Episode Transcript
(0:00) I've got to have a bigger picture, like I've got to have a bigger vision, selfishly, for (0:06) it all. (0:06) Because if you don't step into this role, then either I've got to keep doing it or we'd (0:11) lose it. (0:21) Back to the Millennial Dentist Podcast, a podcast all about working smarter, not harder, pushing (0:28) dentists to go beyond dental school dentistry and build the practice of your dreams.
(0:33) Here is your host, the Millennial Dentist himself, Dr. Sully Sullivan. (0:40) What's up, everybody? (0:41) Welcome back to the Millennial Dentist Podcast. (0:46) Special podcast here.
(0:48) Just got out of surgery with Dr. Z. We're going to interview him. (0:54) It's going to be great. (0:55) He has no idea that I'm going to do this.
(0:58) Before we get going, doing that, speaking of surgery, I hope you guys enjoy this. (1:05) If you're not doing surgeries, hopefully I think it's a bigger conversation, but we (1:07) do have our first courses with a neonatal live patient coming up in August and September. (1:13) Full arch implants, feel kind of good to get that.
(1:16) Ready to get going. (1:17) Extraction graphs, PRF, beginner implants, didactic and live surgery. (1:22) So ranging in prices from very affordable to getting up to doing a couple of live cases (1:26) on your own.
(1:27) So yeah, check that out at 3D-Dentist.com or email Meredith at 3D-Dentist.com as well. (1:36) All right, Dr. Z, welcome to the show. (1:38) Thanks for having me.
(1:40) How was that? (1:42) It was another video we just did. (1:44) Let's start with this. (1:45) Let's back up.
(1:46) So part of this comes from, there's six doctors at the practice, Dr. David is leaving (1:53) or periodontist. (1:55) And so there's a gap between the dentistry that you guys have been able to do and what (2:03) we need to not do, meaning dad and I, correct? (2:07) Correct. (2:08) And so we sat down a couple weeks ago and we basically printed out David's production (2:15) provider or procedures by provider and I was like, this is a lot of dentistry that (2:19) somebody's got to do.
(2:21) And so then you've kind of been saying, hey, I want to start doing extraction graph (2:23) to implants and stuff like that. (2:25) And so the hard part is, and I want to get into some of this stuff in a minute, but (2:31) you know, how do you get somebody from there to where they need to be in more of a fast (2:36) track standpoint? (2:37) Obviously, we've got education. (2:39) So you come into our education is kind of the ideal way we like, we want to do it.
(2:43) But in the short term, it's all about trying to figure out how can we level you up. (2:47) So what do we do today? (2:49) Today, we extracted teeth number one, two and three, two and three pretty broken (2:54) down. So it's all going to be surgical today.
(2:57) And then number one is impacted. (3:01) I guess we started off by making a full flap. (3:06) And what was your and I guess give me your experience, though, because I know you're (3:09) capable of doing it.
You've taken out teeth. (3:11) And you've worked as in a couple of years now. (3:12) I've taken out teeth.
(3:13) What was your experience? (3:18) Like, what has been your experience in taking out teeth? (3:21) Yeah, so I mean, I used to take out a lot of teeth. (3:24) I worked with a lower income demographic, so it's more taken out teeth than saving (3:28) teeth. But I think when it came to the teeth like we did today, I would be (3:33) sweating.
And I got to a certain point where I was like, I don't really like (3:35) doing these teeth. (3:37) So what I ended up doing was I referred most of those upper molars out. (3:42) But I mean, just watching Dr. (3:44) Sully and Dr. (3:45) Rick do all these extractions, like it's been making more comfortable (3:48) just by watching because you can see like how much leeway you actually have.
(3:52) Yeah, but this is interesting watching it. (3:54) And then like today where I was like, I was the assistant and you were the (3:57) dentist. Yeah.
So doing it within today was awesome, honestly, (4:02) just because you could talk me through it. (4:03) And I actually got the hands on experience. (4:05) I could feel everything, the tactile sense of how things should feel.
(4:09) And it was cool, too, because it made me so much more comfortable (4:12) just after this one experience, just because I could see everything. (4:17) I pulled on that flap section. (4:19) The teeth was pretty straight.
(4:20) So let's start with the top. (4:21) So like we do a flap. (4:23) What was different about the flap than what you probably historically (4:25) would have done? Yeah.
(4:26) I mean, even when we learned in school, like this flaps are pretty (4:29) conservative, meaning like we only went down nowhere near as much as now. (4:34) So like you really saw like the ridge from what they showed us in school. (4:37) And part of this is because for a couple of reasons.
(4:39) One, I think is that soft tissue management can be hard. (4:43) And so schools don't want people get in there like tearing much of stuff. (4:46) And two, we're not grafting in school like the like there's a goal.
(4:50) There's a different purpose. (4:51) Get the tooth out because they're hurting, which is very different (4:54) from get the tooth out because we are going to put something back in that hole. (4:57) Yeah, definitely.
(4:58) And so to me, that's like the big difference there is I've got to be able to (5:03) visualize it, see if there's defects. (5:06) But talk about just from an extraction standpoint, (5:08) when you're able to visualize how much of an impact (5:10) it makes is where you put your instruments and stuff like that. Yeah.
(5:13) I mean, I could see the rotation like perfectly clear. (5:16) I know exactly where to section the tooth. (5:18) So we did we did two and three.
(5:20) So three goes first and walk through the sectioning part there. (5:26) Yeah, we made that flap. (5:28) We found the groove and he basically told me just to go straight into the middle (5:31) with the drill and I didn't really have to worry about.
(5:35) I don't really have to see how deep I was going because it was all just (5:37) I could just see it. (5:38) Yeah. Well, I want to talk about that because I think that's (5:40) that's part of the understanding.
(5:42) We have to have this idea that as we move back in the mouth, (5:46) we have to rely less on sight and more on feel (5:50) and more on understanding like visually in my mind where things are. (5:56) And so I think part of the sweating, part of the scare (5:58) scaredness we get is because we don't think about like, OK, (6:02) where are vital structures? (6:03) What can go wrong here? (6:05) How do I avoid that? (6:06) And and then we're trying to see everything. (6:08) It's like, well, if I'm taking out number one and it's back, you can't see it.
(6:13) There is nothing to see, right? (6:15) Today's actually was more of a visually than you'll ever get on number one (6:17) because we'd taken out two and three. (6:20) Some of the things we talked about as we were going that were important, (6:23) knowing the length of the burr, right? (6:25) Knowing that, hey, I need to take this burr to depth (6:28) if I'm going to have any shot of actually getting through the forcation. (6:32) Yeah.
And the first one, how the first one go? (6:35) The first one went smoothly. (6:37) I went all the way down. (6:38) The second one was a little less visibility for me, so I was more cautious.
(6:42) You don't trust your trust myself. (6:44) You don't trust your angulation. (6:45) You don't trust your depth, your burr.
(6:47) And then that's where I kind of when it got into some trouble. (6:51) Well, it's not trouble. (6:52) It's just you break off the crown, you start breaking off in pieces.
(6:56) And like you very quickly, you're like, now this whole thing is (6:58) broken at the gum line. (6:59) Yeah, there's bone all around it. (7:02) And that's when usually the sweat like starts really pouring in (7:05) because it's like, oh, my gosh, I can't get a force up on it.
(7:07) And it's like, yeah. (7:08) And that's why I'm always so hesitant to give you guys forceps or like (7:11) or like to pick it up because it's like it can't be a crutch. (7:15) It can be a tool, but I need to be able to like get it out without it.
(7:20) Mm hmm. All right. (7:20) So then how do we address that? (7:23) So we kind of just reevaluated (7:27) where my angulations were, and then we went back in, sectioned it properly.
(7:31) And then we were able to kind of luxate in between the root tips (7:34) and they all popped out one by one. (7:36) Now, my take home here for you, too, is over time, you're going to have to move (7:41) from less just brute force and more delicate force. (7:45) Yeah, if that makes sense.
(7:47) Like I can, you know, if you notice, I would be like, I could be (7:52) I was like left handed or on the assistant side. (7:54) But if I place the instrument in the right spot, the amount of force (7:58) that's needed is significantly less than if it's in the wrong spot. (8:03) And I'm trying and and when we get into like a traumatic extractions, (8:08) which is the goal, right, and is trying to how do I minimize as much? (8:12) I got to protect the buckle plate at all costs because it's the hardest thing (8:15) to build back is thinking about how I just delicately, like moving (8:20) from the elevator to the little spade proximator, right? (8:25) To just where can I start to get the littlest movement to create space? (8:29) That was another concept I think was today was good.
(8:32) How we want to elevate the roots into the space we've created. (8:36) Yeah, because I was quick to grab the forceps. (8:40) We like, you know, just keep luxating it.
(8:42) And honestly, I just spent another five seconds luxating (8:44) and they all just wiggled out. (8:47) Or as I feel like if I had gone with the forceps initially, (8:49) I might have been putting a lot more force (8:51) could have led it led to it breaking more easily. (8:54) Talk about selective bone removal, because that was something (8:56) we kind of talked about, too, because (8:59) as far as what you can read, what you don't want to remove.
(9:01) Yep. Obviously, we were focused on keeping that buckle plate intact. (9:08) And even when we did section a little bit more selectively, (9:12) we kind of just walked a little bit around the root (9:14) tips just to get enough space to really luxate in between that bone.
(9:18) Yeah. And like when you're taking out teeth (9:20) and like root tips specifically are broken down teeth like you (9:23) you remove bone for two reasons. (9:25) One is to create space for your luxator or your instrument.
(9:29) The others is create space on the other side for the tooth to move into. (9:33) Right. Because if if there's a wall (9:37) that I'm elevating up into with the tooth, then it's either going to (9:41) something's going to break either or either.
(9:44) And what I don't want to be is what I'm luxating into. (9:46) And so if the if the part on the back is stronger than what I'm doing, (9:49) that's where you break whatever you're elevating off of. (9:51) So you want you go ahead and remove or create space (9:54) where you're going.
(9:56) Unless it's the bucket plate. (9:58) And that kind of creates. (10:00) Yeah, a little bit more leverage for me to work with.
(10:03) The first one went good. (10:04) Second we broke off. Still came out good.
(10:06) Just a second. (10:07) And then describe to me that your confidence level now (10:12) from two hours ago. (10:15) It's incredible, actually, like how much more confident I am (10:18) just from this one experience.
(10:20) It's night and day, isn't it? (10:21) Yeah, it's just everything just so much more clear. (10:24) I'm just like. (10:26) I'm asking myself why I haven't been doing this for the last three years.
(10:30) And like, well, here's the deal, but this dentistry, (10:33) like you can make a damn good career doing what you just did. (10:38) Like if you can learn to take out first molars, (10:42) graph them well and put implants back in those place like that. (10:47) That like is what like.
(10:49) Oh, and like part of it is like I'm excited because I wanted to share (10:53) your experience. I think it's also there's a part of this (10:56) that doctors need to hear. (10:57) It's like I've got to have a bigger picture.
(10:59) Like I've got to have a bigger vision selfishly for it all. (11:03) Because if if you don't step into this role, then either (11:07) I've got to keep doing it or we'd lose it. (11:10) Yeah.
And so like I've got to be able to say, hey, (11:15) now, how do we do today? (11:16) Because I think that's something that I want people to hear, too. (11:18) Like, how do we do today with production? (11:20) Um, I think we did pretty well. (11:22) And I think it's no, no, no, who gets paid today? (11:24) You do.
I get paid today. Yes. (11:26) I think it's a great trade off because absolutely just gain the life on skill.
(11:31) That's what that's what I want. (11:32) I want because like to me, it's like, OK, I just give up two hours of my time (11:36) that we could have done that quicker, could have gone out of here sooner. (11:39) But it's a long play for me because I want I need one.
(11:42) I want you to grow. (11:43) Like at the end of the day, like I and I love helping people (11:49) see more for themselves. (11:50) So I'm passionate about that.
(11:51) The second part of it is like I win. (11:53) And then the long run, I'm like, if you can do this, if I can help level you up, (11:56) I would as an associate person here, I would rather you (12:00) do implants than do fillings. (12:02) You know, like it's not it's not just to be my filling guy.
(12:04) It's not that's never was the vision. (12:07) And then the third part about it, then we'll is is like, OK, (12:09) so how do we do that? (12:10) And so traditionally what we do in situations like this, if I'm going to (12:13) like basically block my time, coach, mentally, really be engaged, (12:17) assist you to the entire thing, then, you know, (12:23) I'm going to get basically compensated for it. (12:25) And you get what in you, you get compensated in experience, (12:29) the experience and the education.
(12:31) And for both the doctors listening on both ends of the spectrum, (12:35) this has to be established on the front end because there's just a difference (12:38) between teaching you and mentoring you like teaching you is what I did today. (12:43) Yeah, that was straight teaching. (12:45) Now, my hope is in a couple of weeks, I'm mentoring you, meaning you do this (12:50) by yourself.
I'm in the building. (12:53) I've got a level of availability to where if you get stuck, (12:57) I can come in and mentor you. (12:59) I can give you I can give you a tip here or there.
(13:02) The occasional bailout, you know, to me that and that's when it (13:07) the production moves over, you know, and that's how it should be. (13:11) But I think too often young dentists think (13:14) or dentists earlier in the career, I think they they should be being taught (13:19) by the owner dentist. (13:21) And, you know, that's unfair because I think at the end of the day, (13:24) like they've got to produce and they got to do it.
(13:27) And and then the I think the other (13:30) assumption has unrealistic expectations and what it what it means. (13:34) Like, hey, if I truly want you to get better, that that's what it takes. (13:39) So I found that that's the most effective way to do things.
(13:44) It seems fair. Yeah. (13:47) I thought today was more than fair.
I'm tired. (13:51) I'm actually I'm on a high right now. (13:54) Yeah, you'll probably you're going to you'll probably you'll probably get hit (13:57) with the bricks a little bit.
(13:59) No, you did great. (14:00) And then we went through the bone packing and sticky bone and all, (14:03) you know, and doing all the membranes and stuff like that. (14:05) You know, I think all that is, you know, yeah, you got fast (14:08) track today, what we do in five days on some level.
(14:10) And today can't be that it has to be more than this, right? (14:12) We're doing I think we're doing this again. (14:14) Same situation next week on number 19, which will be great. (14:19) And at some point we, you know, you got to keep going.
(14:22) Now, my my my feedback to you as we continue to do this (14:25) and you grow is knowing when to ask for help. (14:28) Yeah, meaning like and that's another good conversation to have is how (14:33) is I got to trust as you're. (14:36) That you have a safe landing safe to fail, right? (14:39) But as I give you more leash, so to speak, (14:43) it's it's a good analogy, a weird analogy, give you more leash, right? (14:47) To do more, it comes with greater responsibility (14:50) and that like, I need to recognize, OK, hey, I do feel like I'm stuck.
(14:55) Can you look at something? (14:56) Because it's easier for me to help you in those situations. (14:58) Then, OK, I've broken everything, rebuild it. (15:01) Yeah, you know, and so that's, I think, always something (15:02) that is important for you to have those conversations, too.
(15:07) What else? What other takeaways and your takeaways? (15:09) I guess at the end of the day, like I am just really happy (15:13) that I do have somebody that's willing to educate me and push me forward (15:16) because I do think that's hard to find in a lot of different places. (15:20) So, I mean, obviously, I'm here trying to just do as much as you want. (15:25) Well, you're doing great.
(15:26) I've been hard and I'm hard on the wall, too. (15:28) Like he probably wouldn't say that, but I'm hard on him. (15:30) But like I gave him credit.
(15:31) Like we've been meeting Monday mornings early before work. (15:35) You know, like you got to put in the work, you know. (15:38) And I think I tell you guys this all the time.
(15:40) I don't say this enough on the podcast, probably, but it's it sucks (15:43) because like at this point, y'all don't get to see the work that I put in, (15:46) you know, so much the work that I did. (15:47) Right. And that's hard.
(15:49) And even people on Instagram or you hear social media, it's like (15:52) people want to do what what I do or what other people do. (15:55) Like, you know, pay Ray or people like that. (15:57) It's like, God, the work that we put in is a grind.
(16:02) And like and so you got it. You got it. (16:04) That's what it takes.
(16:04) So good as you definitely good stuff. (16:07) I hope this was helpful. (16:08) If you enjoyed this, listeners, my look, here's my big ass (16:12) and I'll be super honest and upfront.
(16:15) If you heard this and you were like, man, I want that moment. (16:19) Well, I can't. (16:21) Unfortunately, my jobs are all taken right now, unless you're a part time period (16:24) honest, and then I could probably hire you for a couple of days.
(16:27) But in all seriousness, if you heard that story and you're like, (16:30) I want that feeling, I want to take it to the next place. (16:35) We want to be a resource at 3D Dennis because that's what we love doing. (16:39) And we've got the opportunity.
(16:40) Now, yours is going to cost more than probably a little bit of time. (16:44) Like it's in the wall. (16:45) But at the end of the day, he could have been doing crowns (16:47) at this time and getting paid.
(16:48) And so like there is a cost. Right. (16:50) And so we have a didactic portion where you can learn to place implants, (16:57) learn the fundamentals, learn to do PRF.
(16:59) And then we have the live patient program where you can stay for an extra (17:02) two days and do this on live patients, extraction, grafts, (17:06) sinus lifts, bone augmentation and even get into full arch. (17:11) So we'd love to be a resource. (17:14) We've got great partners that we work with.
(17:17) So, yeah, I hope you enjoy this episode. (17:19) Thanks for blowing off for joining in. (17:20) Popping all your stuff is good.
(17:23) And yeah, it works a lot harder. (17:25) We'll talk to you. (17:28) Thank you for listening to The Millennial Dentist.
(17:30) Visit us online at millennial dentist dot com. (17:34) And we'll see you next week.
