The Fixed Podcast

Shaping the Debate: Opinions in Full Arch Implant Dentistry with Dr. Damon vs Dr. Stanley: Part 3

• Fixed Podcast

Share episode

Two masters of full-arch implant dentistry face off in a thought-provoking debate that challenges conventional wisdom about photogrammetry and implant placement strategies. What begins as a discussion about digital scanning accuracy evolves into a fascinating exploration of biomechanical principles that could fundamentally change how you approach your next full-arch case.

Dr. Stanley boldly asserts that photogrammetry isn't always necessary, revealing how his team consistently achieves impeccable results using only intraoral scanning. His engineer's mind breaks down the physics of prosthesis flexure, explaining why adding an extra implant can reduce mechanical stress by 300% when maintaining the same anterior-posterior spread. When he states, "After a couple of years of doing dual scans, my assistant stopped because they were always accurate every single time," you'll understand why his confidence in this approach is unwavering.

Dr. Damon counters with equally compelling arguments for a different philosophy. "When we really treat a titanium deficiency with a lot of titanium, we now incorporate lack of blood flow into those areas," he explains, advocating for strategic implant placement rather than simply adding more titanium. His preference for pterygoid implants creates wider support without crowding the anterior region, potentially providing better contingency options when complications arise.

Both experts share insider tips on achieving predictable outcomes, whether through guided surgery and perfect parallelism or mastery of freehand techniques with anatomical considerations. Their respectful debate reveals that successful implant dentistry isn't about dogmatically following a single approach but understanding the biomechanical and biological principles that govern long-term success.

Whether you're just beginning your implant journey or have placed thousands of implants, this exchange between two leading clinicians will give you valuable perspectives to enhance your practice. Listen now to determine which philosophy aligns with your clinical style and patient needs.

Dr. Tyler Tolbert:

My name is Dr Tyler Tolbert and I'm Dr Soren Papi, and you're listening to the Fix Podcast, your source for all things implant dentistry.

Dr. Tyler Tolbert:

So we talk about current trends in full arch and things that are sort of emergent, and they become very popular and often talked about, and one of these subjects is that of photogrammetry. So this is something that came out, I mean, I think for me. I mean I really haven't been in the game that long, but photogrammetry came after I got out of school. That's how recent it is, and I won't give away my age here, but so I'm going to lead into our next topic with photogrammetry. So in today's world of immediate load surgery, the surgical and restorative challenges that are associated with flourish practice have really blended together, right, and there's, of course, this huge incentive to do things faster and less appointments, and one of these modalities that's come about is the advent of photogrammetry, so even the most advanced intraoral scanners. The issue that's being brought up is that there's a difficulty that comes from the inaccuracy that comes from when we're trying to scan a cross arch, because there's a lot of stitching. You're taking a lot of photos across the arch digitally, the software is trying to stitch these things together and you're incorporating inaccuracy upon inaccuracy, right. And so photogrammetry comes into the landscape and it says, okay, here's a separate peripheral You're going to essentially. You know this is a very rudimentary version of it, but we're going to take a picture of where all the multi-units are in space, in orientation in relation to one another. It's much truer than cross-arch stitching right, and this has become very popular and has become a compulsory aspect of what is now the full digital workflow.

Dr. Tyler Tolbert:

So, dr Stanley, in your video why I Don't Need Photogrammetry in my Practice, you stated that you were able to circumvent the need for photogrammetry with two principles that you talk about. One is the intraoral scanning is more accurate when the implants, or multis, are parallel, and full arch scans are more accurate when the implants are closer together. In other words, by placing more implants with an axial configuration and using guided surgery, you were able to capture accurate records using only intraoral scanning, and I do hope that I've characterized that accurately. So, dr Stanley, could you please expand on that topic and talka little bit more about it? I appreciate it.

Dr. Robert Stanley:

Yeah, I think you captured that really well, Tyler. So for a number of years we've been doing digital workflow right and so we're scanning their full arch cases and we're having great success. And I was shocked because photogrammetry came on pretty strong. People were like we're going to photogrammetry, we're going to photogrammetry, and you would hear these people say I can't scan across the arch accurately and you would see the reports that would confirm this. They would have reports. People would put studies up on this on the podium and say here's the study. It doesn't work. And I'm like this is really weird. I don't understand, because in my office it's working and and and I was talking to my team members and we we just couldn't figure it out Two summers ago, not this.

Dr. Robert Stanley:

Yeah, it was two summers ago, not this last summer. It was the summer before I was at the COIS Symposium in Seattle and Dr COIS has a digital specialist and she was on stage and she was stepping through her annual update on digital technology, digital workflow, and she had a series of different presentations that she was doing. Each one it was like a 10 to 15 minute presentation, but she was working her way through it and one of the things she said was it was really. I was like, wow, that's interesting. She says if your scan bodies are parallel, if your scan bodies are parallel, the scanner does a better job of picking them up. And I'm in the audience and I'm like, well, that, as an engineer, that doesn't make any sense whatsoever. The scan body should be giving you a coordinate system in space and it should be telling you where that implant is. That doesn't make any sense. But okay, she said that. And then a little bit later on, she said if the scan bodies are closer together, so instead of two scan bodies further apart, but if the scan bodies are closer together, the scanner does a better job. Well, that one makes sense to everybody, right? Because when the scanner takes a picture, if the two implants are in the picture simultaneously, they are referenced to each other, right? That's why a lot of these scan bodies now they look like the letter T, they screw on and they have like an arm to them. Well, the idea is that if that arm comes close to the next arm, then you're you're bridging the gap, right? So that makes a lot of sense. So I'm sitting there going this is interesting.

Dr. Robert Stanley:

And I said I think I figured out why our system works. So the first thing is my implants are almost they're. They're within a couple of degrees of each other in terms of parallel after the multi-units are placed, because it clearly, if we do it an angled implant, we use an angled multi-unit, but because they were guided that the the parallelism of the of the scan bodies is very parallel. So that was the first thing. And then the second thing is, as an engineer, I I over engineer systems, I don't under engineer systems. So if they needed four implants, they get five. If they needed five, they get, they get five. If they needed five, they get six. That's how it goes. We always add like one implant. It's a simple method of doing it. And so if you have, say, six implants in the maxilla and you've got a decent AP spread, the implants are close enough to gather in their parallel.

Dr. Robert Stanley:

You can scan it with a regular scanner. You do not need photogrammetry. And I I have had so many people hate on me on social media, on youtube, like you can't do it, you can't do it. I'm doing it every single day. Every single day. Every one of my arches for years has been done this way. They're like it can't work. I'm like stop telling me it can't work. I'm doing it every single day.

Dr. Robert Stanley:

So, once again, if you follow the recipe, you get great results. People, if you're not following this recipe, if you're doing a different recipe, you're not going to get the same results. So, if you think about it, if you're freehanding implants because this is where photogrammetry really has its advantage right, you're freehanding implants you don't really know where the implants are going to go. You're going to do an anatomical approach, you're going to flap the ridge, you're going to look for the bone, you're going to look for your landmarks, you're going to place the implants at the time. You're done with that.

Dr. Robert Stanley:

If they're not, if they're not really well parallel and and you and you just do it all on four, because that's what you're just doing they're not close enough together, you can't scan it. So that's where photogrammetry makes a lot of sense. You put some photogrammetry on there and you can scan it and then do an immediate provisional, either print it that day or the next day. Some people do it the next day and that's a workflow that works for a lot of people, right? But the answer is is that if you do it the way that we're talking about.

Dr. Robert Stanley:

You can actually get a. You can do digital scanning with a regular scanner, with a regular scan body, and you can do it all day long and I will prove to you that it's accurate. And you know how you prove to you it's accurate. People are like how do you know? How do you know it's passive? So it's real simple.

Dr. Robert Stanley:

You just scan the arch twice. Okay, scan it once, then tell the computer I'm going to scan it again. You now have two identical scans. It's like taking two impressions. In school we did two, two GUI impressions, right, but in this case we can superimpose those two data sets inside the software and then we can look for error and if the error is less than 40 microns across the entire arch, you have a. You have two perfectly accurate scans and there's no way you're going to do that.

Dr. Robert Stanley:

And and and just luck, get lucky. You know they're to do that and just get lucky. They're the same. And we used to do that on every single case. And then one day I asked my assistant. I said Sarah, can I see the dual scan today? And she goes well, I stopped doing that. And I said Sarah, why did you stop doing that? And she says well, doc, I'll tell you they were always accurate every single time. So after a couple of years of doing just, it was a waste of my time, so she just stopped doing it. So that's our position on photogrammetry. If you are placing implants and they're not close together, you're going to need it. If your implants are all wonky, you're going to need it. Uh, but if you get enough implants close enough together and they're rather relatively parallel, it appears that you don't need it.

Dr. Clark Damon:

Dr Damon, your rebuttal, I would just say that placing your implants close together to avoid photogrammetry would not be an indication. So you know photogrammetry.

Dr. Robert Stanley:

So I would say this if you can get more space between your implants, more AP spread limit for implants anterior to the sinus. Doing that recipe and that principle, you're going to need photogrammetry. So just to be clear, we're not adding implants so that we can avoid photogrammetry. We're adding implants to reduce risk and so it's a risk reduction protocol. And the main reason is, if you just do a simple comparison of an all-on-four to an all-on-five with the same AP spread, you reduce your flexure of your prosthesis 300%. You want to say it again? I'm going to compare an all-on-four to an all-on-five with the same AP spread. Okay, so the same AP spread. One has five implants and one has four and the prostheses are identical. They have the same material, everything's identical. The flexure of your prostheses is 300 times higher with an all-on-four than an all-on-five. If you want to talk about long-term stability, if you do an all-on-four you are going to have more fractures long-term than you do with an all-on-five. And if you go from all-on-five to all-on-six, you reduce it by like 700%. So we don't add implants to avoid photogrammetry. That would be silly. Everybody would know that would be silly. That's how you think. You think about what's in the best interest of the patient and when people, when people say, doc, you did, you did six implants and you did longevity leveling. What are you going to do if they fail? Well, I told you I had two cases that failed, right, and they, they were smokers, they smoked and they failed. And they they had, they had stopped smoking after they failed, they had stopped smoking after they failed. Okay, they didn't stop when they were supposed to, but they stopped afterwards, of course. So we did it again. Right Now you say, well, how could you have done it again?

Dr. Robert Stanley:

Well, if you look to first molar occlusion, you've got from first molar to first molar, from six to six. You have 12 teeth. Could each and every one of us place an implant in each one of those locations? Today, if you said, I'm going to take out each tooth and place an implant in each tooth, and the answer is yes, we've seen them on the internet. We've seen the pictures of an implant in every tooth. We've seen those pans circulate on the internet, so we know that we can do that.

Dr. Robert Stanley:

So if I place six implants, what's between those six implants, bone? So I could have six implants fail and I could place six implants the next day in the in-between space, because there's in-between space. Now you have to do it guided because you can't fall into those holes, but you could do it that way. So I have a different perspective on crowding so-called crowding the anterior by adding these risk reduction protocols. I don't look at them as a risk for a contingency plan in case those implants fail, because I know there's plenty of bone between it and if it's an all-in-five I have even more space right. So I'm not looking to create a lot of space because that creates mechanical complications. As I said at the beginning of the podcast, we have three to four times more complications mechanically than we do biologically. So I'm not worried about that and I'm also trying to keep my patients from smoking.

Dr. Clark Damon:

Yes, uh. However, like if you have a, when you have a biologic uh complication and you have filled the anterior maxilla with six implants, you now have a major uh, a major uh problem on your hand to fix. I have never, I have not seen a case where if you have six implants anterior to the sinus, that you have any bone to go back in and place implants in between, have any bone to go back in and place implants in between. It's typically on those cases it's titanium heavy and you know, often, oftentimes, there's there's reasons why we're redoing these cases, as, as you mentioned, you know you, you see a lack of executed cases. I see them as well and the challenge is you then iatrogenically create them to be a quad or at least have two zygomas. Maybe you can get lucky and get them into the lateral nasal crest.

Dr. Clark Damon:

But that is a significant concern that I see very often and I am a very big proponent of eliminating that approach of having six implants entered to the sinus for that reason in a lack of execution or a biological failure. So also, you know, we know this too, from you know, years ago, when we would do, you know, eight implants, you know oftentimes, you know, multiple implants would wind up failing. So when we really treat a titanium deficiency with a lot of titanium, we now incorporate lack of blood flow into those areas. So by sticking with four implants anterior to the sinus, we are going to have fallback areas if we need them and we are going to increase our blood flow. And where I will you know, encourage if you want to avoid, or the way that I eliminate mechanical issues, is by doing pterygoids on everybody. So now we are moving those implants away, we are building a strong bridge on six implants. We are just moving the supporting structures to the further edges of the mouth.

Dr. Tyler Tolbert:

So I have a few notes on this, dr Stanley. So for one, do you have any? So you talked about and it was very interesting, you talked about all-in-four versus all-in-five versus all-in-six, controlling for the AP spread, everything being the same there, reducing the mechanical stress. Is there a study that correlates to that that I could look up?

Dr. Robert Stanley:

It's actually I just calculated. I did the beam analysis myself. I haven't published it, but I'd be happy to send the content over to you so you can see it.

Dr. Tyler Tolbert:

Please, yeah, no, I'd like to look into that as well, Because there are similar studies, like Dr Damon mentioned, the Wilkerson study that talks about reduction in biomechanical stresses with the use of pterigoids. So it's interesting to see both arguments being supported, or both Very different modalities reaching a similar conclusion Well and then you know, tyler, also, you've got this DUYEC study in 2000.

Dr. Clark Damon:

And you know they used in vivo stress and strain gauge abutments and it was 13 patients. They found that there was no statistical difference in stress or strain in four, five or six implant scenarios when it was in an anterior approach, when they were anterior to the sinus.

Dr. Tyler Tolbert:

Anterior to the sinus. Okay.

Dr. Robert Stanley:

What stress were they measuring? Stress delivered to the bone.

Dr. Clark Damon:

They were looking at tension moments.

Dr. Robert Stanley:

Tension moments. I don't know what that term is. So what happens is that if you apply an occlusal force to an all-on-four or you apply the same occlusal force to an all-on-six, the force delivered to the bone is the same. So if their study was to set up to see if that wouldn't change, the stress would change because you'd have more area with six implants than you would with four. So you'd have less stress to the bone with the six. But the flexure of the beam can be done. You don't. You don't need to do this in the mouth. It gets complicated when you do it in the mouth. You just do it on a piece of paper. So if I have, if I have, two columns that are this far apart and I have a beam running across it, you guys know, you guys know just inherently that if I move these columns in closer, the beam will flex. In between it will bend less. Okay, correct. So if you're trying to cross a creek and there's a narrow creek or a wide creek, if you try to cross the narrow creek with a 2x12, you can walk across it. But if the creek is really wide and you cross it with a 2x12 when you're in the middle, that board is sagging. Okay. So that's the idea behind your implants. If your implants are close together, your zirconia prosthesis will flex less. If your implants are further apart, your zirconia will flex more.

Dr. Robert Stanley:

That's mechanical, you don't. You don't really want to do this as an in vivo study, because all that does is this muddy the water. So that's some master's student trying to get their master's degree in Perio or something, or Pras. It just muddies the water because it's basically it's basic engineering, right. So we don't need to make it more complicated than if the beams. If the beam length is longer, it flexes more. You can just look it up on Google tonight and you'll just see the beam length is how much it flexes. So if you do an all-in-four or you do pterygoids and you spread that beam out, you better make sure you're going with a tall beam, because if you do this with an FP1, you guys that are listening if you do this with a crown high space that's narrow and you spread your implants out really far, you're going to have more failures. You're going to have more mechanical failures mechanical complications.

Dr. Clark Damon:

I mean, I'm not, I'm not advocating for that in the FP1. In fact I don't.

Dr. Robert Stanley:

I don't advocate for FP1s at all, but I you know.

Dr. Clark Damon:

Elon. Elon Musk, you know he talks about engineers wind up over-engineering things, right, things that don't even need to be optimized or engineered. And so I think, going after beam length, you know well, sure, if you're in between, you know your zirconia is 20 millimeters or more, then you need something there. But I don't believe that over-engineering a titanium deficiency to reduce beam length is a wise thing to do, in my opinion. I don't think it's. It doesn't need to be there.

Dr. Robert Stanley:

Because you're concerned that if there's a failure, there's no recovery.

Dr. Clark Damon:

It's either. It's either yeah, in a failure, or lack of execution. You know, on on down the road, it's it's just. I want to leave more bone, I want to leave more blood flow. You just and, and and. I want to be simpler, and if if.

Dr. Clark Damon:

I want to then optimize. Right, you know so so. So where do I optimize? I optimize in, in, in the posterior, because I do think when you have a implant bridge that has six implants, I think it is phenomenal. I think we agree on that. I think it's just kind of more where they need to be.

Dr. Soren Paape:

Dr Stanley, do you think that it's predictable for most clinicians to get accurate scans for these? Let's say you have a bunch of clinicians and they all are doing guided cases right, so they're getting that parallel above and it sounds like that's how you're know you're getting a lot of that parallelism is, the cases are guided, you're able to. You know exactly where the multi unit position is. You know that they're going to be parallel, so you get that scan and it looks great, it looks accurate. Is that something that you know your team has just has a lot of experience with?

Dr. Soren Paape:

Because I find a lot of providers, even if, let's say, the scans are I mean the scan bodies, healing caps, whatever you're scanning right are parallel In a bloody field. I just see a lot of clinicians just struggling with that. Is there anything that you do in particular that would be like a good gold nugget for clinicians to make that scanning easier for them to prevent, like these bloody fields or how are? How is your team doing it to get that 40 microns accuracy over and over and over again?

Dr. Robert Stanley:

So most of the time we're doing, we're doing this scan, so we're not doing. It's very rare for us to do the scan the day of the surgery, you see, because I already have a prosthesis made, so I'm not doing any sort of day of. Very rarely do I do a day of surgery scan and then make the prosthesis immediately. I've done that a couple of times for the sole purposes of measuring throughput, how fast I could do it, so I can do a full arch in an hour, like we've said a couple of times tonight. But when I did it where I didn't have a prefabricated provisional, I wanted to see how fast I could do it.

Dr. Robert Stanley:

So what I did is I placed six implants and then I scanned them before I sutured. I placed six implants and then I scanned them before I sutured the bone, and the reason I did that is that I had the substance right. So we blotted it when we scanned it and everything, and then we delivered it. The whole process took three hours, so still rather quick compared to some people's conversions that are taking four to six hours. Rather quick compared to some people's conversions that are taken four to six hours. Rather quick compared to some people's conversions that are taken four to six hours. They take the implants, they scan and then they build their provisional.

Dr. Soren Paape:

And that makes a lot of sense.

Dr. Robert Stanley:

But that took me three hours and I can do it routinely with one hour with a prefabricated provisional. So I don't do it very often with one hour with a prefabricated provisional.

Dr. Soren Paape:

So I don't do it very often yeah, I understand that yeah, I wanted to clarify that, just to make sure, because, um, doing no photogrammetry in an office I feel like might not be very predictable if you're designing same day and doing same day fabrication. I could see that being maybe something that people are misconstrued and maybe why you're getting some of that hate.

Dr. Robert Stanley:

You're absolutely right. That's a great sorry. That's a great clarification, because we just don't do. I think we've only done it twice. I think we're going to do another one coming up in the near future because I'm always experimenting, as we said. I'm always trying different things. So I think I'm going to do another one coming up again. But it was successful. It's just that you know, if you do these cases, everybody will agree Sometimes you have bleeders right and sometimes you don't. And sometimes you don't even you don't even know why. You can't even really predict it. You're like, is this person on aspirin? And they go no, they're not aspirin, they're not on any. They're not any any Plavix. You're trying to figure out why they're bleeding like a stuck pig Right. And uh, on those cases, it's going to be hard to get a scan right. It will be hard, so that's where photogrammetry would make a lot of sense.

Dr. Tyler Tolbert:

So I have a couple of things. Um for one. Would you say then that, um, because it all matters, you know how close the scan bodies are to one another. It doesn't necessarily mean that the implants themselves have to be close to one another, right? So now what we're seeing are scan bodies you mentioned, like the T-shaped scan bodies. Now we have a Shining Elite True Abutment has one where, no matter where the implants are, they've got these arms that all point concentrically and bring all these implants together and you can sort of now remotely relate the implants together using just a scan body.

Dr. Tyler Tolbert:

And that's a big thing that's going on right now, and people are trying to pivot away from photogrammetry or at least provide a product that's just in a box, everything's there in a box. So that's just. That's less of a question, more of just a note, really. And then, second, the only thing I would challenge just slightly is when it comes to the parallelism of the multi-unit trajectory, right, like how parallel all of our multi-units are. I would only say that I don't know that that's always ideal, especially in the maxilla, namely in the atrophic maxilla, and also in a case where we are hoping to do, potentially, class correction. So a lot of times, you know, between myself and Soren and Caleb, we had a little bit of a contest on who could get who could freehand the most parallel multi-units on the mandible, to get down to single digit deviation. This cool thing the micromapper does you, take a picture of it, it tells you what your deviation is, and we all got there eventually.

Dr. Tyler Tolbert:

But on the maxilla that that's not something that I I'm ever really shooting for. Right On the, in the uh anterior, I'm almost invariably tilting, uh my implants anteriorly to buck out a little bit to compensate for the resorption of a maxilla, especially one that's a dentureless right. So then, how you know, if, if I were to try and get everything perfectly parallel and still have access holes that are in the cingulum, the cinguli of the anterior teeth and the, you know, within the clusal table of the posterior teeth, I don't think I could actually do that in a parallel way. I actually want all of my multi-use to be flaring out slightly buckly. So if I tried everything I could to get everything parallel, I think it would actually have very palatable access holes across the maxilla.

Dr. Robert Stanley:

I think that's a really good point. Tyler, I would say that I do the exact same thing. So all of my screw holes are coming out the cingulum and I'm always driving my digital planners to make sure that they're in the cingulum. They want to place them 3, four, five millimeters lingual to the singular and if you've ever gotten one of those provisionals back, you know that's just awful for the patient. They have this massive wad of plastic on the roof of the mouth and they can't talk and they're listening. It's terrible. So I'm always driving them to do these cases the same way. They would do a single implant. So that access hole has to be out the cingulum. So that's where they're at. So there is going to be divergence, but they are still more parallel than they're not, if that makes sense. Okay, the divergence between this one and this one might be quite a bit, but this one to this one, this one.

Dr. Tyler Tolbert:

Oh, the adjacents are something. Yeah, as you're stepping around.

Dr. Robert Stanley:

they're not diverging too much around the horn, right, I see the nuance. Okay, yeah.

Dr. Tyler Tolbert:

Okay yeah, that's fair. Okay yeah, very good.

Dr. Soren Paape:

I was just going to say, you know, before we start wrapping things up, this did go a lot longer than we had expected.

Dr. Soren Paape:

And I loved the points for both of you guys. They were. They were excellent and I think. I think it really comes down to like every provider has their own set of skills that they want to be proficient in, right, like some, some providers. They're not going to want to have to get a guide for every single case and in that situation, like free hands, wonderful. But if you want another tool to help you know, make the like you were saying, some of these providers that you have seen do arches for the first time right are having excellent outcomes. You know guides can be, can be excellent, but I, either way, I would like you guys both to get a chance to talk about you know, your courses that you have and, if they want to go down that Avenue, I'd love for you guys to have an opportunity to to let our audience know where they might get some more information from you.

Dr. Soren Paape:

Sure.

Dr. Clark Damon:

Awesome. Well, I would say this photogrammetry is Achilles heel. Is the fact that it has to be related to an intraoral scanner right? So, like you know, when you relate your PIC to white healing caps or ICAM scan bodies, you know, or Micron mapper, that's kind of the Achilles heel, and we've all seen cases where when you go to align your implant position to your jaw scan, there's there's some variability there. So that's that's. That is definitely the Achilles heel Now granted it is, it is going to fit perfectly.

Dr. Clark Damon:

But that is when you're going to get these occlusal issues, and you know, then you kind of go down this whole occlusal rabbit hole of dealing with realigning jaw data and jaw scans. So we are, we don't have the perfect, we don't have the perfect restorative material, we don't have the perfect photogrammetry and we don't have the perfect scanner. So you know, I assume eventually we will, but we'll just have to stay tuned. But right now it's, you know, using all of these different things that are dealing with the limitations that the technology that we have is able to provide us. So, so, with that, let's see, I've I've got the Texas Implant Institute.

Dr. Clark Damon:

We do basically two courses. We do all on X standard and it's hands-on models, and day two we go into cadavers and so we skyrocket your surgical experience. I mean, I've even had doctors that have done a thousand arches. Come take my course and they're like man, I learned so much and I was like, really, they're like, yeah, you taught me to hold the retractor the right way. You taught me to, you know, do this with the periosteal elevator. So it's just, you know, everybody has like different little bitty pearls that they just kind of pick up and we go over.

Dr. Clark Damon:

You know how to sell the cases, how to talk to the patients and you know the whole history, treatment, planning, all of that, and then we have our All on X advanced course for atrophic maxillas, which is zygomas, pterygoids, nasal crest, and it's really the same format didactic lecture, hands-on models, and then day two, we roll into cadavers.

Dr. Soren Paape:

I'll advocate as well. We I think tyler and I both probably had done over 500 arches. We went to your first course and I and I took away a lot of takeaways that were great that were very, very helpful. Awesome, awesome yeah so we've been.

Dr. Clark Damon:

We've been doing it since 2018 and uh, we're, I guess, in seventh year it's. It's a little odd this year, um, you know, my, my co-director, rick klein, passed away, uh, right after one of our courses, and so we're we're still trying to figure out you know who, who we're going to do the courses with. Right now I'm a little solo, but uh, still still get just great education. I, I, I primarily did all the lecturing, um, so that that really uh doesn't change at all. Um, so we are uh located in dallas and you know we always have a good, a good happy hour and a good program.

Dr. Clark Damon:

And we like to, you know, eat, drink and be merry after good state too, yeah, yeah, yeah, come texas, but, but, but, but, but, but really, you know we eat, drink and be merry after Good state too.

Dr. Clark Damon:

Yeah, yeah, come to Texas, but, but, but, but, but. But, really, you know, we also offer the mentoring program and you know you guys are in our uh, uh, what is that? The WhatsApp group, and uh, you know it's, it's uh, you guys get access to me, which is which is a good or a bad thing, because I'm going to call you out. I can vouch for that. I'm going to hold you guys accountable because, at the end of the day, I want excellent results for your patients. This is a lifelong learning thing. There is no one course you need to take. Maybe after this, I'll start sending people that need some help over to take Um, you know, maybe after this I'll I'll start sending you know people that that need some help over to Dr Stanley's course.

Dr. Tyler Tolbert:

That's good.

Dr. Clark Damon:

Say, say. Hey, you know what I, I think, uh, I think freehand is not for you.

Dr. Tyler Tolbert:

That's a good segue into a Dr Stanley, if you wouldn't mind talking about your courses.

Dr. Robert Stanley:

Thanks guys, I really appreciate the time. As you guys probably note, I'm a bit of a talker.

Dr. Robert Stanley:

But I'm not very good at selling myself. I can talk about implants all day long, but I usually turn that over to my team, my director of the Institute, stanley Institute. We're based just outside of Raleigh, north Carolina, about eight minutes from the airport, so if you fly in it's real convenient. We have basically Stanley Institute, for Comprehensive Dentistry is. The two primary educators are myself and my wife. My wife teaches the business of dentistry. So if you want to learn, so I like to say there's offense and there's defense in a business. Right, offense is how many cases can I do, how much money do I make? Defense is how much money do I keep? Okay, what my wife teaches you is the defense, which almost no one talks about. Right, we're always like well, if I add this skill set to my practice, I can generate more revenue for my team and for my family and get closer to my goals. What we don't talk about is how can we reduce our tax burden, how can we set up our corporations in a way that are beneficial for us in the long run? That's what she talks about. So she talks about the business industry. I talk about pretty much implants. So we have a onesie-twosie course. It's three courses, but the first course is online, so the first is called Essentials 1. 1 and that's the planning course. That's where you learn how to plan. So that's all online. And then Essentials 2 and 3 are also online. So if you're a remote watcher, you can have a lot of people that follow me overseas so they can take the course remotely. So Essentials 2 and 3 are taught together now as a three-day weekend. Okay, it's a three-day weekend. Okay, it's a three-day weekend, and I encourage people to come to the real course versus the virtual one, because you get to do the hands-on parts. Okay, so we have all these hands-on experiments and there's live surgery as well. So that's how we do the onesie, twosies For the full arch course. It's a three-day course that you're all on X course and it covers everything. It's a three-day course that you're all on X course and it covers everything. It covers from planning, it covers the surgery, it covers the digital workflow all the way through the prosthetics.

Dr. Robert Stanley:

And the main goal with our institute is rather simple Our goal is to reduce risk and improve outcomes for patients, and we do that predominantly through a pragmatic approach to implantology. So we look at some basic things that people really don't consider very often and we've talked about many of those tonight and hopefully that will give you guys some food for thought in terms of ways to reduce risk through mechanical, basic mechanical principles. And we eliminate things like torque. We talk about torque in a way where you start to understand the limitations of that metric versus what most dentists do, because we've been trained a certain way is we kind of stick to these old things and that can lead you down a path that it can lead you down a path where you're doing things that aren't in the best interest of the patient. So that's kind of it.

Dr. Robert Stanley:

And we have a failure to an anti-failure to launch program, which was rather negative, so then we called it a success program. So the anti-failure to launch program, which was rather negative, so then we called it a success program. So the anti-failure to launch program is that we were told that a lot of doctors come to courses and after they take a course they get really excited, but on Monday they're they're back at the, they're back at the grind, right, and they don't have time to actually implement everything that they, that they learned. So we have a success program to kind of walk you through your first few cases and we mentor you and hold your hand through that whole process. So people really like that and it really helps them get going, because once you get going, it's pretty powerful.

Dr. Tyler Tolbert:

Cool, cool. Well, listen, guys, I, you know, there was definitely a world where I saw, you know, bringing on the two of you guys who are very intelligent, very experienced and have a lot of success in your own practice, albeit with almost polar opposite modalities, and, you know, we railed off a few questions and you guys went back and forth and you both just stormed off and said, screw this, this is dumb. So I really appreciate that we didn't let the egos take over here at all and we actually had a really lively and educational debate. I mean, there were a lot of topics that I think are going to be, you know, talked about by our audience that listens to this, and I think there were a lot of challenges, you know, for both camps and looking across the aisle and saying, well, maybe there are some merits at this point, and vice versa. So I really just want to thank you both for coming on, bringing on your expertise, bringing on your experience and, you know, just be mature about this and, you know, living out the Socratic debate and just talking about things in a way that you know is really just meant to benefit those that are trying to do more full arch and trying to benefit patients and trying to do better for people.

Dr. Tyler Tolbert:

And you know, personally, I learned a lot here. I know Dr Soren did as well and I just, you know, can't thank you guys enough for your time. We're running into about two and a half hours. There's actually a record for our podcast. We never recorded that long. Well, maybe we have with Dr Damon, but we did it in parts. So thank you guys so much for sparing your time and coming on. I really can't thank you enough.

Dr. Robert Stanley:

Awesome, that's my pleasure thanks guys, I really appreciated it awesome you guys take care okay, bye.