The Digital Dental Podcast
The Digital Dental Podcast
Season 2, Episode 4: Dr. Peter Barndt
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In this episode of The Digital Dental Podcast, we sit down with Dr. Peter Barndt, DDS, MDSc, FACP—a nationally recognized leader in digital dentistry and former U.S. Navy Dental Corps pioneer who helped drive the adoption of digital workflows across military dentistry.
Drawing on more than two decades of experience, Dr. Barndt shares insights from his journey leading digital transformation in the Navy and discusses how he leverages cutting-edge technology in his Vermont practice today. From restoratively driven implant planning and guided surgery to advanced digital workflows and full-arch rehabilitation, Dr. Barndt reveals the strategies, technologies, and clinical principles that are shaping the future of implant dentistry.
Whether you're a clinician, lab professional, or digital dentistry enthusiast, this episode offers valuable perspectives on integrating technology to improve predictability, efficiency, and patient outcomes.
Greetings, everyone, and welcome to the Digital Dental Podcast. My name is Neil DeMajer, and this is the podcast where we talk about all things digital dentistry from milling to 3D printing to computer-aided design and so much more. Um, I'm super pleased today to have as my guest on the show retired Navy Captain, Dr. Prosedonis, and all around super nice guy, Peter Barnett. Peter, welcome to the show. Thanks for having me, Neil. It's a pleasure to have you on. I've been planning this for a while, actually, because we've known each other for some time, um, but never actually just kind of got around to it. So I'm really glad that we're here today. And I appreciate you hosting me up here at your beautiful practice here in Burlington, Vermont, where they got the great mountains in the background there. Hopefully, everybody at home can see that. For those watching the video, that is for those listening. You'll just have to imagine them. They're they're mountains here in Vermont. So, um, so yeah, lots to unpack with you and lots to talk about. Um, I guess maybe well where we'll get started is you know, I mentioned a moment ago that you're retired captain from the US Navy. And uh in that time, and you're you know, I think it was what 20 years in the Navy? 20 years. Yeah, we appreciate your service, of course. Um, you were the very first uh digital dentistry specialty leader for the United States Navy. And we had uh your your your successor, um Captain Trey Harper, on the podcast a while ago, and he had a lot of interesting things to say, but I wanted to like get it from from your angle, which am I correct in that? Were you the the very first?
SPEAKER_02So there were there were two. There were uh yeah, uh so uh the way it happened was uh they they basically knew there was like a need to solve, and that need was like how do we improve like access to single crowns, like laboratory services were challenged. So it was uh at the time it was Commander Steve Stirlitz and myself, and Steve was more like angled on the the giant building the giant like CERIC community.
SPEAKER_03Okay.
SPEAKER_02And my task was like figure out the lab world, which was like there was no one solution there. And we kind of had to like do research and figure that out. Um, and then uh Steve and I together like tried to build up like you know, CEREC utilization and then kind of taking like the Omnicam or the Prime Scan and eventually just turning it into an intra-oral scanner to feed the laboratory system, which I know like now sounds like so of course, yes, but uh but at the time that was a battle, and we had to like you know bargain with Sorona, take a like STL export, which they didn't offer because there was a completely closed system at the time.
SPEAKER_01So it's like if you scanned with that, you had to stay in that workflow and there was no way out.
SPEAKER_02Seems so foreign now that, but yeah, there was it was totally sealed up. So that was like a big deal for us to like get that breakthrough.
SPEAKER_01Nice.
SPEAKER_02Um, and uh, so yeah, and then I had to just travel. Uh, you know, lab day was an awesome place to do research. And I just had like great connections uh in the lab world, uh, like Nick Azera with Bago, yeah, you guys, like people that could like take me around to laboratories who were already you know on that digital march, already like kind of super digital in their processes, and I could see what they were doing and uh and then try to like pattern the navy or like the best practices I saw.
SPEAKER_01Like, what were some of those best practices? Like, what did you see? Were there anything that like sticks out in your mind? I know this was a while ago, but like yeah, that you saw and you were like, oh wow, that's a great idea. I'm gonna, I'm gonna implement that in an A.
SPEAKER_02Uh well, there's like so there, yeah, some of these things just show you, like, I guess how old I am. Uh, is that like one of the things I saw that was like a big deal uh back in like 2012 were uh was like basically people are still submitting traditional impressions and triple tray impressions. And how do you digitize those, right? Without necessarily like creating a model and then scanning that, like like pouring a cast and going through that process. So like one of the big things I saw was like, oh, there's a lab that's like scanning triple trays and and going completely digital and with no physical uh cast. And so that was like one of the moments where I was lucky to have access to see the people doing that and then try to like build build the navy in in that kind of pursuit.
SPEAKER_01Yeah, yeah. Well, it must have been a pretty, a pretty cool time because it was it was kind of right at that time when things were, you know, starting to open up. Like I feel like if you went to Densplay Sorona whatever a few years earlier, you know, there wouldn't have been any way that would they would have opened that up, but it's like they I think they kind of saw the the direction things were going with open, you know, open format, industry standard format.
SPEAKER_02Yeah, totally. I I think you're totally right. I I remember we were at uh a big dental meeting and and Steve and I had the chance to like go in and make our sales pitch to the leadership of Dent Supply Serona, and we were and they're just like, okay. And and like when we made the ask, and uh so clearly they they yeah, it wasn't it wasn't that we were that good at uh you know pitching our case. They I think like you said, they already had it in mind, they knew the like direction uh the industry was going. So yeah, so it was an anticlimactic uh yes.
SPEAKER_01But hey, it's a win, yeah. So so yeah, so you had that win. Um, you know, you you you're kind of um, you know, I know you hate anybody tooting your horn, but like you're kind of well known throughout Navy and military dentistry as like the guy who brought Exocad to the military. Like, how didn't how did that all go down, you know?
SPEAKER_02Yep. Uh no, so that's a really good question. I don't I definitely I just happened to be the person that was like you know, the f the first one. So whoever gets to go first then gets to, yeah. Like I'm not gonna claim that that uh title or anything, but um, so the way the thing that really drove us to ExoCAD was a lot of our interaction with Imagine. So uh it was it was actually uh an IvaClar laboratory uh rep for us uh coming to Bethesda. And we were, you know, on the hunt for like, okay, we want to have lab technology and we want to do in-house milling.
SPEAKER_03Right.
SPEAKER_02And he's like, yeah. And then we said, well, we really want to make implant parts. We're frustrated with like the results we get by submitting to you know, uh large services that insist on designing the custom abutment themselves. They don't design it the way we want. Um, and there's limitations on their blank, right? There's like all those things as uh yeah, that you're just like, I just want to make my own part, right? Like, why do I have why can't I just go right to it? And so uh this IbuClar gentleman directed us to uh imagine. He said, Oh, there's this company out in Chantilly, you should talk to them, right? And uh, so my initial thought was like, I I never heard of them. Okay. Uh, but we we made a field trip out there, uh, and then that just like kind of unlocked our world. So we had already been using Exocat a little bit, okay, but we were using it through a different reseller who had a wrapper on it. Oh, yeah. And basically, like the implant side of it was very locked down. Uh, and so Felix Chung was the was the one that like kind of like uh uh blew that up and was like, oh, well, you guys haven't been using open exoCAD, right?
SPEAKER_01And it doesn't have to be that way.
SPEAKER_02Yeah, and uh so then we, you know, on the tour of Imagine at the time, then we discover the world of Hyperdent uh paired with ExoCAD, right, and what we could really do uh for implant manufacturing, you know, whether it's utilizing tie bases or going to abutment or implant level. And that was like the thing we were after like the whole time. And so that really like shoved us off, I think, on the journey with imagine and um and your technical solutions like first in the implant world.
SPEAKER_01Right, yeah, right, yeah, yeah, it makes sense. And that was that was what 2000 was like 12, yeah.
SPEAKER_02Really? Yeah, yeah. Um time flies, right? Yeah, yeah, maybe 2013.
SPEAKER_01Yeah, somewhere around there. Somewhere around there. So um so yeah, so I mean, yeah, time flies, you know, you you've you know kind of finished up your career with the military, you know, you you found a great place to land up here in Burlington, Vermont. Um I'm sure it's been quite a transition to be in the military for two decades, right? And then come into you know, private practice and and you know, it's gotta be I mean, you're doing the same thing, but you're just doing it uh in a different way or or doing it like I yeah, uh help me understand that. How is that transition big?
SPEAKER_02Yeah, so okay, so there's I I knew this question was gonna come, and this is this is a complex question. So uh so the first thing is I I for a long time I had used like my own digital workflow and had a lot of experience, like we did everything in-house, right? Um, maybe with the exception of like in the occasional full arch that came by, right? Um we might ask someone else to to help us make the definitive restoration, but otherwise we made it everything ourselves. And uh so I wanted to bring that capability to private practice, and I wanted to do it on a platform that like you know was all the equipment that I'm accustomed to using.
SPEAKER_03Sure.
SPEAKER_02Uh so basically I duplicated my setup within the military in private practice, and I was lucky enough that like my practice owner, Tara Hopkins, was like willing to like support me in that. Um, but I felt like that's like a really important part is that like whatever a patient needs, when they need it tomorrow, yeah. I'm like, yeah, we can do that. You you you broke your full arch implant prosthesis. I can, you know, mill PMMA and in 24 hours you're like back to as you were or better. And yeah, so um, so that was a big part of it. Uh, but then the other component I think that's maybe been one of the harder adjustments is the average age of my patient probably went from being, you know, 30, right, uh, 25, very unremarkable medical history, right? Uh, to uh very complex medical histories, average age of the patients now probably more like 65, 70, right? And also the mouse clicking is much more extensive. Uh so instead of you're designing six, eight teeth, maybe the occasional full mouth rehab, uh now it's like every time, you know, you're you're trying to place 28 teeth. And like um, so definitely learning ways to like gain efficiency and deal with just like larger scope of project. Right. Um, and then I think the other just I don't know, the the real reality of being a prostodontist in the civilian world is you're just meeting a lot of people at the end of their dental journey. And there's like an amalgamation of dentistry, you know, uh four different kinds of implants in their mouth. Um, some of them are failing, yeah. You know, they're in bad positions, they're you know, and it's just like, yeah, bring all that together and make it work. Yeah, right.
SPEAKER_01Man, that's kind of because like four different types of implants probably means you know, four different surgeons placed it. So you got like you got like, you know, whatever, four half a dozen different doctors work in there, yeah, and then it all just presents to you, and you're like, you know, okay, yeah.
SPEAKER_02And then and then just to like sort of like cap off this point and as like uh I guess a nice tip of the cap to military dentistry, right? Because I know there's there's lots of ideas of like what what goes on in military dentistry, but the one thing that's so hard for me to do in the private sector is like when I now I I need to like kind of like put the brakes on my chase of ideal, uh, because now there's a dollar amount that comes with that. And so there were so many times in the military where you know, you'd be maybe you're doing an implant and uh uh a full coverage crown, and next to it is, you know, an MOD amalgam, and you're like, I'll just like you okay if I do this? Like, I'll just we'll do a nice inlay or onlay for you here. And the patient's like, awesome, do it, right? And they feel like they're getting really good benefit. And now that's you know, that that uh additional element of your treatment plan is like a substantial increase in cost. And uh so it's just it's just a different way to approach it. And um, like uh definitely you get to work as like a perfectionist in the military, yeah, and I love it for that reason, and it's like such an awesome way to get experience uh as a prosodonist. So I'm I'm saying it more as a positive for uh military practice and and particularly like prosodonics.
SPEAKER_01Yeah, right. I mean it's it's yeah, right for better or for worse, like whatever the cost is of that procedure for somebody in the military, that's that's just covered, that's part of them being in the military.
SPEAKER_02One of the it's like one of their greatest benefits.
SPEAKER_01On the perks, yeah, right. Yeah, yeah. Um, but yeah, you know, coming coming out that that goes from, you know, hey, do you want me to do this? Sure, to like, hey, here's this thing, it's gonna be this much money, breaking it all down and and having to help them understand and figure out is it worth it?
SPEAKER_02Totally. And then like, I mean, the the care we provide, uh that I provide now in private practice, it's expensive. Like, I totally understand that. And uh just being like very fiscally minded for the patient and uh try, you know, if they have a certain amount they can afford to invest in their mouth, like trying to like be really targeted with that, yeah, and get the the dust bang for their buck for what they are willing to invest. Yeah, yeah.
SPEAKER_01Which yeah, that must have been that must have been a tricky, a tricky transition to make. You know, still still going on. Yep. You know, but uh you know, I'm sure there's gonna be people listening to this that like are happy to hear that because you know, there's there's a lot of uh military dentists getting out all the time for for a variety of reasons, right?
SPEAKER_00Yeah, you know, so they all have to make that make that transition, you know.
SPEAKER_01Yeah, so yeah, I can see I can see where that would be take a little bit of time. So um, so yeah, you're also kind of known for um you're presenting. You've done a lot of presenting and lecturing, uh, a little bit for Keystone implants, you've done some for Imagine, you know, probably you know, a ton more in the military. Um, I had the the good fortune of seeing one of your lectures just a month ago on Colorado, which was great. Um helped me understand from from from somebody the like it seems to come naturally for you. Like, what was it always is it as comfortable as it looks for you to be up there talking to these people? And if it's not, like how did you get there? And like you know, what's what's how what's the best way or what are some tips that people can use when it comes to training on whether it's on digital dentistry, exoCad or or something else? Like, how do you get in that comfort zone?
SPEAKER_02Okay, uh that's a great uh that's a great question. I haven't really thought about that. So I uh I'm sure people who know me, I'm I'm very like introverted. Uh and I don't know what it is about like uh the presenting technical things, but for some reason uh that comes easier. So I think definitely as you go through uh a prosedonics residency, it was a big deal at UConn to be like uh very polished as a presenter. And like it was, I guess uh our senior residents kind of presented it to us as like this is the way you make your mark in the world as sort of um, you know, a subject matter expert, you need to be articulate, you need to be good at you know, delivering a presentation. So, so they were the ones like pushing us as like young first year process residents. And then um also like experiences like uh preparing for like Northeast Implant Symposium, uh venues like that is just like I don't know, you you just put I feel like if you put a lot of work into your your preparation and your material, um, then it's easy to tell the story. Right. Uh I think along the way, um, I also was like presenting and got on board with keynote early on. Yeah, like so going to like ACP or AAFP presentations and like early keynote users, everyone was like, Oh, like those are amazing graphics and like just super clean presentations. Yep, and then I think and then I initially I think I think that's kind of leveled out, yeah, leveled out, but but initially keynote was a big deal, and then the other thing was like Steve Jobs and his whole like presentation style. Uh I sort of like I guess as an Apple keynote user, I paid attention to that. Okay, and so his big thing was like no text, right? Uh and so I've always tried to like build presentations that way of like the whatever's on the screen is like helping me tell the story, right? And uh, so I don't have to like you know have a ver a written narrative or anything. It's just like the everything that goes on the screen is my prompt. And of course I know the story because it's like you know, uh technical dentistry or it's the patient I treated or whatever. And uh so the way it's like it's like kind of flipping the pages of a book, going from one slide to another, um, and just trying to tell that story. And I think in general, like people are more entertained with oh yeah, photographs than bullets, yeah. Oh yeah, yeah. So um, so that's that's probably uh I guess how I arrived at the style I try to use, which of course now is like super widespread, right? Like it that evolution uh sort of occur occurred, I think, in Dash Tree.
SPEAKER_01Like um But not everybody does it well, you know, and and people can try the no text thing, but it's like you know, it's it's you know, it takes a certain level of comfort and humility and uh and humor, you know. That's one thing that I always try to any presentations I do. I always try to integrate some humor in there, you know, to break it up. I I noticed a couple things that you did there as well in the in the one that I saw, you know, the the launching wolf land from the from the the the yeah from a cruiser or something, yeah.
SPEAKER_02Uh yeah, I mean the other I mean I think all dentists know the practice of dentistry is very humbling, right? You you think you're on top of your game, wait, wait a day, right? And tomorrow we'll teach you a lesson. And uh so I I also try to present from that vantage point of like, you know, I dentistry is tough, and like I don't want to ever pretend like uh the things I'm showing were like, you know, oh that just like falls falls into the patient's lap, right? Like everything is a challenge, like stick to your workflow and the details and like kind of per persevere uh through the challenges. So so maybe that is part of this the style is like I can I can admit it it's hard to to do things the way you want.
SPEAKER_01So, and probably you know, providers that are in the audience listening to that probably take a lot of comfort in hearing that, you know, like oh, it's not just me that it died for. Yeah, I'm not the only one who has these struggles, yeah.
SPEAKER_02Yeah, yeah. I I mean it's super frustrating to be like, I've been doing this 20 years, and like I could be humbled in any one moment, right? Um, and certainly now in the private practice world where like you're just dealing with uh things of more complexity, more uh, you know, just more variables. Um, it it it's just like waiting to teach you a lesson. So yeah.
SPEAKER_01You know, you learn something new every day. That's what they say, right? Uh so speaking of learning, so you mentioned uh Yukon, University of Connecticut a moment ago. Um, but I happen to know you went, I forget where, but you got uh Bachelor's of Science in Mechanical Engineering before you went to Yukon for dentistry. Is that right?
SPEAKER_02Yeah, that's true. Uh so I went to Virginia Tech. So I grew as a Virginia kid, and uh so that was an easy fit to go into Virginia Tech. Um and uh that was engineering was like kind of just I don't know, my it was always my backup plan. I I enjoyed it. My father was an aerospace engineer, so it was like kind of one of those things, it's like predetermined that like, well, you're gonna do engineering, then you can decide what you do after. Um, but then uh but then these are you know, these are the weird things that like things happen in life and you feel like your career path was like meant to be. Right. But uh, so part of applying to dental school is you need to shadow and like get experience in uh you know dental practices. So just you know a couple blocks away from my apartment in Blacksburg was a dentist who happened to be uh a gentleman who was, you know, in the ear on the leading edge of dental implants and like prided himself that way. And so in his office, I got a uh basically I learned about IMZ implants, which is like one of the original systems. Wow. And they had this like soup, what they felt like was a very clever solution is they used a Delrin, like a polymer uh intermediate abutment that they felt would function like uh a PDL or like give the restoration like shock absorbing capability.
SPEAKER_01Right, yeah. Uh and essentially not a bad idea. Right.
SPEAKER_02Not not a bad idea, but unfortunately, like uh it doesn't allow you to clamp parts together because like of that it's Like it's like a gasket that's like too thick, right? And so you could put put those parts in with whatever preload they g they could stand, right? Trying to like clamp them, but ultimately those polymer screws would break. And when they broke, they it would be the threaded portion still stuck in the implant for him to retrieve. So that became like my senior engineering project. And uh and they broke so frequently that I got to like test my prototype tool like in his office. Oh right. Um, and uh yeah, so it was it was like that whole experience. There was basically no way I could avoid being a prostodontist, I think, uh on the other end of dental school.
SPEAKER_01Right, right. Yep. Yeah, so that's kind of how the whatever the the path led to dentistry was just like that time. The the the time you spent interning and then plays right.
SPEAKER_02Yeah. And then I mean, and the other, I guess the other thing about engineering is like I feel like it's like all the all the disciplines of engineering uh are really well suited to dentistry. Um, and I know there's a lot of other backgrounds that that are probably they all have unique angles in terms of like how you approach the practice of dentistry, but uh I do think an engineering background, like the materials background, like understanding um definitely like with implants, like the way things get assembled, yeah. Uh, and just stresses like the mouth is a super complex biomechanical machine. And uh, and so engineering is like a nice fit, and particularly for prosodonics, I think that like gives you gives you like uh I don't know, do you you need background on on things that can be?
SPEAKER_01Yeah, I mean I have to believe that it it it gives you it informs your decision making from a perspective that uh a provider without that uh degree, you know, wouldn't wouldn't intuitively go to that, you know, place.
SPEAKER_02I I think so. I guess maybe like it's probably you know, scientists, engineers, I I feel like uh a lot of what we do in prosodonics is you're looking at failures and then you're trying to like engineer your way, like understand why it failed, right, how it failed, and avoiding that and whatever you do to restore the patient, right? And uh so that's very much like like that pursuit uh is is like an engineering mindset, right? Is like the diagnosis of the failure, uh, which a lot of times um can be like mechanical in nature, I think when we're dealing with like you know, large-scale tooth replacement.
SPEAKER_01Yeah, it's a good portion of the time. If you just think about it, I mean, like you said, it's a complex system to begin with, and just like the forces involved can be very significant, right? I mean, I forget, I mean, you probably know the numbers off the top of your head, but like how much force when you're fully biting down as hard as you can, like that's a tremendous amount of force.
SPEAKER_02Totally. And uh, that's another aspect of uh of engineering applied to dentistry, is like being uh that I feel like pros uniquely equip me to do uh is like meeting the patient and quickly identifying like risk factors, right? Like based on their skeletal relationship and things like that. Like you know, oh, this is this is like a high force patient. This is a patient who's gonna like I have to use the best materials, I have to over-engineer, build factors of safety, all those kinds of things. So yeah, yeah.
SPEAKER_01I mean, it's uh it's um, I don't know. Have you ever met another procedonist who had a BS and mechanical engineering background?
SPEAKER_02Uh I have. Have you? Yeah, yeah. There's there's some uh no there. I've I've met like uh UConn actually just had another mechanical engineer, uh Greg Tao, uh who is like yeah, the same, like basically in a very similar way, like quickly like dives into the CADCAM world and like just like eats that up. Yeah. Uh and uh yeah, so I th I think it's like it's a it's a hard to is there's like a gravity to pros that if you're an engineer, like it's it's inevitable. You're like you're just gonna be pulled into prosodonic.
SPEAKER_01If you're an actual engineer or just even just engineering-minded and you're you're moving towards a career in dentistry, yeah, you're end up. You might as well just give up. Yeah, you're a prosodonist. It's already been determined. Congratulations.
SPEAKER_04Yeah, yeah, yeah.
SPEAKER_01So so yes, we've been talking uh a lot about kind of like your your history, your background, kind of what you've done. But I mean, this is the digital dental podcast. So let's let's talk a little bit about you. Mentioned earlier uh when you came to this practice, um, you were able to kind of copy paste the system that you had within the military here in your practice. So so unpack that for us a little bit. What is what is your catchem system? What's your protocol? Like what do you what do you use and how do you use it?
SPEAKER_02Yep. So so dating back to those original days of like system building in the Navy, uh, so we always were intimately tied with Den Splice Verona because of the CEREX system. So uh for a long time I've used a prime scan. Uh, I really respect that scanner. Uh and also in private practice, like um using the prime scan to like for patient education, like the huge touch screen, all that is uh is really nice. So the prime scan is my my starting point uh of everything digital. Uh and then I've been lucky enough, like working with you guys, and now that I can, you know, make my own decisions about equipment. Uh certainly we have a cone beam in our office. Uh so that's an important data point. And then I've been lucky enough to add uh recently Ray Face. So that's always been a frustration of mine is like um, you know, using we've always used photographs and exocad, and you can do a lot with like 2D planning. Yeah, but now being able to go to like that 3D world, especially for patients that are uh a dentalists, that that is like a great uh leg up on like your diagnosis and planning. Um, and then also uh new to new to our clinic is uh device like Modjaw. So that is also like you know, mind-blowing information uh and diagnostic capability. And uh I'm just like starting to get into that, but that's that's like all the elements of like the digital patient, yeah, yeah, yeah. Building that digital patient, and then uh it all rolls into Exocad. Uh and so that that's like my indispensable treatment planning tool. Yeah.
SPEAKER_01Um and you do you like when it comes to like treatment planning and and you you mentioned for kind of show and tell or interacting with the patient, are you using these you know, screens and software and digital tools with every patient, every case, or is it just the really complex concepts that you're trying to convey?
SPEAKER_02Or yeah, no, it's a great question. Uh so there, I think maybe if it's a single posterior tooth, um, there's still gonna be like we're still gonna capture uh an inch oral scan, a cone beam, uh they were missing a tooth. Like, well, I'll do I'll chase guided surgery every single time, right? For predictability. Um, and we'll so we'll still have a digital wax up, even if it's just like missing, you know, first molar. Like we're gonna digitally wax that up and and work it all the way up and have a surgical guide. Um, but I think when you get into the 2D planning, the 3D planning um for anterior, like cosmetic things or just larger prosthetic rehabilitation, um, then that's where like it it really gets uh deeper or bigger in scope. Yeah. But but I'm in exocaden for every single patient. And uh I feel like one of the things I've learned in residency is is like every time you think like, uh, this is simple. I don't need to like do the, I don't need to do the wax up, I can skip that step. I can those those are the times you get burned. So uh so yeah, so we're very like dogmatic that way in that like okay, we're gonna do this process every time. And it's so efficient that like one, you know, once you get in the habit, it it doesn't slow you down. So we'll we'll do that uh whatever kind of digital prototype like blueprint we need to develop. And then we'll take that into the cone beam world and do our surgical planning um so we can have that like restoratively driven, kind of like space oriented uh approach to to implant positioning.
SPEAKER_01Yeah. And that's uh any any of the cases where you know you're the patient is presenting without the implant already there, you know, you have that uh protocols kind of set where it's like, okay, it's gonna be guided, it's gonna be digitally planned, that way it can be prosthetically driven, which has got to be uh such a breath of fresh air compared to uh, you know, just patient presenting with XYZ implant and some crazy angle that you're like here, deal with this. Yeah, no, totally this mess up.
SPEAKER_02Yeah, totally. I I think another thing that like I think uh it it has been a little bit challenging to like uh you know, you you have to break in new surgical partners, right? Uh in wherever you move, whether it's in the military or the private world. And the the one challenge is like a lot of surgeons who are particularly experienced think like, what is guided surgery gonna add for me? Like, I can put in the implant with very good alignment. I've done this a long time, right? But the a couple variables I feel like that like I've really liked the control of like digital planning and doing guided for every single instance. Uh, one is just recognizing like deficiencies, no, like when the patient has lost bone and and has like uh a defective alveolus, like that gets diagnosed and built into the surgical planning and sort of like quantified as well. Like you you know how many millimeters, right, you need to add, which can shape a treatment plan. And then the other thing that just is you know hard to get surgeons to like initially to buy into is the control of depth of the implant, right? So even if you're you were maybe guiding like the initial creation of an osteotomy, like I want the implant like delivered through the guide to the depth that like it was planned. So we have emergence, and I think we're finding out like more and more how important emergence is uh the angle of that emergence to like prevent uh future periimplantitis, or it's like I mean, it's it's basically become a risk factor for uh for home loss.
SPEAKER_01I haven't heard about that.
SPEAKER_02Yeah, I mean, I think they're building that data set, but like you can find like uh conclusions like that or references like that. And um, so that's I think depth is big for that reason. Uh it's also big for just making sure like you have enough room to to store, you know, stack all the components you need and not have them biting on a screw head, right? Um, so uh so that's all like I think I really like knowing that like we if we design it all on the computer, we can like go to the mouth, execute that plan. There's no surprises, and all the involved parties, surgical, restorative, feel good about like what happened at the end of the day.
SPEAKER_03Yeah.
SPEAKER_02Um and then so sorry to wrap up your question about like what is that package uh of of equipment. So coming out the back end, the other, the other really important piece to me was a five-axis mill. So I tell people all the time, I was like a spoiled brat. Uh I've I've always always yeah, I've always I mean of all the pieces, I think um, you know, intra oral scanner, exoCAD, five-axis mill, like couldn't be a prostodontist without that grouping. Um, and the reason for that is just the ability to like turn turn around projects quickly, but also like once you get good, uh I think once you have experience with hyperdent um and just you know being involved in that manufacturing steps, there's there's things I do when I mill my restorations to like preserve the fidelity of the design I had in Exocad, like sprue locations, uh the way it's the angle it's nested, all those kinds of things. Um, and just that level of control. Not uh not that I'm a control freak, but like process, yeah. When you when you have that process start to finish, that that is awesome. And then I think the other piece is like uh adhesive dentistry. Um, so whether instead of you know, it it's again not a new concept, but like instead of doing a traditional full coverage crown, doing things that are more conservative with two structure, but sometimes are hard to like maintain provisionals on. So that's like where the Ceric world is like, well, we just bang it out in you know, an hour, an hour and a half. But uh having an in-house five-axis mill gives me like the highest quality indirect restoration, right? Like so precisely milled, and I can have it the next day, right? And I think it's creeping towards like I might be able to have it in an hour as uh centering like speeds up faster and faster. Um, but uh, but that is, you know, I I can settle for next day uh to have like the quality and and also the aesthetics of like the zirconia centered, you know, on an eight hour cycle. And we know that that's gonna be more aesthetic uh result than than a than a one-hour cycle uh or a 30-minute cycle. So um, so anyway, so that's that's like an important piece of my workflow. And then this of course, 3D printing, so so important for like being able to like execute mock-ups. Um, we do a lot of our own aligners. Uh, so all those things just like roll in-house. I've now that I'm in a a a civilian private like prostodonic practice, yeah. Uh now complete dentures. So out of my form 4B, uh, I those are like an awesome product. Um whether you're doing printed base and teeth. Printed base and teeth. Okay. Yep. And uh, and I I wouldn't say that like I have I have patients that are using that as uh a definitive restoration with the understanding of like when it comes time, we'll just we'll just print another, right? Uh and then, but then other times we'll access milled solutions for dentures as well. But just to like have uh an initial prototype, particularly on patients that might be more challenging denture patients, right? It is just so quick and uh financially efficient to make to be able to 3D print that denture. And they they fit amazing. Like I there's very it's almost like I don't have to use pressure paste at delivery if you've like put in your time with your impression method. Um and so that that's another avenue of printing. The one I guess the one area I'm like dragging on because I've I've always had a five-axis mill, yeah, is all everything implant. I just prefer milled PMMA uh as my as my like interim solution rather than printed uh crown bridge material, right? Uh those kinds of solutions.
SPEAKER_01So yeah, well it's it's it's kind of like you were talking about earlier, right? Like you define the process and when you know it works as long as it's efficient, you just follow the process. The process is the boss, you're just uh following the process, right? So it's like why unless there's a problem with mill PMA provisionals on top of a tie vs. Like, why would you restrain from that, you know?
SPEAKER_02Yeah. And uh I I guess the other things in that in that respect is um kind of meeting patients in the middle financially is milk PMMA has become my best friend of helping a patient break up the expense of a very expensive like rehabilitation. And uh and unfortunately the milk PMMA might be too good uh that like when they say how long is is this gonna last, I don't really want to give them an honest answer, but but uh but no, it's definitely like you know, you can put these things into service for like a year, two years, and like buy the patient time to like make the next financial step. Yeah. Um I think the other thing is when you have your own five-axis mill, uh I mean it's hard to keep your mill, our mill runs a lot, but it doesn't run 24 hours a day, right? Right. So if I need to spend two hours milling uh an abutment level PMMA, you know, full arch um interim solution, like that that's fine. It's not it's not blocking me out from making the crown I need for the next day or the on lay or something. So um, so that's like kind of the beauty, and uh and maybe you can be a manufacturing snob when you have like a five access mill just waiting for like the next project. It's like to enter it, you know.
SPEAKER_01At the end of the day, you know, here in the private practice world, if that spindle isn't spinning, a machine's not making you money, right? So it's like if it's down, put it to work, you know, even if it's for milled night guard, like who cares? You know, like let's get something out of it. Yeah, yeah. No, totally, which is another you you mill night guards quite a bit, right?
SPEAKER_02Still, yeah. So that would be, I guess if that's another example of me being the manufacturing snob, right? Is like, well, I have the five-axis mill. There's a you know, this one puck that I just love from Prino Tech.
SPEAKER_01Uh is it the flex, the flex PMMA?
SPEAKER_02It it isn't that way. It's it's one that gets like ordered from Germany every time I ask for it. Uh, but it's just a clear PMMA, but it's just a specific variety. And uh I just found like it it has like awesome durability and mills really nice. Nice. Um, but that that is like you can you can almost mail it to the patient, right? Like if you've done really good jaw relations and everything. Um, but I I would also say that was an area where I definitely had the most growth to do is the hyperdent world, the cam world, right? Right. Um, and and thinking like, oh, I'm gonna start manufacturing all my stuff. Like that is an area um where like you really need to have like mastery and even something simple like a night guard, have like you know, some some higher level challenges cam-wise to get you like consistent results. Yeah. And uh, but then once you have that process built, right? It you could mail it.
SPEAKER_01As long as the variables stay the same, you don't change what cutting tools you're using, you don't change what what material you're milling, and you calibrate your machine, calibrate your machine, yeah. You know, yeah, you know, then you should expect the same outputs. But um, you know, I I think I think cam software, hyperdent, and you know, other cam software is is something that is underestimated, like the importance of it uh is underestimated a lot in our industry, especially by new users. So unpack that you made a statement a moment ago of like, you know, there was it was a lot of learning I had to do there. There's a lot of things like unpack that a bit. Like, what are what are some of the top, what are we whatever, top three things that you think most people forget or don't realize or underestimate when it comes to cam software for dentistry?
SPEAKER_02Right. Uh so I guess when you hear the term, and I I'm saying this because I was guilty of this for sure, you know, five-axis mill, right? So you just think like, well, the machine can tip and do whatever it needs, and it's gonna like get into all the nooks and crannies and like get it all milled out. And the part on the screen that came from Exocad is the part in my hand leaving a mill, right? And uh it doesn't quite work that way, unfortunately. Only but I mean I think it I think it's uh getting closer all the time, right? As they add like automation and algorithms to like, you know, find those uh undercuts and get them for you. Um, but I would say like that's where Imagine's been like instrumental in my journey with Hyperdent is like learning like, okay, how do you what are the limits of the machine and like how do you make sure you're not asking it to exceed those limits um for tipping and things like that. But also just the approach in hyperdent of like identifying the areas that aren't going to mill out unless you like create a custom tool path to do that. Right. And that sounds like complicated, but it it isn't. It's just like you just have to know what like buttons to click in hyperdent to like show me the areas that aren't gonna mill, and then you tell hyperdent, go get those areas, right? Um, but it does require, you know, like being aware of it and and knowledge, yep. And then also kind of checking that like the solutions, the orientation of your part, that like those are all reachable areas. Um and uh so yeah, so even on something as simple as a night guard, um, you know, we I didn't realize initially it's milling like a three-axis machine unless I tell it to do more sophisticated tipping and and searching for those undercuts. So uh so that that little like um discovery and disruption, like, you know, kind of like disrupted my product briefly. And then and then I re-established like the settings, and now you're back to like I can mail it to you, right? Um, but uh so anyway, so that's a big part. Um, I think of when uh we talk about you know, milling full arch implant interims or or definitive restorations, or even things um definitely if you're milling dentures or or treatment partials, like finding undercuts and making sure that those can be milled out. Um, that's like an important part of the the cam journey. Yeah. Um Yeah.
SPEAKER_01I mean if you if you get a turnkey solution, assuming you get a turnkey solution from whoever, imagine or or anybody in the market, it's going to define the cutting tools for you. It's going to have the milling strategies and templates already defined and created. You know, so you don't have to worry about that, which in in in other industries, you get cam software, it's like figure out the rest. You pick your tools, you define your strategies, right? So at least for us, all that work is done by the vendor, you know? But even when that's done, you still have to have the diligence and kind of the presence of mind to be like, okay, wait a second. What's not going to be milled out? What in this orientation, what is the machine gonna miss unless I tell it to pay specific attention to you know?
SPEAKER_02Yeah. And I I know like people that are big 3D printers are thinking, like, I don't have to deal with any of that, right? Because it all prints.
SPEAKER_01Uh they have to deal with other stuff, right?
SPEAKER_02So they they have to deal with like polymerization shrinkage, right? And they have to deal with scarring uh on their part. And like so there's trade-offs both ways, but uh, but I I think uh in general, I feel like we do a lot with PMMA, and I'm just amazed at like the fit that can be achieved when you like know, you know, when you can do that last critical step with hyperdent to like make sure you get the product that Exocad like designed for you. Yeah.
SPEAKER_01So yeah, yep, I agree. Um, so let's see. So we kind of kind of went through a lot of your history, school, the navy, stuff like that. You're here in this practice. Um, and one thing that I definitely wanted to bring up and and ask you a bit about was something that kind of we worked on together and established whatever that was late last year, late 2025. You became took on the role as Imagine's first clinical advisor, which is great to have you on board as part of the company. Um tell us a little bit about that. Like what, you know, you know, completely separated from you know what you think we want from you or anything like that, like coming into this, like what are you, you know, in your mind, like what are you hoping to be like, I want that, I want to do this with Imagine as their clinical advisor, you know?
SPEAKER_02Yeah. Uh well, that's a great question. So I I feel like having been in the military and and having uh a long working relationship with you and your engineers, uh, there's always been like an RD side, right? Of the partnership. And um, I know that like uh there's a lot of military prosodontists like function in that role for you. And that was just like something I didn't want to lose access to, or like it's like an important part of my practice of dentistry. The this like makes me happy is like uh okay, well, I'm not just gonna do it like I've always done it. I'm like always like looking at how it turned out, how can I do it better? And I need like the help of of really smart engineers, dental nerds, yeah, and and people who people who can write the the template to mill the thing I want to mill, or you know, um, so like process improvement. I feel like to really be uh engaged in that, I think it's important to be treating patients, but then hooked up with like some a company like Imagine and with like the the kind of smart people you have working uh in in Imagine to get that done. So that that's just like uh a really satisfying part of practice.
SPEAKER_01That closes that loop, right? Because like, you know, integrators like us, which that's for from my vantage point, that's what I think of our company as, is we integrate all of this software and hardware and consumables and burrs, and we put all that together into a process that works and and we offer that process to customers, and that's part of how we bring them value, right? But like we don't treat patients, right? We don't deliver prostheses, you know, we don't we don't do those things. We're not in the clinic or we're not share aside, you know. So to have, you know, from our vantage point, to have a clinical advisor who does that every day, you know, be able to close that loop and come back to us and be like, hey, this would be better if it were like that, or if we put this little thing here, I'll be able to do this and that'll be great.
SPEAKER_02Yeah. No, totally. I I think uh I was fortunate in that like I could do that uh with you guys in a military capacity. The military is like such a great environment to like be on that leading edge.
SPEAKER_03Right.
SPEAKER_02Um, it's a little harder now because like you know, when you're breaking in new workflows, you you kind of need to find success rapidly.
SPEAKER_03Yeah.
SPEAKER_02So um, so anyway, but that that is uh I think that's always something that I I'm like looking forward to working with you guys like more closely in that regard. And then also just the the teaching element is it's just it's it's fun, it's something uh I've always done. So like approaching it from a standpoint of like just teaching dentistry, right? Like independent of any uh company manufacturer material, right? Just like the principles of dentistry and the principles of a lot of digital dentistry, right? Um, and like you guys can provide the platform for me to like participate in in those kinds of continuing education uh events, um, and and just like you know, kind of continue on to like what I got to do in the military of trying to like help help young dentists like find their way and and and find success in the digital dentistry world.
SPEAKER_03Yeah.
SPEAKER_02Um, just as someone who's like, you know, suffered through uh the challenges, like the both the successes and the failures, and like trying to make it a a less uh I think a more pleasant experience, right? Yep for them on their digital journey. Yeah.
SPEAKER_01So yeah, less scary, less obtuse, you know, and just more even keeled and easier to navigate.
SPEAKER_02Totally. And I I think that's uh I appreciate that that you guys are imagine in general is giving me the freedom to try to like build courses that will allow like it isn't sexy to talk about Cam, you know, details of Cam, right? But it is so critical to like understand those things because it will like undermine every all of the great things you've done, right? Leading up to the moment you need to mill or print something if you can't like finish that off. So uh I'm looking forward to to trying to build uh uh education that's like centered around, you know, simple, complex, whatever it is, uh patient-centered treatment, but like giving the details that like were so painfully discovered, yeah, uh giving those details to others of like how to go end to end uh from start like from start to finish and just like get the result you really want.
SPEAKER_01Yeah. Um, yeah, even if you're just highlighting the pitfalls, right? Be like, here everybody gets caught in this trap. Don't do this, do that.
SPEAKER_02Yeah. I think there's I don't the other thing is it's just interesting to me to see the continuing education world, right? That everyone wants to learn. Oh, I want to do all on, you know, prosthetics. I want to, I want to be involved with everything all on, but like there's so much detail in a single implant uh in veneers on seven through ten, six through eleven, right? Like the details of doing just like traditional dentistry really well and making it like enjoyable, right? Uh, because it's predictable and like turns out the way you want it to be. Um, so so I'm excited to like try to uh build that area of continuing education, which I think would be in particular appealing to to new dentists, young dentists that that want to like um you know start to diversify their practice in the area of prostodonics and maybe like don't feel like they want to go to residency, but they still want to like grow in those areas.
SPEAKER_01So yeah, you were at what was in the University of Maryland not too long ago talking to a whole bunch of residents?
SPEAKER_02Uh yeah, so my my wife taught at Maryland and that kind of like got me just whatever, I think, in just her her travels, uh her her promotions of me. Uh I ended up like speaking with the residents, and so that's like one of the greatest like forums, I feel like, is cross residents. That that is like uh the one of the most rewarding areas to teach because they're eager to like do the new thing, to like be part of like the the leading edge of like the way we treat patients. Um, and so I think that's appealing to like teach them both the basics, but also show them how like ExoCAD can like it's such a potent tool. And uh if if it if they can think of it, they can probably do it right uh on that platform. So uh yeah, so I got to I got to spend a day with Maryland residents and and go over treatment with them and um it's probably really invigorating for you too, right?
SPEAKER_01Because it's like you know, you you you spend whatever a day or two with whatever a dozen residents who are all fired up about this career and this journey, you know, it'd probably come out of it a little a little bit more jazzed up yourself, right?
SPEAKER_02It is, it also is revealing of like you know, these younger generations, like they they latch on, like I learned things too when I go and teach them. But yeah, there's moments where like something seemingly simple, they're like, oh, that's that's how you do that, right? And you're like, okay, well, if nothing else, I taught them that one simple thing today. But uh, but no, I I think that that's always rewarding. Um, and I think that like the I don't know, kind of the the cycle of of Prosodonis, like like they're getting their training and they're they're eager to to take everything that they can get. Uh and uh I think like being able to like be a part of their growth, um, and and kind of like inspiring them that like hey Exocat is like this is the tool you will carry with you for the the rest of your life, right? Um and uh yeah, so it's it's usually a good fit. They're eager to learn it, and I'm like eager to try to like get them fired up about it. Yeah.
SPEAKER_01So yeah, nice. Well, I'm glad you have the opportunity. I'm sure they're gonna have you back at some point in the not too distant future, right?
SPEAKER_02Uh yeah, I it's it's I guess it's become an annual uh thing. Um, but no, Maryland has an awesome program, so it's easy to like go back there and and and interact with those residents. Yeah.
SPEAKER_01Yeah, yeah. Nice. Well, believe it or not, it's it's almost out of time here, but uh, I did want to close it out with asking you the same question I ask at the end of every one of these. Uh Dr. Peter Barn, do you enjoy going to the dentist?
SPEAKER_02I definitely do not. You don't? No. So I'm a terrible dental patient. Uh and uh I've even, yeah, I've I fail on multiple levels. So one, I'm probably squeamish, you know, even during a cleaning. Ultrasonic working on my T's. That's really funny. And then I even made myself aligners and need to do it again. And uh, you know, started off on the aligner thing, lost a retainer, you know, went went off the rails. So yeah, I'm uh just all around terrible patient myself.
SPEAKER_01Yeah, we can funny. Yeah, yeah. I'm not the best patient either, but terrible gag reflexes, man. It just doesn't code well.
SPEAKER_02Yeah, I know you're so embedded in the field, it's got it's gotta be helping you.
SPEAKER_01Like you know, all right, so so I'll tell a story here uh to to to to emphasize how it's not helping me, right? So my my daughter is a dental assistant at this practice not too far from from her apartment. And I went there for a cleaning a couple months ago. I think I already told you about this. Um, and you know, her her boss, the main doc comes over and you know, does does his look in my mouth and he says, Oh, you got something going on on the upper posterior back here. You know, you should probably get that taken care of. And in my mind, I'm like, listen, my daughter's already told me about how you guys roll here. I know all you do is take analog impressions, you've only got one inch oral scanner, and all you use for it is invisalign. I don't think I want you to take care of my tooth. And I kind of said that to him in nicer, a nicer way than that. Um, but still, I think I I don't think I made a good impression on him. So I think I know too much, and that kind of gets in my way because anybody else would have been like, all right, doc, take care of it. I'll make an appointment next week. But here I am several weeks later. I haven't made an appointment yet because I'm I'm like, no, I want somebody who's gonna like give me a same-day crown, or at least give me, you know, give me a crown, you know, whatever, day or day later, like you were saying. Yeah, you know.
SPEAKER_02Well, I have good news for you. Oh, do you know a guy? Vermont Restorative Demistry is accepting new patients. So yeah, but I mean, probably probably your uh your fees are gonna be slightly elevated. Uh yeah. Well, yours will be too no. My other my other question for you though is uh, do you think that dentist listens to this podcast?
SPEAKER_01Probably not. I hope. But if he does, Dr. Roe, I'm I'm sorry, I didn't mean to it came out, it didn't come out, right? Cool. Well, Peter, thank you so much for for being on the podcast. I've been wanted to have you on here for a long time. Um, so I'm really glad that we took the time uh on your day off, no less, to invite me up here to the practice. So thank you very much. And uh, and as always, everybody, we appreciate you listening and watching. And um, if you have any questions or you want to be a guest on the podcast, I'm always happy to hear that. You can shoot me an email at Neil N E A L at Imagineusa.com. And I hope to hear from you soon. But aside from that, happy CAD camming, everybody. Take care. We'll talk to you next time.