Let's Talk Teeth
Get ready to take a bite out of dental school with Let's Talk Teeth, the podcast that gives you the inside scoop on what it takes to succeed in the world of dentistry. Join hosts Victor and Saad, two D2 Dental students, as they share their experiences, offer pre-dental advice, and discuss the latest trends and technologies in the field of Dentistry.
Feel free to always reach out to us at letstalkteethpodcast@gmail.com regarding any questions you may have or if you are interested in being a guest!
Let's Talk Teeth
Unveiling the Journey of Implant Dentistry: Dr. Tyler Tolbert's Insights
Welcome back to another episode of Let's Talk Teeth! Today, we are joined by the esteemed Dr. Tyler Tolbert as he walks us through his incredible journey in implant dentistry. From graduating during the challenging COVID era to pioneering full-arch practices, Dr. Tolbert shares his experiences, insights, and the hurdles he overcame. He discusses his educational background, mentorship, entrepreneurial ventures, and the mental resilience required in this demanding field. Tune in to discover invaluable advice for dental students and learn about the future of digital and full-arch dentistry.
00:00 Introduction and Guest Introduction
00:24 Tyler's Dental School Journey
01:54 First Job and Early Career
03:19 Starting Smile Now Dental Group
06:36 Mentorship and Continuing Education
09:07 Navigating Practice Ownership
15:52 Marketing Challenges in Full Arch Dentistry
22:31 Clinical and Mental Challenges
37:26 Advice for Aspiring Full Arch Dentists
All right, guys, welcome back to another episode of Let's Talk Teeth. Today we have a very special guest, Dr. Tyler Tolbert. Tyler, if you don't mind introducing yourself, kind of, where you went to dental school, where you're working at, where you've worked at, where you're working at now, because I know you got some new things in the works, so why don't you take it away.
Tyler Tolbert:Yeah, I know. So, like you said, my name is Tyler Tolbert. I appreciate the introduction. So, I graduated from the dental college of Georgia in 2021. From from Augusta that's our only dental school over there. And then I was a COVID grad, so missed out on about half of my senior year due to, you know, Unprecedented times and an abundance of caution, whatever it was that they were sending at that time. And so I lost a lot of clinical time, but it was an opportunity for me to really dive deep into the sort of industry that I wanted to be doing getting out of school. So I kind of took a break from working on requirements and I got to the things that I was really passionate about. And so, you know, while I was in dental school, I started taking some implant courses. I got a scholarship of sorts to go through all four sessions of implant pathway. I was not able to place at the time I was D2. But I was able to go to the live surgical sessions and see a whole lot of action, jump between different operatories in different cases and see ridge splits and sinus lifts and full arch, single implants, a little bit of And the way I mean, I was even more inspired having to, you know, having the opportunity to go around and like seeing all the things that were possible with implant dentistry, that was just so much more engrossing for me than, you know, a lot of the bread and butter type of stuff. And that was kind of when I caught the implant bug. So right out of school after I'd taken that sort of, you know, six months to Hammer down on what I want to do and take courses and shadow and, you know, interact with mentors and things. My first job out of school, I've been working with the share praxis podcast up until up to that time. And then the share praxis group started then. And they were starting some denture and implant offices with an emphasis on fixed arches. And I knew that's what I was really interested in. And so the first job I took right out of school was in Phoenix, Arizona at Valley Dentures and Implants. At the time Dr. Elissa Mancini was the lead doctor there. And I went over and associated and my first day of licensed dentistry was an upper, lower all in four. And it was an absolute battle. I mean, it was a great case, but, you know, just for me, like coming off of not really having. That's for sure. But it did go well. I think the patient's experience was long, but it was good. And she was very happy with her case. And she ended up being a happy patient when it was all said and done and restored and all that. But yeah, you know, I started things like really hot out of the gate and. You know, was definitely humbled in that experience, but knew that I was on the right path. And I was there at validation implants for about 10 months to a year. And then the opportunity came to start an office back in Atlanta called peach tree dentures and implants where I was for two years. And then I decided to take a departure from the group. And start my own office and partner up with some buddies as well. And start smile now dental group. And so we have four offices now we are in Boise, Idaho Denver, Colorado Eugene, Oregon, and now smile now tri cities has just opened up actually this week in West Richland Washington. So really excited about that. We're just seeing some patients already got some cases on the books and yeah, you know, I'm all about full arch, I guess, in terms of. I did kind of gloss over some experience of mine. So while I was still, you know, with shared practices and everything, I was a clinical director for them you know, trained about 30 to 40 docs. And while I was doing that, I was taking CE at full arch club and you know, different courses around the country, going to Brazil for life. Surgical training focusing on, you know, really a trophic maxillial learning different techniques for, you know, taking advantage of the trophic situations and just sort of being able to widen you know, the array of patients that I could treat at the time. And you know, it was an incredible experience to definitely expanded me as a as a clinician taking all those courses. And then I also started the full arch podcast where. For about a year, I was, you know, interviewing a whole bunch of people from around the full art industry and learning all along the way. And then broke off from that as it was sort of a shared practices, affiliated thing and a sorts and started the fixed podcast, which has been out for, I guess, maybe a month and a half, two months now with Dr. Soren poppy. And we've been heading that one up and going into the world of video podcasting, which was a little bit different than what we knew we were getting into, but that's actually been a lot of fun to be able Some really cool content. And you guys have been doing some amazing things with the let's talk teeth and really happy to do a little bit of a crossover and do some promotion and stuff and talk about what I do, I imagine there's, you know, some people, you know, in you guys audience that are still trying to figure out, you know, exactly what kind of dentistry they want to do. And hopefully I can shed some light on that.
Saad Alamgir:Yeah, definitely. I mean, it seems in your short, what, three years that you've been a licensed dentist, you've gone all over the place. So kudos to you and my question for you is how did you feel prepared to go into full arch? Like you said, your first day of licensed dentistry was a full arch case. What did you, how did you prepare in dental school accordingly? Because obviously there's A whole lot of extra things you need to learn for full arch. And what was kind of that process like versus maybe deciding to do a residency and AGD, GPR or perio anything like that?
Tyler Tolbert:No, that's good. So no, I mean, sometimes you just have to send it, right? I read a book and watched a couple of YouTube videos. It's okay, good to go. No. So like I said, I did implant pathway. I did also take my first implant with Dr. Paul Goodman up in Philadelphia and went to several different, you know, implant conferences. But aside from all the CEO and big shout out to implant ninja, that's probably one of the most implementable C resources for dental students out there, very affordable to do film student discounts and learn on your own time online. I think that's really cool. They also have a a study club as well. That's really useful. I think Dr. Stephen Vorholt heads up a lot of that. He's a fantastic educator. I had the pleasure of working with him for a little while before I left the group, but you know, that was a big part of it, you know, online education and everything, but the biggest thing that I really want to impart to people is that the people I know that were able to. I want to talk about, you know, some residency ideas that I have as far as ones I think are useful for that. But the biggest thing is mentorship, finding people who are doing this in the real world, being able to go in and look over their shoulder and see how they do what they do and really just pick their brain. I think that's more valuable than any course you could really ever take with the exception of some live surgical courses, I suppose, but obviously you're not really going to get access to that before you're out of school anyway, but mentorship is huge. Just having somebody that's willing to spend a spread of that time to talk to you and talk through different issues and cases they go through and getting that sort of experience. And you know, also while I was in school and when we were actually, you know, actively in clinic, I was taking every surgical case that I could you know, if someone, you know, had an immediate denture case, but didn't really need the extractions anymore, didn't need the denture. You know, I would be trading them something, right. Something I can do for them, some case I can give them or whatever, just so I can pull more teeth. Cause that's really one of the biggest things, dr poppy he spent a bit of his time, I actually fair portion of his senior year essentially working with an oral surgeon out of a hospital where, you know, after school he would take off and go over to the hospital and just do like several full mouth extraction cases. Right. three or four nights a week. He finished up short of a lot of his requirements pretty soon. And I think that's really important to be a gunner as far as requirements are concerned. That way it kind of frees you up for doing other things, finding opportunities like that while you're still in school lines you up for, you know, extraordinary opportunities out of school. You know, if you're in a hurry I don't encourage people to be in a hurry to just come right out of school and do full arch or whatever. I think, you know, that would be. It's very irresponsible of me to say that, you know, that's just like a gold standard. It's really not. I mean, I know plenty of people that, you know, did do a residency and came out far ahead of where they might've been. Had they just, you know, join an affordable dentures or something like that offsides of school. So there's a lot of different ways to do it. You know, in your first one, two, three years out of school to like really get your skills up. No, not at all. I mean, I definitely think you have to be aggressive about learning as much as you can, getting as many experiences as you can. But you don't necessarily need to get yourself, you know, into the next tier any faster. Like you don't need to own a practice right out of school. You might be a lot better positioned. Like I used to talk about this when I would like kind of advise people on practice ownership and acquisitions and stuff like that. I think we had kind of, share practices and the pursuit of ownership podcast I did for a while for a while it was kind of this, you know, anointed position of being someone that owns a An office right out of school. And yeah it's sexy. It's cool. It's really cool to say that you did that, but in a lot of situations, people kind of find themselves in ownership positions that probably would have been a lot better had they been Take it a year to get some capital up and get to production under the belt. They probably would've got better loans, might've had better rapport and been able to get larger practices you know, at the time of acquisition, as opposed to something smaller. So there's just something to be said for just being very strategic, I think, in terms of what you want to do, not just being passive and kind of going along with the crowd and just trying to keep up with everybody else, you know, don't be afraid to sort of forge your own path. There's not a lot of. You know, people that are trying to go into full arch right out the bat, they kind of want to just do bread and butter for a while, and then kind of bridge into some singles and the overdentures and the fix. And that's perfectly fine. But you know, if you're going along with the crowd and your progress is going to be very similar to, you know, what most people are experiencing, but if you are kind of brazen enough to say, look, this is what I want to do. I'm going to kind of focus on that. There's certainly ways to do it. And it's a better time to be going into full arch than has ever existed. So.
Victor Razi:So was that a part of your plan? I'd say like your third or fourth year is were you considering buying an office or did you know that you wanted to kind of have more mentorship and learn more prior to doing that?
Tyler Tolbert:No, that's good. So, pretty much, I think the first official dental CE I took was actually about two or three months after I got accepted into dental school. And I hadn't actually started school yet, so I was still a pre dental student and I took the advanced startup. This was taught by Dr. Scott Luna over at breakaway seminars. How was that?
Victor Razi:I've seen that before and advertise and stuff.
Tyler Tolbert:I don't really know. For sure how it is now. I can't really vouch for it. I took it in 2017. Since then Scott Luna had actually sold out the company, which, I mean, as far as I know it, they retained him for some time and they've maintained the brand and they're still doing the courses and stuff. I just can't really vouch for the quality after that's taken place. But it was cool. I definitely didn't really know what I was getting into, but I say all that to say that I definitely had the entrepreneurial you know, seed very early on. And one of the reasons I chose dentistry is because I saw that they were still at Avenue. Whereas, you know, in medicine and things that had largely gone away. So. I definitely wanted to do that. And the whole reason I got involved in, with the groups that I did was because they were focused on those types of things. And so it was really until probably late third to mid fourth year. I mean, I was sending out flyers. That was half of my, you know, COVID resp, but it was just sending out flyers to hundreds of dentists or Georgia offices to to purchase. Right. I was school. That was the idea. But then the DSO thing happened and there was an opportunity to do implants and have a sort of executive position in a DSO, at least or so I thought, and that's the direction I ended up going. I kind of just saw it as, you know, there's still some entrepreneurialism there, but it's a smaller piece of a much larger pie that was kind of what got me going this, you know, that way. And. Absolutely. You know, since then I learned a lot of lessons and now I have a larger piece of what I hope to be a larger pie one day. So we'll see if you hear anything in the background, I apologize. That's some some subcontractors still finishing up the new office,
Saad Alamgir:man. Completely understand. Just honestly. Yeah. Going off that you're like you said, you're starting a new. Practice. And I mean, for those of y'all who weren't here, we're talking before, and this is what your second day of this practice very new. And I was just wondering have you noticed any substantial differences between owning and maybe doing the advertising and just everything that has to do with owning a business versus being an associate of shared practices? How has the, have you been managing the differences and do you think it's been worth it so far?
Tyler Tolbert:Yeah, no. I want to answer that in the most cordial way possible and not let my the Cordless drill. That's like tearing up my operatories to try. So is it loud to you guys?
Victor Razi:Yeah, it's not that bad. I can't even hear it. Okay. Okay.
Tyler Tolbert:It's just terrible over here, but anyway, I'll focus on. So, yeah, in terms of like difficulty things, I think that if I were coming right out of school and trying to navigate. Practice ownership at the same time that I was navigating, learning how to be an implantologist or whatever you want to call it, doing full arch and all of that. I think that would have been a lot. One is going to pull away from the other. There's going to be comprehensive compromises on both sides. Both of them deserve quite a bit of attention. I think at this point in my career, I'm at the point where. Clinically, I'm much more comfortable with anything that comes through the door. I know how these things are going to go. I know what can go wrong and when they do, and I know what to do. So that's allowed me to focus in a lot more on how the business operates. Now I was sort of tangential to a lot of business operations while I was still on my last job. And so there was already some precedent of okay, this needs to be done. This needs to be done. I had like mental checklist of everything. I think that, you know, running through it now, it's just figuring out how to mentally compartmentalize, and this is a similar skill, be it clinical or entrepreneurial to mentally compartmentalize all the different things that require your attention, learning to prioritize them. You know, there's that whole like punnett square thing of like things that are very important, not so important, urgent. Not so urgent in figuring out how to actually prioritize that. And being able to disconnect as well when that time comes and not just being like go all the time, because that's, you know, you're a candle burning at both ends of that point. So to answer your question more directly, I think that I benefit greatly from having already established a clinical end of things to where the business stress really. It's not a kilter of stress. That's any worse than what I'm used to. If I were doing both simultaneously, I do think that would be difficult.
Victor Razi:I see. So, not necessarily on that note, but the, are the rumors true that like full arch marketing is like pretty expensive in comparison to like general dentistry marketing can you elaborate on that? How are, how was you, how are you navigating that with the new office and stuff?
Tyler Tolbert:Yeah, no. So, I mean, that's, that really is the beast of full arch. I think within every problem is a solution that can be you know, very useful for you. And it's looking at the problems within a model that can sometimes reveal a whole nother model. Right. So, In general so like when you talk about general practice, the value in a general practice, both from a clinical standpoint and from an entrepreneurial standpoint is that once there is an existing patient base, you have a flywheel. You have a number of patients that are coming back on a three or six month basis. And they're coming back with new problems and you have a whole new suite of things to solve them with. And you can afford to be very conservative with them because you have this long term relationship in, you know, that. Filling you did six months ago, it might be a crown, you know, in a year or something like that, who knows. Right. And then that becomes a root canal and a retreat and extraction and implant. And there's this, you know, like I said, there's this stepwise thing that can happen with thousands of patients you may have in your active patient base. And if you go to buy an office, you're buying into that. If you go to sell your office, then that's part of the value that you have. When it comes to full arch, it's totally different world. I say that a year in a full arch exclusive practices is like a marathon of sprints. Every month you're sprinting to try and make the best one possible. You have a certain, not that you're trying to make a certain amount of money that needs to come in just to break in with even with the office. And then you need to try and blow past that in order to be profitable. And no matter how good of a month you have, The next month you're starting back from zero, right? And you're having to do that again because the model works off of new patients. Right. So to address your question about marketing, yes, it's very expensive. And the more people that are doing this, the more expensive it gets the more saturated an area you're in the more expensive it's going to be. So. I would say that just in any given market, which is a funny thing to say, because it varies so widely you should expect to spend on the very low end per month, about 10, 000 a month in marketing. I would say more reasonably to expect 20, 000, 30, 000. I do know some colleagues of mine, they're spending as much as 60, 000 a month. I do know that some of the bigger guys like new via clear choice they're spending somewhere in the order of 250, 000 a month,
Victor Razi:which
Tyler Tolbert:to some degree, I would say that there is an advantage there. If you're going to a place that already has your new videos, your clear choices, your big guys, they're also doing some marketing for you because they are charging a whole lot more money. Their models are More labor intensive in terms of specialists, things like that. And so you can kind of benefit from the education that happens within that community.
Victor Razi:Right?
Tyler Tolbert:Like the best consult you can ever get, at least as far as what we're doing is someone who's already been declared choice and been handed a 60, 000 treatment plan or 50, 000 treatment plan. Then they come to you and you're, you know, maybe a full arches. You know, 40, 000 or something like that. And they're like, Oh my God, this is amazing. It's like the same thing. And you can do it here. Yeah. So yeah, I mean, this is a very churn and burn marketing intensive thing, and it only gets more expensive as more people end up doing this. And so, I do think that there will be opportunity in the next several years for people who. Learn to create those types of flywheels that we see in general dentistry within the context of full arch, because there's a lot of dentistry that comes through full arch practices that aren't necessarily appropriate for full arch and having a funnel for those cases as well is a very low hanging fruit, I think if you have the skills.
Saad Alamgir:Right. So Tyler, what is different about y'all's business that would help patients be attracted to y'all more so than these big guys or maybe even shared practices?
Tyler Tolbert:Sure. So I would say the biggest thing is, you know, big boats change direction very slowly. Right. So, by the time like one of the biggest, probably the biggest revolution in Fuller Sinister in the past 20 years, if we go past. You know, Palo Malo and the only four configuration is digital dentistry. So the ability to literally have a patient and walk in, do a series of scans and photos and a CBCT perform a surgery and have them leave with teeth. Literally the same day. That's not usually how we do it here because there's a whole lot of preamble, but it's very doable. I've done it before where like patient walks in and they get treated that same day, they're walking out with homemade teeth. That's not an easy thing to do in the context of analog dentistry. So digital is huge and being able to implement digital. In a comprehensive way and make it more efficient and cheaper for yourself means you can also pass it on to your patients. Also having a single provider model where the same person that is placing the implants is also restoring the implants. One thing we learned from zero bone loss concepts and a lot of people are telling us now is that You know If you want to begin with the end in mind the person that is making the teeth should also be placing the implants Right, like we need to You know, look at the end result, think backwards and make it optimal from start to finish. A lot of those big guys, they work off of prosthodontist. Oral surgeon, right? That's just both newbie and clear choice. Both do that. They're changing that a little bit. They're starting to hire some general dentists to restore all enforced. They're realizing that someone doesn't need a three year residency to frankly make teeth implants are there. I won't go too far into that, but Yeah. I mean, there's just a lot of ways in which we can make this more expeditious, not just for our patients, but for ourselves. In the little guys we're able to be a lot more nimble as things come out and there's more advances in technology and techniques and things that we can do. And you're not having to pay the Piper for a full time anesthetist for a full time restoring doctor, full time oral surgeon. You're just going to an Omni capable. Provider who oftentimes isn't even a specialist. They just really focus on this pseudo specialist, if you will. And that helps really lower those costs. And, you know, for patients, I think there's just, there's more options coming out all the time and things are only going to get better for them over time and cheaper. And people are gonna be working harder to, to make a more valuable. Offering for them.
Victor Razi:Sweet. That's I kind of have two questions and just really curious to see your answers to this, but for the first one, would you say it's more challenging to manage the surgical side of things or more of the prosthesis side of things when it comes to fulleridge?
Tyler Tolbert:Oh, surgical is way harder. So there were sort of aspects. So, I mean, That answer is incomplete without talking about your design team. Right. So, currently I work with JB dental lab out of Tempe, Arizona. They are, in my opinion, absolutely the best in terms of digital design and in fabrication communication how you work with them, it's just. They are one of the sponsors of the fixed podcast, but I was working with them long before that. I think the first time I met Steve Barr was over three years ago before any of this happened. So, they run an incredible operation and what they do in terms of getting the data, right. In terms of photos and scans and notes about what I think needs to happen with the vertical or a class correction or whatever that may be, what they're able to do to put together a plan. And then. Get more records from, you know, pre and post surgical records that we take, and then marry that all together and make it into something remotely, right? Like they're doing this, you know, they're doing cases for people all over the country, maybe even out of the country, I don't even know to be able to make those designs. into something that is going to be functional and aesthetic and predictable and centered on the patient's face. It's an amazing thing. It really is. And so a lot of that difficulty could be taken care of by a really well trained designer, whether that be. In house or you're forming it out. I mean, there's some people that are, you know, sending out their designs for, you know, less than a hundred dollars an arch to some 16 year old in Bangladesh. I mean, that's definitely a thing. Like you certainly can but but yeah, a lot of the artistry happens on the lab side and on the digital side with the design as far as the surgical stuff. Yeah. It's. Definitely hard, but it does get easier over time as you get more accustomed to this. And if you're doing this, if this is the only thing you do it can't be hard forever. Like it has to get a little bit better. I think personally, I'm not someone who just picks things up immediately and is like immediately good at it. I do need a fair amount of practice. A lot of times you're a normal human being. Yeah. Like I'm a human being. Exactly. Not so much like my cohost. But yeah that is hard. It's extremely stressful for some. I mean, I know a lot of people who get into this and they're really excited about it and they have the skillset but mentally it's just too much. Right. There's just, the cases are too big. Complications are too scary. And it's just not worth it. And they would rather just be in a much more low key lower liability type situation where you're not going to do these like really massive cases and get psyched up on and stuff. So, you know, I think the mental aspect can be a huge stroke. I went through it myself. There was definitely a period of time where you're like really questioning your decisions and whether or not you're cut out to do this type of dentistry and things like that. And like that, that does happen for sure. But if you can kind of break through that and get used to that sort of constant humbling that comes along with really pushing yourself clinically to to become really competent. Then it all becomes okay. Like when you appreciate it as a part of the process, it's fine. But but yeah, I mean, I think in terms of, you know, the restorative part, that's absolutely the easiest part. And digital dentistry has only made that way more simple. It literally took out half of the process from the analog. I mean, we can do these in three or four appointments, no problem. There's no verification jigs anymore. It's not nearly as technique sensitive as it once was from a restorative standpoint.
Victor Razi:Sure. That's sweet. Do you have any I mean, this is a very general question. I feel like most people's answer is no, but do you have any regrets throughout your process of getting to where you are now? Or like anything that you wish, you know, you could have strategized better to, you know, put you in a position you'd prefer.
Tyler Tolbert:Yeah, I'm actually going to be getting no regrets. Like just tattooed across my neck, but I was looking for it. I didn't
Victor Razi:see it.
Tyler Tolbert:No I wouldn't say so. I mean, there's definitely, everyone has cases that they wish they had done differently or not taken or steps they took along the way that were, you know, fumbles, but I mean, I really think that, you know, as long as you're upholding your ethics stumbling is not falling. Right. Like you're going to have to make mistakes to learn from them. The reality is that if you're trying to do a lot right out the gate and take on a lot of huge challenges, like you're absolutely going to get humbled. And so long as you learn from them and grow from them and the problems that come along, become more grandiose as you go. And when I say grandiose, I mean, it's not the right word. You know, like the things I used to stress about when I was getting right out of school are not even anything that would register on my Richter scale now. Right. Like the things that stress me out and give me that similar feeling are much more complex than the ones that used to.
Victor Razi:Yeah. And so it's like face cut open. That's pretty yeah that's a
Tyler Tolbert:little more stressful. But you know, people that. You know, do residencies and they're fixing lacks, you know, like face lacks is at 2am in the morning. Like they don't really sweat those types of situations either. So it's you kind of have to make some mistakes or go through hard times and get humbled by stuff to grow. And no I don't regret anything. There's a lot of things where I feel like a lot of, Situations in my career where maybe I felt like I was being taken advantage of, or I made a poor decision, or I wish I had seen the forest for the trees before I did this or that. Yeah, those are definitely there, but I would not have learned those lessons had I not done them. You can't just learn everything from someone who's already encountered it. That's just not, that slows you down. If you're just never trying to make a mistake, like you'll never do anything. So no, no regrets.
Saad Alamgir:That's good to hear. But I was wondering about complications as you face as a general practitioner, obviously. I guess the notion, there's some specialists who kind of look down on general practitioners because they feel like they can't deal with complications. So I was wondering, how have you dealt with, because I'm sure you've done a bunch of arches and you've had a fair share of mishaps, and I wonder, I'm wondering how you deal with that, those complications.
Tyler Tolbert:Yeah. So this is a, this reminds me of a conversation I had with Jason hour back otherwise known as the bloody tooth guy. So he's pretty big on Instagram. And one thing you said was like, and he's very, I mean, as an oral surgeon, he's one of the more I mean, he's certainly one of the most charismatic surgeons I've ever met. And he's a lot more liberal in terms of what he feels general dentists can be qualified to do. And that basically means that, you know, if you know your stuff and if you can Then, you know, you should be able to do it. Like he said, one of the most informed people in all of dentistry with regards to implant industry is literally a dental hygienist teaches courses about dental implant maintenance and stuff. Right. And so if you apply yourself to things like, you know, you can be an expert at whatever, regardless of your credential. Having said that, he also says, you know, you shouldn't do anything if you can't handle the complications that are associated with it. Now that's the only thing where I feel like there's a bit of nuance in that situation, especially as a general dentist who didn't do the residency. Right. So, you know, oral surgeons and a lot of GPR AGDs that are surgically intensive, you'll actually be in the hospital and you're going to be on call. And what you're doing is you're going in for complications, right? The people are coming to you, they're not your complications. They come from somewhere else and you're, they're literally being funneled into a program where you just handle complications of dentistry. And then you get really competent with that. And then you come out and you start being the primary provider for that. Like you're the one that treats the thing that caused that complication in the first place. And that's great. It's great that you know how to deal with those types of situations, but that is not. The experience of everybody who does implants, right? So like general dentists who don't do residencies, or maybe they did do a residency and it just didn't have that type of affiliation with a hospital or whatever, they were just doing implants and then complications happened to them for the first time. And I think what's ideal is not that you've seen it before. But that you are educated about what gets indicated for a given situation. And then when that situation presents itself, you at least have some sort of lexicon for, okay, how, what do I need to think about doing here? How do I do it? Do I need to call somebody and figure it out? There are going to be things that present themselves that you've never actually seen before, but you should at least be peripherally aware of them and know where to look for the answers that's really my thing. And, you know, if you think about even if you are a resident and you're in the hospital and you're dealing with complications from dental procedures as they come in, well, who gave you those complications that you could learn from a general dentist that couldn't handle the complications, right? So it's this sort of chicken and the egg type of thing, or maybe it's catch 22. I don't know. But like someone has to make any complications for people to learn from them. I don't believe you should just cowboy it and say, okay, well, you know, I don't know what to do with this goes in The sinus, but i'm just going to hope it doesn't go in the sinus. It's that's very irresponsible, right? You should at least know what a call the luke is. No The general procedure for dealing with the situation, then when it happens. I mean, it's like going to like ACLS training and you worked on mannequin and then you go out and now you've your IV station certified and you know, you're technically the state acknowledges you as a person that should be able to handle an emergency situation. But you know, was someone supposed to have a heart attack in front of you for you to be qualified to treat? Oh, like these things are not controllable. They're not predictable. They just do happen to you and everyone has their first case where they have to deal with something and just having the mental wherewithal and the fortitude to deal with an unpredictable or an unpredicted situation. That's what it comes down to. And like a lot of the things I've had to do to deal with complications. You know, I kind of was aware that could happen. They never happened to me before. I didn't know exactly how to do what needed to be done, but I knew what needed to be done. So having that sort of didactic library of what needs to be done when certain things happen, I think that's enough. As long as you, you know, have built up that sort of stomach lining for, you know, dealing with those situations, staying calm, being able to remain in control and, you know, just be the captain and be able to say, Hey, look, you know, this is happening. This is what I need. Stay calm, set the tone. Don't freak out. That's the most important thing. It's not Oh, I shouldn't place an implant if I haven't gotten one out of a sinus, right? That is, that doesn't make sense.
Saad Alamgir:Yeah. That's very reminiscent of what. Sean said, Sean Land, he was on our podcast a couple months ago and he said, I mean, basically the exact same thing you said. If you're qualified to do it and you have the literature to back up what you're doing, then no one can really tell you what you're doing is wrong necessarily. So I like that vision and it makes sense. So much sense, but we've talked a lot about the surgical aspects, but I'm curious to know what's the hardest thing about full arch, would you say, aside from all the surgical aspects of it.
Tyler Tolbert:I would probably say the mental component for sure. You know, it's hard to disambiguate the things that, that come up as a result directly of clinical stress and the things that are sort of around that. So, you know, I, I do know a number of people that are very competent in doing this, that. You know, even six months, a year more into this, like still have sleepless nights, like they see someone coming on their schedule the next day for a post op for a case that maybe didn't go ideally or a case that, you know, there's certain aspects of it, they're uncomfortable with. And they still they're not sleeping well at night, right. Like they get really stressed and depressed about it. Also if you're doing full arch, you know, the general statistics about implant survival and different complications, you know, those studies are typically done on healthy people that need like one implant, right? You're not talking about ASA 2 slash 3 people that have, you know, sort of abdicated themselves from dental care for 20 years and have a smoking history and are diabetic and all these things. So more things are going to happen with this patient population if you're focusing on Fuller specifically. So. Yeah, there, there's more stress involved in that and being able to care and be empathetic and be proactive about issues and trying to take the best care of your patients is what you need to do. But sometimes there's a mental barrier there where you're just kind of running a little bit scared of problems. And you know, some of these people are very afraid of dentists and that's part of why they're in the situation that they're in. And then, you know, you have to come to them with some, you know, bad news, like an implant failed or whatever, which. You know, that's all about how you present it. But you know, you're worried about letting them down or losing their trust because you're like the first provider that they've trusted in a long time and you're doing your best. But things just don't always go to plan even when they're executed really well. And so, yeah, I mean, I think just the mental component of trying to believe in yourself even when things don't always go to I ideal and sort of show up as the same person. Every single day and set the tone for your team. That's really hard. And that also kind of segues into the other thing that's really difficult about, especially running a practice. And this is of any model is being a leader, right? Like above all, no matter what's going on in your mind or emotionally, like you have to be a leader. You don't want to show, you can show vulnerability and transparency, but you don't want to show weakness. You don't want to show panic or just like visible anxiety because. you're setting the tone. Everyone else is going to be either more anxious or more depressed or more scared or whatever than you are. So if you're already there, then everyone else is just losing their minds. So being able to be that sort of, you know, steady ship in the, in a storm is probably the hardest thing. I think that's where you grow the most not as a clinician, not as a business owner, but just as a person, just being able to deal with the the chaos that can sometimes come along with things. Yeah.
Victor Razi:Yeah, that's good stuff. Well, Tyler we can tell just by listening to you that you've worked really hard to get where you are now. And I think things are definitely coming together for you. Do you have any last minute advice for dental students who are. Interested in full arch surgery and just kind of want to immerse themselves in that field after dental school.
Tyler Tolbert:Yeah. I would say you know, find a full arch podcast you like and slide into the DMs and offer help. Talk to him. All the clothes
Victor Razi:dollar what's your You're how to get to you, your podcast, let's let them know what they can do to learn more from you.
Tyler Tolbert:Yeah. So I'm on Instagram is Dr. Tyler J Tolbert. That's the handle for now. I've been told I should probably have a separate professional and personal page. Good advice in retrospect, but I'm a little lazy with the socials. You can also find us at the fixed podcast. com. We have an Instagram called the fixed podcast as well, where we post the shorts from our record. Recordings. And then we do have the YouTube where we post the you know, the full cases and videos and things. Also of course called the fixed podcast. Also look up Dr. Soren Pappe. He is much more active on the Instagram more competent with that. I'm kind of a boomer in relation to him, but you know, anyone's welcome to To email me I would prefer you email the thefixedpodcast@gmail. com is usually the most focused way. So that it doesn't kind of get involved in the slurry of emails that I get nowadays from my other email accounts, but but yeah, please, you know, DM me message me on Facebook, whatever I'll get to it the best way I can and, you know, I love interacting with other doctors, dental students, you know, it's all the same to me, we're all trying to do the same thing, so please do reach out.
Victor Razi:Well, we really enjoyed you coming on today and we look forward to having a part two and catching up with decent. And.
Tyler Tolbert:Thanks guys.
Victor Razi:Definitely. Thank you man. Sounds good