Episode #119 | 3D Printing At The Dentist with Dr. Nabeel Cajee

If you have ever wondered why dentistry can feel both high-tech and oddly hand-built at the same time, this conversation connects the dots. We talk with Dr. Nabeel Cajee, an oral implantologist in Newport Beach and faculty at Torque Academy and Implant Ninja School, about what it really takes to bring digital dentistry into daily patient care without turning your practice into a science project. From the earliest days of open-source 3D printing to today’s clinical workflows, he breaks the ecosystem down into what actually matters: data capture, dental CAD design, and fabrication with dependable post-processing.

If you care about dental 3D printing, chairside CAD/CAM, guided implant surgery, or the future of restorative dentistry, subscribe, share this with a colleague, and leave a review with your biggest question about digital workflows.

Show notes: https://3dheals.com/episode-119-where-is-dental-3d-printing-with-dr-nabeel-cajee/

YouTube Video: https://youtu.be/FOKQNpMJjb4?si=DImMXMXEiNH5oheH

Transcript

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Why Dentistry Struggles To Scale

SPEAKER_00 0:00

I think that the issue with the dental industry is that we practice, we're still a cottage industry. Many dentists go to a single dentist practice. There they're still small groups, but the complexity of cases we're bringing patients, the complexity of our operations have grown tremendously. So we're at a a mismatch of capacity to solution. If we were practicing in larger groups together, I don't think the industry by sentiment will move in this direction, but say if we were practicing in more of a hospital-based system, now we would have the teams, the resources to implement these solutions in a more streamlined manner. More teams for support. Instead of it would be much easier to implement all of these solutions.

SPEAKER_01 0:46

Please listen to the disclaimer at the end of this podcast.

Meet Dr. Nabeel Cajee

SPEAKER_01 0:50

Hello, hello. Welcome to the pot. Today our guest is Dr. Nabeel Kaji, who is an oral implantologist. He has a private practice in Newport Beach, but he's also the faculty at Torque Academy and Implant Ninja School. But more importantly, I know Nabeel for almost a decade, maybe since the inception of 3D Heels. And he has always been on a mission to democratize advanced dental care, combining advanced fabrication and personalized medicine. So Nabil, welcome to the pot.

SPEAKER_00 1:26

Thank you, Jenny. It's always a pleasure to join you, whether it's in person or on a podcast. I'm happy to be here.

SPEAKER_01 1:33

We know each other for many years since the beginning of 3D Heels history. And you have also been the 3D Heels dental ambassador for many years till today. So you um since we have not been on a pod for I would say many years, it's the last time we have recorded episode together was probably more than six years ago.

From Hackerspaces To Healthcare

SPEAKER_01 1:53

So I think maybe it's a good opportunity to refresh your origin. Because I remember back then you were still in University of Pacific, a dental student back then, and you just very proactively reached out and want to be part of this community. And you're really just on a mission to change the dental industry. So love to just hear from back then how did you become really interested in not just learning about the tools, but really start a movement?

SPEAKER_00 2:22

Yes. I mean, I think our journey, getting to know each other, mimics my and just follows my timeline of interest in 3D printing and crafting solutions for patients. We connected when I was when I was a student at University of the Pacific and a resident at Highland Hospital and on my journey in private practice now for the last 10 years. So it's, you know, for myself, when, and this goes back to my days in undergrad in the earlier 2000s, uh, 2008, 2009, 2010, when I was in the middle of my undergrad. And I would read about 3D printing opening up, becoming more open source and solutions being crafted. And what is the potential of 3D printing to be able to design one-off products rapidly prototype, be able to bring things into existence quickly. And as a predental student at the time, then dental student, I was looking at all the analog or manual fabrication of our one-off customized biocompatible pieces and saying this needs to be 3D printed. And those questions led me on a mission to visit hackerspaces around San Francisco and later discover 3D heels during that journey. And uh once I found 3D Heels, I said, wow, this is a community of healthcare professionals with very much the same questions I have is how do we unlock this technology for our patient and for our profession?

SPEAKER_01 3:58

I think till this day, many healthcare providers still want to do that unlocking process. And it hasn't been super easy. Now, since we're talking about decades earlier, I'd love to just hear a little bit of walking through history. What was it like to use 3D printing back then? And now, since you've been growing with the industry essentially, what is it like today?

SPEAKER_00 4:21

Yeah.

The Three Pieces Of 3D Printing

SPEAKER_00 4:22

I mean, when we look at say 10 years ago as a, say, specifically, I'm speaking as a clinical dentist, there's there's elements of our information puzzle that we need from patients, right? We need to get correct optical scans in the mouth. We need to have a design suite that allows us to fabricate, design what we wish. And we need to be able to print it and post-process it with the appropriate materials and workflow. So at that time, there were many fewer 3D printers available on the market. That was one thing. The material selection was much more limited. And one of our biggest hurdles was the design process. To design, whether we were designing surgical guides to guide implant placement, designing restorations such as crowns or prostheses that fit over teeth, designing implant restorations, designing aligners, those soft softwares were either not available or they were much higher cost. So I see those as the three components that are needed in order to power an ecosystem of 3D printing. And time has moved on since then.

SPEAKER_01 5:34

Absolutely. Now, when you just started, it was probably more extrusion type of machines, and it was probably not very UIUX friendly. Now, I could imagine a bunch of people just got discouraged and stopped using it altogether. And what did you what did you feel when you were very excited and then realized this is like a tough thing? Did you feel like this is just a hype? And were you skeptical? Were you super just enthusiastic embracing this? What was the psychology going through? Today, obviously, you're still an advocate of digital dentistry, but when you first encounter 3D printing in reality, what was that story like?

SPEAKER_00 6:17

That's a great question. I think that there's a part with any adoption of technology, we're going to run into hurdles to roadblocks. And there's using technology in a hobbyist sense, and then there's using technology for actual solutions for patients. And when I separate the two in a hobby sense, say with 3D printing, if you're printing, say, a toy, for example, if you have a fail print, it's not a big deal, print one the next day. Right? It's different when you're printing something and you need to hit it. You need to take care of it in a timely manner for clinical application and pull things together. So my first 3D printer was an extrusion printer. Thankfully, very quickly, things did move to light projection printers with resins, printing resins. And I think that proved itself to be a better fit in clinical dentistry. So I quickly moved to implementing those in our practices. Crafting the workflow and the solutions, what I've realized is that it's it has to be easy enough that you can delegate it and train staff to take care of it. So if we're looking at solutions that, for example, and I'm gonna talk about this in my personal private practice sense, if I'm looking at a solution like a surgical guide for an implant, it's rare that I need that guide designed and printed within an hour or less. That can be printed and we can see the patient the following day in a few days' time. The turnaround timeline is longer. However, what has been a challenge historically, and I think these are now puzzles being unlocked, is getting us now to applications that we essentially want immediate solutions, such as restorations on teeth, crowns, inlays, onlays. And I see a lot of the industry at this time pushing to unlock those solutions because in clinical private practices, those solutions in time, I think, will have the highest return on investment for clinics, uh, will lead to patient satisfaction and allow for clinics to have a lot more throughput of their cases.

SPEAKER_01 8:38

Absolutely. And since you mentioned implant and you are an implantologist, um let's just focus on implantology for now, and then we can talk a little bit more about the economics you mentioned, which is super interesting as well, you know, digital dentistry.

Implantology Explained With End In Mind

SPEAKER_01 8:53

Now, can you explain to the general public what do you do on a day-to-day basis as an implantologist?

SPEAKER_00 9:00

Great. Wonderful. So yeah, let's let's focus there. So as an implantologist, my practice is focused on implant procedures, which has two components. It has a surgical component where we um we place implants into the jaw to support teeth. And then it has a prosthetic component where we fix prosthetics onto the implants in order to restore a patient's function to chew, to eat, and the aesthetic rehabilitation that comes with that. Now, in the early days, I would say this is even predates my time in practice. Implants were often executed in a way where implants were placed, and then prosthetics were then designed and made. And there has been a shift in understanding where you first need to design the prosthetic element, then you plan where the implants need to go. And you so you're you're building from the end in mind. So the surgery component part of the process is a component of the prosthetic phase. And that's an understanding that we now have and it is taught widely and is taught where I teach at Torque Academy in detail. The the nitty-gritty of exactly how your prosthetics need to fit. Then from there, where your implants need to go to precisely match the prosthesis. And then once we have that understanding, after taking 3D x-rays, scans in the mouth, we digitize this process. And we can either use what is commonly used at this time, which is called static guides, which fit onto patients' existing teeth or structures in their mouth. And that allows us to guide our implants precisely to where they need to go. And those components are 3D printed.

SPEAKER_01 10:50

That's a very interesting transformation in terms of perception of having the end in mind first rather than just doing implant. I mean, what is the is it because how how did the industry decide that change? And is it because the availability of 3D technologies?

SPEAKER_00 11:08

I th the change was decided even before the boom of 3D technologies. But 3D technologies helped accelerate that change in thinking. So because what was happening, and it still happens in cases today when that type of understanding is not implemented, is you end up with a after the implants are placed, if the prosthetic component has not been thought through, you end up with what we call biomechanical issues where the forces are leveraged incorrectly. You end up with spacing issues that don't allow the proper prosthetic material thickness or design to take place. And you end up with areas where you have to compromise the result in some fashion or way to get the puzzle to come together. So it quickly became apparent that the surgical phase of implantology needs to follow the prosthetic planning. You first need to design the end in mind of how the prosthetics need to fit, how they need the appropriate spacing, material thickness. And then from there, we plan the proper implant support for those prosthetics. And then the beauty of it is, for example, we do these cases fairly routinely now. And I'm going to give a larger example, is when we do a full, say a full arch, say that the top jaw on implants, we plan the exact spacing of how where the teeth exactly need to be in relation to the jaw. We can digitize that process. We plan that in our CAD softwares, and then we mesh that with our 3D X-rays, our CBCTs and our cone beams, and we can plan out the exact position of where we need our implants to be. And then the puzzle of these cases starts to come together seamlessly because when it was when it's not done in that way, we end up compromising, we end up learning where things need to be, we end up running into material issues, and and that that lengthens the treatment time and costs involved with these cases and and patient time.

SPEAKER_01 13:11

So it sounds like with the end-in-mind kind of strategy is more of a mainstream strategy these days for a most implementologist.

SPEAKER_00 13:20

I believe that we're now in that area of end-in-mind. And with that end-in-mind approach, we need tools, we need resources in order to execute that. So that's where our our 3D technologies come to aid us.

SPEAKER_01 13:36

Okay. So if a doctor just start drilling in your tooth, that's probably not a good sign if if they don't do the CBCT or the digital planning for you first.

SPEAKER_00 13:51

There's cases where we don't need the 3D x-ray, right? And there's cases where we definitely need 3D X-rays, need this more comprehensive planning. So this isn't a blanket approach where I'm saying every single case under the sun needs it. Depending on the clinician's experience, depending on the types of cases they've been able to execute, I would say that there are a number of clinicians that can evaluate a case and based off their experience and their mind's eye piece a case together. However, I would say on the on the same side of that, even for the experienced clinician, having the 3D technologies available allows us to be much more predictable, allows us to execute cases with uh removing variables. And that's what it's about.

SPEAKER_01 14:38

Absolutely. I I don't want I I think removing the art part of practicing medicine actually serves patients in many ways than one or two good doctors who know how to exercise the art of medicine, but like many people, this unpredictable outcome, like you said. So now from your practice day-to-day, what has changed? Where does it have the most impact on your practice?

SPEAKER_00 15:05

Where I mean, I I think that in in my practice, I I need the use of these every day. We're at a point where I have cases that even though I've placed an untold number of implants in my last decade, I have cases where it's coming to patient comfort, sedation time that we're that that that gets added in here. If I do a case guided uh where I can be less invasive during my procedures, I can um the the procedure goes smoother, uh it can it can it can s speed us up because we've done the pre-planning beforehand. So for cases that say if it's a single-tooth implant, uh there's often times when I I do like to have guides, especially if I'm dealing with narrow tolerances between teeth. Um however, there's times when I I don't need a um a guide. Uh for larger cases where say you're doing implants in multiple areas of someone's jaw, for them to tolerate the stress of the procedure, we we want to make things as streamlined and easy for patients as we

Dental Labs Versus In-House Tradeoffs

SPEAKER_00 16:16

can.

SPEAKER_01 16:16

So we earlier we were talking economics slightly. We were talking about these on-side fabrication, how it can change uh economics. But I want to expand that topic just a little wider because I'm sure you you still use dental labs uh for services. How is that relationship changing between you, the practitioners, and the dental lab who used to make a lot more um pre-3D printing? What's the story there?

SPEAKER_00 16:43

Yeah, I mean, I I think that for many dentists, even those that are advocates of 3D printing with in-house 3D printers, there's a level of expertise in design work. And there's only so much equipment for many of us that we can bring in-house without needing to build out a full lab team of our own. So I have close relationships with dental labs that I've worked with uh for a number of years. There's times when for certain prosthetics we need, can we technically fabricate these in-house? Yes, we can, but it would involve purchasing more resins, utilizing more staff time. Um it just makes more economic sense to outsource a number of these components. So there's a fine line in terms of what we can take on and it's worth it for us, and then where we need to utilize an outside lab. I do see a relationship in over time developing where labs may end up potentially doing more of the design work. Um, and as 3D printers become more available in offices, you can end up with more 3D printing of the components in the offices. I think that's a potential that may develop in time. I think there's also a part to where for 3D printers that we use, if you have a lab that's relatively close by, just like people would go to FedEx, Kinkos to have their print jobs done, it may make sense for some dentists to do their design work and then have it printed in labs. So I'm curious as to where that will go in flux, but I will say that there's more options being developed at this time.

SPEAKER_01 18:30

Aaron Powell What kind of 3D printed products that you currently use for your practice right now?

SPEAKER_00 18:36

The main 3D printed products I use, uh number one, it would be surgical guides and stents. The other would be uh 3D printed prosthetics, uh mainly for our my temporary prosthetics. Uh we use them that are often 3D printed, and from time to time, night guards. But there is a mixture of where some of these prosthetics that we use are 3D printed and some are milled, and that's a that's another discussion.

SPEAKER_01 19:06

Yeah, I I need to adjust that I'm not just focusing on 3D printing, but digital fabrication in general. And and I when I I had a conversation with you about using these chair side machines versus going to the lab, which takes weeks typically to come back, this decision making process is actually nuanced. It's not straightforward. I mean, for the patient, obviously I want to get my temporary or microunds today, uh my night guard today, uh, but you actually don't think that's always the case. What are your decision tree typically for these kind of cases?

The Race For Same-Day Restorations

SPEAKER_00 19:46

Yeah, I think that if in an office setup, if the office or the team has made the investment in the capacity to do same-day 3D printed, it's possible. There is a window of time that I think is what I would say like velocity is the return on investment in these cases. So if you have a patient and you want to provide same day, and we're I'm moving away from implants, I'm gonna say things that would maybe demand it same day, such as a crown, or if you have a tooth that that broke red cavities, you can say, I'm just gonna give some more background. Say if you have a tooth that is decayed, sometimes you can put a filling in it as a dentist. If that, if if it looks like it's too big to fill it, then we have what are called restorations, which restore, literally, build up the tooth in a manner where we fabricate these out of the mouth and put them into or on the tooth, which are called inlays, onlays, or crowns. Those often involve a lab fabricated process, which can be done in the office or in a traditional lab. For patients, from a patient perspective, to be able to have that process done in one appointment, I think is favorable. Patients like the idea of that. From a dentist perspective, yeah, if you can have that solution fabricated at the same time for the patient, it's also favorable. Where I see things going, and I think this is something that's actually developed within just the last couple months in the field as well, is uh same-day solutions have been on the market for some time for milling. A player in the area that's been around since for a very long time, it's been Serac, which has been a closed system using a, using a mill. There are other mills on the market out there. To me, it's it's a it's a time. There's a window of time that makes it worth it same day, and there's a matter of time and effort that doesn't make it worth it. So, where we're seeing with 3D printing now is that there are solutions on the market where the 3D printers themselves have become smaller, have become more automated, have increased. Incorporated AI design suites. And this is getting exciting. And there's a number of companies out there that are pushing into that space. To name a few off the top of my head, one would be SprintRay, Xylo, Shining, and there's others out there that are trying to crack that puzzle for chaircide fabrication. And I think that I haven't tested all of these printers personally. However, I think that this is a promising aspect to see if these solutions from the design, fabrication, and processing that's involved, this time can be cut down to half an hour. I think that's very promising. There is another aspect to get into in terms of material strength and longevity. But as far as the timeline to make it feasible to keep someone in your office for these solutions, I think that that timeline, that velocity is getting more and more promising.

SPEAKER_01 23:00

Now, we I have seen quite a few startups. Uh one of them is actually called Dento AI. Um, and there are a couple a couple others in Europe as well that use AI algorithms to just take care of the design process. I don't know if you have tried any of that, and do you even trust that?

SPEAKER_00 23:16

You know, I I think that these softwares are very promising. I think I like the idea of AI in the design phase. I think that these softwares may not give us 100% of what we need in the design. But if these softwares even take us 80% in the design, and then we're manually refining 20% for now, it's a big help. So that's that's how I see them. I I haven't, I can't say that I've tested them extensively, but for the ones that I see I have used, I don't think it's giving us 100%, but it's getting us closer.

SPEAKER_01 23:52

So to summarize what we have just talked about, you think uh it will become a lot more economically interesting if the whole from uh data acquisition to complete manufacturing is less than 30 minutes. That's that's gonna be very interesting. I don't think have seen anything like that so far. 30 minutes.

SPEAKER_00 24:11

Yeah. And I think it's it's also getting challenging in a way when I think of the landscape. The the early players into the the digital fabrication market were closed systems, right? Where data acquisition planning, uh data acquisition, the designing and the fabrication within one closed unit. There has been a big push, and this was something that we've been quite excited about and have discussed, to have all these solutions in a more of an open system market. So you can use whichever scanner you wish, you can use whichever design platform you wish, whatever fabrication you wish. That's opened a lot of solutions on the market. But then now how these solutions work with each other into an integrated workflow, that's also can add steps to this process. So while I would say on these three components, a lot of the tools have gotten better, how well they work together and um allow the UX part of this process to synthesize, that's raised itself as an issue in this process.

SPEAKER_01 25:13

Yeah. We we talked a little bit about Sarah, which is more of um a subtractive technology. I'm

Milling Versus Printing And Materials

SPEAKER_01 25:19

actually really surprised. I feel like the technology there has stalled. I obviously am biased because I see all the news progressing in the 3D printing side of things, the additive side of things. I feel like the subtractive site should have done a lot better now. It's been around commercialized for decades. Why has it not why I don't get offered chairsite milled crowns? Why is there such a barrier for uh scalable solutions and maybe narrow it down to the 30 minutes that you were talking about? I mean, it sounds like they should have done it a long time ago.

SPEAKER_00 25:54

Yeah, I think there are practices that have successfully integrated the CERAC workflows into their system. CEREC's been around a long time. Right. Where I've historically have seen the barriers has been the cost to entry for offices. Number one, the the solutions were um were cost prohibitive for a number of offices. The other part is the involvement of staff time in the designing and designing fabrication. Because these were milled restorations, they would require not just the milling time, but also a a centering, a baking time. So that added more time involved. So then the solution became a solution to basically fix one tooth at a time, which the effort to go through that whole fabrication process for a single tooth or a few restorations, the return on an investment and then at a scalable level didn't match for many.

SPEAKER_01 26:57

That's very interesting. If you compare this to the additive side of things, it feels like additive might have more potentials. I feel like the two methods of fabrication, they face similar challenges, right? The design process both have to have more streamlined design process. They probably do also have material challenges. I don't know. I mean, you can tell us what do you think of the material side challenges differ between these two? And then the labor cost side of things. I feel like 3D printing, the additive side has more potential of more widespread use. What do you think?

SPEAKER_00 27:35

I think the cost to 3D print is more economically favorable. The speed is increasing, and the speed will be quicker in the time phones than milling. In looking at these solutions, that is where 3D printing has its advantages. However, the durability of the 3D printed materials does not match the milling materials. And there's actually a part that some can argue that the accuracy of the prints of the 3D printed, because we don't have burrs cutting in to form geometric spaces, um, 3D printed products have the potential to be more accurate and have better what we call marginal fits, prosthetics. So 3D printing has its advantages, but the disadvantage, and I think this is something that may hold 3D printing up, will be that the flexural strength and durability of the materials is questionable. It's still questionable at this time. So for example, what's standard used for many permanent crowns today is a material called zirconia. It's used for implant crowns, it's used for crowns on teeth themselves, on natural teeth, that has a flexural strength, and we we we measure this in megapascals. It's the ability to withstand until it deforms. So we we measure that. These numbers, just for comparison purposes, may help us understand. Uh it's about 1,100, some can argue 1200 megapascals for zirconia, depending on the type of zirconia. For our resin ceramic uh 3D printed materials, I think we're looking around 150, maybe more uh megapascals. These numbers may not be perfect. We can look up these change will change every day, but just for the sake of noting that uh from a flexural strength perspective, our 3D materials are not close to our milled materials at this time. So where I see things going is for these same-day solutions in areas that may not need this high flexural strength, we'll see the first application used, right? So that maybe in smaller type restorations like inlays, some onlays. But I'm hoping, I'm hoping that it may even surprise me. I'm hoping that we'll see as these technologies get implemented, we'll see what flexural strengths of these materials are actually needed for long-term durability, because I think that there's question marks in that area.

SPEAKER_01 30:21

What about cosmetic solutions like veneers? I've seen Boston BMF came out with a veneer solutions. Would you trust those materials for permanent solutions for cosmetic?

SPEAKER_00 30:34

You know, in my practices, my partners do a lot of cosmetic work, veneer work, and there's still an element. There's gonna be a saying, we have a solution, it's marketed for this. Do we run with it? And then there's gonna be tried and true, and from a clinician perspective, what works for your patient, which lab technician is behind the final staining, the centering, the design to get the results, to get the aesthetic result out of the material. So I think that there's gonna be a trial error, a trial period here, uh to where we see how these materials get implemented and how they work. Now, if we have the ability, and I think how I would see a number of this unfolding is for a lot of these cases, if there is an option to use the 3D printed materials in the provisional stages, and then milling may be there for the permanent stages, right? Um until until we see enough of these cases being executed to the levels of precision, to the levels of aesthetic demand, and um that milling can be provided. I think 3D printing will always have more of a provisional role.

SPEAKER_01 31:49

Well, you're in the industry, yeah, but it seems like Surac is the only milling solution. There's no other competitors. Whereas for the additive side, there are many players, and and it seems like dental industry in general are probably dominated by major players that's out there, just they're looking for acquisition target. So is SIRAC, yes, it is a wonderful tool. It has been working, but it is kind of monopolized and is not expanding is innovation. Like what do you think? Because I'm not seeing that side of things right now. You probably have a better understanding than me.

SPEAKER_00 32:25

I mean, there are a number of other milling companies that or that manufacture mills. I'm gonna name a few: Roland, VHF. There's a number out there and that that make high-quality mills. I think that Sarac is one of the few that has a closed model of scanner, design suite, and mill. I see. The other ones mainly focus on the milling. Um, and then you need to use a different design suite software and then a different scanner or data acquisition to piece these solutions together. So I don't think since Sarac came onto the market, and there are some labs that have created milling solutions. Uh, Glidewell in Newport Beach has a milling chair side milling solution that they also provide lab support for directly. So it it forms a hybrid relationship between chairside milling and a traditional lab, which has support for that adoption, because I think that's that's one of the whether it's milling or printing, if you're in the middle of a day and you're trying to craft a chair-cite solution and it's not working, where do you get your help? That's often been a drawback, whether it's printing or milling. So I think that solution that Glidewell has implemented is trying to ease that and help clinicians with that aspect. Where if they're running into an issue milling, then the lab can fabricate it and have it made, just trying to find those pain points and takes them out.

SPEAKER_01 33:48

Great. It sounds like we we probably would need milling and additive at the same time together to create this more comprehensive solution. Now, in terms of the markets, who do you think is gonna win in the next couple of years? Do you think is the equipment manufacturer or the implant brands and like big players out there who's just gonna do merge and acquisition?

Open Systems Need Real Integration

SPEAKER_00 34:15

I think that that's that's a phenomenal question. Where I think that we're at, and I think of where we were a number of years ago, where it's we asked, did we have 3D printers available that could that could print what we need? And we can say today, yes, we have them. Do we have materials today? Yes, we do. The materials are getting better and better. Um I definitely we're we're definitely seeing strides of improvement in our materials. And then do we have our design suites? Yes, there's ones that you can acquire where I think the model of that is changing, where design suites are often now offered. Different companies, um, such as Meta, who's a scanner company, now has a design suite, and now you can either have a subscription plan to uh have unlimited exports of designed items, or you can export and have a design fee so you don't have the barrier of buying a whole software. I think they're trying to chip at that barrier of entry. I still think that there is an aspect here of system integration. Like how do we how do we integrate these systems all together? Because there's there's 3D printers out there, there's mills out there, there's scanners, design suites. And I think the larger question to me is how do we integrate all of these solutions into a user-accessible manner for clinical teams?

SPEAKER_01 35:43

Yeah. I mean, since you're on a mission to dip democratizing advanced dental care, you're teaching other dentists, how do you think you're you are expanding the competency of these people so that they are going to be convinced to make certain catbects and reinvent their practices?

SPEAKER_00 36:02

Yeah. I mean, I would say it's it's once you in your practice for any dentist, we have needs for our lab services, whether it's surgical guide design and or fabrication, it's crowns fabrication or design, it's it's all of these aspects. And once you can look at your practice and say, this is an area where if I were to bring in 3D printing, it would end up saving time, saving costs, and it's worth it for me. Um I think that's an that's a part to every practice to look at and dentist to look at their numbers. And then there's a part to say, you know, is that cost savings worth it for me? Do I want to take that on in the practice because, or do I want to focus purely somewhere else? Um, do I is is just worth outsourcing it? But I think that there is a part to, there's a part to even before you may even get to that part, there's a part to understanding what 3D printing can do for practice, right? Can do for how you approach cases, how you look at solutions for your patients, and to even know what options are out there. So whether you're printing it yourself, whether you're using a fabrication lab, you still have to know what you need created and on what timeline.

SPEAKER_01 37:21

Yeah. I think to follow up my earlier question on who's going to be the winner, I certainly hope the dentists, uh, especially the general practitioners and the patients are going to be the final winner of this uh technological evolution. And you have a school, your your faculty at a school right now. Tell me a little bit about your Torque Academy

Training Pathways With Torque Academy

SPEAKER_01 37:43

and Implant Ninja. Like what do they do in terms of trying to transform the industry with the technological insights to transfer to the next generation of dentists?

SPEAKER_00 37:57

Yeah. So at at a Torque Academy, Torque Academy was started by dentists, clinicians, primarily in uh focus on dental implant cases. Um the goal of the academy is to train dentists to execute dental implant cases at an extremely high level. Uh, a level that allows them to minimize complications, maximize results, and overall just provide this care at an extremely high level. So I always see, and as a clinician, there's an aspect of your eyes only see what you're prepared to understand. Uh that's that's when you look at a patient case, two clinicians may even look at a case very differently. So for us, it's very important that dentists understand what to look for when treatment planning uh when planning implant cases. Like we said, exactly where does the prosthesis need to go? And when it comes to dental implant cases, sometimes it's where exactly the prosthesis needs to exit the gum tissue, right, to that level of detail, where it needs to fit in the bite, where the bone is, where the implant has to be, where the augmentation of bone may need to occur, and where the gums may need to be augmented and grafted. There's there's levels of planning and decision making to this. So at Torque Academy's courses, we teach all those levels of planning and clinical execution, both from a planning and design side as well as from a clinical implementation side.

SPEAKER_01 39:43

Now, you have taught some students, and I'm sure their level of understanding is different. I mean, they came from their day-to-day practice. They probably weren't following 3D printing news and stuff like that. What do where do you see the gap is in terms of their the baseline knowledge uh when you're starting to teach these people?

SPEAKER_00 40:03

I mean, I I would say that the those that have come to our program have picked on pretty quickly. Okay. And and often what happens is after folks come to get trained or repeatedly get trained, there's always a part to where when you have a patient case or they have patient cases from time to time, they will submit cases to us and to say, can you assist us in the planning? So they'll they'll gather the 3D x-rays that are needed, the scans, and then we have a team that we work with that'll guide them through the digital planning process, right? The clinical protocols that would be needed in these cases. And so it's a continued relationship until these concepts are all clicking. Um and either they're able to execute them all on their own or they want to continue doing these cases with continued support. Cool.

SPEAKER_01 41:02

And you offer these classes online or in person only? How does it work?

SPEAKER_00 41:07

So and and you you mentioned in Plant Ninja as well, phenomenal online programs. Torque Academy's courses are actually we take groups of dentists from the US, Canada, um, and we have training like mini residencies that we host in Brazil. Yes. So the so for us, it's a way that we have uh patients we care for in Brazil that otherwise would not be able to get these advanced dental procedures done. So it's done as a social enterprise on that side. And then you have dentists who wish to be trained. So we have an affiliation with a university, and um every patient is digitally planned and executed to extremely high levels in follow-up care.

SPEAKER_01 41:54

And so I'm assuming you also use 3D printed guides and 3D scanning, all the digital tools we just want to do. That's wonderful, and I'll certainly make sure I include a link to your um school. And so we're reaching the end of our conversation. I always want to have a little bit of fun at the end.

Five-Year Predictions And What Dentistry Missed

SPEAKER_01 42:13

Um, I want your boldest five-year prediction for dental 3D printing. Boldest.

SPEAKER_00 42:21

My boldest, even though I'm cautious on where materials are with 3D printing right now, my boldest prediction will be that the material advancements in five years will match milling. That's my boldest. And if if the material scientists can do that, then we are on a we're we're in a completely different conversation.

SPEAKER_01 42:50

Okay. My next question is slightly harder. What do you think the dental industry got it wrong so far?

SPEAKER_00 42:57

I think that the issue with the dental industry is that we practice, we're still a cottage industry. That the many dentists go to a single dentist practice. They're still small groups, but the complexity of cases we're bringing to patients, the complexity of our operations have grown tremendously. So we're we're at a mismatch of capacity to solution. If we were practicing in larger groups together, um, I would even say, I don't think the industry by sentiment will move in this direction, but say if we were practicing in more of a hospital-based system, now we would have the teams, the resources to implement these solutions in a more streamlined manner. Uh more teams for support. Um, instead of uh it would be much easier to implement all of these solutions.

SPEAKER_01 43:58

Uh yeah, I I have. I have never um talked to people who are in very large dental groups, but I've heard the private equity have been merging some of these practices and then create these ginormous entities. And they don't do they have that kind of integration embedded? I'm not sure.

SPEAKER_00 44:16

I mean, I would say that there are DSOs that own a lot of offices. Right. Um, but I would say that what's kept, and it's interesting, what's kept dentistry small has been the the relationship that a lot of patients want to have with dentists.

SPEAKER_02 44:34

Right?

SPEAKER_00 44:35

They want it to be a similar relationship that they have with with their barber, right? Like I go to that one person. And I think because of that, uh it's come from the patient side that patients, that type of demand has not allowed practices to grow very large easily. Just that demand of the relationship. But I think because of that, it's been more and it's been more and more difficult for dentists to implement more and more complex solutions or solutions that involve these levels of complexity that would make it easier for patients.

SPEAKER_01 45:10

So yeah, that's uh I guess it's a trade-off of stay boutique versus becoming a giant scalable complex entity. Yeah, that's I think it is a really interesting but very difficult problem to solve. Maybe if we have a more souped up Reddit for dentists, maybe, maybe that can help with scale up uh complexity.

Career Advice And Staying Current

SPEAKER_01 45:35

Now, um, what is the best advice you have received in your career so far? And what are some of the wisdom that you can share with young people? I mean, you're still young. I just want to say that.

SPEAKER_00 45:48

I was about to say, Jenny, what do you what are you trying to tell me here? Um uh but I would say that they say you're new until you're 10 years in practice, and then you're no longer new. So I just uh I cross that barrier or that milestone. So I can say I I'm I'm definitely not new in practice anymore. I've I've experienced what it's been like for the last 10 years and pushing at the corners where I can. What I would say is it's important to surround yourself by good people. Uh especially for dentists in a cottage environment, you're often practicing alone, trying to implement solutions for your patients, trying to learn, trying to grow, trying to manage the operations of a business. Having colleagues that are in that same journey with you, uh, that have similar goals that you have for how you want to take care of patients, for the solutions you want to bring patients, you need to have people that are of that similar mindset to keep you motivated and pushed. I think that was that was part of an advice a mentor gave me early on. And I personally found many of those colleagues just by taking as many continuing education courses as I could in the areas that were I felt of most interest to me and meeting colleagues along the way on that journey. So step by step, it's not like you go to one course and you meet your best friend for life, but after just pursuing a path, following your passions and meeting, you meet people along the way that um that share them. And then stay close to those people.

SPEAKER_01 47:26

Yeah, I love those. Um, you're always a very curious person, always want to learn new things. I have observed that. And also you're super open-minded to new friendships, to new connections. So every time I want to make an intro, you're like, sure, Jenny, go ahead. I love you about that. Um, okay, finally, what what do you usually typically consume in terms of media to stay up to date, like YouTube, podcasts, blogs? What do you usually would how do you find new information? How do you get updated?

SPEAKER_00 47:59

That's a great question. I think this this puzzle's changing because of our ability to search. Before I would keep like a Google news and then tag items that popped up in the news, uh, so articles would pop up. I've been tinkering with like Google research more recently to search for trends in topics. Um I've been, yeah, I would say Google research at this time. I'm always open to suggestions. So I think that this is now a moving puzzle for myself to find out. I've been finding all these different AI tools, one called Periospot that helps you search dental literature quicker. Very interesting. And and now I feel like I'm in a position where now there's so many tools out there. Too many. I don't know. I don't know which ones to use. Yeah. Send me a and and then once you open a tool to learn how to use that tool is now becoming uh inundating. So um, so I I think for now I'm gonna keep it as simple as possible. You know, tinkering more with Google research, uh seeing what what what I can what I can pull there to pull in news quicker and some of these others.

SPEAKER_01 49:12

Wonderful.

Closing Thoughts And Disclaimer

SPEAKER_01 49:13

Well, thank you, Noble, for this uh great conversation together. Always very interesting to see your perspective on what's happening because things are certainly changing very fast in the industry. And I hope to invite you back to the pot, maybe in a couple months, to see what's new.

SPEAKER_00 49:28

Definitely. Thank you so much for hosting me. Uh, Jenny, it's always great to have a chat with you.

SPEAKER_01 49:34

Always. Thank you. This podcast is for educational and informational purposes only. The views expressed do not constitute medical or financial advice. The technologies and procedures discussed may not be commercially available or suitable for every case. Always consult with a licensed professional.