reference points throughout. And that's the same whether you're dentate, whether you're doing a full arch case of just upper crowns, like say you're doing 14 units of crowns, you still have to have a way to register,
capture and remember, yeah, where the bite is where CR is. And it's the same principle. So I think step one is going to be outlining what are the fundamentals? What are the principles? What are we trying to maintain and solve for along this process that we just can't violate and we can't lose sight of? And then we give several different case studies of here's where we could have run a foul of those principles or here's where oops, the ball was dropped somewhere by myself, by an
assistant by a tech by whomever. And we lost our bite. Here's how we recaptured it. Here's a here. Here's how we got back on track. And here's how we finished the case. So I think examples of cases that went well, cases that were hairy and that we got creative to solve. And then cases that didn't go to plan. And here's how we took a couple of steps back and then and then finished
it out. But it's listing the principles. And then having examples to reinforce those principles, because yeah, you're you're never going to be you're never going to be able to have a completely prescriptive way to do a solo wilderness track. But by knowing sound principles of like, let's use our compass, let's have some dry wood, let's make sure that we have a lighter, having those
principles dialed in will will help you to avoid catastrophe. Yeah, yeah, that's a good one. That's how I have to approach it, because we'll come up with, and we'll have this all on SPGU as well as the part two course we're going to do, of course, but it's, you know, people have used the term breadcrumbs or, oh, it's building a cake, layering a cake and so on. And I was most recently my son
for Christmas, got like a bunch more Lego things. I was like, Oh, you know, Legos are also another thing you can kind of see, because they all need to stack together and those little nubs and the, you know, the male and female parts Lego, that's they need to have a connector between every image you do. And so digit, there's so much to talk about digital. But that's, I think, the most exciting
part clinically for the doctors in 2025. But speaking of growth of the platform, I'd love you to speak on, you know, we kind of you did 20 some offices 23 down to six, we're going to, I've heard we're going to be right around that six and then it's off the races again. It's like a natural little dip in between two waves. But yeah, yeah, there's so many variables at play here.
And the way that I would think about it is that we we've done so much data gathering and so much perfecting of our approach to not only execute new locations in a timely and high quality manner,
but also the way that we're assessing the validity of a location. We have access to so much data that we've that we've sourced from our own annals of past performance in addition to just demographic psychographic data of different locations, where we have our own proprietary ranking system, where we're able to plug into our own model, any place in the country and get a rating relative
to other locations of how likely is this to be a solid location. And we're able to say not only in a specific city, but also a specific street corner and give give a ranking and give it's amazing give a grade. And so we have a very high degree of likelihood of of nailing the next however many locations that we're able to open. And the exact number is is going to be sort of add effect to different factors that some of which are within our control and some of some of what you're beyond
our control. But we're very fortunate because we have so many doctors that have expressed interest over the past couple of years of wanting to work with us. There's several that have just said, look, you tell me the best place to go and I'll go. And so we're just we're just very excited to be able to finally start the new location engine up again, get some more openings in 2025. And then yeah, I mean, the the the sky is very, very blue for 2026, 2027 and beyond. Because we have an idea of
how many locations the US can hold. And it's a much higher number than I than I at first thought, just based upon the data that we've gotten. And and the demand that's out there from a patient perspective. But we're very fortunate to have doctors that have done their own self study that love the the full arts approach that have taken courses on their own that that are eager to plug into SPGU and come out and even stronger, more well rounded full art surgeon. So we're just excited
for the future. And we we know that there's a lot of a lot of amazing accomplishments ahead. I think with the small case study that was Kansas City and key for having a doctor on a much longer on ramp. And then a long ramp. Yeah, I think that's going to be huge. Because if we have someone who he was like waiting and then we say, Hey, we've got a beat on a spot,
it'll be four months. But we know they know it's going to come in four months. That's we have all the time of the world to get them primed to go and and their team, whoever the team is the size to go on there. And so the other thing in 2025, besides digital, which is the big thing is you and I have and the mentor team, which will be growing in 2025 and we'll probably announce that at a doctor
meeting, talked about what we're calling the five stages of doctor development. And I'm looking at the thing right now, but it's essentially we tried to come up with in the last year, if we look at someone like a Devon in Grand Rapids, and we say like, what was what were Devon's kind of main inflection points where we can start to do certain things. And so if we can kind of put our doctors in buckets to allow them to have the most correct type of support, I think we can even make it even
better. And so I'll just read them off and we can talk about them. But the five real quick are five stages are fundamentals, predictability, efficiency, enrichment, and then mentorship. And so start with fundamentals, which kind of like to your point about the camping example is like you need to have good fundamentals, you need to know which way is north, you know, and do I follow
the river downstream or upstream? And you need to know how to build a fire and go from there. So fundamentals, you know, it's all about increasing confidence through teaching sound treatment planning, good technique, patient selection, and again, they're they're head right about the work flows. And I think to your point, which isn't in this list, but getting started fast, getting going in the first, getting a surgery on the books in the first month of a practice is probably we
determined a much bigger deal than we maybe knew before. Just to kind of get the team engaged and get the doctor engaged and not feel like they have to start looking for other ways, like start doing more dentures or overdentures or whatever it is. So speaking of fundamentals, any thoughts on
that first stage? Well, there's a lot of fundamentals that can be ascertained remotely prior to opening, prior to joining the company in SPGU in the course of visiting existing SPG locations in self study, especially when you think about the hard skills, because a lot of our doctors come to us and they've done plenty of arches of all on four, they've done plenty of full art surgery, they're comfortable
with a lot of those fundamentals. But then there's also the soft skill fundamentals. There's that other category of how do you interface with your team? How do you interface with patients? How do you apportion your time appropriately? When you're when you're joining a location? There's so many things that come into the the fundamentals of not just the actual execution of the procedures or the planning of the cases or the delivery of the cases. So certain fundamentals can be
gleaned early on, even before practice opens. But then others of those fundamentals have to happen with experience with reps and with engaging with your doctor team. You mentioned the fact that we've come such a long way with how we are able to tailor how we mentor our doctors according to the time in the company, the number of repetitions the doctor has, the specific development point
that that doctor is at. And yeah, I think there's a lot of fundamentals that are gained just through getting in, getting reps and auditing some of these mentorship calls, some of these new doctor roundtable calls, and just being awash in the SPG way of operating. Yeah, the two, the Dr. Miller's addition of this roundtable for newer doctors to the network, and then also these office hours that our mentors do. Once a week, there's just an open invite to
join a Google Meet and talk to a different mentor is you can see a lot of fundamentals there. We've already seen some things that I think would have otherwise thrown out of the radar. For instance, someone will join and will say, hey, show us a case you have you have on the software because you like you can test them as fundamentals right away by show us where if you can physically put the implants where you put them, you drop them the software on the scene, we go, okay, here's what
I'm seeing X, Y and Z. And why did you do that? Okay, let's correct that fundamental thinking into how we understand it to work. So I think those kind of calls are really big on fundamentals. But yeah, you're right. A lot of it can be done a little bit before you get into practice and then
logging in and kind of looking at plans can show us. And so once you get the fundamentals and then showing us the surgical fundamentals, pulling teeth, flapping efficiently and without tearing the tissue, you see that with your mentor when you're over the shoulder, then it becomes predictability. So stage two is predictability. It's settling into a treatment sequence. It's less stress into planning, executing similar modalities multiple times, and we're immediate loading at 90% or higher.
That's kind of our one little benchmark there. So now that we have the fundamentals, we're still not necessarily reaching for extra max area implants or doing crazy approaches or treating highly variable patients. But we're getting predictable in our actual surgical technique. You're seeing cause and effect. Like you're being able to project out, this is what the
effect is going to look like with the correct input. And to use some of your and Dr. Miller's terminology from your intro to all of X course and on SPGU, you're able to be pretty predictably consistent in green light cases. And you're starting to say, okay, these yellow light cases with mentorship, with planning, with doing the case on the computer multiple different ways ahead of
time, then we're starting to feel confident in working with those yellow light cases. But I think green light cases, we see cause and effect, because we've done enough on the front end to say that I can expect this outcome. This is where I may have issues finding really solid bone on the upper left up here, because experience shows XYZ. And so just having that extra layer of critical thinking that's informed by a direct experience. Yeah, I think at this stage of a doctor's development,
their offices probably not super busy. And so we're still doing single arches, we're splitting our doubles, keeping it as low stress as possible, getting it out, predictably loading, finding anchorage points. You know, after we get through the predictability point, now we've seen, you know, five to 10 cases where they've posted the panel after and the CT, we look through and say, okay, like you're getting it and the plants are going the right spot and we're loading things. We start
talking about efficiency, which is stage three. And this is kind of like SPG in general, right? Fundamentals was like get a wide market cap predictability was, okay, let's, let's make sure everyone's profitable and efficiency is now let's let's kind of turn the heat up a little bit in the oven. So now we want to increase the speed of the surgery and the restorative process. And so we want our just some general guidelines, max the researches below two and a half hours surgeries,
not conversions. You know, this is just like from from needle to stitch mandibles hour and a half, double arches less than five hours. This is where we're going to start to if you've been working on this single art, now we want to start bringing the double arch because it has its own nuance. You don't want to be doing double arches when they're taking seven or eight hours. So you
just that's not helpful for anybody. We want the total patient life cycle to now get shortened to at least at most 22 weeks for analog patients in 16 weeks for digital. For all the reasons we've already spoke about, we don't want to have patients floundering in temps or working through a thousand different wax setups. And this could be, you know, this is the one part where we start to stop looking at the surgery and say, hey, maybe, maybe efficiently,
we're not doing a restorative process, right? We need to tackle why you're having so many wax try-ins or prototypes, are we not getting it right at the beginning? Are we not sending expectations correctly? So efficiency is probably when this is when they start to feel really comfortable, right? They're in a groove. And the the obtainment of the groove surgically
really does dovetail nicely with the efficiency overall. And I love that concept of the total patient life cycle from start to finish from consultation through walking out the door with the finals. That's an important metric that becomes more and more important. The more mature
a clinician is and the more mature a practice becomes. Because one thing that I talk about in our SPG focus days for the team, especially, is that in a young practice, you're just doing consults, then you're doing consults and smile designs, then you're doing consults and smile designs and surgeries, then you're doing consults, smile design surgeries and post-ops, then you're
layering in restorations, then you're layering in everything else. And so all of a sudden you have all these different buckets of procedures that have to fit within the same number of hours per day per week per month per year. And that's where efficiency really comes home to roost. And so generally when you're starting to have those types of quote unquote restrictions on your schedule, when you're doing more restorative work, it behooves you to start focusing on
what's my time for an art? How efficiently and effectively can I schedule doubles? When do we want to put most of our surgery blocks in the week to be able to keep up keep open the number of consult blocks that we want to have open? So that's when efficiency comes into play and you obviously can't put the cart before the horse. You can't you can't be focusing on, you know, clocking yourself too rigorously when you're just getting your reps in. But efficiency is
important for your overall performance. And it's also important for patient care. Because to your point, if you're doing a double for eight hours, nobody wins in that scenario. Right. Except anesthesiologist if they're included. Yeah, they definitely laugh all the way to the
bank. But the efficiency, yeah, that's a good point. I mean, I'm looking at doctorate development, but efficiency in the office staff and the scheduling is probably this is where things start to really you hear of the doctors complaining like, Hey, I have a surgery and they're and they're booking post ops and denture adjustments and relines alongside it. And I'm getting pulled and now my
surgeries are taking longer. And so it's it's if that's happening, we need to either train staff to take care of those types of appointments or talk more openly about where those are best to go and just making sure that the office runs now at the end of stage three of this efficiency group. They should be doing all parts. Like you said, consults to file deliveries, and they should have a pretty good comfort level is like how those are scheduled,
the timeliness, you know, the flow of the office. After that comes, I think the most exciting one, or maybe the second most which is enrichment. And this is where we're starting to really enjoy the surgeries. We're not we're not sleep not sleeping on Sunday night before Monday morning, right? We're also having a high income now and good outcomes. So we're seeing things much more predictably good outcomes. And at this point, you're probably starting to take home,
you know, half a million dollars or more on much less stress. And at this point is when we can start to incorporate advanced techniques, maybe encourage different CE levels, whether that's Teragoids, palatal approach, FP1, eventually zygos, etc. And other ways to enrich, you know, the whole process is when we can start to now sprinkle in things that really take you
full circle, full scope. Yeah, that's the fun part is when you start to breathe a little more easily, and you it's just like playing sports, where you're still going to be keyed in, you're still going to be dialed in, you're still going to be attuned to giving the best performance possible. But there's just not as many butterflies because you're truly getting secure in your own skin, your own capabilities, your own performance, and your own consistency of outcome. And I just love
how the momentum of that gets pretty contagious, where you do you feel that way. You embody that with how you can you fulfill your surgeries for your patients, your team picks up on it, your team has an increased resounding level of belief in you. And then your office has its own momentum that stems from that belief and that proof of concept. And that's that's when it gets fun
because everyone truly sees the transformational nature of what you do. And then you're able to layer in, yeah, more advanced approaches and you're able to see a broader array of patients. Maybe you're able to tackle some of those harder yellow light type cases and maybe even some of those cases that would be red light cases for others, you're able to handle those because you've sharpened your saw so much. Yeah, I think that's that's where I see people who have been in the network
probably about a year or more is where you start to see this. We've had some doctors who join and their first month, they're like, when can I go learn terrigoids? I obviously need to learn terrigoids and they post a case that maybe doesn't even technically need them, but they feel like they should put them in because the zeitgeist of full art right now. And it's that'll come. Let's make
sure we can do 20 arches of all on four predictably. And then we can talk about this. And if you need to tell that patient that needs terrigoids, hey, we're going to evolve and in a year's time, let's let's get back and just be honest with them be like, that's not it's a technique I know you need, but I don't I don't do it right now. I'm going to learn it. I have a plan to learn it. You know, we can make the denture we can do this or if they like your staff and the price, if they can just be
patient, a lot of those patients will come back. You don't have to like give up on the case or and then offer them, you know, if if if applicable, it'd be like, or we could refer you right now somewhere else, you know, but I think people jump into wanting to do what's like sexy and cool before they really had the fundamental these fundamentals done predictably and efficiently. And it's like, you can't add a bunch of stuff to this soup before this the vegetables have really
like softened, you know, like you're getting ahead of the game. So yeah, and the other part of it too, is that sometimes we're conditioned to see certain situations based upon what we think others would recommend in that scenario. And it doesn't hurt to send the cone beam to you or to errand into a mentor and say, am I seeing this the right way? Am I seeing this the most straightforward way?
Because sometimes we we get terrigoid or zygote happy. And in reality, there there's a more straightforward solution that maybe escapes us the first time we see it.
Yeah, absolutely. Absolutely. And the last step of the Dr. development is mentorship, which is just turn around and give back to the person who's coming up the development path as well, whether that's an official, you're invited to be an official mentor role, or you have we do the buddy system, or you just we have several doctors with a lot of experience in the doc chat who are just wealth of knowledge and love to give their experiences and show off complications,
for instance, and how they managed it and those kinds of things. And so I'm sure we'll tweak this a little bit, but I think it was good to get it down on paper as an idea of what we want our development path to be. Yeah, I would say this whole thing takes about a year to get through to the enrichment phase where now the doctor starts to go learn terrigoids and learn different approaches and FP one, which will become a lot easier once we're all digital because I know that's that's
also something that our doctors ask for. Once you kind of have done all those buckets, maybe up to zygos or something now it's time to turn around and kind of help other people and make the company even better because also at this enrichment phase, you almost more than likely have also earned equity in your practice. So it behooves you now at this point to turn around and help
the network as it were. So I think you took the words right out of my mouth. I was going to say that as you get better individually as a contributor, that that poisons you to be able to support your teammates. And that's why I'm here. That's why you're here is because you can do some cool
stuff individually. You can make this a solo endeavor in dentistry, but you can go so much further in a much cooler direction as a team as part of something larger than yourself than than you can forging your own path, which you and I have have done each individually, Steve, and I don't want to speak for you, but I'm having so much more fun doing something like this that is way larger
than any one of us. And it takes every single person rowing in the same direction. And the more that we see mentors and leaders in our in our doctor core, pouring into one another, that's that's what we've been shooting for all along. And it's really cool to see it playing out. Absolutely. Well, yeah, I'm excited for 2025. I'm excited. I'm sure by the end of 2025, the shining elites will have that thing primed and in will be like the main place to learn it probably at this point.
But yeah, I'm excited for digital most off, but then also just the general um, doctor development stuff too. Yeah, it'll be a big year for for SPG for the for the TFAB community for our courses that we're going to be facilitating throughout 2025. So it'll be a banner year. Sweet. All right, man. Well, thanks for coming on the TFAB and let me join you on SPG pod. Everyone else happy new year. And here's to a great start to you