The Fixed Podcast

Navigating Full Arch Challenges: A Talk with Dr. Sean Lan: Part 1

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Soft tissue wins the full-arch war. That’s the hard-earned thesis we explore with Dr. Sean Lan as we move beyond torque chasing and into the quieter skills that make cases last: augmentation strategy, disciplined planning, and candid communication when things get tense. We start with lessons from the Orca Symposium, where soft tissue and regenerative approaches stepped out of the shadows, then unpack how Sean’s study-first approach condensed years of progress into months. Literature fluency, surgical fundamentals, and an environment for high-quality reps created a slingshot effect—turning complex surgeries into predictable systems.

You’ll hear a visceral case study: an anterior nasal spine fracture mid-surgery and the clear-headed salvage that followed. Instead of forcing a graftless solution, Sean reframed the event as an unintentional ridge split, stabilized with allograft and PRF, tightened closure, and staged the implant for success. The message is simple and timely: regeneration isn’t a last resort, it’s strategic insurance. Even when cases go smoothly, smart augmentation protects prosthetics, preserves options, and keeps the door open for future revisions.

We also tackle the often-ignored foundations of longevity: fitness and posture that let you operate with a clear head and steady hands, plus leadership and communication that prevent small issues from becoming practice-threatening problems. From seated surgery and core bracing to crucial conversations and books that sharpen your voice—How to Win Friends and Influence People, Crucial Conversations, The Courage to Be Disliked, The Anger Trap—we share the tools that keep teams aligned and patients confident. If you’re serious about full arch, this is your blueprint to move from technician to doctor: case logs and debriefs, regeneration readiness, and the people skills that preserve your nights.

If this conversation helped you rethink your process, subscribe, share with a colleague, and leave a review with your favorite takeaway—we read them all. What’s one change you’ll make before your next arch?

SPEAKER_00:

My name is Dr. Tyler Tolbert, and I'm Dr. Soren Poppy, and you're listening to the Fix Podcast, your source for all things implant dentistry. Hello, and welcome back to the Fix Podcast. We're on for a very special episode that I have been trying to make happen for, I don't know, probably two years now, um, approximately. But uh I'm here with Dr. Sean Lan, who's a uh honorable colleague of mine, but also a very close friend. Um, we've worked together, um, had the pleasure of working in the same uh office before. And, you know, now we work on two diametrically opposed uh, you know, states of this country. Um, but we are still very close and we coordinate um all the time. Most of the time that I'm reaching out, it's it's sometimes to check on him and how he's doing. Most of the time it's like, oh no, uh, I'm in trouble and I don't know how to do soft tissue stuff. And, you know, is this is this idea crazy? And then Sean will come back to me and say, That's really ridiculous. I'm gonna send you some articles, and I know you won't read them, but here's what you need to do. And so he'll send me a stepwise, you know, process on how to do like a graft. Um, but no, seriously. So I I want to welcome um Dr. Sean Land to the show. Thank you so much for coming on, my man.

SPEAKER_01:

Dude, we've been I'm thank you for having me, man. This is this is great. This has been in the making. Um, but yeah, I'm super stoked to be on here and um and yeah, share what we got.

SPEAKER_00:

Yeah, for sure. So um just to kind of give some context, um I I I wanted to have Sean on, not just because he's my friend, but I truly think that he is one of uh the most studious and pedantic people that I know in dentistry without being, you know, completely insufferable. And he has a very strong grasp on all the modern literature uh having to do with all things implantology, like we like at the Fixed Podcast, be it soft tissue, hard tissue, implants. He's really the person that changed um how I looked uh at full arch, really, because I, you know, I was all about just getting torque, putting screws in bone, um being able to immediately load things. That's that's what I thought was really the art of full arch. Um but what I've come to learn is that the subtle art is in the soft tissue. And that's something that um, you know, Dr. Land here, he was studying from the moment I met him. I met him I met him about two years ago. He came to Shadow of the Office, he was coming um, you know, out of the uh out of his uh Air Force program. This actually was more than two years ago, wasn't it? And um time flies. And, you know, he was learning all the soft tissue stuff. And, you know, at that time and and even up to now, I mean, it was something that was maybe not uh at the forefront of my mind. It wasn't really part of my algorithm and figuring out full arch. I kind of assumed that soft tissue worked its way out. Um, but as I've you know gone through my practice, I've really learned uh to understand how important that is and also augmentation as well. Like there, there is a place for that. And, you know, if you do this long enough, you're gonna run into issues where you kind of wish you could grow something back. Unfortunately, um, Sean knows a lot about that. Um before we get into it, I do want to mention um we did get to see each other at the uh 2026 Orca Symposium, um, which was fantastic. It was in Las Vegas. And um, you know, I don't know what you thought about it. I I hope you can share some, but uh, I thought it was fantastic. I was I was there for the first annual symposium, um, which I thought was fantastic as well. I thought it was, you know, incredible to have so many big names on the stage and to have all these full arch people in one room was really incredible. And, you know, that's pretty much all I expected the second time around. Um, but what I saw more was uh there was more talk about soft tissue augmentation. Um, there was things for various skill levels. It all wasn't about showing off, you know, a bunch of zygote cases. It was about um transinus, it was about all kinds of other remote anchorage, it was about even um getting into full arch. You know, Athena Ghadarzi did something about, you know, here's what you want to do if you want to get into full arch. Here's your roadmap to excellence, which I thought was fantastic. It wasn't just preaching to people that have been doing this a long time. And uh, you know, a lot of people showed out. I think there were about 300 attendees. Um, I was also able to see um meet a few of you guys in person, um, you know, fixed fans out there, Alessandro Retis, um, Judson Murray, who I already knew prior, but it was the first time meeting him um in person. And then George, he wanted me to say Politicus, but that's Americanized. He told me it's actually Politakis. So I am now saying his name correctly. I've said it on the show before and I completely butchered it. And he told me very politely that I did that. Um, and he was uh gracious enough to tell me how to say it in person. So, George, thank you very much for your patience with that. Um, but yeah, so how how did you enjoy the symposium?

SPEAKER_01:

Man, I I loved that. I mean, everything you said was great. Um, you know, uh my favorite part that I took away, and I don't honestly the main reason I went was, I mean, obviously the content's great, but um we we consume that like day in, day out. But um, it was really cool just meeting a bunch of these surgeons that I've been talking to, like some of them for like three years, you know, even other colleagues and dentists trying to get into it. Um, and just like on Instagram. And that's like kind of what brought me back, like you know, social media, we're sitting there scrolling, everyone's you know, no one's immune to that. Um, and so whenever I catch myself, I'm like, man, I just why why am I be using this? Um, but man, moments like that is when I was like, this is exactly why, you know, as with anything, if if used with intention, right? Like it's it's a it's a beautiful thing. I learned so much um from from talking and posting my cases, and you know, great surgeons like you know, Dr. Gonzalez um or Thomas Kaczynski, they'll they'll just comment on my post and like be, hey, nice, man. But here's what I would do, like, you know, and and just give me little um things that will that'll make me that just made me better, you know. So um, and also shout out to those guys for taking the time to help young surgeons like us, you know, get better and um and hopefully we can do the same, you know, for the next for the next group.

SPEAKER_00:

Yeah, no, I I totally agree. And and I've experienced that phenomenon as well. I share a case and I'm you know feeling really you know high and mighty about it. And I'm like, oh man, my case looks so sick. And I'm getting likes and comments and fire emojis, and then Simon will comment and be like, call me. And this has happened. We we we've had to sort this out before. He he's had to you know teach me some lessons about uh how I do full arts, which of course is welcome and it's only benefited me um substantially in my cases. But uh, but no, totally. I mean, being able to receive that kind of feedback is so important and it's so um, I mean, it really means a lot that people who have extremely busy schedules take the time out of their day um to coach people on techniques and make your cases better. And that's what it's all about. Like it's a very competitive world um that we live in in full arch. You know, if you're, you know, um either if you're an associate in an office, if you're starting your own office like you are, um, Sean, I mean, you know um how competitive it is out there. And um, you know, we can it it can lend itself to a scarcity-based mentality. Um, but I think at the root of it all, we have to realize that um there's a lot of people doing full arch, but there's not a lot of people doing it really, really well. And the people who do it really well and they research and they associate with one another and they share knowledge and they try to empower others, those are the people that I think will win out, you know, long term, not just you know, economically or competitively, but I just mean, you know, to have clinical success in full arts requires attention to detail and it requires some humility and the ability to be open-minded and learn new things as you go along because it's an extremely challenging thing to do. Um, and it it only gets worse if you're trying to do it in a silo. So really appreciate Orca for putting that together, bringing together uh the best full arts surgeons literally in the world. I think they were represented, 30 countries are represented there. That's insane. I think there were more people from out of the country than in the country. It is ridiculous. Um, so that was a really cool thing to be a part of, and you know, I'll certainly be there next year and I'll have some more hats to give out. We got it, we got a fixed podcast hat in the background on your fee, which I certainly appreciate. Uh Sean went with the cream. That is my personal favorite. Up with the skulls. Yeah, exactly. Up there with the skulls. That's fantastic. Um, but yes, that's that's much ado about things other than you. So um, Sean, if if you would be so kind, can you kind of just share with us, you know, your journey, you know, from dental school, getting into residency. How did you find that implants uh was your thing? How did how did you go about pursuing that? And what did you do through residency and coming out of it to sort of lead to where you are today? And then kind of catches up with what's going on.

SPEAKER_01:

Yeah. So uh dental school got me into dental school, even which I th I thought I wanted to be an orthodontist. And uh pretty quickly I found out that's what I don't want to do. Um yeah, I I I kind of was just going through my way and um through the specialties, you know, first year and like came across uh oral surgery, uh, which is the one that spoke to me most. And so I just started hanging out with them throughout school, you know. Every free moment I got, I was in their clinic. Um uh third, second, third year, I started taking more calls with them, you know, um that kind of stuff, things that you know um a lot of the listeners probably have done. Um, but that was my main interest was oral maximal facial surgery, and that's what I thought I wanted to do right out of uh dental school. Um after dental school, I um I had a three-year contract with the Air Force, and so I started that, and the first year was a one-year AGD residency, and um in that residency is kind of where I um, you know, still I was full steam ahead. I'm gonna apply for the, you know, take my CBSC, apply for program um as soon as I get out, and uh, because I decided I wanted to do a program uh outside of the Air Force. Um, Air Force has great programs, just they only have the four year, and I thought I wanted to do the six. Um, so I was preparing for that, and then man, I just had, I don't know what it was. I was sitting there and I was just thinking, I was like, man, like how this is really stressful, you know. And I had like sat back and think thought thought of my life and like, hey, like how how much additional happiness will um doing maxillofacial surgery bring me? And I was like, it certainly would bring me additional happiness, but um, I started seeing, you know, a lot of GPs and and even you know, Peridonists and other colleagues do a lot of great dental alveolar surgery and and implants um on Instagram. And also through Instagram, I've met other people, you know, that have been doing really high quality work that I thought, oh man, you have to be a specialist to do this. Um and it just got me thinking, like, man, may maybe this path could be possible, but I still want to do it the right way. If it takes me to specialize, I'll specialize, you know. Um in residency, I had really uh supportive uh attendings, they were all specialists in their in their own right. So my endo uh attending was an endodontist, my period was a periodonist, oral surgeon. We had two of them. Um prostodontist was a prostodontist. So um, and they were all just it was almost like they were just trying to compete to see who they can come, you know, convince to join their specialty after, which is great, you know, because in the Air Force, you're sent to a base and you're it's just GPs, unless it's a big enough base, um, they don't have specialists there. So they really wanted, even if you wanted to stay GP, they really wanted you to know how to do all this because if you refer, it might be like a two-hour trip for the the airmen that um that's there. So they really wanted you to do a lot, and and if you wanted to, and so the but I think in a very responsible way, and so and so this kind of was like the formation of how I think and and how I learn. Um, I my my periodontist and oral surgeon, they sat us down intro week, and they're like, listen, you guys can graduate here just doing SRPs and and simple extractions, or you can graduate here having done over 50 IV sedations, you know, um full bony impacted, thirds, osseous periosurgery, some soft tissue, it's not heavy on soft tissues is only a year program, but they're like, you can do it as long as you prove it to us that you're in it, you know, and you can and you can um put in the work. And so what that meant was literally like, for example, for my periodists, he said, okay, if you have a patient that needs, for example, periosseous surgery and that's something you want to do, um, prove to me that you can, you know, get 70% of the way, and I'll take you the rest of the 30%. So we'd go read textbooks, you know, we can ask the questions that he would answer is, hey, uh, what kind of papers do you suggest, or like what authors would you suggest? And he would give us those names and we would go read them. And then we had 30 minutes, you know, we had a scheduled meeting with him, had 30 minutes to sit down, talk through the case, um, talk about the literature we read, and um, and if we made him happy, he would take us to the rest of the way and let us do it. And so I think that was a really um formative way to teaching me how I teach myself nowadays, you know. And so I just kept doing that over and over and over. And um, when I graduated, man, I had so much confidence not only in what I was doing, but in myself to teach me um to be able to learn these things, obviously with guidance, but you know, to be able to learn these kind of procedures um and be able to trust myself to critically think. Um, and so that was the first, I would say, the the most important thing that I developed in residency um that helped me on my path. Now, kind of in the next two years afterwards, and this is kind of everyone, every path to doing implants in Florence is different. But I think um I think you said on, you know, very early uh episode, podcast episodes on the previous uh podcast that you had. Um, but you said you know, you you were talking with uh Soren, and um you guys were just talking about like the different things that you need. You know, you can look at different flavors, but what you need is you know, um obviously didactic knowledge, right? You know what you're doing, you know the anatomy. Um two, you need solid surgical fundamentals, right? Like uh Soren took out thousands of teeth in dental school, right? Because he was with the oral surgeons, didn't place implants, but flapped a ton, took out a lot of teeth, you know, very comfortable cut and bone, uh sectioning teeth, all that. Um, and then three, you got to do the damn thing, right? Um, you have to do it. So finding an environment um that allows you to do the thing that you're doing. And so Didactic Park, obviously, that was kind of what uh the first arm is what I developed in residency. And then over the next two years um in the Air Force, um, when I was working at a clinic, I had a lot of time. So that's when I really, really started to dive into literature, textbooks, you know. Um, we had so many books come out in you know, it's 2017, like Urban's book, Pico's book, uh Zero Bone Loss Concepts, all those. I read them all um and a lot of other papers after that too. Um, just kind of preparing because I was like, this is what I want to do when I get out. And um so I was preparing myself didactically, um, still talking to my attendings for that guided learning component, right? Um, not just out here on my own, you know, completely. Um if I had a concept that had trouble understanding, I would text them and and and have a call with them and they would, you know, guide me through. And um, and then two, I was also developing that surgical, that second arm, right? This developing surgical fundamentals. All I was doing at um any third that was coming through the clinic, any kind of surgery, biopsy or whatever, uh benign, obviously, uh, I would try to do, you know, uh within my comfort level and uh and my scope. And so building very good fundamentals, flapping, sectioning teeth, all that. Um, and then so that at the end, which is kind of where our press crossed, um, was three, having the environment, right? Now I had this environment where it was a full arch clinic. I got to watch, you know, a very uh adept surgeon um like yourself perform the surgery that I had been reading about for over two years, and it just all clicked, you know. And I I still remember the first day when you're like, all right, you ready? And I was like, Yeah, man, like let's do it. And it was like it was such an exciting day, man, because it's like you all this is the culmination of like two years of just you know, this is all I was thinking about, and then you gotta do it, and then that's all we did, you know. For I think I was with we were there for like two and a half months together, yeah.

SPEAKER_00:

Um well, I I think something that you know is so remarkable um about your development. I think it it it's it's a tale of two different paths, right? Like for me, I went straight out of dental school into doing doing full arch. And, you know, truth be told, I mean, I I feel confident saying now, I had you know very inadequate experience to be doing what I was doing. That's just the reality of it. Um, I know that now in retrospect. At the time, you know, you you you tell yourself what you need to to get through it, right? Um, because I knew it's what I wanted to do. And I and I had done some research. Like I'd read a lot of books and listened to a lot of podcasts and done a ton of shadowing. Um, but you know, I was also a COVID grad and I'd pulled like 40 teeth, you know. So there's a lot of learning on the fly, and I and I had tutelage and I had guidance and I had backup, you know, and that was important. And, you know, I I just grinded my way through uh literally and figuratively, a lot of arches and learned a lot of hard lessons very quickly, and it was particularly stressful. And I learned so many lessons in retrospect. Um and I I don't know if that that's really the preferred way to do it. And I kind of look at what my progression was like and how my cases were looking through, say my first year, second year, and what that progress was like and all the things that kind of happened there. And, you know, as I was running into complications and and getting into hot water with certain cases, it didn't go the way that I thought they would. You know, that's when I would go back to the books, go back to the literature, go back to textbooks and and and try and relearn a lot of these things and question, okay, I thought that this would be good enough, but it obviously wasn't. What do I need to kind of supplement? And and I would kind of, as I went along, I was going back to try to learn those fundamentals better, right? And I go to courses and people would teach me how to properly flap, you know, they teach me how to properly uh extract a tooth. And I and I'd learn I'd learn everything going back to square one, even though I was already full steam with full arch. I think it's very, it's very seductive to go out and and do this as soon as someone gives you a job. Um, and maybe there's some virtue to that, you know, maybe there's some grit there. I don't know. But um, in your case, there was a whole lot of preamble where you were in residency and you were learning literature like the back of your hand and having to face the scrutiny of specialists and having to prove that you had a right to be doing what you were doing. And while it took you longer to get to the actual opportunity of getting to do the work, um, you took off like a bottle rocket. You know, I mean, from your first case to when you were placing pterygoids to when you were doing, you know, advanced regenerative surgery, this was all happening in the in the period of like six months to a year. I mean, I watched, I watched the entirety of my full arts progression that took like two and a half years up to that point, get condensed into like six months because you already knew everything you needed to know. And it was just about getting that opportunity. Sorry, I got my fixed logo going absolutely bonkers behind me. Um if you're watching the video, you're getting quite a light show right now. Um, but um, yeah. I mean, I I think that it's a it's a really good demonstration of this kind of slingshot effect that happens when you're getting, you're, you're prioritizing the training first before you get the opportunity. And while, you know, economically you can you can toss up opportunity costs and talk about that, whatever. Like just throw that out for just a second. And I think when you look at the body of work that you have done since you've been able to actually do all these things you've been studying to do, um, your cases are fantastic. They're beautiful, they're complete, you know, they're harmonious and hard and soft tissue, they have the right arrangements. I mean, your your cases got to the point of being, you know, functionally, prosthetically, aesthetically, everything uh being immaculate a lot quicker than I could. I hell, I'm still trying to get there. Right. And so I think that, you know, you make a very strong case for being intentional about the training first, making sure you know all these things first and really knowing the literature. Because once you've already gotten out and you start doing these things, it's really hard to learn new stuff. I mean, I have been, there are so many things I've been wanting to implement in my practice because I know that they would make my practice better. But like there's this hump of having to learn it first. And that's a really difficult thing to do when you're already in the grind of it all. And so my progression as a full arch surgeon has really leveled off. I mean, I think it still continues to, you know, get better over time. Um, but that growth is not nearly um as exponential as yours was when you first started. So I think you make a very good case for putting that training first, um, even though economically sometimes that may not look as advantageous as just going out and working in some full arch clinic as soon as you're out of school. Um, but uh there's pros and cons to both, and I think there's a very strong argument for going about the way you did.

SPEAKER_01:

Yeah, I mean, at the end of the day, there's different ways, you know, there's no one way better than the other. You know, you did, um, I wouldn't discount yourself at all, too, because I know you I know you did it. You were even taking implant C in dental school, and that's something I didn't even think about, you know.

SPEAKER_00:

I think I took, I think I took as much in dental school as I have since. That's that's that's how time changes you, you know, and how much work um holds you back from getting more training. But yeah, please go ahead.

SPEAKER_01:

Right. No, but I mean I think I mean it I think the similarities between both their paths is that um you're we're always constantly reevaluating cases, right? Like you can do we and we've seen it, right? Um both were mentors for for a large full arch DSO and we've seen everything, right? We've seen people, oh yeah, placed thousand implants as a GP. Cool, all right. And then you start seeing some of the cases, you're like, oh, I can I can kind of see the complication rate for those thousand was probably a lot higher than the literature states.

SPEAKER_00:

Yeah, you get a lot of reps when you're redoing your own stuff.

SPEAKER_01:

Yeah, you can do the same thing wrong a thousand times, you know. Um and it's not to say that we're doing it completely right, but you know, I I would I think to say we the difference, I mean the the the similarities that we have is that we're constantly review reevaluating our work, seeing what we can do better, see what we can tweak um in order to have better outcomes. And and at the end of the day, we're not trying, there's no way to avoid complications. I certainly had them, um, and I actually learned the most from them. But it's about you know, trying to minimize them, you know, and uh and just accepting if you're if you're not gonna, if you're doing surgery, you're gonna have them, and that's okay.

SPEAKER_00:

Yeah, for sure. Um, so yeah, going back to you know the story of you, um, so you've gotten uh your first full arch under your belt, you had that experience. What does the next six months to a year look like? Kind of catches up to where you are.

SPEAKER_01:

Um, you mean from the from the start point?

SPEAKER_00:

Yeah, yeah, like from when we did your first arch together and then before we get it.

SPEAKER_01:

Yeah, so uh kind of um yeah, we had our time together and then um started working on my own um as well. And then that was a real um another big moment because like it was also my first time as a dentist practice myself because in the military we had five other dentists um in the building, and then I went to two, uh just me and you, and then now it's just me. So very short time, yeah. Right. And it's not just talking like, man, how'd you manage like the cord on like you know this crown prep? It was like Like, you know, full arch. So um, yeah, not a lot of people that you could talk to, but of course, uh, you know, that's where kind of Instagram and and meeting people there and having met meeting mentor other mentors on there um kind of came into play a lot. Um and um continuing to uh read, continuing to kind of um, and that's kind of where it gets hard, right? Because now you're running a practice and um you have a little less time for that, but uh but um you know if you have cases that come up that you're like crap, it requires this this this procedure, this technique, you know, trans scientist or whatever, like I better read up on it and make sure. And that's kind of like the opportunity that you have to kind of make in in your daily life to to read, you know, it's when when you're forced to have to do it, right? Um so yeah, the next kind of six months was just that. In fact, uh we had talked about it before, but um was looking at my case log uh because they keep a case log for every single case they do. Um thing is amazing, by the way.

SPEAKER_00:

And if if you'd be gracious enough to share it, I think it would be a really awesome resource for people.

SPEAKER_01:

But yeah, yeah, put a link up or uh put my email up and we can I can uh uh send it to people. But uh the most important thing is, you know, and it's it tracks everything, but it the most important thing I always tell people is hey, like track your failures, first of all. Um, and I always try to write down like the cool mobilities of the patient, blah, blah, blah. Um, but uh it's it's really just a uh so you can run back. Um it's just like watching the tape back on you know, like on football. You know, everyone sits down, they watch the debrief. Um, I do debriefs on surgery, not not as much anymore, right? Because it at a certain point it just becomes more and more routine. But every time I push the limit or try a new technique or something, yeah, uh I sit down and and write my review um of of how things went, how things could have gotten better, and then that way have something solid there and I don't forget it, right? Like it sounds bad, but at a certain point, like it's it's hard to remember what you did yesterday, you know. You got something going on in the clinic. So um, so yeah, it's just a lot of that just continuing to grow and and uh learning how to trust in myself and trust in this process that I've invested in um and and growing from there.

SPEAKER_00:

Yeah. So I mean, you we both had similar experiences in in being mentors for tons of clinicians around the country. We've flown around, help people out with cases, and we've gone and done revision cases, things like that. What would you say, you know, having seen and and helped so many people in their full arch development, what would you say that most full arch clinicians are kind of missing in their toolkit?

SPEAKER_01:

Um yeah, so I I I think um a lot and especially a lot of questions I get to is just like, man, like you know, buckle plate fractured or like um this happened, like what do I do? And you know, for me, and and I'll share my one of my own complications actually. Um I'll never forget it because I still remember, like I can still see it how it happened. Uh it was a very tight maxilla, you know, it's a uh palate approach on the posterior implants. Um, I think, yeah, anterior implants uh were standard, but um it's very tight without a nasal palatine, it would have had like 12 millimeters of AP spread, but with a nasal palatine, it would have been 15, which is uh which that three millimeter increase is definitely worth it, like Pedro Rodriguez was talking about, you know, uh reduce that anterior cantilever. Um yeah, I was like, all right, I'm gonna have to place that MP and squeeze it in, but it's gonna give her, you know, avoid zygos at least for for the time being. Um place the posteriors, went in great, place the anteriors, and I was like, all right, like let's let's do the bones a little soft, you know, got like 30, 40, even with Versa and undersizing. Um it's but it was looking like I could load all the implants, and I was like, all right, I gotta undersize this one, um, which is when I learned in the anterior maxilla or places with highly cortical bone and not a lot of trabectal bone. Probably shouldn't undersize it.

SPEAKER_00:

It doesn't uh stretch very much, right?

SPEAKER_01:

It doesn't stretch very much because it's cortical. And uh sunk the implant, and I just saw I was like, hell yeah, it's going great, it feels great, it's grabbing on, and then I just saw the ANS, uh, the anterior nasal spine kind of fracture, um, start to fracture. Um, and I immediately stopped. Heart sank, heart sank, and I was like, Jesus, like I don't have any micro plates, like I don't know what do I do? Started like I backed it out, and I was just sitting there and I was like, man, like gathered myself, took a couple breaths. I was like, all right, wait, this is like essentially like uh unintentional quarry plate, right? Or unintentional ridge split. Like, yeah, and I know how to do this, so I you know hydrated some graph PRF, some allograft, and I packed it around that site. Um, I could still load the case because uh there's four perfectly good implants, and um grafted the anterior maxilla, um, used uh stabilizing sutures and other techniques to to get it really tight, like a sausage technique, and I let it heal and it healed great. Um yeah, four months later, placed an MP uh uh implant this time prepping a little bit bigger. Uh didn't get great torque, which I was not expecting great torque, but after three months, uncovered it, loaded it, and she's she's doing great. Okay. Um so that's that that's just a complication that can happen to anyone, but because I had these other skills, not just placing implants, you know, uh the hard and and soft tissue skills, that I was able to, you know, be able to manage that confidently um in after the fact of you know having that first you know moment of oh my god, yeah.

SPEAKER_00:

Yeah, I mean, I I definitely want us, um, and we'll kind of do this in a second here because I think it's a topic all and of its own, but I I want us to get into the regenerative portion of things because you know, when I was first coming up into full arch, it was very anti-regenerative, right? Like we were moving away from sinus lifts, we were moving away from grafting in general. Um, in fact, you know, some of my early mentors who were teaching me how to do full arch, they wouldn't even like graft sockets. I mean, they they would just do the case, place implants, and you're like, oh, it's gonna fill in. You got as long as it's a four-wall defect, don't worry about it, right? It was just like place the implant, immediately load it, it always works out. Fix, you know, fix is just magical like that. You don't have to think about all these little intricacies of uh of regenerative industry. But, you know, as I've gone along, you know, I really wish I had, you know, uh really invested in that a lot earlier and taken on some of those cases and done more regenerative because it it's really it's a great fallback for when moments like that happen. Um, because they are going to happen. You know, when you're you're trying to do everything graftless and fixed immediate load and all that, but you know, if something falls apart and just about anything can, you can outfracture this or that, you know, you need to learn how to um rebuild. And and also that there's definitely virtue in, you know, even if the case does go to plan, there are things that you can do in the case to set yourself up should anything go wrong, so that you have some more real estate later. You know, we can kind of get into um open approach uh trans sinus, we can get into you know sinus lifting. Um there's a lot of little things that we can do even with our fixed full arch cases that go to plan just to set them up even better um for when things go wrong. But uh, but yeah, so let's continue on a little bit. So some things that you know dentists are missing in their toolkit. So they're you know, we gotta make sure we have the augmentation there. Where are some other places where we're kind of a lot of people are falling short short when they get into full arch?

SPEAKER_01:

Yeah, and I'm really glad you asked this question because um I think we get so focused on the clinical, and obviously that's you know at the core of what we do every day. But yeah, that clinical skills, I think um, expanding the clinical set is always you know something that you can do. Um, but I think taking a bigger step back and um and and looking at what you can do to improve your your full arch game in general is um you know fitness, um personal development, and then also just thinking more like a doctor and not technician, you know, like uh putting four screws and bone is like the easiest part of the entire process, like at a certain point. You know, you you'll you'll hear every any any any person placing doing this procedure all the time. At a certain point, that's the easiest part. Um, but yeah, fitness, you know, it's really taxing on the body. Um, I think you and I both, you know, we're we're both proponents of regular physical, you know, uh regimented um, you know, resistance training. Now you don't have to go to the gym five times a day, uh five times a week. And um it's actually a video idea I want to get out to, but uh as long as you're doing stuff that you um the strengthens your back, strengthens your neck, um and and especially your core, doing a lot of core exercises, I think it really sets your body up to be resilient, right? Like I and another thing I do too is just try to be ergonomic. I sit for all my surgeries. I picked that up from Dr. Wong Gonzalez. I couldn't believe it when I first heard it because all the surgeons, you know, they want to stand, you gotta stand to be a surgeon, you know. Um, but luckily, the type of surgery we do, you can sit, you know. And I saw this guy, man, he's slinging quad zygos and Terry's sitting down. Like, why can't I do it? Like, yeah, yeah, yeah. And another thing he loves to do is like he, you know, he's just wearing like a$40 headlamp, you know, like you don't need a you know, three thousand dollar expensive, you know, it's nice to have. I'm not saying you don't need, but I'm like, man, this guy, yeah, if he if he can do it sitting down, I can do it sitting down for sure. And that's been a huge, um, huge uh benefit. But um, another thing is just like being like once you learn how to lift, right? You learn how to breathe properly. And what I mean by that is we learn how to expand, breathe, and and really get increase that intra-abdominal pressure. So it's like breathing into your belly, you know, flexing, like literally flexing your abs like you're about to get punched. And I'll do that if I have to bend and because inevitably we're gonna have to over just to see something, or I always just consciously get a sip of air, go in, and it sounds silly, but man, I I don't feel my back ever. I don't, you know, the only times I ever feel my back nowadays is when I go to mentor and I have to do it standing because most offices are set up standing, or if I'm at Colorado Surgical, it's all standing. Um, and I'll bring my like resistance uh like training belt uh with me that day. But yeah, some days I'll that towards the end of the day, I'll feel pretty sore because I'm not used to standing. But because we work regularly work out, our bodies are just used to that. And the next day I feel fine. I never have any issues, you know. So I think um investing time into CE is great, but also investing time into the fitness is is uh just as important.

SPEAKER_00:

No, I think you make a great point there. And and too, I mean, I've been you know lifting for a long time, since long before I was a dentist. And but I used to have a lot more back pain than I do now. Um, and I think that you know lifting is great, but just not just like any kind of lifting, like really focusing on core stuff, looking at your own posture. I think that's a really important thing, and figuring out where your issues are. Um, I went to a physical therapist and they're like, Yeah, you're all kinds of screwed up. Like, first of all, you're way shorter than you should be. You got forward head posture, you've got you know, weak core, over you know, tightened back, you got, you know, I mean, he's just like running through me, right? Like this is what we do, the patients in it. Yeah, yeah. It's just turned around on me and I'm like, good lord, I'm like the hunchback of Notre Dame. Like, this is insane. And and you learn like the types of exercises and where you need to strengthen yourself. Like if you have, you know, rounded shoulders, your pecks are too tight, right? And you have a weak upper back. So you need to kind of reverse that a little bit, work on your flexibility, get those shoulders rolled back, right? Um, get your chin, do some chin tucks and things like that. Learn how to correct the posture and use muscles to reinforce that. Um, and it's changed a lot. Like, I definitely still have back pain because I still stand for surgery. And uh yeah, after a double-double, you bet, like my dogs are barking, but it's not as bad as it used to be. I mean, there was definitely a time, actually through dental school, where you know, I questioned if it was even a viable career for me because I I there would just be some days where it was so painful that I'm like popping ibuprofen to get through the day. And I'm like, this probably isn't sustainable. I'm not even working yet. Um, so it's extremely important, you know, early on to form those habits. And, you know, what you're doing in the very beginning um, you know, really shaped how you do it for years and years. So, like, if you can go ahead and start sitting for surgery, go ahead and start, you know, using both hands, learning to, you know, give one or the other a break. That's one thing that I that I am glad I did kind of early on, is like I I learned to use both hands so that because I did notice like after like several hours of surgery, like I would start to cramp up and like I would kind of lose dexterity, and I was like really having to grip my teeth through um surgery, but now I can switch hands and stuff. So, like all of the things that you kind of start doing, even when they're really uncomfortable, will prevent you from getting a whole lot more uncomfortable later. Um, so yeah, I think that's a great point. I'm glad you bring that up.

SPEAKER_01:

Yeah, 100%. Um, and then so the next point is uh you know personal development. I think uh again, the surgery is the easiest part. People dealing with people, um, communicating with people is always the hardest part. So I think and when it when it comes to your team, when it comes to your patients, um, that you know, managing stress is a high stress environment. You know, you're um in one of these kind of offices, you know, it's I think it's really the better kind of the better person that we are, the better leader we can become as well. So I think um that helps a lot of the that's another thing that we you know had a field questions for all the time for mentees is like, hey, like I got this little office drama going on. Like, how do I, or this patient said this, how do I deal with this? And um, you know, what really helps with that is just reading personal development books, reading leadership books, and getting these other ideas from um great leaders, great entrepreneurs that have dealt with all these issues, you know. Yeah, um, and it helps day to day, you know, it just gives you more ideas and how to handle these kind of situations. So I think that's another uh important point to to to get. I'm curious, like uh because I know you read it uh and you're into this kind of stuff too. Like, what are some like your favorite podcasts or like maybe a book you read recently um in this kind of subject area?

SPEAKER_00:

I mean, the ones I come back to ones that people talk about a lot, right? So, like how what how to win friends and influence people is a huge one. It kind of helps you learn how to you know talk to people and you know gain influence, right? Like it it how to make a better impression, how to be impactful in a conversation, um, you know, how to you know really empathize with the person and connect with them. I think that that comes up all the time when I'm doing you know a consult or you know, if if a patient's having a hard time or they're upset about something, um, just being able to, you know, interact with them in a positive way and have them come away, you know, feeling better than they went into the conversation is really powerful. Um, it's also important for networking and things like that. There's a lot of entrepreneurial reasons. Um, other than that, I would say, you know, crucial conversations is a is a really, really big one. Um, you know, I think most of the things that give me anxiety on a day-to-day basis really would be solved by just having uncomfortable conversations more often, um, confronting problems while they're small before they get bigger. And when I look back at you know, issues I've had either with my team or with patients, what have you, a lot of times there were opportunities to correct those things early. Had I just been willing to have an uncomfortable conversation with a person and kind of nip it in the bud before you know it got a little bit out of hand. You know, if you wait until you don't really have a choice but to confront it anymore, you have a much bigger problem on your hand that really could have been solved um pretty strategically. Um, other than that, I just had it in my mind. Um shoot. Was it oh, the uh the um the courage to be disliked? I think that's the one there. Oh, I haven't heard of that one. Yeah, that's that's a really powerful one. So it it it it tacks on to uh, I mean, there's a lot of topics in there, some of them relevant to what we're talking about, some of them not so much. Um but one of them is is learning to not filter what you say through the lens of wanting to be liked by other people, right? Um, it's uh, you know, I I think both of us deal with um a people-pleasing nature, and um that can really be to a detriment. I I saw so many um other doctors who I perceive to be you know very successful, who you would learn, you know, some people regard them as being, you know, frankly, assholes, right? Um, but they're successful and they have teams that stick with them and are with them. And I and sometimes I would ask myself, I'm like, I'm I'm a really nice guy. Like I'm a I'm a really nice guy, and I always say nice things. I'm never degrading, I never insult anybody, but I have turnover, like I have these issues, like I have all these problems. But then when I read that book and I started having conversations and being willing to say things to people, regardless of how they would receive it. You know, there's a certain way to deliver things, of course, but like letting go of any fear of judgment or, you know, consideration that I'm a dick or whatever that may be, just learning how to talk straight to people gained me so much more respect in my life. And uh and it led to stronger relationships. Like even if what I said wasn't exactly what I, you know, I didn't feel comfortable saying it because I felt like it was gonna make me look a certain way, um, it would gain respect, you know, with my team. It gains respect with patients. Like just being able to talk straight to people, saying what needs to be said, thinking, thinking more about what needs to be said in that moment than how it's gonna be received or how people are gonna think about you when you say it, um, it's a really, really powerful thing. And it lets you think more objectively about like, okay, what does a good doctor do in this situation? What does a good business owner do in this situation? And then you just do that thing. And then whatever happens, whatever gets thrown your way, be that as it may, as long as you have your own strong sense of self, it doesn't, you know, those kinds of things, they bounce off you a lot easier. And uh you end up with a lot less problems that way. So I think those, those three have been very formative for me. Um, but in that, you know, there's podcasts, of course. I like Alex Hermozzi. Um, you know, uh, I like a lot of those like personal development, you know, podcasts. And I think, I think just exposing yourself to that. Um, I really like modern wisdom. That's a big one, Chris Williams. I love that guy. Sure. Um, you know, he he's great. And it just like exposing yourself to people like that, not getting like too far deep into the manosphere or whatever, um, but just engaging with people who uh or podcasts or whatever that just talk about how to interact with others and have positive relationships. It's just a healthy thing, you know. It's better than just doom scrolling all the time, you know. Yeah, be good to your brain and and try to learn as much as you can from people who are trying to do similar things, either in your field or or another. I think it's beneficial.

SPEAKER_01:

Yeah, and I I like that the theme of the last book because it's just like um it becomes a us versus the problem thing. It's just like in relationships, right? Like how to have um, you know, conversation with your your significant other, like hey, it's us versus the problem, not me versus you, you know. Um, and I think when we have those kind of conversations, it does build that opportunity to get closer. Um, I think one other book that kind of inadvertently helped me, and this is kind of I started reading this book just for my personal growth, um, but it's to uh it's called The Anger Trap, and it's a book that uh helps you. I think I told you one about this one. You have told me, but yeah, I like hearing it. Yeah, yeah. Yeah, it's it's it unexpectedly helped me, and and it's a daily practice too, you know, like anger, right? Everyone's got it. It doesn't mean like you when you think of anger, you think like the big you know, big dude red in the face, like yelling, but it it manifests in a different way, you know. You know, you can be the quiet type of anger like we um that uh we can be, or you know, you might be the person that, like, oh man, like I wish I said something, but I didn't now you're feeling frustrated. That's also anger. Um, I think reading that book really gave me insight into how like the science of anger, how it works, and um, you know, through the lens of a um um a professional that has has dealt with you know thousands of clients with this with these issues. And um, after reading it, it really started helping me see, like even in patience, like mad patience, right? Like talk about the most difficult things in your day. It's not the double double that you just had today, it's no pissed off patient, you know, that for some reason, you know, so just some kind of misunderstanding, right? Or the the team member that had some mis kind of understanding. And so people, once you start recognizing, you know, anger, you can kind of be like, okay, there this is not a personal thing, you know, this is just a frustration that they're dealing with. And I, because I know about this, I can I have, and it's again, it's just like how to uh win friends and influence people, it's not to manipulate people at all, it's just that guiding per it's almost like you're moderating the conversation um because who else is gonna moderate it, right? You're not gonna bring in a moderator and to arbitrate that car conversation right now. Someone has to be the bigger person, right? And again, it's not a me versus you, it's a hey, how do we talk to this problem and how do we reach a solution that we're both like, all right, I agree with this, you know?

SPEAKER_00:

Yeah. Yeah, no, I I think that's great. And you know, you you touched on it, like all this really comes back to patient relations. And like, you know, when you talk about the things that stress you out and full arch over time, like your first year, two years, like you're gonna be stressed out about cases. Of course, like you're just gonna be pouring yourself through CBCTs and um, you know, thinking through surgeries every single step, and like you'll you you might weigh, lay awake at night and thinking about this case or something you haven't done before, something you want to try, or you're worried that something might go wrong. That that does like generally go away. I mean, as long as you're kind of pushing a little bit of discomfort, like you'll you'll think about these things, but over time you do gain confidence to where you deal with enough things that don't go your way and you you deal with them successfully and you realize that, okay, you know, I I generally know how to, you know, select my cases. I know how to not get way in over my head. And if things don't go wrong, or if things don't go my way, like I've got plan A, I've got plan B, I've got plan C. Like I things are gonna be fine. And like I've gotten to a point where I really do not stress about surgery anymore. Like I usually will do um, you know, every couple of weeks, I'll go through all the cases I've got coming up. I'll plan them, you know, and I and I I look through pictures, I plan the case, I tell my assistants, you know, what we need for the for the surgery. And then I I generally don't think about them until like literally the morning of. I walk in, I'm like, okay, what are we doing today? And I I look over it, I look over my notes, and I'm good to go. Like I it it it all happens in the operatory and then it it's it's over. And it really is like that. Um, but what you know bothers me like on a daily basis is these patient interactions or something that may have not gone ideally with a team, or maybe you didn't handle something well. And and I don't think that's ever going to change. Like, I think that is just that's business, that's the art of people. Like that that is some of the hardest things to do. And it really ends up being what makes or breaks you. Like you think it's your surgical. Skill and it's it's truly not. Like, of course, that's important. Of course, we're here to talk about that. Um, but man, like you, you just uh I and I hear it all the time. Like, I I know, I mean, the best educators and the best clinicians I know, they they can still tell me about these problem patients. They they know their names, they'll name them. You know, I was at a three-on-six course recently, uh, you know, back in, I guess it was actually September. There's been some time. And I remember Dr. Logan Locke, you know, he's he's uh one of the primary doctors there, and he teaches three on six. And um he's a brilliant, brilliant clinician, really, really fantastic. And uh, you know, he had this one patient he mentioned, I think it was like three or four times like throughout the course. He's like, Yep, that's that's her, you know. He's like present in his mind. He was like getting texts about it, you know, and he's like, I mean, he's one of the best like FP1 people like in the country for sure. And uh, you know, surgical stuff's gonna happen all the time, but it's just how you deal with people. And and that's uh it's something that you you can always work on, and and it will always make there's just a few things that are gonna make your life easier than just learning how to deal with um sometimes difficult people.