The Pacific Aesthetic Continuum's Podcast
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The Pacific Aesthetic Continuum's Podcast
From Gold Bridges to Digital Design: 50 Years in Dental Technology
The secret heroes behind beautiful smiles are rarely acknowledged, but Gary Vaughn's remarkable 50-year journey as a master dental technician reveals just how crucial these skilled artists are to modern dentistry. As the Chief Technical Officer (CTO) for Corr Dental Laboratory, Gary offers a fascinating glimpse into how dental materials have transformed from basic gold bridges with porcelain facings to today's sophisticated zirconia and lithium disilicate restorations that mimic natural teeth in both form and function.
Gary's passion for craftsmanship shines through as he describes the evolution of dental ceramics from the earliest pressed materials like Empress to contemporary options offering gradient coloration and translucency. What becomes immediately apparent is that despite technological advances in digital design and milling, the human element—the relationship between dentist and technician—remains irreplaceable for truly exceptional results.
This conversation delves into the business aspects that many clinicians overlook. While some practices focus exclusively on laboratory fees, Gary and Dr. Miyasaki highlight how investing in quality laboratory work actually saves significant chair time and frustration. A restoration that costs slightly more but requires no adjustments can save hundreds of dollars in productive time, not to mention delivering a better experience for both doctor and patient. As Gary poignantly states, "You can buy all the machinery you want, but if you don't have somebody that knows how to run the machinery and somebody that's checking QC—a human being—I think you're in trouble."
Ready to transform your practice through partnerships with master technicians? Discover how educational programs like the Pacific Aesthetic Continuum (PAC) can help you build relationships with skilled laboratory professionals who will elevate your clinical outcomes and practice success. The future of exceptional dentistry lies in this collaboration between clinician and craftsman.
For more information contact the Pacific Aesthetic Continuum at https://thepac.org.
Hey everybody, dr Michael Miyazaki and welcome to today's recording where we have Garrett Caldwell and our special guest is Gary Vaughn. Now, gary Vaughn is a talented dental technician. He's been doing this for 50 years and what we're going to do is we're going to get the passion from Gary Vaughn, who heads up the laboratory for Core Dental Laboratory, and I hope you like this because you know today we don't know who's doing our lab work. It could be a lot of it's digitally designed and we have someone that's just doing it all on a computer. But in the days where aesthetic dentistry really took off, we had really talented artists and technicians, and that's kind of how we describe Gary Vaughn. So I hope you enjoy listening or watching as Gary describes what he's seen happen over almost a half a century of dentistry.
Speaker 1:We're excited today to have Garrett Caldwell again, ceo of Core Dental Laboratory and the Pacific Aesthetic Continuum, and our guest today is Gary Vaughn. Gary Vaughn is the CTO, the head technician and head honcho as far as the laboratory side of the Pacific Aesthetic Continuum's adjacent laboratories, which include Core, and I'll let Gary fill in he's got a lab down south that also is kind of a little satellite lab. So just want to say welcome, gary. How are you doing? I'm good, I'm good, how are you guys doing, good? Good, as we get into this, just to kind of set the stage, do you want to kind of let people know how you work with CORE Dental Labs? So CORE Dentalell Labs up in Roseville, but you've been a master technician for decades, almost centuries, but your lab is located more in Southern California and yet you managed to cover both labs.
Speaker 2:Right, right. Well, they've given me a title of CTO, so I'm not sure if that means chief technical, chief training or chief tenured, since I'm so old, but either way, I've been around for quite a while in the business. But our laboratory down in Southern California is just a small boutique laboratory. We receive cases from Core Dental Designs once they've done the preliminary work. We typically do work from all over the country and even outside the country from time to time.
Speaker 1:With your, as you mentioned years in the dental laboratory side. What are some of the changes you've seen in dentistry? I mean, there's been so many changes, but from a laboratory technician perspective, how far? Do you want me to go back, I don't know From the time you made.
Speaker 2:George.
Speaker 3:Washington's dentures. Do you remember him Well.
Speaker 2:I've been in the business actually 50 years, and so things have changed an awful lot. Pfm used to be the state of the art for everything. We even thought an aesthetic restoration was a gold bridge in the posterior area where there was a ponic. We'd have a pin facing that was waxed around and then removed before the bridge was cast and you'd replace the pin facing and that would have a porcelain finish to it on the outside, the buckle surface. So that was considered an aesthetic restoration. So we've come a long way, but that's the cool part about it To me.
Speaker 2:We've reinvented ourselves a number of times, simply because the materials have changed, the opportunities have broadened because of technology and the introduction of new materials. The advent of Empress was huge. Back in the 80s there was other companies that followed suit doing felspathic type veneers done either on a matrix model or done also with the foil technique. That was the most popular, were done also with the foil technique. That was the most popular. But now there's, you know, that's evolved from Empress to Empress II, to Ares, to Emax, which is a lithium disilicate material.
Speaker 2:There's other materials out there now made by other companies. Lissy is one of them. So we just have a great basket to pull from. We've got zirconia now. When it was first introduced it was kind of a horrendous-looking material. It just looked toilet bowl white, basically, and now they've introduced other ingredients to that formula. It's allowed it to look more aesthetic. There's even materials now that have a gradation of color so that as you place your scan into the milling and nest it properly on the puck you've got a darker color towards the gingival and as it goes towards the incisal it becomes more translucent. So we've got some options now that we never had before, and Core Dental Designs has embraced the best materials in the market, which makes it exciting to restore teeth now.
Speaker 1:Yeah, I remember when I was in dental school we had to make the gold bridges with those little horse and pin inserts and yeah, that was aesthetic dentistry back in the day it was. So let's go back to that because I mean now we have zirconia that we can infuse with the ceramics. We can bond it like a, an emax, but get some of the physical properties of a zirconia and because of the materials have changed so much. As a dentist we're so focused on taking care of our patients and trying to manage the practice that it's really hard to keep up with the materials. So how do we work at the lab? When we're working on an aesthetic case today and maybe it's a 10-unit veneer case and we write down give us a 10-unit veneer case do we ask for a certain material? Or how do we work with the lab and communicate these days?
Speaker 2:Well, I think the advantage with working with our laboratory is that typically you're going to be able to communicate with somebody, either in a diagnostic department or, if you've already got a wax up or you've got a design already figured out digitally, we can discuss it over the phone, we can do a video conference, we can take photos and go over those photos. It's always nice to have models in hand for the laboratory. I'm still kind of an analog guy because I'm used to palpating things and touching them and making sure that I see tactically what we're going to do. But photography is an important part of the business and so If we can see what the wear factor is, if there's been attrition or there's been erosion or whatever, we can make suggestions.
Speaker 2:Obviously, the doctor is going to make the final decision, but I think the teamwork between a doctor and a laboratory ceramist in particular is critical to determine what kind of material you're going to want to use for a case.
Speaker 2:We've got a number of cases that we do now that seem to be the doctor might want an empress or, excuse me, an emax in the anterior region and then in the posterior region he may want a zirconia, and we feel confident enough now, with the materials we have available, that we can make that a very seamless transition from the anterior to the posterior without it looking like there's been a change of material. But you're going to get a factor of strength that's a little more increased in the posterior because of the use of zirconia. We can also layer zirconia in the anterior. If you want the occlusal area of the material to be in zirconia, we can. But we can also layer, cut it back and layer it just as we would with a lithium disilicon material and use the nuances that we would use with a feldspathic porcelain that's accommodated by the zirconia.
Speaker 1:It has to be compatible, obviously, because there's different ratios of of thermal expansion when you use different porcelains and in these recordings that we do, garrett and I have been really focused on the business side of dentistry. And so if you had to talk to a dentist, a clinician, that maybe is calling the lab and wondering, well, why would it make business sense to use Core Dental Lab? Do you have an answer for that or is there a feeling that you have?
Speaker 2:I feel like the onus is on me to make sure the product that leaves my laboratory is right where it needs to be. It needs to be spot on, it needs to be something I'm proud of, something that the doctor understands. Hey, this guy's paid special attention to my case, and so that communication thing is critical. I see these larger laboratories that I don't think there's a personal relationship usually with the person that's working on their case, and so I think that's one of the critical things about our laboratory. I once had a dentist that I was discussing working with in Colorado years ago and he had been close friends with one of the accounts that I'd worked with for years. In fact, that particular doctor right now, the one that he had discussed working with me about is now the president of the American Dental Association. So pretty reliable guy. And he said the reason you want to have Gary do your work is because he reads your prescription. And I thought that was pretty novel because I've always read prescriptions.
Speaker 2:But apparently there's places where people don't read the prescription and that's really tough. I mean, there's laboratories that are so functioned to produce massive amounts of work massive amounts of work that the work is placed in front of a technician and they just scramble through it to get it done without paying close attention to the detail. And so in our laboratory, I think the reason it's critical is if you don't get a phone call with a question for something that may be left out on your prescription, that's not our laboratory. Our laboratory is going to say hey, wait a minute, we didn't get any photos. They said they emailed photos, but there's no photos. Or they didn't put a shade down, or they told us to call them. We pay attention to those things and we do it right away, because otherwise you could be at the finish line. Usually a turnaround time can be anywhere from a week and a half to two weeks. Maybe when we're crazy busy it might be three weeks.
Speaker 2:But you don't want to be the technician at the end of the line that's receiving a case and nobody's paying any attention to the details, because then you know you're stuck. You've got a case that's due out the door that night and nobody's paying attention to the prescription. So I would just say the focus that I've always tried to do is make sure I'm reading the prescription and if I don't understand something I'm going to call the dentist, and likewise, I've made myself available even when I'm out of town or when I'm on vacation, even over weekends. I've talked to doctors at 10 o'clock at night because I make myself available for that.
Speaker 2:I don't know if every laboratory does that, but that's just been commonplace for me, and I know for a number that the technicians that work in our laboratory have also become available. We've got, you know, an implant department, for example, and there's cases that need to be discussed with the implant company. We have to be acquainted with every one of those systems and that's not easy to do. Same thing with things like occlusion. I'm probably getting off on a tangent here and I may be another question along the line here, but a lot of times there's different schools of thought for occlusion and if we're not acquainted with all of them, we can't fake our way through it with a dentist, because they know just by the nomenclature that you use about a case whether you know what you're talking about or not.
Speaker 1:You know, that's one of the things about, I think, Dentist Today. I don't know. I opened up a journal the other day and there's a laboratory that's like dirt cheap right, and I don't think that's the type of pricing that CORE is trying to achieve, and so I think the personal attention is the important part.
Speaker 1:And you do pay a little bit more when you're working at the lab that's actually going to pay attention to what you want, a lab that's actually going to pay attention to what you want. And I think one of the things that the doctors have to understand is that you know, when you see the befores and afters that are posted on social media, they show the before teeth that are all crooked, dark and worn and they show the after case with all the veneers in, but typically they don't show the preparations. You know the part that the doctor's doing, what the patients the patients don't want to see all that part, but they want to see where the patient started and where the patient ended up. Well, that end result isn't really the doctor's work, it's not our work, but it's really what the laboratory has been able to build into that case, whether it be some patients want bleached white, monochromatic white teeth that look like chiclets, and so you need a lab that can do that. And then some patients want the gradation with the genital warmth, the wider mid body area with some incisal translucency, and so you have to have the technicians that have the skill, like as you mentioned, to layer in all those different colors, and I think that's where the value of using a lab like CORE comes in.
Speaker 1:So when we talk about that, you've got the before photos that the doctor sends you. You've got an idea of where you want the veneers to end up. But sometimes the limiting factor is the preparations right. I mean, the doctors have to give you the preparations that will allow you to make the teeth wider or narrower, longer, shorter, move midlines and all that. So the question is that Core Dental Laboratory supports a specific aesthetic continuums education program, the PACS education. How does that play in and how does that help the laboratory and help the doctors achieve that final result?
Speaker 2:That was actually one of the most exciting things for me as a ceramist to be involved in is the fact that we can actually work straight face-to-face with a dentist. We can be in the operatory with the dentist, we can critique what's being done without being offensive. We can tell them flat out hey, if you want to move that midline, then we're going to need a little more work on number nine or number eight one way or the the other, so that we can shift things.
Speaker 2:And that's tough to do when you're getting something from across the country on a prescription and you haven't built that relationship with that doctor. I'm not saying everybody has to take the course, but I'm saying it's very, very helpful and if somebody has taken a course either with us or with another aesthetic group, then we can communicate, because then they understand when I tell them hey, you know I can do all these things, but I'm going to need a little help here or there to get the end result that you want, and so that's been a real eye opener for me. For me, fortunately, I've been able to be involved in that for the past 20 years, which just really kind of opened some doors for me in the business that I was unaware of before or unschooled in, and so you feel more a part of the team. When you're involved in.
Speaker 2:The education angle of it actually helps the dentist understand that you can't just send an impression or a digital scan and expect a miracle if they haven't done their job too. So you were alluding to it, and the best cases we get are when there's some thoughtful preparation done and once they learn those tools through education one of our courses, for example with a live patient situation. It's difficult otherwise to get the end result that you want. And yeah, if all they want is a white tooth, that's one thing, but if they want the nuances that natural teeth have, then they're going to have to be mindful of those things when they make the preparations. Absolutely.
Speaker 1:I think on these aesthetic cases, if we focus on that right now, the laboratory is involved from the very get-go. So you know, the doctor could scan the teeth as they are, take an impression, an analog impression, and send it to you. The lab will take the small design that the doctor requested and create a diagnostic wax up with that and with that diagnostic wax up, the doctor can then go back to the patient and show them. You know, here's your teeth, here's the diagnostic wax up, which shows what we can do. And then one of the things that we teach in the course is you could take the temporization, uh stent that the lab prepares off of that diagnostic wax up and sometimes even do an acrylic overlay over the teeth, which I like to do when we can do that, because the patient can actually see and feel what that change is going to look like in their mouth, instead of doing something that's a simulated digital. And then once the patient says no, I'd like that, then we're off and the doctor, if they know how to prepare the the teeth right and working again with the lab to get the color, contour and the shape, because a lot of times the doctors may not appreciate it, but when they get the veneers, a lot of times the doctors are looking at the margins. You know there are the margins closed or the contacts there, and one of the things that that core does so well is if you got, say again, a ten unit veneer case is they'll take the veneers and put it on the solid model, not the one that's pin decks, because when you have the one that's pin decks the pins can move around or the dies can move around a little bit, but actually put on a solid model when possible to make sure that when you go to to insert those 10 units, that's basically just like boom, boom, boom, boom, boom. Right, it's like I, I about it.
Speaker 1:The days when I used to deliver a single unit crown, I'd have to try it in and almost always we'd have to adjust the mesial and the distal of that crown, the contact, to get it just right for the floss to pop through, and then we'd have the patient bite down and we have to grind on the occlusal to get the bite just right and it would take as long to deliver a single crown as it would take to do a properly done 10 unit case. And I think that's one of the things that scares doctors. At least it used to scare me. I used to think how am I going to do 10 units when it takes me so long just to do a single unit? Well, the answer came back that if you use a high quality lab, you should have zero adjustments to make. We just sat, we did a four unit implant case. It was 18, 19, 30, 31.
Speaker 1:And this case happened to be a screw retain case and I know we put it in. You know, working way back there, it's tough to get those little screws and everything and the abutments and all that lined up. So you get them all in and I was just praying I wasn't going to have to do any adjustments. So I got them all in and I asked my assistant for the floss and we flossed all the contacts. They were perfect.
Speaker 1:You know, core had the contacts down and then I had the articulum paper and I'm thinking I hope this all goes down because it was just too hard to get way back there. And to boot, this patient had fallen about a month ago, fractured her cheekbone, she had multiple fractures in her arm. So she came in black and blue and I'm telling her I'm going to try to be as gentle as I can because she wanted her teeth and so I'm getting back there with the screws and I got the contacts. That was good. And then we had her bite down just to make sure the occlusion was right on and we had to do zero adjustments on those four molar implants that we put down there. So again, I mean, if I had used any of the lab and had to adjust contacts and had to adjust the occlusion one, it would have taken so much longer to deliver that case. But in this patient's case it would have been so much more uncomfortable for her that I was glad that we were using core.
Speaker 2:So I just hope that when she walked back out in the waiting room you explained to everybody that that didn't happen. I didn't do it.
Speaker 1:That's right. Well, when we walked her out to the reception there, I said she paid her bill late, sorry, and everybody just started throwing money at me. So I don't know what that was all about.
Speaker 2:Hey, whatever works. Yeah, whatever works. That's that's. It's interesting that you'd mentioned all that about the contacts, because those are the things that are that make everybody scared about doing multiple units, because about the time you think you've adjusted it perfectly, because you had to adjust the mesial and the distal, sometimes one of them or the other is going to open up on you and that's then. Then you're sending them back to the lab and everybody's pulling their hair out. So that's why we painstakingly do those on solid models. Sometimes I've even done a backup solid model because I think I may have abraded one too much. We use microscopes to look at things too, which enhances the opportunity to get things just right, which enhances the opportunity to get things just right. And so, yeah, I just I love working in that environment to where we have some constants and some things that we can go to, that know we're gonna end up with a nice result. It makes things a lot easier on the lab too, because nobody wants a remake.
Speaker 1:No, yeah, All right, if you've liked what you've heard so far, hit like or hit subscribe, so that we make sure that we get this information out to you every month. And if you need more information on what the pack is all about, go to the pack T-H-E-P-A-Corg and check out the pack. Hope to see you soon.
Speaker 3:You know, from my perspective, being able to sit kind of in a different position, more on the business side but being involved in the in the educational side as well I always tell doctors you know I really don't understand your crown and bridge, we'll have Gary for that, our CTO.
Speaker 3:But if you want to do an interior case or a complex case I've spent so much time in the clinic with you, mike, and in our past lives with Pacific Aesthetic Continuum, larry Rosenthal at Aesthetic Advantage and David Hornbrook, spending so many hundreds and hundreds of hours in the clinic you get to realize what the value of having the laboratory right there in the operatory with you is, and it is for the doctor and for the predictability of the case. And I think we talk about the change of business. Business change is slow. It's like how do you boil a frog, and we used to talk about you. Don't boil a frog by throwing them in the water because it'll pop out. The industry has changed very, very, very slowly and I think a lot of the new doctors don't even understand that there has been change.
Speaker 3:They don't know what it's like to have a relationship with somebody like Gary Vaughn who is a CDT with 30 plus more years of experience in all of the materials and the value that that brings and the gaps that that fills in case predictability. So for me, from my standpoint, I see it from a business point of view. I see a lot of the newer docs and when newer docs even going back 10 years, these doctors never really had the experience of needing to work one-on-one with a laboratory. And then when we look at the new robotics with milling and printing and the monochromatic materials that have become acceptable that require no communication because the result expectation has been lowered, it's the same way you boil a frog you turn the heat up slowly until the water is so warm the frog doesn't know he's been boiled. I think the industry is that same evolution has taken place. I think there's been such a slow change, but a definitive change in the industry that what's acceptable now may or may not even require somebody with that experience if the result expectation is so low. And I really mean low because if I look at the cases that the doctors are capable of delivering and a lot of generally what's being delivered out there. There's a big difference between getting a case from Gary Vaughn and getting a case from a laboratory where it's been built. Even, Gary, like you said, if it's using a hybrid material that may have multiple colors throughout the material, it still doesn't equate to what the potential may be for the patient, to what the potential may be for the patient and I think the way that that affects the businesses.
Speaker 3:I think the doctors should understand that a laboratory technician should be part of the team. It shouldn't be let's send it to the lab. It should be every case that's going in. There should be a communication, a consultation with the technician or a relationship at a level where the doctor knows that if there's something that's not ultimately the best for the patient's result, aesthetically or clinically, that the technician and the doctor have that relationship where they're going to get a phone call from Gary and say, hey, we can do better on this, or this prep has an undercut, or why don't we change this, or the doctor can call and say, hey, I'm a bit confused about this. What do you think, Gary?
Speaker 3:And I think that's the value that Gary's talking about, that he creates when he does education. He spends 40 hours side by side with the doctor. It's like well, it's easier to work with a laboratory where I have a relationship with a very qualified technician who understands all of these materials and has a larger quiver to pull from of knowledge and materials, rather than just every single tooth is a crown, everything is milled With Gary. It's what are we looking for as a result here, and I think that's what's been lost from a business point. I've seen the change and a lot of it's been lost to the eyes and to the ears of the doctors that we're working with. So that's the value of the course.
Speaker 3:But without the course, regardless of the course, like Gary said, I really do believe that doctors need to understand the value of a boutique laboratory, meaning not a laboratory where it's going to go in, get chopped off by FedEx. Ai is going to look at the thing that's going to get built, that's going to ship back and no technicians looking at it. In fact, some of the largest laboratories in our country no longer employ Sirenus, and I'll let the doctors that are listening to figure out who those are. They're proud that they no longer have a syringe, OK, so I don't think that's something to be proud of.
Speaker 3:If I'm a patient. I want that kind of service. I want to go to the Montage or the Ritz Carlton, I don't want to go to the possibly the least expensive hotel I can go to. So I think having a relationship with Gary really elevates the value. And I guess the last part of this is Mike Royce talked about to our doctors how to present yourself in the public as somebody, as a practice. That's being different, that offers more what makes you distinctive. And if you're just delivering monolithic, monochromatic drill and fill dentistry, you're not going to be able to compete now or in the future with the doctors that are delivering high quality, beautiful aesthetics and then have a really big quiver to pull from with regards to offerings to their patients. You're going to have that practice from a business point of view. I just don't see how you can do it without a laboratory technician that's highly qualified as part of your team.
Speaker 2:I think, listening to Garrett, there's a lot of dentists that come out of school and I think they're just tooth fixers. They find a tooth that's got a problem, they fix it, they bill it and out the door the patient goes. And I think the most important thing I learned when I got involved in education is to see the whole picture and to realize that and I've been with you on a number of occasions, mike, where you talk about the whole body and its relationship, and at least we teach people that the face is the frame for the picture, right, and the picture is the teeth. And once they recognize that this is all part of the same thing and that they need to focus on the whole matter and we open that, that opens their eyes to it. I'd been a ceramist for I don't know how many years until I did my own case, and that was by a fluke. It probably still wouldn't have happened if it hadn't been that one of our dentists had a patient who decided not to do the course about a week and a half before the course was to happen and he called me and wondered what to do and I said, why don't we do me? And it really helped me understand that a lot of times we're guarding our smiles if they don't look good and we don't even realize it, and that's the projection that we give to the public. And so when I had my case done, it really made me realize gosh, I don't mind smiling now because I know it looks good. Gosh, I don't mind smiling now because I know it looks good and I wasn't embarrassed anymore. And so there's a lot of patients that may not have a toothache and they may not have, you know, caries that need to be filled, but they may be suffering emotionally because their teeth don't look good. And that's been the beauty of being involved in this kind of an environment where we teach and we're a team with the dentist in helping them discover those things that, like I said, I was in the business 30 years and didn't realize the things that I've learned even in the last 20 years, so that's been exciting to me is to be involved in that.
Speaker 2:The other thing I wanted to mention is that you ask about cost. Well, you can buy all the machinery you want, but if you don't have somebody that knows how to run the machinery and if you don't have somebody that's checking at a QC a human being, I think you're in trouble. And we pay our technicians really well. We've got a group of very talented people that work in our laboratory, and so that's not cheap either. And we pay our taxes and we pay our insurance and we do all those things that maybe somebody who's working out of his garage isn't going to be doing.
Speaker 2:And I'm not trying to be critical, but that's just the reality of things. A lot of times people don't even know where their work's coming from. There's laboratories out there that all they do is gather the work and they ship it off to a foreign country to be done, and you know who knows what materials are being used. So we use the highest quality materials. We have well-paid technicians that are involved, and that's going to keep the cost. You know we're not the most expensive, but we're certainly not chasing the basement either.
Speaker 3:So I I think, Gary, to your point. I think the value of artisan based restorative partnership is completely different than sending a case to your lab and I think the experience, communication and then the ability for a doctor to talk to you or somebody at your lab and say you know what's your opinion, you know have a collegiate relationship. I think there's a big value in that and it is a game changer at chair time, at seat time, for the patient.
Speaker 2:And on our end it's not only gratifying but it's also humbling to know that a dentist trusts us that much that they want to talk to us about a case and we've had a good enough relationship and enough experience together to know that, hey you, he's going to give me an opportunity to figure it out for myself, rather than just trying to do it without any outside influence.
Speaker 1:We're not the most expensive as far as crowns go, we're not the cheapest as far as crowns go, but we want to make sure that we can use a lab that gives us the quality product. And time is always money, you know, and redos are very expensive to do. So, the way I look at it, if there's a $10 difference or even a $20 difference from the cost of one unit to another, depending on the lab that you use, I've always found that it's better to spend that little bit extra because it just makes life so much easier. As we mentioned before, having to adjust contacts and we all do it slowly because we don't want to have a tight contact and end up with an open contact, which means a redo. Or I know some people will go ahead and wipe out the occlusal contact, but we try not to do that because that's not the best thing for the patient. But as we do all these adjustments, and if it just takes 10 or even 10 minutes and you think that the average clinician should be doing about $1,000 an hour now that's easily $150 worth of time. So if that crown that costs $10 more, $20 more, pops right in and it saves me 10 or 20 minutes, then I've saved $300.
Speaker 1:So is it better to spend $300 for the crown or spend $100 for the crown and have to spend that extra time? It's not just the time but the frustration and the not being able to predict. You know, if you adjust a contact and you overdo it, you know that that's one of the most frustrating things that can happen. So I always think that you always get what you pay for. There's those that are going to always go for the least expensive product. It could be crowns, or it could be cements or composites and typically when you go for the cheapest you are going to run into more problems, longevity issues and all that. So I would encourage the clinicians to really think more value-wise. Not always look at the price as why you make a decision, but look at the value, the performance you're going to get from that product, the service you're going to get from those that provide you that product, and when you weigh all that together then I think you can figure out what's best for you.
Speaker 1:And from a clinician's perspective, we all see that too right. If I'm trying to do the cheapest crowns, I'm gonna make up for it. As Gary said, in volume of the crowns I do. We can't spend the time necessarily finessing everything the way that we would ideally want to. And then you have your favorite relative that comes in and you tell your front desk oh, schedule me extra time, because now you want to spend a little bit more time to do the kind of prep that you want, which is going to cost you more. But you know that's probably the way you should do everybody. But you can't afford to. So instead of doing that, just charge a fair fee, use a good lab, spend the time you need to with the patients, do the best that you can, and I think you're going to live a happier, healthier life.
Speaker 3:Yeah, I know, at the end of the month when you get that lab bill and you see that $10,000 lab bill, it's easy to you see your lab bill, you say, wow, that lab's expensive. But I think to your what you're saying, because you have to go back and look at your productivity and you have to say to yourself, okay, if you're spending 8 000 on that lab bill but you're spending 10 to 15 minutes adjusting every single case, if you're not putting the same value, if that's not bothering you or you're not identifying that same value, if that's not bothering you or you're not identifying that expense, that cost I think we talk about with that in some of our businesses that really for the clinicians for me to start really placing a value on their time, it's a real cost when you pay your lab bill. It's also a real cost when you're adjusting contacts.
Speaker 3:I think doctors tend to forget that because there's no dollar bills. But maybe we should have the doctors, as an exercise, put $1,000, put $10, $100 bills in the operatory and see the crown. You get to take one of those out every 10 minutes and hand it to the assistant. Then there will be some value in understanding what you guys are talking about. Because I see that there's difficulty sometimes with the doctors at the end of the month to see the lab versus focusing on the productivity.
Speaker 1:You know, and I think the other thing to think about too, since we are trying to talk about the business side of the practice in the lab, is that if you're trying to keep your lab bill really low, then you might be shortchanging your practice. I mean, if you look at your lab bill and it's only 3%, you might think, well, that's great. But if your lab bill is higher, typically that means you're doing higher revenue producing types of restorations. And you know we're not saying to do a crown if the tooth doesn't need a crown.
Speaker 1:But sometimes I've seen doctors and clinicians get frustrated because they have a large restoration and they try to do all in composite, which is very hard to do when it's expended. You know halfway to the buccal and halfway to the lingual and then you know that that's not gonna last as long. So, instead of getting good at case presentation and having the patient understand the value of doing a crown, perhaps, or an indirect restoration of some sort, so, and having the patient understand the value of doing a crown, perhaps, or an indirect restoration of some sort, so it's stronger and the tooth itself will have better longevity, which will increase your lab bill. But I think one of the things to do is when you're looking at your revenue and your practice and look at your lab bill. If your lab bill's too low, then maybe you're not diagnosing properly and that's something to kind of take a look at. So some of the listeners might think, yeah, you know the lab's not a substantial part of my expenses. Well, maybe it should be a little bit more this is like you said.
Speaker 3:It might be 10 or 20 for the restoration, but that opens you up to be able to have access to somebody like Gary who can help you elevate what you're delivering, both in terms of quality and aesthetics and also education and knowledge.
Speaker 3:Because at some point what I really fear is that we're losing the artisans very quickly and that type of dentistry is not going to be available and the doctors aren't going to know soon what that was even like.
Speaker 3:To be able to have that and I think doing the type of work that we know is profitable whether it be implants or full mouth restorations or anterior aesthetics, indirect, all ceramic you really need to have somebody like Gary Vaughn and Core Dental Designs and you need to have somebody like Pat and Mike Yu teaching implant courses. You need to have somebody like Gary Vaughn and Core Dental Designs and you need to have somebody like Pat and Mike Yu teaching implant courses. You need to have that education. You need to have the laboratory or else you are going to be stuck. You're not even going to be able to deliver, even if you want to those types of cases. Encouragement is is that we're moving very quickly towards a different sort of environment with the laboratory relationship and the quality and the education and I would encourage all of our listeners to really listen and keep it. Call Gary Vaughn up and chat with him and join the pack and get a relationship with Mike.
Speaker 1:No, I want to thank you both for your time. I think we covered a lot of interesting parts of the laboratory side of our practices, from how it's changed, how the materials have changed, how, gary, how you were able to provide that artisan quality and a personal touch, which I think is very important, and we also discussed the money side of everything. So I think we've covered everything pretty well in this program. So I want to thank you, gentlemen, both for your time and for your contributions.
Speaker 2:Thank you, mike, appreciate being on. Thank you, thank you.
Speaker 3:Thanks Mike, thanks Gary.
Speaker 1:You go back to vacation now.
Speaker 3:Have a steak, oklahoma, steak Gary.
Speaker 1:Bring me back some gas.
Speaker 2:It's cheaper over there than California, that's for sure. And that's only going to get worse in Cali, from what I hear.
Speaker 3:Hurry back, Gary. Okay.
Speaker 1:Thanks guys, Take care, thank you.
Speaker 3:Bye.