Let's Talk Teeth

The Full Arch Journey: Unveiling Dr. Juan Gonzalez's Story

• Saadman Alamgir

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Welcome back to Let's Talk Teeth! In this episode, Dr. Juan Gonzalez shares his inspiring journey from graduating dental school at the University of Puerto Rico to becoming a world renowned oral maxillofacial surgeon & full arch specialist. He discusses the challenges and triumphs he faced, including his extensive service in the Army and Air Force Reserves, the importance of the PATZI protocol in full arch procedures, and his contributions to teaching and training future dental professionals. Dr. Gonzalez also highlights his involvement in international courses such as ORCAA and emphasizes the significance of continuous learning and dedication in the field of dentistry. Tune in to hear valuable insights and advices from his rich 26-year career.

00:00 Introduction and Welcome

00:16 Dr. Gonzalez's Background and Education

01:43 Joining the Military and Residency

03:13 Transition to Private Practice

04:56 Teaching and Full Arch Journey

12:37 Social Media and Skull Collection

15:56 Full Arches, Full Auto Course

16:44 ORCAA and International Courses

26:21 The Importance of Sharing Knowledge

27:25 Explaining All-on-X and PATZI Protocol

31:24 Learning Prosthetics and Surgery

33:39 The Role of Digital and Analog Techniques

41:06 Training and Community Support

48:01 Balancing Work and Life

52:42 Final Advice for Dental Students



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Saad Alamgir:

All right, everyone. Welcome back to Let's Talk Teeth. Today, we have the Dr. Juan Gonzalez. Gonzalez, if you don't mind, just introduce yourself. Tell us where you went to dental school, what you're doing now, where you're practicing at, and we can just go from there.

Victor Razi:

Oh yeah.

Juan Gonzalez:

I'm Juan Gonzalez, and I live in New Braunfels, Texas, which is about a half hour northwest of San Antonio and about an hour south of Austin. And I've been in Texas now for 25 I graduated from dental school in the University of Puerto Rico in 1998.

Victor Razi:

Oh wow.

Juan Gonzalez:

From 98 till 99, I did a one year GPR residency. after that I wanted to do a oral maxillofacial surgery, but only pick one resident in Puerto Rico it was a very good training program, but it was also very political. And so I I ended up not into oral surgery

Victor Razi:

Right.

Juan Gonzalez:

and I decided at that point to look at other options. So

Victor Razi:

Right.

Juan Gonzalez:

that there was was an oral surgery resident because their residency was so good with trauma that they had residents from the army. Rotate through, Through, through the program. So that's when I decided, you know what? I'm gonna give it a chance. So I contacted the Air Force and they had a pick at that point. They only had two positions for all surgeons. And then I contacted the army and they had seven positions. So I decided to go with the odds

Victor Razi:

Yeah.

Juan Gonzalez:

I joined the army.

Saad Alamgir:

Wow.

Juan Gonzalez:

when I joined the army, I missed the deadline to apply. And after missing that deadline, I had to wait a year to apply. Then I applied and I get

Victor Razi:

I see. I

Juan Gonzalez:

I had to wait another year to start. And at that time I was with a unit that was called a forward support battalion. So I was a dentist. I had a mobile clinic and gave support. To the tanks, to the tank battalion. So we are in the back medical dental x ray. And while they're fighting miles in front of us, we give support to the troops with dental. And I was supposed to deploy to Iraq, but the commander of the company said, Hey, you're doing residency. Go to a residency. We'll replace you with another

Victor Razi:

Another one. Yeah.

Juan Gonzalez:

that's, Started residency with the army in 2002 and finished in 2006. Then

Victor Razi:

Wow.

Juan Gonzalez:

I went to Fort Hood, Texas, where I Years there, and I was a chief of oral surgery for the Fort Hood, Texas clinic.

Saad Alamgir:

Mhm,

Juan Gonzalez:

under me,

Victor Razi:

Nice.

Juan Gonzalez:

Really good friends. I did a lot of trauma. I did a lot of wisdom teeth, a little bit of everything while in residency. Then was getting ready to get out of the arm in 2011, I started working a few years before that moonlighting a private practice in Austin. And that private practice, it was doing mostly thermal or singular implants mostly dental viola. Then

Saad Alamgir:

Mhm,

Juan Gonzalez:

do orthognathic cases and I was then doing, I started doing trauma at a level one trauma center at Austin Brackenridge hospital,

Victor Razi:

Okay.

Juan Gonzalez:

Being on call and I did that for a few years. And after I got out of the army for two years, I was just doing private practice I decided, you know what, I don't want to lose all those 12 years I did in the army.

Victor Razi:

Right.

Juan Gonzalez:

So I joined the Air Force Reserves and in the Air Force Reserves, was assigned to a unit in to squadron in San Antonio,

Victor Razi:

I see.

Juan Gonzalez:

and I would drive Austin to San Antonio one week in a month. I'm there, I wouldn't do anything related to, even though that my job was a oral maxillofacial surgeon,

Victor Razi:

Right.

Juan Gonzalez:

that's the job if I get deployed. So I was in

Saad Alamgir:

Let me see

Juan Gonzalez:

one point of five physicians, because I was the most senior.

Victor Razi:

Yeah.

Juan Gonzalez:

I had two pediatric doctors, two pediatricians, two OB doctors internal medicine doctors. So I was in charge at one point of five physicians, two pediatricians, two internal medicine doctors, two internal medicine doctors. And two ER physicians. So I did that for a while. And then I finished my 20 total years. 12 years active duty army. 8 years Air Force Reserves. And and I retired from that. some time in there is where I started my full art journey, which is a, another story of its own.

Victor Razi:

Yeah. Damn, dude. That's that's a crazy way I'm sure you didn't even have it drawn up like that in the beginning because it sounds like you just ended up in like random like routes to where you got to like today,

Juan Gonzalez:

You never know you start a journey. You never know where he's going to take you, especially if you follow the path that is laid in front of you and continue to follow it. And I've been lucky enough that I've had a good path that I've been following and,

Victor Razi:

right,

Juan Gonzalez:

but. It could have been different if I would have been accepted in Puerto Rico, I could probably still be living in Puerto Rico doing a surgery, nothing wrong with

Victor Razi:

sure,

Juan Gonzalez:

I would have gone and done all the things that I've done so far,

Victor Razi:

right,

Saad Alamgir:

Yeah,

Juan Gonzalez:

After the military and especially with this full arch, the journey has been even more incredible. And I'm enjoying it. I'm having fun

Victor Razi:

right,

Juan Gonzalez:

traveling. Did I lose you?

Victor Razi:

we're good.

Saad Alamgir:

Okay, we're back now, yeah.

Juan Gonzalez:

Yeah. I'm not friends with technology. So yeah, so I, I practice all the different Parts of of oral surgery and oral surgery. And when you're a resident, basically are also a teacher because In the first year, you're learning from your second, third, and fourth year on Year, you're learning from your third and fourth year and you're teaching the first one. So it goes like that every year until when you're the chief, you're doing most of the teaching and then you have your your staff to assist you. But by then you're. pretty much are good to go almost on your own with the staff barely supervising if you've done your job their job is just to make sure you stay safe and they they trust you. Most oral surgeons almost all oral surgeons are just do teaching. So I never thought I would be involved with teaching, but while I was in the air force every summer I would do my two weeks, I would do it with the army and air force residents in teaching them different things. Then Getting to the full arch, they were very behind in the full arch, especially with regular full arch and then remote techniques.

Victor Razi:

Right. Right, right, right, right.

Juan Gonzalez:

almost none. I don't know, this probably was somewhere around 10 years ago. one day through a friend of mine, because this is a long story, but through a friend of mine somebody reached out to help open a Full Arch practice in San Antonio. And at that time I had an oral surgery practice in San Antonio with another surgeon partner, and we were practicing. Planning on closing it because we both had jobs part time on the side and we're doing great and that clinic was not really like doing that. Great. So when these doctor, which is Dan hospital

Saad Alamgir:

Mhm

Juan Gonzalez:

to expand to San Antonio. So we started working in that office in San Antonio and after about a year. We ended up closing it and there were so many issues there. The other oral surgery partner left the manager got diagnosed with cancer. So we ended up at one point closing it, but before that happened, we were doing a lot of full arch and we're

Saad Alamgir:

Mhm,

Juan Gonzalez:

implants, whatever the bone was. Combining an oral surgeon and a periodontist, it's it's a good recipe. So I went and I took a two day course on, on zygomatic implants. And then I came back and started doing zygos and then figuring things out and modifying the techniques. Cause I took a course on intrasinus, but I started changing it to extrasinus. I'm modifying technique and adding things and I'm proving it. And then one day I was in the clinic and at that time Dan was not doing Zygus. So he was watching and I showed him a lot about Zygus. And then one day he shows up at the clinic and says, Hey, check this out. It's called Terry Good Implant. So

Saad Alamgir:

Mhm.

Juan Gonzalez:

Terry go to the implants. And frankly, at that time, we were not really sure what we were doing. But then we figure experience, we figure things out and perfected the technique. So we combine everything. And then after closing that, that office, then Dan and I concentrated on the, Round Rock office. And one day I tell him, Hey Dan I've noticed this pattern that I always follow, just starting in the back, then to the front and then to the middle. He had already published a FAST,

Saad Alamgir:

Right?

Juan Gonzalez:

already. And I was Let's find a name for this. And he's well, what about Zippy? I'm like, I don't know about that. We're trying to figure out a a name and then I was given a course and gonna give one of the first courses because frankly for the first two years I refuse to teach because I at that time I believe, General dentists probably shouldn't be doing this zygomatic or anterioids and all

Saad Alamgir:

right?

Juan Gonzalez:

But of course over time I, I changed my mind because I worked with many talented general dentists that do really good work. So then I decided, okay, I'm going to start teaching because who better? Now if I don't teach them, it's

Victor Razi:

Someone else.

Juan Gonzalez:

The blind leading the blind or

Victor Razi:

fair.

Juan Gonzalez:

to learn from a surgeon. So I on that first course, night before I was finishing the press presentation at the bar in the hotel, then he was right in front of me, pterygoid, anterior, Implants, And that's where the name came from. And it's an easy name to remember.

Victor Razi:

Right.

Juan Gonzalez:

it works, after that I started promoting it into social media and started catching up, more people started and then at that point before that or at that point, somewhere around there there was a rep from an implant company specifically at Neodent Casey. So Casey one day was in the clinic and she said, how come you're not in social media? And I said, because I don't like social media. Yeah.

Victor Razi:

Right.

Juan Gonzalez:

And she's well, you should be in social media. I'm like, why? And she's because you do good work. And I'm like, so what? Many people do good work. And You do really good work and you should be in social media. And I'm like,

Victor Razi:

That's it.

Juan Gonzalez:

you going to manage it? Are you going to manage it for me? And she's no, you have to do it on your own. As you guys figure out earlier, when I was trying to set up

Victor Razi:

Yeah.

Juan Gonzalez:

and kind of, Technology retarded. And that happens as you get

Victor Razi:

Yeah.

Juan Gonzalez:

to you

Victor Razi:

Not your forte.

Saad Alamgir:

Yeah.

Juan Gonzalez:

once your kids turn into teenagers you realize, oh crap, I don't know how to do any of this

Saad Alamgir:

You're really behind. Yeah.

Juan Gonzalez:

Figuring out, the social media thing and posting stuff pretty much like everybody did.

Victor Razi:

Right.

Juan Gonzalez:

then as I figure things out, I was like, you know what? don't want to use my social media to promote myself and I don't want to use my social media for the public. So that's when I started my Skoll collection.

Victor Razi:

I've noticed that.

Juan Gonzalez:

Yeah, so when I started the Skull Collection, nobody was posting everything. Posting the 3D view from the front. Then, on the rest of the post, I would put lateral pictures. I would put the prosthesis.

Victor Razi:

The whole

Juan Gonzalez:

I

Victor Razi:

case.

Juan Gonzalez:

before, after, I will put the combium CT, coronal, and asthma abuse, everything. I started putting everything in it, which

Saad Alamgir:

Right?

Juan Gonzalez:

because everybody wants to show only the good. So I was showing the bad

Victor Razi:

So this is every case was just, you were going to put it.

Juan Gonzalez:

Every case, Was doing it myself. I would stay after the clinic, get the postop ct, get the clinic. I took the pictures with my phone. I took pictures of the screens. I edited everything myself. And I started posting that on a little narrative. So that started, taking off and then that's when people started reaching out a can I come and hang out?

Victor Razi:

Yeah.

Juan Gonzalez:

sure. then more people, dozens of people came from all over the place, mostly the U. S., a few international. And I would say, yeah, I never charged a penny to any of them. to come in and hang out and usually they would watch a couple of days of surgery and many people that did this, many good friends now that I have too many to to list, but among them, Stephen Nelson and Buelow and David Buelow. They came early Watch and then it's awesome because you can see when you have somebody like Steven Nelson and below that are very talented surgeons

Victor Razi:

Right.

Juan Gonzalez:

you see what two days, just two days of over the shoulder, you can go back to their to their Instagram and you can find exactly the point where they yeah, where they came to the clinic and learn Patsy and

Victor Razi:

Yeah.

Juan Gonzalez:

the practice,

Victor Razi:

So you noticed

Juan Gonzalez:

changed.

Victor Razi:

Yeah.

Juan Gonzalez:

Yeah, and many other people like that that come over the years, actually, it would cost me money every time somebody would

Victor Razi:

Yeah. Your time.

Juan Gonzalez:

I no, my time. I always treated them with something unique is and it's that. A lot of these people had never shot a gun in their

Victor Razi:

Yeah.

Juan Gonzalez:

I would take them,

Saad Alamgir:

show'em the Texas experience.

Juan Gonzalez:

yeah, well, I would take them to a range that I ended up getting a VIP membership at that range. So I have access to the upstairs. It looks like a country club.

Victor Razi:

Yeah.

Juan Gonzalez:

I would take

Saad Alamgir:

Wow.

Juan Gonzalez:

to shoot machine guns. And

Victor Razi:

Full arch full auto.

Juan Gonzalez:

Yeah, so you'll have people that have never shot a gun in their life and they're suddenly shooting five, six different machine

Victor Razi:

Yeah.

Juan Gonzalez:

and machine guns are hungry. They like ammo and they go through ammo. I'll buy all the ammo. So every one that came that I would. Two

Victor Razi:

Right. Yeah. Yeah. Yeah. Right.

Juan Gonzalez:

Never forget once you shoot a machine gun for the first time. And that's where full arches, full auto came from I was there one day and I was thinking, why I would like to do a course here. It's, and I'm going to name it full arches, full auto. What started as a, maybe as a joke, and then as an idea, now it's a course that we're doing twice a year. And we have one coming in March, and this is the first one we're going to do with cadaver. So Simon O comes, and then we have also Appearances from other people like Tyler Rushing is going to be in this one. Sven Bone. So we we are making the course, we're growing the course and making it bigger and better. And that, that, that's how that, ended up. Yeah, so social media took off and then from there, more opportunities to teach, I I teach currently I teach with Raj chef at AOX Academy in Arizona. We do

Saad Alamgir:

Right?

Juan Gonzalez:

Of times a year, cadaver courses too. I teach also, Hey Full Artists, Full Auto. I teach with Adam Hogan at the Atlantic Institute.

Victor Razi:

For

Juan Gonzalez:

I was doing with Clark Damon great guy, great course too in, in

Saad Alamgir:

Texas.

Victor Razi:

sure. I've

Juan Gonzalez:

Institute, Are most of the courses that I do here. I also Ways of the Arches with the Marquez brother, Nestor. That's, there's a, an amazing

Victor Razi:

seen that one.

Juan Gonzalez:

Oh, crazy experience. Amazing course. I highly recommend it too.

Victor Razi:

Okay.

Juan Gonzalez:

International courses here and there. With Dr. Christo in Australia, we're doing a cadaver didactic model cadaver course. I have an upcoming course in July in Brazil. And of The main one that, that you're wearing the hat. Yeah. And it's,

Victor Razi:

I'd have wear it for you, man. It was for you.

Juan Gonzalez:

Orca is just that's that's something that we're very proud of. And that's

Victor Razi:

As you should be.

Juan Gonzalez:

proud of. I'm going to be biased, but it's the best advance and well, not just advanced, cause we have different levels of course my opinion in the world is the, it's just an experience. The symposium was just a little, taste of that experience. And it's like nobody, none of us are there for the money. We're all there to advance. Yeah, it's expensive. Yeah, it's a cost, but you guys have no idea what it takes to run, to be almost a week in Guatemala

Victor Razi:

Yeah.

Juan Gonzalez:

50 close arches and each person That that comes is there are people that cannot afford this course.

Saad Alamgir:

Right?

Juan Gonzalez:

This treatment. So not only do they get treatment, but they get treatment with respect. They get treated like a person. Not an

Saad Alamgir:

Right?

Juan Gonzalez:

I've seen in other courses in other countries. The One at ORCA, patient is number one. Number Course, the teaching, no unnecessary treatment, only what the patient needs. If they don't need a zygote, they don't get a zygote. And every single one of them gets restored. They get a temporary restoration the next day and through the support of the university, they get a final once they have healed a few months later, they start a process and they get a final zirconia final. And that's finished by the local residents. We have the support of the implantology department. Department Prosto Prost department there. So the amount of people involved with this, there's like several hundred people. They the university there UFM.

Saad Alamgir:

Mhm.

Juan Gonzalez:

Universidad Francisco Marroquín is like the facilities are amazing. Better than probably like 99 percent of the schools in the United States. The

Saad Alamgir:

Mhm.

Juan Gonzalez:

there and the support of the faculty, the dean, everybody, Dean Mata, Rodrigo, the head of implantology, and so many people there that help us and the residents. It's just amazing. Something that I encourage everyone to go

Saad Alamgir:

Mhm.

Juan Gonzalez:

server there as an observer is a good price. You get food, you get a 50 plus C credits. You can see a lot of surgeries. There's a lot of networking too, and we have so many people that come in as an observer.

Victor Razi:

Right.

Juan Gonzalez:

And then

Saad Alamgir:

Mhm.

Juan Gonzalez:

they end up coming back as a participant to do either level two, which is basic full arch

Saad Alamgir:

Mhm.

Juan Gonzalez:

mandibular with an introduction to pterygoids

Saad Alamgir:

Mhm.

Juan Gonzalez:

Level three is full arch anchorage and atrophic

Victor Razi:

I see.

Juan Gonzalez:

and that's pterygoids, zygos, quads, transnasal,

Victor Razi:

The Shebam.

Juan Gonzalez:

and sinus,

Saad Alamgir:

Yeah.

Juan Gonzalez:

whatever the patient needs. And we obviously follow Patsy. Then the other thing about Orca is the staff. It's not always the same staff. It's not always me teaching. It's not always Simon teaching. We bring a world class. And when I say we're class, we invite people from all over the world to come, some of them because they have their own courses. And I understand that it would be completely different. They,

Victor Razi:

Right. No, it's still come. Nice.

Juan Gonzalez:

They don't want to come to a course that might money away from their courses, but the ones that are more committed with teaching, they will come for these yeah, for March for March, for February, which is in a

Saad Alamgir:

Mhm.

Juan Gonzalez:

of weeks. Of course

Saad Alamgir:

Right.

Juan Gonzalez:

have for level three, we have David Zelig

Saad Alamgir:

Mhm.

Juan Gonzalez:

He's an amazing surgeon. He's already come to about, three no, this is going to be his third Zach Brown, which

Saad Alamgir:

Mhm.

Juan Gonzalez:

surgeon. This is going to be second, We have, of course, Simon, all we have me and I'm bringing also internationally from Brazil, an excellent young surgeon. his name, Marcelo Zamperlini and a very nice guy. No egos. We

Victor Razi:

Yeah.

Juan Gonzalez:

Instagram and really good surgeon because when you get exposed. To multiple surgeons from multiple places. You learn different techniques because we all don't do everything the same.

Saad Alamgir:

Mhm. Mhm.

Juan Gonzalez:

We're bringing also an excellent lineup to from Virginia area Charestra Pirellia, very knowledgeable and talented surgeon. And you need to understand all these level two. They can all teach level three also. So just because they're level two, it doesn't mean that they're less of a Sergio. No,

Victor Razi:

Right.

Juan Gonzalez:

they're all do all day long. Suresh from Pirelia, we'll get Sam Jiric. Sam Jiric is a very knowledgeable. He's been doing this for, before you guys were born. And And he's going to do a demo surgery on superior osteo, mandibular superior

Saad Alamgir:

wow. Yeah.

Victor Razi:

Nice. Yeah.

Juan Gonzalez:

and Samer is in the Chicago area. He's a young guy, a beast doing a full arch, very knowledgeable.

Saad Alamgir:

Mhm.

Juan Gonzalez:

his own courses. And very good surgeon. We also have Panos. Panos, and I cannot say his last name because it's Greek and it's difficult to say surgeon period honest. I've been he's been following me for years I've been seeing his work and He actually reached out And told me that he was interested in teaching and I saw his work. I said absolutely You can come and then we're gonna also have On this one, the first alumni from ORCA, from the first ORCA that she was a participant on the first ORCA that we had. So she's going to be the first alumni that come back to teach.

Saad Alamgir:

awesome.

Juan Gonzalez:

Yeah, this is a Melanie toe. She is honest in Maryland and like she quads and it's so rewarding watching somebody like that is You have been since I started doing remote Anchorage, then you see them progress. And it's funny because on that first Orca, she said, Hey Juan, I don't know how you like teaching because I would never like, I don't think I would like it.

Victor Razi:

Yeah.

Juan Gonzalez:

And she came on the last Orca. As just as an alternate, because what I do is I will invite sometimes people as alternates just to come hang out, but while they're there, I will ask them to help and

Saad Alamgir:

Mhm.

Juan Gonzalez:

is I'm waiting their capabilities to teach and if I see that they have good capabilities to teach and teaching, then I'll invite them back to teach

Saad Alamgir:

One, for the listeners who are still here, you could tell that one is in every, if you heard of all on X or any type of implant surgery, that one is on the forefront of it. So one kudos to you for doing all the courses that you

Victor Razi:

Yeah.

Saad Alamgir:

doing everything that the full arch community. It means a lot knowing that the future of full arch is in good hands, such as yourselves and. They're getting the best education. And like you said, there's no competition.

Juan Gonzalez:

future of Full Arch is you guys, it's who knows 20 years from now, 20 years from now, somebody might look at all the work that we're doing and be like, what the hell were these guys thinking? These idiots. Yes. Don't know. But

Victor Razi:

Yeah.

Juan Gonzalez:

far

Victor Razi:

It's Perfect.

Juan Gonzalez:

we're having good long term results. We're seeing people are 10, 20 years out. I had a patient that came. she had a mandibular all in five. And I asked her when she had that done. She said 46 years ago. So

Saad Alamgir:

Wow.

Juan Gonzalez:

she had all in five before all in four even existed.

Victor Razi:

insane.

Juan Gonzalez:

So you don't know. And in the teaching, it's no good if you learn how to do something or you come up with something and you don't share it.

Victor Razi:

Makes sense

Juan Gonzalez:

because years ago, yeah, years ago, one of the ways that this started was when I was doing surgeries in Austin, there were people that would come from all over the U. S. to get surgery there with us. I frankly didn't like that. I was in my head this is not good. If the patient, when the patient goes home, if they have a complication or problem, I'm not going to be there

Victor Razi:

to help them.

Juan Gonzalez:

My vision was to get involved where and teach at that point where. At least every city in the whole U. S. and eventually pretty much in the world, people could do what we were doing, And if we could teach that and spread, then people wouldn't have to go and travel. To get the treatment that they deserve.

Saad Alamgir:

So one I have a question about that. So you've mentioned all on five, all on X for the, those are the listeners who aren't familiar with that as I'm sure some of our listeners are could you explain the difference between all on four and all on X and how Patsy just goes into that whole protocol?

Juan Gonzalez:

Yeah. So all four is a technique as described by poly molo where you have people that have either, they're either a dentals or have a terminal dentician. and then you placed four implants in the mat. Seal have four implants in the mandible, and then they have restoration that's screwed in. And that's your traditional all on four, then

Saad Alamgir:

Right. Yeah. Right.

Juan Gonzalez:

on four, because we don't know all on ads could be all on six at the top and all on four, all on five or all on six all on eight, in some cases, like when you do an FP one, normally you put more implants. It's just a term that encompasses all those different techniques. Then Patsy is just a way, Patsy also evolves as described before. And it would be, We don't have enough time to go through the whole Patsy protocol here. It's more complex than just pterygoid anterior tilted zygomatic.

Victor Razi:

Yeah.

Juan Gonzalez:

that's in, in the protocol, it's described all the different options that you have in the posterior. You can also think of it like posterior, anterior, and middle. And it's just all the different techniques to put posterior implants, anterior implants, middle implants, but it's a way for you if you do it and follow it and you know all the techniques and of course that's a caveat, you have to master all the techniques. If you master, there's almost no case that you can do. It's just a protocol,

Saad Alamgir:

Yeah. Right. Yeah. I've I was reading the paper that Dr. Sammy and you and Holtzclaw made over the Patsy protocol and it makes sense. It's just step by step you go through what works and what doesn't work and their case. For those of you listening, if y'all want to just look at Patsy protocol, Y'all can find this paper and it's really easy to follow along and they have different cases of different patients who they had and just the mind the reasoning that they went through to place those implants. Even for someone who still is yet to get into clinic, it was relatively easy to follow along. Yeah, for those of you listening, y'all should definitely at least check it out to see what Dr Gonzalez means.

Juan Gonzalez:

Yeah. And I hate classifications and Sammy, I love you, Thank you for writing it, but because I am, I'm really lazy with writing. I come up with stuff and then, I will discuss it with other people and, they, they write it. Don't. Concentrate that much on PA, P one, P two, everything. No, just use the p like In the courses, use the P as posterior or tego and then the A for And there's like a ton of different techniques for anterior implants.

Victor Razi:

Right.

Juan Gonzalez:

Same thing with the t for the tilted, there's a of different techniques for tilted implants. Lastly if everything else fails then. go to the zygoma and so many different ways of placing zygomatic implants. That's why I have a slide

Saad Alamgir:

Right?

Juan Gonzalez:

to show with four properly placed in different where you had the platforms as far anterior as the lateral, which I've Platform as far into as the midline as I did in

Saad Alamgir:

Wow.

Juan Gonzalez:

at a cleft and it could be as far posterior as the third molar position and anywhere in between.

Victor Razi:

I see one. So to change the pace here a little bit, I know your background is very surgical and full arch. The surgery is a major component. And then the process is the major component. How are you able to like, At least, get into that arena of learning at least the foundations of PROS to even get started because that's a new thing and that's the future of full arch, you know,

Juan Gonzalez:

That's a very good question and I'm glad that you asked that question. So I went into surgery because I didn't like pruss.

Victor Razi:

ironically.

Saad Alamgir:

Look at you now.

Juan Gonzalez:

Then when I started doing orthognathic surgery, guess what? When we're doing orthognathic surgery, you got to learn all the basic and more advanced principles of PROS because you have to Of like work to put the occlusion the AP, Medial, no can'ts, and the lip, Lip and repose, full smile, and all that. So not only do you have to learn and know all the aesthetics, because unlike with full arch, where you can print another maxillary prosthesis, once I place a It heals, that maxilla is in position, that's it, I cannot move it. And I can change it. Not only do you have to learn all those aesthetic principles of PROS, but also, back then, now everything has changed with digital, I had to go to the lab. had to use a facebook. I had to mount that. I had to mount it on the articulator. Then after mounting it on the articulator, I had to mark the lines

Saad Alamgir:

Right?

Juan Gonzalez:

I had to decide the moves. If it was going to be an advanced rotation, can't fits in a can't. And those parts, sometimes it had to be a multi piece left forward. So I had to do all these moves the model, on the stone model, cut the stone model, fixated with wads, doing all this stuff, I had to do an intermediate splint and a final splint with acrylic.

Saad Alamgir:

That's insane.

Juan Gonzalez:

It was hours in the lab

Victor Razi:

Yeah.

Juan Gonzalez:

Stuff, and it's a skill that unfortunately is going to be lost because now with VSP, with vertical with virtual surgical planning, I, last orthognathic cases that I did, I pretty much planned them while driving and looking at my phone.

Saad Alamgir:

Oh my gosh.

Juan Gonzalez:

Telling the person, yeah, move it this, move it like that, whatever, and then they make it explains everything and

Victor Razi:

Yeah.

Juan Gonzalez:

to the mail.

Victor Razi:

That's awesome though. It's that convenient now.

Juan Gonzalez:

was teaching residents in oral surgeon, I would definitely 100 percent encourage them to do the first four or five, six cases. So I applied all these concepts. When I started work doing full arch, I applied all these concepts to it. Only thing that I had to learn what was MUAs and positioning the MUAs, but

Saad Alamgir:

Right?

Juan Gonzalez:

recommend that any surgeon, being an oral surgeon, periodontist, GP, or whatever, prostodontist. endodontist these days. If you're going to get into the full arch start with the PROS, because the PROS is what guides. I always Implants without a prosthesis are just screws in the bone. So learn the PROS first. When Sammy to work with us, I, and we were using digital we had also a restorative dentist,

Victor Razi:

Right.

Juan Gonzalez:

That was the PROS. challenged him to I said, Hey, the first about like 10 cases, I'll And you do your own pickups. for the next over a year, every single case he did his pickups and until we went fully digital, then he stopped doing it. But for over a year, and you know what, it teaches you how to, Place your implants better, how to angle those multi units, how to be a better a host, thinner prosthesis, and, it Surgeon.

Victor Razi:

Sounds like it's definitely worth it. Right. Right. Right.

Saad Alamgir:

into more digital dentistry is a good thing, or is it. Good to learn analog and it's almost becoming like a lost skill in today's world. Right.

Juan Gonzalez:

Surgeon. It's going to help you learn the basics better, and there's still a ton of providers out there that are doing analog, and some can do the analog faster that most digital. And let's say that they suddenly You'll have a prosthesis and your printer broke or your scanner broke or something broke. You can always go back to the analog and doing it. But over time, yeah, it's to continue to get to be lost. But it's a good foundation because just like with orthognathic surgery, it makes you understand. The moves better. And the statics and tooth show on the midlines, the can, the occlusion, everything.

Saad Alamgir:

Yeah. One we and you were able to talk at Orca for a little bit and I don't know if you remember this conversation, but we were talking about,

Juan Gonzalez:

I don't remember much from Orca.

Saad Alamgir:

But we were talking about how oral surgery residencies need to have, or you were mentioned how oral surgery residencies need to have a bit more. Full arch emphasis on it on their training. Do you still see that as in residencies today?

Juan Gonzalez:

It is a problem because in I like to say this, this is a half joke, but basically I like to say that periodontists took implants from oral surgeons because at the beginning, all surgeons were the only ones doing implants,

Saad Alamgir:

Right.

Juan Gonzalez:

Periodontists step in because in oral surgery, concentrate doing so many of the bigger procedures, the orthognathic surgeries, the trauma, the joints, medical rotations that we do, the, all the cosmetic procedures and then they concentrate on all this stuff that they don't spend enough time in building basic skills, especially with implantology. So you would have this oral surgeon that graduates from school and that you had the general dentist. I'm talking about years ago. And to this day and it happened to me, where the general dentist will refer a single implant and the oral surgeon will place it where the bone is and it wasn't restorable. So

Saad Alamgir:

Wow. Yeah.

Juan Gonzalez:

this kind of stepped in and started paying more attention and doing the implants better and they took over and likewise same thing with full arch. Once this side of the GP started referring full arches and the cases came back on restorable, they were like, you know what? Yeah. We'll just go. Learn how to do it myself.

Saad Alamgir:

Right.

Juan Gonzalez:

And basically, so I, frankly I've worked with many and many of my courses. I work with many GPs, oral surgeons, I can teach the surgical part to an oral surgeon easy. And I have no issues, probably like most of the oral surgeons only need to watch me do a few cases and they get it, that switch that switch changes, but it's the cross part, it's the prosthetic

Saad Alamgir:

Right.

Juan Gonzalez:

That it's, they need to learn more to be

Victor Razi:

Right.

Juan Gonzalez:

Same thing with GPs, usually GPs, they get the PROS part, they have the PROS part, but then they have a lot of deficiencies in the surgical part because it's there's a reason why we do four years of surgery,

Victor Razi:

Makes sense.

Juan Gonzalez:

you cannot, Sir, all these advanced surgery in just a couple of weekends. So that's why you see that most GPs will take, start. And this is why I recommend to start, with the pros. Once you had the pros and single implants, learn how to play single implants. Once you place a good amount, which is different for everyone of single Plants didn't take a basic full arch course, all on four course, like the many available like Adam Hogan and Clark Damon Rudsheth, there's plenty out there, Orca, once you understand the concepts of full arch. Then you're going to start running into cases that don't have enough bone or the bone is too

Saad Alamgir:

Right.

Juan Gonzalez:

or revisions. Revisions is going to be a big, and that's something that to mention earlier that at Orca, we don't only have level two and level three, but we also have a really good process. prosthetic course headed by Adam Hogan. So they are

Saad Alamgir:

Yeah.

Juan Gonzalez:

so this is how important the process that everybody concentrates on the surgery, but Adam and his LDAD and his team, they arrive usually a couple of days. Because before the surgical team and they're scanning all these patients, getting all the pictures and getting everything ready. Then we come do the surgery and they're the last ones out because they're the ones that after we're done with the surgeries, they're scanning and then their whole team is in the lab designing, printing. So they probably have the hardest job

Saad Alamgir:

Yeah. Definitely.

Juan Gonzalez:

Surgeons always get the credit and the surgeons always get the attention, but the PROS team, they're the unsung heroes there. They spend a lot of time. So once you do that, then I recommend doing didactic cadaver models courses, and then progress at your own pace. Everybody's different. I have people, I had Jason, I forgot Jason's last name, Jason, sorry, from Florida. He came years ago. He only wanted to learn Terry Goods. He watched me do Terry Goods for two days, and then he goes back, and he's I get it. I get it. I'm like, OK. And he keeps saying, I get it. I get it. And I'm like, OK, Forrest Gump,

Victor Razi:

Right.

Juan Gonzalez:

you know, and he comes, he goes back and he just starts sending me pictures after pictures, nailing those Terry goods. So some people can learn just by, by watching some other people just have to learn. There's people that they learn six months ago, a year ago, and they still struggle with their, with the Terry

Victor Razi:

Sure.

Juan Gonzalez:

So it's a process and then just just put the time and Like I said, everybody has a different ways of learning. Then there's a lot of people too that do in office training. I do of course, because I'm, if I go to your office and you don't even have a CT and I asked you for an implant, you don't have an implant. We're going to have a problem. So I do a very limited, but in office where you put your time, you've done all the studying, you're doing the courses. Now you're at your office and you had the first Zygo case and your first quad case, and you're unsure. And you contact me, Hey Juan, Hey, can you come here and help me? And I'm like, sure. But book like two or three cases so you can make it worthwhile

Saad Alamgir:

Stay busy.

Victor Razi:

Right.

Juan Gonzalez:

If you're paying me to go there, I don't want you to pay me just to do one case. I want you to do multiple cases.

Saad Alamgir:

Just see the different types of complications.

Juan Gonzalez:

you can get the most out of it. And

Victor Razi:

Yeah. I

Juan Gonzalez:

other thing is I all the people that we, whether it's any of the courses that I'm involved I'm like in so many different groups on WhatsApp. But, and people, you guys are proof. How do you get to Orca Symposium to tell your testimony?

Victor Razi:

saw it.

Saad Alamgir:

Man, I I just reached out to one here, texted him saying, I'm a broke dental student.

Juan Gonzalez:

before you're aware, you didn't even have my phone number,

Saad Alamgir:

Yeah, no I, sorry. I DMed him on Instagram saying I'm a poor dental student and I'm really interested in all on X and he gave me his number. We got on a call. He let us come for free. We wouldn't be, yeah, we wouldn't be having this conversation without, you

Victor Razi:

Yeah, man.

Juan Gonzalez:

and I'm, and that's you, who I didn't even know who the hell you were, but A lot of the people, all the people that are in these groups that go to any of the courses it's it just creates a group multiple groups where you have people supporting you When you have a question, when you have a problem, when you have a complication, that there's just a very big support and a big community that you're joining that we, just like I asked answer, when you send that message, you have this big support community that will help you with whatever, whether it be, Oh, what do you think about this new scanner that's on the market? Well, guess what? We've all used it or there's somebody has used You their opinion.

Victor Razi:

Right. Juan, what's your take on the digital guides for implants?

Juan Gonzalez:

They have their place. Everything has their place. If I were doing, I'm not doing many single implants, but if I was doing single implants, I would definitely use guides

Victor Razi:

Let's see.

Juan Gonzalez:

because a single, everybody concentrates on full arch and they look at full arch and full arch gets all the attention. But to me, full arch is easy. A single implant is hard. Okay. Full arch, okay. So I place usually four to six implants in a med seal and four to six in a mandible. I have all this canvas, I have all this area and all these techniques that I can use to replace it. You place a single implant, let's say you place a single anterior

Victor Razi:

Right.

Juan Gonzalez:

and that implant you don't place it properly, or you don't have good soft tissue. or it fails. Now you're back to less than zero, because now you had to build that area. You had to soft tissue, a soft tissue defect, a bone defect. Single implants are not easy.

Victor Razi:

I've heard.

Juan Gonzalez:

So to make it a little bit easier, I would use a guide. So for full arch using guides I think it's something that for the person, for the novice that's starting. something that might help them understand angulation. It might help them understand positioning of the implants and as get better and prove they're like, okay, I don't need, it's like training wheels. You start with training wheels in your bike until you get better and then you don't need the training wheels. Lie on them for every single case. I think it gives you a false sense of security because. You run into an issue during the place, the case now you don't know how to solve it on your own. And I think that most people that start with guides. Eventually transition to to free hand. Now, there's new technologies like EdSnap and Yomi and all that stuff. I'm not opposed to those, to any of those technologies. They all have their

Victor Razi:

Right. Right.

Juan Gonzalez:

other technology, when you are an early adopter. It's a good thing and a bad thing. It's a bad thing because you're usually to go into a very high cost on somebody, something that's still basically in development and you're Develop men but then it's like right now, inaccuracy, of course, they're going to be more accurate than anything, but they also raise the cost in the time

Victor Razi:

So you gotta account for that as well.

Juan Gonzalez:

yeah. Yeah. And you had to put the fiducial, you have to screw these monitors and things. So until all that Improves and gets. probably going to continue free handing. I even I encourage some people to do a Juan versus Yomi, do a couple of cases and see, but that was more of as a

Victor Razi:

Yeah.

Juan Gonzalez:

fun promotion, but yeah, it's

Victor Razi:

Nice. Yeah.

Juan Gonzalez:

that came out, the roadster, it wasn't that good. And then look at now we're.

Victor Razi:

Yeah. It's getting pretty far. It's like it's almost there where it's just doing crazy things.

Juan Gonzalez:

to take a little bit more time, for me to retire,

Victor Razi:

Yeah. Yeah.

Juan Gonzalez:

but younger people like

Victor Razi:

Yeah,

Juan Gonzalez:

there's going to be a point where it's all going to be AI and robots.

Victor Razi:

to be pretty crazy. We talked a lot about your story one and honestly, it's pretty crazy road to get to where you were today. So out of curiosity, I know you're a busy man, so you take it day by day with everything that comes at you. Do you have any five to 10 year goals of what you want to accomplish slash serve in the full arch community?

Juan Gonzalez:

Well, I just want to continue with the balance. I've been lucky that for the last, about, Seven years. I've only worked part time two to three days a week because something I've not owned an office, so there's pros and cons of owning an office. So if you own an office, it's great because you're building something. But also the other thing is, and this happens a lot when I go to friends offices and I go to their offices, they have a great office, wonderful office. And we'd like about 20. Employees and the way I see that I'm like that. That's a big burden to have on you you understand that you have at least 20 people that depend on you. So it's not just you, it's all these families that depend on you. Lot of people become a slave of their practices, but once you build that practice and you bring associates and partners or things, then it allows you to start stepping back and having time. Well, I didn't have the luxury of doing that because I was in the military. So that

Saad Alamgir:

Yeah.

Juan Gonzalez:

there that I couldn't build a business. Then when I started building it, it was late. it didn't go as planned or as well. after that, I just been working contract and I, I work as little or as much as I want. I just would love to continue doing what I'm

Victor Razi:

Yeah.

Juan Gonzalez:

where I can

Saad Alamgir:

Right.

Juan Gonzalez:

can go teach, and then I can do one or two days a week where I have my own patients that I can take care of And continue travel and then. Continue doing the stuff I like to do, like spending time with family, traveling with family, flying, and yeah, five year goal is continue what I'm

Victor Razi:

Yeah,

Juan Gonzalez:

10 year, 10 year goal, hopefully just go to where I do this only like a couple of days a week.

Victor Razi:

sure.

Juan Gonzalez:

Just to busy.'cause if you retire you die. So you have to stay busy. I take it day by day. Think about the future, take it day by day. And Remember a lot of people concentrate on money. Money is not everything,

Victor Razi:

I agree

Juan Gonzalez:

I, if I work five, six days a week, I could make a lot more money. But one of the people that influenced me. A lot in my life was my senior resident. So when I was first year, I had this second year Rob Stone from Georgia. not only taught me a lot of stuff about about surgery and hospital and, or, this is a brother. It's somebody I spent,

Victor Razi:

for sure.

Juan Gonzalez:

some days, eight hours, some days 16 hours

Victor Razi:

Right.

Juan Gonzalez:

so I learned a lot from him about everything, life and then, what, when I learned the most from him was when he died, because, two years after he graduated, he got diagnosed with cancer, and then

Saad Alamgir:

Oh my God.

Juan Gonzalez:

Got diagnosed with cancer, six years later, he was dead. So that had a profound impact on me where it made me think, you know what? I need to live

Victor Razi:

All this work.

Juan Gonzalez:

I can't just work Know people that have worked to six days a week, have 15, million in the bank. And they don't enjoy life. Practice. Maybe that's what they want out of life just to And, but, and then one day they just dropped dead and somebody else is going to enjoy all that.

Saad Alamgir:

Yeah. makes you wonder what they did it all for.

Juan Gonzalez:

Yeah.

Victor Razi:

yeah that's sad. But it is I guess you can be blessed to know that you got to know him and experience that to help you adapt in your life to what, how you want to live,

Juan Gonzalez:

yeah. No, you have to, you have to learn you always learn from people. Let's say that you have a really bad teacher. Or you're watching somebody do something and they do it really bad. Well, you learn from that person, you learn how not to do things, everyone. You just have to pay attention and see what they're teaching you. Is it good or is it bad?

Victor Razi:

Right. Well, thanks for coming on today, Juan. Do you have any last minute advice for dental students that want to get into full arch or just general advice from someone who's been in the dental field for many years and experienced a lot? Of

Juan Gonzalez:

Yeah. Actually the best advice I can give is, and do what you like to do, enjoy what you do it well. care of people because at the end of the day, that's what we're supposed to be doing. But a lot of See this aspect of it. But

Saad Alamgir:

Right.

Juan Gonzalez:

care of people, knock on wood, I've been practicing for 26 years now. Is it 26? No, let's see. Now counting dental school. This is going to be my 27th. And I've always treated people with respect and I listen to them. And to this day, I have never been sued. never

Saad Alamgir:

Yeah, that's great. Especially in this field, a full arch.

Juan Gonzalez:

Or a board complaint either When there's a, it's usually because you have not treated that person. And the other thing is stay away from crazy. Don't treat crazy, but, Do that. And then Remember that dentistry is not your life. I see dentistry is something that I enjoy, something that I like to do, but it's a means to an end. It's a mean it's a way for me to take care of people, make money and enjoy life.

Victor Razi:

course.

Saad Alamgir:

Right.

Juan Gonzalez:

keep that out. And then the other thing is Diversify into something unrelated to dentistry. Be, some type of business where you can early on invest, on something that dentistry becomes more like a hobby for

Victor Razi:

Right.

Juan Gonzalez:

where Your main source of income, which could be passive income, and then you do dentistry for fun a few

Saad Alamgir:

Right.

Victor Razi:

Right.

Saad Alamgir:

Yeah. When you take the money aspect of dentistry out of it, you ultimately just got to enjoy what you do. And it seems like You found a lot of enjoyment and what you're doing, what you continue to do. Personally, I could say thank you for having a heart big enough to let two random dental students come to a conference, man. It really does mean a

Victor Razi:

For sure.

Saad Alamgir:

It's inspiring to see genuinely Bitcoin

Juan Gonzalez:

more would have been able to come, but there were only three. People that reach out to me, and then it takes it takes balls to do that. For you to reach out to somebody that you don't know, and you might think that this person, oh, they're not going to listen to me or whatever. So it takes both. So if you don't have. The I had to say like that. If you don't have to the balls to do things like that in life, it's you're not going to progress. And that's where you have to take chances. You have to try things in a lot of us, have not, I've been afraid of taking chances of things in the past and not taking advantage and trying, and like they say, if you try something and you fall, you get back up and you try again. And that's what's going to help you in life. And you guys, for example, look, you guys have have podcasts and things you're using taking advantage of your of the technology, and which I, I know nothing, when people tell me about it, when people tell me about crypto. I'm like, Oh yeah, years ago I bought I bought Bitcoin

Saad Alamgir:

or something. Yeah.

Juan Gonzalez:

and then I sold it at 6000. And when it came out, when it came out, I was like, what is that? Imagine if you would have put a thousand dollars of Bitcoin when it was a dollar.

Victor Razi:

Right.

Juan Gonzalez:

You don't know and you're afraid to get into and then, you miss opportunities like that.

Saad Alamgir:

Yeah. Well, we appreciate it one. That's all we got. And let's keep in touch. We could make this like a quarterly update. That's something you're interested in, but we really appreciate you taking the time to talk to us one.

Victor Razi:

For sure.

Juan Gonzalez:

And I got I got a lot of, a lot, when you start getting old, you have a lot of stories and

Victor Razi:

I want to know.

Saad Alamgir:

Yeah.

Juan Gonzalez:

I have many different stories on many

Victor Razi:

Yeah.

Saad Alamgir:

Yeah.

Juan Gonzalez:

many subjects and not dental related, not dentistry. And I have many dental stories too.

Victor Razi:

Awesome.

Saad Alamgir:

One. We appreciate it, man. Let's keep in touch because this has been awesome.

Juan Gonzalez:

You got my phone number. You know how to reach me. And yeah, you guys I already told you once I have a place a fixed place where I'm going more often, you guys are welcome to come and hang

Victor Razi:

Thanks, man.

Saad Alamgir:

Yeah.

Victor Razi:

it.

Saad Alamgir:

take you up on that, man. For sure.

Juan Gonzalez:

and shoot

Saad Alamgir:

you again. Yeah.