Adam Hogan: Forward deployed. Digital workflow and business in Phoenix, Arizona. Are you ready for digital workflow and business clarity in one focus program? Join myself and Dr. Chris Barrett at JB Dental Lab in Phoenix, Arizona for forward deployed. Digital workflow and business, full arch fundamentals, same day conversion protocols, digital workflow, case presentation, live surgery, and team alignment. Register today. Evan Kinnear: Hey, today's conversation resonated with you and you're looking to sharpen ⁓ just your technique, but your judgment, your discipline, and your long-term vision, ⁓ this is exactly why we built the Atlantic Implant Institute. This segment is brought to you by JB Duna Lab, your go-to partner for full arch prosthetics, zirconia, PMMA, and digital workflow. With a proprietary portal, designers, ⁓ an advanced education center, ⁓ will experience reliability, ⁓ ⁓ consistency. Visit ⁓ Adam Hogan: theatlanticimplantinstitute.com. Evan Kinnear: The all-in All-INX Pod is brought to by JB Dental Labs. The elite lab, trusted by full-arch surgeons, ⁓ prosthodontists, and digital forward practices ⁓ internationally. JB specializes in precision full-arch zirconia, photogrammetry workflows, and fast turnaround times that don't sacrifice quality. ⁓ JB delivers a truly digital workflow powered their... This episode of the All-In All-Inx Pod is powered by JB DunaLab, your full arch lab partner for predictable, beautiful, and digitally precise results. provisional same-day conversions to final zirconia, ⁓ delivers consistency, ⁓ and craftsmanship that elevate your practice. The case portal keeps your team connected with quick communication and real-time updates while their in-house designers and ⁓ This is not just some collection disconnected modules. ⁓ This is the core continuum, ⁓ for education and full-arch workflow. begins with 1, Boot Camp Fundamentals, where we establish surgical foundations, diagnostic discipline, and repeatable decision-making under real-world pressure. online portal for easy case uploads, real-time tracking, and fast streamlined communication. comprehensive full-art services ensure precision from conversion to final zirconia. and then it continues module advanced prosthetics and full digital workflow where occlusion, vertical dimension, aesthetics, condyles, and execution ⁓ all converge. If you're looking to grow your skills, JB's Educational Center hosts hands-on courses with live surgeries. to streamline your All-INX workflow ⁓ a lab that truly understands the surgical and prosthetic connection? ⁓ ⁓ and tell them the All-IN All-INX pod sent you. ⁓ for listening. And then we have Module 3, which tackles remote anchorage, pterygoids, zygomatic, complex anatomy, taught through biomechanics planning for predictable outcomes. If you're looking for a lab that understands immediate load, passive fit, and the demands of modern all-on-x dentistry, then JB Dental Lab is redefining what a full arch parter can be. Learn more at JBDentalLab.com. ⁓ Tell them that the all-in all-on-x pod sent you. And after the continuum, we have modules in FP1 fixed immediate load and also business, this is business leadership and operational strategy so that you can build surgically actually works in practical business. If you're ready to go into full arch dentistry with intention, structure, accountability, and purpose, you can learn more at theatlanticimplantinstitute.com. Adam Hogan, DDS: welcome back to the All in All NX podcast. Chris Barrett is joining me, my friend, now my colleague at SIN 360 KOL, by the way, for a while. But now it looks like we're going teaching together. We're going to go beyond implants. We're going to get into Dr. Chris Barrett's life. He's a surgeon educator. He's a trustworthy ⁓ educator in this business of full arch and not just in surgery, but in its execution across the entire system as we've already gotten our ⁓ familiarity out of the way here a little bit, but we're talking about all these multiple locations and business ventures. So obviously a business mentor as well. ⁓ Chris and I are going to be teaming up at JV Dental Lab on June 5 and 6 in Tempe, Arizona. And we're going to be putting together a two day course that's going to be a real powerhouse of a course. I'm kind of dubbing it the, ⁓ I mean, sort of the teaser of my module one, two and business. It's going to have fundamentals, digital workflow and business in just those two days. So it's going to be a real steal. This is going to be a great conversation. We're going to get real unfiltered, authentic, and talking to Chris Barrett who's in the game. So thanks Chris for joining me. Chris Barrett: Yeah, thanks for having me. Where would you like to start? Adam Hogan, DDS: Let's go on the let's get into the event later. ⁓ So it doesn't sound like just a shameless promo because you are you have a lot to offer from for listeners out there. Been a clinician practicing a rap, know, so so many cities and states. Chris Barrett: Sure. Do you me to give you little bit of background? Adam Hogan, DDS: Yeah, let's go to the background because you're in so many cities and states. So you have like a unique position to tell us a little bit about the ecosystem of different cities, markets, people, patients, what's the same, what's different, business. I mean, go ahead. Let's kind of start with your background. Chris Barrett: Yeah, so I grew up in Davenport, Iowa. My grandpa was a dentist and that's kind how I got interested in it. He was really big into organized dentistry. Past president up here, Pierre Fouchard Academy, past president of the Iowa Dental Association, worked heavily at the college, University of Iowa up until he passed. So he was a big influence. And then ⁓ When I went through dental school, I really loved ⁓ oral surgery and endo. And it was basically because the adjunct faculty were the most fun in both of those two departments. And at Iowa, if you get done with ⁓ your requirements your fourth year, you can go spend as much time as you want in whatever clinic you want. So go up to oral surgery and just hang out with those guys. And everybody that I talked to that said that they did a GPR. ⁓ Said that wouldn't trade that for another year of private practice. So I ended up doing the GPR at Iowa and I was married at the time we had just had our first child and And I kind of saw what what OS was doing there and I was like, know I'm not sure if I want to go into that or not, you know implants at the time were not on my radar at all because you had ⁓ Perio residents, they'd take three hours to put one in and you'd have the OS guys that would just kind of like use the guides, you know, that I was fabricating, but I was using, you know, this old drill press on a stone model. I mean, it was, it just didn't make sense conceptually to me. That's 2011 to 12. Adam Hogan, DDS: What year is that? What year is that? Okay, all right, I'm just trying to get my head around the technology, but yeah, go ahead. Yeah. Chris Barrett: Yeah, so that wasn't, I mean, it wasn't high level ⁓ 3D CBCT planning at the time, at least that I was exposed to. Awesome program if you want to go learn orthognathics. And I'm sure they've made, you know, in the last 15 years, I'm sure they've made, you know, huge advances and all sorts of things. enjoyed my time there. And I practiced in Eastern Iowa for a year, just kind of piecing things together, just trying to figure out what I wanted to do. ⁓ I either wanted to go practice in Chicago. in Colorado or in California because I had friends and family in both of those places. So I ended up in Colorado and I joined basically like a PROS office. It was a very high level GP focused office. And ⁓ they were solely restorative dentists. And the gentleman that started that office, he was very good friends with Niles Goucher. And Niles Goucher is kind of royalty when it comes to Pras. He had invented the danar articulating system for Whitmix. And he had gone around the country way back in the day teaching ⁓ basically nathology. so I was exposed to that when I joined this office. Adam Hogan, DDS: Thank Chris Barrett: And they treated a lot of TMD at that office and they did a bunch of partial and full mouth reconstruction as well as just everyday dentistry but it was solely restorative. And all my friends out in Denver were like, if you get a job at this office you gotta take it even if you wanna go do surgery and endo and all that stuff, just hang that stuff up for a while. because you'll learn a lot. And I really did. So they taught different levels of occlusion out of that office, ⁓ phase one and phase two TMD. And so I felt it was all the information that I didn't know that I needed was just like drinking ⁓ from a fire hose. So I was at that office for a few years. Adam Hogan, DDS: Right. Chris Barrett: and restored a lot of implants. I was probably five, I think I was six years out of dental school before I placed my first implant. So I was late to the game as far as doing surgery, but I felt very confident in the treatment planning part of it. And so I went through a divorce and I ended up living with a BioHorizon implant rep named Matt Goff. Adam Hogan, DDS: Okay. Yeah. Chris Barrett: and great guy. And through that relationship, I ended up meeting Mike Freymuth, who was a big mentor of mine. He was a ABOY diplomat. And this was probably 2015. I ended up going out to dinner with him and Matt. He says, hey, Matt, do you know this guy Mike? And he's like, yeah, know. had heard Mike had filled in for Justin Moody on the AAID podcast. And so. Adam Hogan, DDS: Okay. Chris Barrett: I was like, oh, there's this guy local and he's an ABY diplomat and he's doing all this implant stuff. And, you know, I want to go over and see what he's getting into. I was like, Matt, do know this guy? He's like, yeah, he's my number one account. That guy's an animal. So I was like, he's like, Hey, I'm having dinner with them, you know, in two weeks. I was like, Hey, can you please like get me in onto that dinner? So I go out to dinner with them. Um, and I was like, Hey, do you mind if I come over and just like hang out at your office sometime? He's like, sure, like no problem. So go over to his office and. He really expands my mind on what is capable as a general dentist. Because I had, you know, had kind of like this limiting belief that like, my, degree only allows me to get to this point and beyond that other people do these things. So I go to his office. He's got you know two mills going. He's got three lab techs. He's doing you know F.P. one case ⁓ in Op one. He's prepping veneers and up to he's got four hygienists that he's checking over here and he's just like running around doing the super high level of dentistry. And I was fascinated. I was like hey how did you learn how to do this. He's like you know I did. Adam Hogan, DDS: Yep. Chris Barrett: I Mish, I Coice, I did all these other things. right at that time, him and Moody were starting Implant Pathway. And I had just gotten done with the Las Vegas Maxi Course. I was just trying to fill in all of the gaps that I had in my mind as far as implant dentistry would go. So I went and I was like, you know, Mike, I don't really understand the sinus and some of the stuff I'm running into is these implants either either need a bump or I need to do a graft and I just, can you help me out with that? So he's like, hey, sign up for the course and I'll line you up with some sinuses. I was like, sure. So I went down, this had to be maybe like the second live surgery course that Pathway was putting on at the time. And so went down there, had a blast, placed a bunch of implants. Adam Hogan, DDS: Mm-hmm. Chris Barrett: ⁓ met Moody and then through that relationship, ended up eventually leaving Colorado and going to going up and taking over Moody's, ⁓ implant practice in South Dakota. And Moody left South Dakota and went down and really went all in a pathway at that time. Adam Hogan, DDS: Okay. Chris Barrett: And so then I was traveling back and forth between South Dakota and helping out with all of the different, ⁓ pathway courses. So I was in Arizona probably twice a month. And eventually I was like, you know, it probably makes more sense, ⁓ to be in Arizona full time. So I transitioned down to Arizona and started brightly and brightly was basically a replica of what Moody had started up in South Dakota, which was like an implant only office or concept. And, ⁓ and got really heavy into full arch. At that point in time... You know, in South Dakota, my usual spiel at my level of skill at that time was, Hey, if I don't get enough torque on these implants, you know, I might have to sleep them. might have to give you a denture and that works well, you know, in certain areas of the country. you know, I still have colleagues that prefer to do it that way, ⁓ that are very high level people and they tell patients that's the best way to do it. And, the patients, you know, trust them. And so that's the way they do it. moving to Arizona, there was probably. three or four docs on my street that were like, hey, I can give you teeth today or tomorrow. So I needed to add some tools to my toolbox. And so I ended up going down the remote Anchorage road, taking a bunch of courses, being able to, you know, revise your own cases. Hey, if the sinus graft doesn't work, what are you going to do next? ⁓ Adam Hogan, DDS: Mm-hmm. Mm-hmm. Chris Barrett: And just got really heavy into that. ⁓ Fortunately, I was doing well at it. ⁓ did ⁓ briefly, I did some stuff with Norris as far as helping them out with some core stuff. yeah, and then SIN came to town and their headquarters were like 10 minutes away from the office. So ended up spending a bunch of time with Patrick and the SIN team. then... ⁓ ⁓ I was asked to help out with their design of their pterygoid and zygomatic implants. So ended up going down and doing a bunch of R and D and doing some surgeries with some Brazilian Oss's and, ⁓ yeah. And then before you know it, you know, fast forward left, ⁓ left, rightly, and have just been doing the traveling implant thing, but, ⁓ still doing some education, ⁓ still help out pathway with their full arch, ⁓ course. And then some mentoring here and there for docs that I know and trust that I feel like are gonna do a good job both prosthetically and surgically. And then here we are today, sitting down chatting about implants. Adam Hogan, DDS: It's, ⁓ I'm tired of listening to you. You're everywhere. And you didn't even mention, you know, the kids and the two houses, the different States and the family. And so you have no doubt a personal secretary and a travel booking agent, someone to manage your schedule and itinerary. I'm ⁓ my God. Do you ever get like me and like, get like two days before you're supposed to go teach somewhere and realize you've got to book the flight or the hotel. Chris Barrett: Yeah, I wish, wish. Yeah. Yeah, or I booked it on the wrong day or I show up to the airport and I go to, you know, American, but I'm flying United that day. And, ⁓ yeah. So. Yep. That happens for sure. Adam Hogan, DDS: Yeah, All right, I accidentally fly into Miami when it's in Fort Lauderdale and it's like an hour without traffic. I'm like, wait a minute. This plane, I look out the window and I'm like, wait, that looks like Miami. It's not Fort Lauderdale at all. So god, there's so much going on. mean, let's, know, Pathway, I would pull that up. that's, you kind of got in early on that. What year was that? I got a screen here with Pathway in there. Chris Barrett: Yeah. Yeah. Yeah, that started probably back in 20... Adam Hogan, DDS: Here's you guys. Chris Barrett: 17, 18, 19 back in there. And I was in South Dakota from 17 to 19 and then moved down to Arizona the late part of 19 and started Brightly and then, yeah, and then from 20, so end part of 19 to 2023 was doing that. And I probably mentored. Adam Hogan, DDS: Yeah. Yeah. Chris Barrett: I don't know, every course for almost three years. And that was hugely beneficial for me. I do well teaching with small group settings. ⁓ As far as the feedback that I get from the docs, the early on mentors were a group of high level GPs, some periodontists and some moral surgeons that were colleagues of Moody's and you end up just exchanging all of these ideas. ⁓ as far as, know, hey, what do you like to do in this situation? How do you approach this? And you'd just be able to get, you know, these, these pearls from all these other clinicians that were coming down to mentoring. I also was fortunate to ⁓ a good friend and colleague of mine, Todd Schoenbaum, who is, he was the, ⁓ he's a general dentist, but most people think he's a prosthodontist because he's such a high level. He's, he's written a couple of implant books. ⁓ ⁓ implant prosthodontics and ⁓ I can't remember the name of his other one. I'm sitting right behind me on my bookshelf but ⁓ through him I was able to make some connections and ⁓ something that I loved doing, of the colleagues that I met When I did the Las Vegas maxi course was a gentleman by the name of Phil Gordon. And he had a podcast that he's in Kansas city. He had a podcast at the time and something that he loved doing was, you know, getting into people's offices and see how they would work. And I love that too. Any office I could get into that someone would allow me to come in. Cause they're all different. Everybody can get to like the same outcome in all these different ways. so I ended up. Adam Hogan, DDS: you Right. Chris Barrett: going with him to meet Jack Hahn. I love the history of things as well. So we fly to Ohio, he's in Cincinnati, I think, and Jack is taking out a blade implant that he had put in decades ago to put in two Hahn implants. And I'm like, dude, you're such a boss. Adam Hogan, DDS: Yeah. Chris Barrett: I mean, you're pulling out a blade and you're putting it in your own implant. Like who else is doing that? So get to chat with him about some of the history of things. Adam Hogan, DDS: Yeah. You all right? That's like past the matrix mode, you know, he like, he saw the matrix get built and now he like dissects it, you know, just all the zeros and the ones, right? Yeah. Chris Barrett: Yeah, for sure. was able to, through Todd, ⁓ I was able to end up meeting ⁓ Dr. Bachli. He's a very high level oral surgeon down in Southern California. I get to go spend a couple of days with him in his office. ⁓ He wrote a bunch of early papers on ⁓ tent pole technique as far as grafting. ⁓ So just different little tips and pearls being in different people's offices and seeing how they do things. so very fortunate that, you know, I like to try to put myself into positions to, you know, learn things, but also be very respectful of, you know, people's time and their generosity of, ⁓ of inviting me into their offices. So just really just things like that, picking stuff up along the way. Adam Hogan, DDS: Yeah, I had a similar approach. I'm not too much older than you. I came out of the dental school three, 2003, Navy to six, and then. The next, depending on the next five or six years, I had a mentor. worked with Truman Baxter, who was an icon, but there weren't a lot of programs. There weren't a lot of programs you could go into. I Picos was around, I did a few of those, but I was like you. was just like, Truman would give me, I would look up the name of all his friends and I'm like, if I could fly there and go observe for three or five days, anybody who would have me, and you learned so much along the way. ⁓ just from that kind of experience. It's incredible that you also pay homage to those that go before you like Jack Han and things like that. What a wealth of knowledge, man. I can't wait to kick off this class with you. Maybe I want to just hear you talk and just sit down and listen to what you know. I've heard enough of my self-talk. So you go into Phoenix in an 18-ish, and that's right as the Chris Barrett: Yup. Adam Hogan, DDS: bubble as it's like blowing up, right? Isn't that like kind of like right at the aggressive growth phase of Full Arch and Phoenix, would you say? Chris Barrett: Yeah, you had a lot of things happening right around that time. You had very low interest rates. had, ⁓ you know, other kind of full arch players coming to town. It was very fortunate that ⁓ Vishy Bhrumand is here in town and was able to create a relationship with him. Our kids go to the same school. So we see him all the time. ⁓ took his Zygo course that was putting on his time, but he's a gem of a guy as well. So you had like a confluence of things happening that it felt like you could be a part of this like quick evolution of whatever was happening. ⁓ Very fortunate to be part of Dan Holzglau's very first pteragoid course, which was down in Dallas at the time. And... Adam Hogan, DDS: Any? Chris Barrett: I'm sitting there and at the next table over you have Mike Picos. And if Mike Picos is at a course learning something and you happen to be next to him, you're like, okay, I I'm in the right spot. So it was like this weird, yeah, just a weird, a weird time in implant dentistry where a lot of either old things were getting modified and revised or, ⁓ just new ways of looking at things. So yeah, I was, was fortunate to kind of catch some of that wave. But then you have economically, have this buildup and then you have all of sudden this rise in interest rates, free money's gone, ⁓ business dynamics were changing. And I think you're still seeing that. You're still seeing some of these old concepts trying to be applied in ways that aren't working. And you see a number of different groups try to figure out ways to adjust to that as far as what they're going to do long-term. Adam Hogan, DDS: Mm-hmm you think So a couple questions on that I mean I've got a business course the how to 510 20 is in two weeks here in Virginia Beach and I Teach doctors how to be successful in full arch and any concierge any high-end practice could be cosmetic even but I've got a doctor coming from Phoenix, Arizona And I as I look at the roster. I'm like man that is I mean you you're in the alligator pit like you are swimming in a frenzy of sharks, feels like to me, it's just, it's a different market coaching. Someone in Phoenix and is in South Dakota. You know, what would you say to, I think, I think I've got a flyer on that. Yeah. What would you say to somebody that is like young and trying to open in Phoenix in 2026, a GP. Chris Barrett: For sure. ⁓ I think at this point in time ⁓ I think it makes the most sense to have a really healthy general practice. And in my mind, there's two, if you're a GP, it would be very difficult to go all in on all on X in the current market. And so in my mind, I'm building out two separate practices. I'm building out a very healthy general practice that is going to be recurrent revenue. ⁓ You're basically building out a book of like a recurrent book of business. And from that, you can start to take implant stuff out. If you want to start building an O and X, then that's almost like a separate business where ⁓ the verbiage is different, the marketing is different, the spends are different. People have to be... When you go to a general office that not doing larger cases and you tell someone that they need to start talking about treatment plans that... If you want to start building an O and X, then that's almost like a separate business where ⁓ the verbiage is different, the marketing is different, the spends are different. People have to be... When you go to a general office that not doing larger cases and you tell someone that they need to start talking about treatment plans that... they're normally talking about something that's $2,500 to $5,000 and now you need to start talking about 20, 30, 40, 50, $60,000. That's a whole different mindset shift. And so in my mind, they're two separate practices. ⁓ You have to be incredibly efficient to not lose your margins on the all in next stuff. And if you get into this... they're normally talking about something that's $2,500 to $5,000 and now you need to start talking about 20, 30, 40, 50, $60,000. That's a whole different mindset shift. And so in my mind, they're two separate practices. ⁓ You have to be incredibly efficient to not lose your margins on the all in next stuff. And if you get into this... Adam Hogan, DDS: guess. guess. Chris Barrett: Hey, your verbiage is not correct. You can't lead someone to a known outcome and you just end up falling into a void and that void will start to eat you alive if you don't know what you're doing. So. Hey, your verbiage is not correct. You can't lead someone to a known outcome and you just end up falling into a void and that void will start to eat you alive if you don't know what you're doing. So. I think a lot of that is ⁓ correct treatment planning very quickly. I think a lot of that is ⁓ correct treatment planning very quickly. like quick, efficient treatment planning, as far as you know that you can take someone from A to B and the steps along the way, as opposed to, I think I can get you there. I think we're going to do these things. That's when you start to get burned. ⁓ And that's very difficult as a young practitioner because you just haven't gotten the reps. And I think anybody can do this stuff, but I was very fortunate to be able to put myself into a position of getting a lot of reps very quickly to accelerate my growth. And as a general practice, that can be very difficult. courses are great. I think you should take all of them. If I had all the time and the money in the world, I'd still take all the courses. I mean, I can improve on all aspects of my game. But I think... Adam Hogan, DDS: Yeah. Yeah. Chris Barrett: I think as the young doc, you really need to find a mentor where they can help guide you and they can keep you out of the pitfalls because you don't want it to overspend, back yourself into a corner, start, you had one great month and now you've overspent and now you've got... you know, one or two bad months, well then that third or fourth month, you've got to make up for the previous months plus that month. And it can become a somewhat debilitating. So you've got to be cautious. I would, I would really build out a very healthy general practice first. And then I would start to incorporate the implant part of it from that. Adam Hogan, DDS: Yeah. Yeah. I mean, I'm going to recap because I don't want to steal all the minutes here over your time, diversifying, I hear diversifying because that is just like diversifying the stock market, right? If you're going to be in crypto, you also want to be in something pretty safe like the SP 500, right? Just something you know is going to always make money. When I came out of the Navy, Truman handed me all the root canals. I don't want to any root canals, but I mean, I had time on my books and it was going to pay the bills. I haven't done a root canal since 2007. Chris Barrett: Yup. Adam Hogan, DDS: You know and also like you know, like Lee Corso says I've got an article in a magazine called not so fast my friend right now just published but Like Lee Corso said not so fast my friend not so fast my friend like slow down learn a little bit You don't have to jump in, know and do this in like 12 months out of dental school You said you had the opportunity to learn some things and get some reps I too I did my first full arch experience in my red GPR residency 2003 but then over ten or 12 years, I I learned pieces and building blocks of various parts of surgery. So when I went all in, all on X, I was very proficient in all the little parts of all on four, you know, because it's really just all at four is a huge elephant. It's a marathon of a procedure, but it's just filled up, filled with like little sprints along the way. And you have to be able to be good at all the little races in between. So I like that diversify and, ⁓ and take your time. The other thing you said, to the resource, the expenses, the expense sheet in an all-in-four practice is vastly different than a general practice. And if you're trying to do both intensely at the same time, you can get spread very thin and you can actually lose a lot in expenses for sure. ⁓ So you have some very good, very good points on that. Absolutely. Chris Barrett: Yo. Adam Hogan, DDS: You can have associates in your new practice or the one you're building out to help buffer that general general dynasty a little bit. Chris Barrett: ⁓ I'm not building anything out right now. I'm still just doing the, traveling surgery thing. But if I were to do an office, I, that's what I would do. I would have, ⁓ I would have kind of like an associate led office that, ⁓ that then I would end up kind of cherry picking some stuff, but there are plenty of docs that don't want to do the same stuff that we love doing. So, you know, find the time. And then the other part of it is, you know, taking the time to train your team. The offices that I see since I get to go into so many offices, the offices that seem to be the most successful are the ones that are, that have systems in place that have, you know, worked on training and they're training all the time. It's not like they train once. It's like, we're consistently training, training, training, training, training, and then having something put in place where. In the, in the. Dental model you see high turnover where someone's leaving a job to get two dollars more an hour over at this other office and Unless you've built a certain culture or some way of retaining these people there's such a huge loss of Continuity and training when you lose someone that you've invested in and they go somewhere else So having something put in place to retain those key members of your team is really important Adam Hogan, DDS: You're speaking my language. I'm going to throw this up one more time. Because at my business course, this is probably about the fifth time we've run it. Everybody comes in with, where do I advertise? How much do I spend? And I just signed down with a marketing company. And I've already pledged out 10, 20, 50 grand a month. And it's like, again, not so fast, my friend. Because this course, everybody wants to those marketing questions and lead management and closing and we're going to get to all that. But the first four, the first half a day is all about systems and you know, your, your schedule being a production funnel and not just a calendar and you know, your ORM and your CRM and your KPIs and how you measure your people and how you manage your team and what team has to be in what positions. And that's all so very important. You can't even talk about how much should I spend on my, full arch advertising until you have all the systems in place. So, you know, they say I'm about to sign on with XYZ marketing company. Stop. What systems you have in place? What do you mean exactly? Don't spend a dime. Let's talk. You know, we've got to, we've got to go down that road. You're not very similar. We've obviously probably been burned by the same fires along the way. Chris Barrett: Yeah, probably just going through that stuff makes an indelible mark where it's like, you, there's only so much, so many times you can do it the wrong way before, you know, life is hitting you in the head saying, Hey, you got to do these fundamentals correctly first. Adam Hogan, DDS: Yeah. ⁓ so you bring these, ⁓ we're, doing a class together, JB, ⁓ we're going to go out to Tempe and I have, I've seen you talk. You're, you're a really good motivator and you're a smart clinician, obviously a great educator. ⁓ but what can, you know, what's, what's your approach to education going to be like? mean, bringing in new docs, what's the most important thing? I mean, how do you indoctrinate them? How do you get them started? Chris Barrett: ⁓ Man, that is a loaded question. So that makes me think about, you know, some associates that I had that I was trying to train and ⁓ It can be difficult to train someone quickly. So I think there needs to be some sort of, and I don't know the best way to do this, but my approach would be to have some sort of like progressive timed thing. And again, the docs need a lot of reps. So, ⁓ From my standpoint on the training stuff, it comes back to just fundamentals and maintaining a high level of excellence along the way. The treatment planning has to be done correctly because all of your data, you know, garbage in garbage out. So you've got to give the lab good data. And then once it comes to the clinical side of things, really having a very good understanding of what you're doing. so that step one, one of the things that I see younger docs are new, I shouldn't even say younger because there's all sorts of ages that come to these courses. But when you start something new. your mind is, you want to grasp, spawn to absolutes because you don't know all of the potential pitfalls or landmines. And so most of the time people just want to be told what to do. Hey, tell me step one, tell me step two, when in reality they need to understand general fundamental concepts and then apply those to each situation because every patient in every surgery is just a little bit different. And on high level people like yourself or the other colleagues that you've had on the show that I know, ⁓ they make it look like easily routine and ⁓ they take complex stuff and they make it look simple. And they do that by, they don't move on to step two until step one is done almost perfectly. So now that step one, for example, they lay a very clean flap and they base that off of a very good incision. Once they've laid that flap, then they're going to take out the teeth. Once they've taken out the teeth and everything is debrided and cleaned correctly, then they're going to plasty. And there might be slight different variations of this, but each step builds on the last step. Adam Hogan, DDS: Mm-hmm. Chris Barrett: And so one of the fun things to do when you're walking someone through, like, for example, ⁓ me and a colleague, Raj Sheth, started the All On X full arch course at Implant Pathway. And one of the things... that was fun was like that I'm gonna do with you is we're gonna take a patient from surgery to provisionalization and we're gonna walk the docs through the steps, but it's cool to see how each step builds on the last step. And if you do each one correctly, it's like all of a sudden magic, hey, everything fits together at the end. And when new docs are starting, they want to skip steps or they want to kind of get to the end faster than they should. ⁓ So really slowing things down and almost just like you're saying that Lee Corso thing where it's like, Hey, just hold on, slow it down, focus on what you're doing. Make sure that each step is done to a high level of excellence. And before you know it, you just end up at the end in a really good spot. ⁓ Adam Hogan, DDS: Right. Chris Barrett: It's a simple thing, but it's difficult to do. ⁓ And training someone to get to a high level is just, it's a years, years, years long thing. So you've got to have the right ⁓ mindset probably that you're also trying to coach and to help. ⁓ Adam Hogan, DDS: Yeah. Chris Barrett: And then in implant dentistry, something that I got from the office in Colorado was as far as the occlusion and the full mouth stuff was you've got to be a thinking dentist. I remember John Bassett always telling me that you've got to be a thinking dentist. And one of the things that is really ⁓ fills a certain bucket for me in implant dentistry is it's a thinking man's game or a thinking woman's game because you're going to have things come up during these procedures and you have to take a step back, detach, take a deep breath and then say, hey, what are my potential options of how I'm going to, you know, fix this problem or come up with a solution. So you've got to help docs slow down and get to that point where Just because what they thought was going to happen didn't happen, that doesn't mean that the case is over and it's like, ⁓ my gosh, what do I do? It's, hey, what are our potential options to keep moving to get to that outcome that we Adam Hogan, DDS: Agreed. mean, this is a, it's very much a recipe for success. It's a cookbook. All I'm for is a cookbook. And if you add the right ingredients at the right time and the same sequential order every single time, you can hopefully expect the same or similar outstanding result. Each step builds on the one before it. You know, like you said, you can't have a good closure with keratinized tissue all the way around your implants if you don't have a great incision line in the very beginning. And you know, you're not going to have, Chris Barrett: Yeah. Adam Hogan, DDS: Wonderful alveolipasty without a great reflection and you know extractions without all that stuff So I do things in a very methodical order every single time. It's like we always do this before that before this before that but Chris Barrett: Yo. Adam Hogan, DDS: things come up and you have to be able to pivot if there's a little change in the dynamics of that particular case. So it's like being a thinking dentist is very important. So I'm with you on that. When I'm giving my basic surgical lecture, it's exactly like that. It's a cookbook. It's step one, we're going to do this and this we're going to do it perfectly. And step two, we're going do that. And everything builds on the one before it. And I threw this up. This is a graphic of the ⁓ Atlantic Implant Institute because ⁓ You really can't teach full arch or learn it in a lecture or a weekend. It's something that is, it's a progression all through your career. And I found that when I tried to just teach like, okay, the full arch course, this was when we opened, I think just three years ago, we're just coming up on. Chris Barrett: Yo. Adam Hogan, DDS: for ⁓ our third anniversary, I think. And we had the full arch course and it was a four day course. I was trying to jam so much into four days and I wasn't even doing it. And so now we've got this ⁓ continuum, basic, full arch, that's that boot camp. And then you've got core digital in the middle, which is advanced prosthetics and core digital. and then Anchorage, and then that's all the FP3 stuff. And then this thing called the Crucible, that's our live surgery training program, which there's a huge announcement coming. We're gonna be going down to Brazil. And by the way, you might get an invitation. You know who we're gonna be working with. I'm gonna be coming up with that in a couple of weeks, but we're gonna be taking them all down there. Why? Because you need a progression. And I've done too many live surgery courses where doctors turn in an inflated resume. And then they show up to reflect and cut and drill on a patient. And you realize that the patient is in danger or jeopardy. They don't even understand the procedure yet. And so we're taking a very methodical and responsible approach to education as stepwise fashion to go, okay, we're going to learn one, two, three, bootcamp, digital, Anchorage, and then we're going to be able to take you to surgery. And by the way, you see these other pyramids, by the way, we have FP one out there and we have mentoring out there and we have business out here. what we're doing in the forefront, this forward deployed, if you haven't noticed, everything's a military reference, but you know, from my Marine Corps days, but forward deploy, that's where you and I are going on the battlefield out in Tempe, Arizona. And we're taking a two day seminar to kind of take the fight to the enemy. So it's like, we teach education just like you do all on four in a very methodical approach. I'm excited to have you as a part of this. ⁓ Where is, I'll have to bring in. We got to, I got to get to, ⁓ by the way, there's us, there's our, there's our, ⁓ flyer for Tempe, ⁓ Phoenix, Arizona. It's actually in Tempe, June 5 and 6. Now you've taught here before, correct? Chris Barrett: Yeah, ⁓ I've done a few different things down at JB. They've got a nice classroom and then they have a surgical suite built out. So I've done maybe three or four live surgeries down there. Adam Hogan, DDS: Yeah. You're going to be the one leading the surgery. We're going to kick out. We're going go in on Friday morning and ⁓ you're going to be, you're going to be kicking off that surgery. So the way I like to do it is you're going to come in and we're going to do the surgery right away. And that that's perfect because it's going to fit into your schedule really well. You've got a patient for it already because I like that people come in and they see a surgery first because then when you do the didactics and the type of dots and everything afterwards, they have so many more questions. Okay, their brain is already filled up with questions on where we're going from here. So yeah, talk about that. You've done it this way before? Chris Barrett: Yeah. Yeah, something that's nice about the live surgery, especially when it's, you know, right there at the facility is that docs can come into the operatory. It's literally, you know, connected. So if they want to see, you know, specifically a part of the flap or, know, a part of the blasty or, um, It's going to be a double edentulis. So ⁓ there may or may not be a zygote that needs to be put in. ⁓ just different kind of exciting things for new docs to see. ⁓ It definitely keeps them more engaged than just coming in and getting the didactic right off the bat. Adam Hogan, DDS: Yeah, that's kind of a part of the reason for teaching one, two, and three together before you go into the crucible and into surgeries, because you never know what you're going to get. You might think you're going to place a zygote, you don't. might not have no idea you're going to do a zygote, but you end up doing it. I mean, the last digital workflow class I did, I didn't expect to play zygotes, but here we were with these beginners placing a zygote on each side and everybody was like funneling around taking pictures. it's just the lesson is you got to be prepared. You can't say you're never going to do this. Going back on something you said, by the way, I sent Paula an invitation. So she might dial in here pretty soon. But were you gonna say something? Did I cut you off? Chris Barrett: Nice. You know, when we were talking about that, that made me think about, ⁓ depending on who you ask, they'll say, hey, when should you really start learning the more advanced techniques? something that, you know, I was taught when I was growing through this on the early part of my curve, my mentors were very MISH based. And you kind of have, Adam Hogan, DDS: Okay. Chris Barrett: Europe and Paulo Molo and all on four. And when he came out with that in the nineties or early two thousands, you had, you had Mish over here and it was all six over six and straight. And there was different things about occlusion and, ⁓ you know, how the bone and the implants and the forces related were going to affect things long-term. So I was of a certain mindset where it's like, you know, I don't, I don't need to be learning those things. If I could go back, I would learn some more of the remote Anchorage and different styles sooner because something that I've seen out of the courses that I've helped with is if you teach someone a basic all in four course and you know, you're showing them the Bedosian classification and it's like, Hey, since you're a new doc, you're going to be living in zones one and zones two and zones three. You're going to be looking at zone two and three patients, and that's really where you're going to start cutting your teeth. And sometimes people will say, hey, you've got to do 50 regular all on X cases or a hundred or whatever before you even think about touching these other ones. I would, I would tend to disagree with that a little bit in the sense that Adam Hogan, DDS: Mm-hmm. Chris Barrett: I don't think they need to be jumping in to be doing remote anchorage off the bat. what would happen was these docs would then take patients and put them into an all-in-four box. when they really weren't that type of patient. But they did it, they couldn't mentally see that they weren't that because they hadn't been trained to say, hey, you know, this is a zone one, zone two patient. And depending on how the plastic goes and some infection and some other stuff, maybe you start to lose zone two on the edges. And then what are going to do? And before you know it, they've got four implants towards the front. Their AP spread isn't good. So ⁓ I do think that there needs to be comprehensive treatment planning. with remote anchorage right off the bat and then the suggestion is, hey, each one of these surgeries I feel takes a tiny bit of my soul. And so if you get into, if you have a couple losses right off of the bat, that's very difficult from like a personal and a mental where it's like, hey, I don't even know if I should be doing this. Like I was really excited about it. So you really want to be setting yourself up with a lot of wins right off the bat and do those cases. So my suggestion for newer docs is. If you can correctly treatment plan the case where it's like, there's a 50 50 chance they need remote Anchorage and I don't want to get halfway through the surgery and then feel like I don't have the skills to complete this. would create a relationship with a surgeon in town where you are quarterbacking it and you properly treatment plan it. And then you, know, Hey, here's the local OS or whatever. you find that relationship where the OS is okay for you to come over and watch those surgeries. So you're starting to get mental reps, you get to see little things that they're doing. And then in a few years, after you've seen a hundred cases or whatever, you can say, hey, I wanna start learning these surgical things myself. That's what, there was something that you had said that had made me think about that. Adam Hogan, DDS: I don't know what I said, but it's a brilliant point. I'm big on, okay, going back, when should I learn remote Anchorage? I get this all the time. I wanna take the continuum, but you got that module three in there. I don't think I need it yet. I think... I think that that's the wrong attitude. That's the wrong way to think about it. Even if you don't feel competent or proficient in it, I think you still need to learn, you know, and know why and know because then you know what's outside your scope. But two, you're never going to be comfortable doing it if you don't get exposed to it at some point. And that's one reason I don't have you just like, okay, submit me a resume, okay, to place implants on Zygos on live people. And oh, by the way, all doctors lie on their resume. So they all say I placed 500 implants when they place 50 and then they show up and then they're not comfortable and you're not comfortable. it's take it early, take the education early and learn. Let's get exposed to it in a responsible fashion. Let's go watch the surgery. Let's learn the didactics. Let's do the type adults and then let's do the cadavers. And then you're going to go home and your mind's going to then all of a sudden all the questions are going to come to your mind. And then you're going to go, okay, I need another course. And I'm the first to tell everybody, go to all the other courses. Chris Barrett: Yeah. Adam Hogan, DDS: You know, go to pathway, know, go wherever Chris is metric. Go see Chris, you know, go. I don't care if you go see Dunlop. I mean, anybody you want like, but go to everybody go all over the place, but you better go to you better go to Vishy my buddy, Vishy too. ⁓ But you're going to the more places you go and get exposed to the more comfortable and proficient you're going to be. And that that way, when you do get to that level, you're ready to go. ⁓ The other thing you said was. Chris Barrett: Yeah. Yeah. Adam Hogan, DDS: Oh, how'd you phrase it? Having a relationship with a patient, the way I phrase it is setting expectations. So when I was young and before I was into pterygoids and zygots, let's face it, there's a lot of maxillary arches where you can't get an AP spread over 10 millimeters. I mean, it's like 12 tops. And you don't want a three-toothed distal cantilever. And so responsibly, I would tell the patients, we're going to do your bottom. we're going to take out all your upper teeth and we're going to scrap your sinuses or whatever, and we're going to come back in six or 12 months and do your top. And there's really nothing wrong with that. If, ⁓ if you're taking it responsibly and they're getting a good outcome. So you can, you can do that and stage things in that respect. The other thing I would tell people early on is, you know, set yourself up for success so that you don't have any, ⁓ Chris Barrett: Not at all. Adam Hogan, DDS: any disappointments and I'd say, look, 5 % of these cases in the top, can't load one in 20 cases. You know, even though I could load 99 out of a hundred back then, I would kind of like let them know, like there's a one in 20 chance you might get a denture. And so you don't, you're not under the, the, the severe pressure to perform in an unrealistic situation. Okay. Nowadays with teragoyd zygos, I'm like, Hey, look, I haven't not loaded a case in about two years, but Chris Barrett: Yeah. Adam Hogan, DDS: you know, the next one's coming. I mean, I can't tell you, but it's probably going to get loaded, but you know, it's, it's a possibility. So, you know, my verbiage changes as my confidence in my career and experience have changed. So young people, you don't have to just set the expectation upfront. What's, what's real. Yeah. Chris Barrett: for sure. Yeah, that's a really important point is don't be afraid to phase cases or even just something that, especially with all of the Instagram and social media pressure of like doing double arches and loading them and everything, that seems probably very normal and for certain people it is, but... ⁓ Adam Hogan, DDS: Mm-hmm. Chris Barrett: To your point, don't back yourself into a corner and over promise and under deliver. And then it takes so much stress off of you and your team. If you just phase the case, as well as if you don't have the ability to provide, ⁓ you know, a certain level of anesthesia. you're gonna run out of local anesthetic if you adhere to the guidelines as far as how much you're supposed to be using per day per patient. So ⁓ just something else too where it does, it takes a lot of pressure off, just do one arch at a time, as well as setting the occlusion and coming back and getting a good bite. Do the upper, come back two weeks later, do the lower. ⁓ Patients really... I think doctors, especially once they gain a little bit of confidence, patients really trust and believe you. And so if you tell them, I think this is the best way to do it for you, Mrs. Jones, and I'm very confident we're gonna get a great outcome if we do it this way. ⁓ A lot of times they're gonna go along with what your suggestions or what you're telling them. Adam Hogan, DDS: Yeah, that's I mean, I've forgotten some things early in my day. mean, these things come to my mind when I'm teaching the beginner class, no doubt. But you you just forget about them day to day. But when I was just doing this under local anesthetic with ⁓ walking sedation, like oral sedation with Halcyon Triazolimid Valium. And I was very concerned with too much anesthetic, local anesthetic in a single sitting. I was concerned with how long the total surgical time took because I was a little slower back then. And I didn't want to stress out myself, the team or the patient I've been experienced. And so it wasn't uncommon to do, I would do the mandible first. because a couple of reasons. One, the big reason is I'm an occlusion guy. And if I, I set the mandible for function and if I could set the mandible, I would have a much better result. Like I like to set 24 and 25 in the occlusal scheme and set my posterior is one, two, I could get it done quicker. Three, the patients didn't swell as much as the maxill. I tend to notice, and if they do like patients notice mid maxillary, facial swelling, they don't tend to notice it so Chris Barrett: for sure. Adam Hogan, DDS: much in the mandible. And so there was a few times, I think at least once or twice where you did the maxilla and then you're going to do the mandible later. And the, and the patient said, ⁓ that was so terrible. I'm not going to sit for the bottoms. I'm not going to come back and do the bottoms. And you're like, it's not going to, the occlusion is not complete till we do it. And you're trying to convince, and they got their beautiful teeth up top and they don't want to sit the bottom. That was the other thing is I was hold back the cosmetics. So they'd have to come back in four or six weeks for the top. ⁓ but Yeah, it's a good tip for the beginner to think of that. Just slow down, do the bottom, and then come back and do the top. Because I have seen too many litigation cases where one of the patient's primary complaints is that they were in the chair until 9 p.m. or 10 p.m. Anyway, you were gonna say. Chris Barrett: Yeah. Yeah, I think we also were bold when we started out. I mean, it was all analog at first for me. And I probably did all of my own conversions for two years. So I was my own lab guy and you learn a lot from that. But one of the things when you're doing an analog surgery is you don't have to worry about fiducial markers moving. You can extend your incision line back further. You can complete a full reduction. ⁓ And so I think there's some pros to almost doing that a few times to understand the difference between the analog and the digital workflow. ⁓ Yeah, what else was I going to say about that? Maybe it'll come back to me here. ⁓ the other part of the potential of... The potential of not having someone sedated well or not having profound local anesthetic and most docs have a big heart and they don't want to hurt their patient. And so what happens is they're running out of local, they're on the second half of the procedure, whether or not they've done the lower or the upper. And so then they skimp on the plasty and they don't do the plasty correctly. And just like we were talking about before where it's like step one, know, step two builds off of step one, step three builds off of step two. Adam Hogan, DDS: and him. Chris Barrett: So as soon as you don't want to hurt your patient and do the correct, you know, plasty, you are just setting yourself and the patient up for just, you know, appointments of heartache, of trying to like finagle this stuff prosthetically. So just one more reason to phase it and make sure that you've got really profound local anesthetic to make sure you can, you know, do the proper surgery to set your process up correctly. Adam Hogan, DDS: Mm-hmm. Yeah. So you mentioned something about, um, fiducials. before I get to that, I want to comment. You had a couple of years doing analog pickups. I, you know, I did that from 2003 to, know, probably 16 or 18. I don't know. Um, and I believe that to become a better full arch surgeon, you really should know the analog process. You learn so much about the prosthetics and bone reduction and everything when you're analog workflow. But you mentioned, I'm going to see if I can find something here. You mentioned the Fidu- not being able to do full reduction alveoloplasty. I'm going to share my screen here. I don't know if you know I do it this way. And I'm going to ask you to do it this way in Tempe. OK, but looking at this mandible, all right? I put my fiducial, if you see my cursor. I put my fiducial here, right in the middle of the chin. And I put it about 17 millimeters below from where I expect that in size alleged to be. So that fiducial will be right here. So we're going to put it in there in the midline. And we're going to be able to do our full alveoliplexy all the way out. And with this method that I developed, I'm pretty sure I've never saw anybody else do it before me or talk about it since. But by putting it in the midline in the chin, we're not going to have to worry about selective extractions or saving back a tooth or not doing the full level of oplasty or anything like that. Plus, we're going to get even better alignment. So there you see it in the top of the SIN, versalis implant right there in the 23.3 site. But that fiducial is going to be well out of the way. And same in the maxilla. Here's an example of that fiducial probably in like 2020 or 2022. We got it way down low. And so it's going to be totally out of the way. ⁓ And it really streamlines the digital workflow process and makes it much, much quicker. So that's pretty cool. ⁓ I'll be bringing those with me for you. We'll be doing that together. Chris Barrett: Okay, great. Looking forward to it. Adam Hogan, DDS: Yeah, right. Because it sounds like you were still putting him in the posterior mandible. Chris Barrett: Yeah, I usually do. I have used yours. ⁓ Danny Domain is, I would consider him a friend and colleague. so ⁓ he sent me some of your stuff. And I'll have you guide me on how you like to use it. ⁓ yeah, looking forward to any sort of pearls I can glean from you. Adam Hogan, DDS: Well, yeah, and I'm going to get a ton of pearls from you as well. The problem I have with digital fiducials in the back, and that's the way I was shown how to do it. I think, ⁓ gosh, Patrick Dewey might have come in and shown me how to do this ⁓ with SIN back a long time ago. he was like, put a couple in the posterior mandible. And the first thing I thought of was, that's right in the way of my incision line, right in front of the retromolar pad. Now I'm not going to get full reflection. And no, I can't do my reduction until the end. And oh, by the way, there's a third molar there. And I got a drill in the impacted third molar. Or in my case, I had pathology there in soft bone, the fiducial mood. And then one of the biggest reasons was when you have a fiducial on both sides of the arch and you're trying to scan across the arch, you get a deviation in your intral scanner and you can't align both. So you're just guessing which one. ⁓ by the way, also the sub-idibular fossa possibly being shallow, the bone not being quality X, Y, and Z. And I was like, I'm going to find another way. And I just found this long screw before the one that Keith and I, Keith Klaus and I conceptualize the, ⁓ conceived the idea and then we don't produce or manufacture anything. So Danny, close friend, we're like, here, make this. And, ⁓ I was like, give me a screw and I just want to drop it right square in the chin. I'm going to get it way low out of my way. And Keith Klaus goes, it'd be even better if it had an MUA on it. And I'm like, you are god damn genius, Keith Klaus. I was like, gulp, Forrest. I was like, how'd you get so smart down there in Mississippi? ⁓ So I was like, I want a long ass screw right in the chin. And Keith goes, I want an MUA on it. And Danny's like, easy, done. Like a month later, he's got him out. So that's what you're seeing there. ⁓ Chris Barrett: you Adam Hogan, DDS: It's just all of my mandibles have just perfect plane because I'm right dead center. It never moves. It's D1 bone. And it's totally safe. By the way, I just taught digital workflow a month ago. And a student back in the class, goes, I was just somewhere. And they know you do that. And they said that it's really dangerous and you could kill a patient. And I went, whoa, what? And he goes, yeah, there's apparently like Chris Barrett: Yeah. Yeah, I haven't heard that one. Adam Hogan, DDS: There's apparently arteries in there. I said, let me pull my screen back up. I said, OK, let's talk about this. All right, I don't know who told you that. And I'm like, who told you that? I was like, no, I don't even want to know. I was like, let's talk about this. All right, so here we are with the mandible. OK, you're in the chin. Guess what? We also take off the chin, symphysial block grafts. We dig in there about six millimeters, eight millimeters deep, right? People don't die. You're talking about the genioglossus artery. Measure on your CBCT. It's going to be in there like 12, 18 millimeters deep. And we can manage it, by the way, and we talked about that. But you're only drilling into that mandible about 6 millimeters at the most and then dropping the screw. I'm like, this is, to me, way safer than worrying about the lingual nerve back here, the facial artery if you get into some endoblodary phocis, et cetera, et cetera. Chris Barrett: Yeah. Adam Hogan, DDS: So I was like, I would much rather be on the sepsis. I don't know who told you that. And by the way, anytime you do surgery, it could have devastating effects just from pharmacology and anesthesia, by the way. So, you we don't take that lightly, but no, I don't think that this is a grave risk. Chris Barrett: Yeah, I would agree with you. From an anatomic standpoint, there's far less ⁓ potential downfalls right in the front of the mouth there, for sure, if you're doing it correctly. Yeah, I've seen, to your point, I've seen fiducials get lost down into the lingual space ⁓ when docs are too far lingual, where they don't really understand the anatomy. ⁓ So it's very technique sensitive and when you first start it, it doesn't make a lot of sense. So I mean, your mind was thinking about it correctly and it, I didn't get to the point of, you know, helping to create something that would be better, but it was like, man, it seems like we're taking things. When I first started doing it, I was using tads and white caps. And so I would just take tads and strumming back there. ⁓ But I was like, man, we're taking things that weren't designed for this and we're just using them as a placeholder almost until something comes along that's better. So I'm looking forward to seeing exactly how you like to use this. Adam Hogan, DDS: Mm-hmm. It's going to work out great. You know anybody that's still using stickers that swears, ⁓ I can just put stickers on the palette and I get perfect alignment every time? Are you hearing that? Chris Barrett: No, I haven't heard stickers. know, periodically you see something and it's almost always like a prosto or something that's like, check this new workflow out. it's like, obviously you don't do a lot of surgery because that, you know, the movement of those to, especially when I see people put, you know, fiducials in, you know, to the pallet as an angle instead of, you know, dead center. So you can get a proper reflection of the tissue. You just, you start to see things as like, okay, they just haven't done enough or they just haven't been burned by things that just don't make sense. Adam Hogan, DDS: Yeah, I mean, while we're talking about it, ⁓ we'll make this last part of this pod ⁓ a lesson in fiducials, I suppose, but you've seen my two point fixation here in the middle of the pallet. Chris Barrett: You know, I don't know if I've seen yours specifically, but I've seen things like that. Adam Hogan, DDS: I don't know if anybody developed it before me and I'm not trying to say nobody else ever did but you know when we were putting in one or two or three back here again there was always that one would move and It just five years ago. I just thought to myself why I don't do on light bone grafting with one screw You know, you got to get two-point fixation. So we just developed this we call it the tank two points And it does really well. The mandible always does well. I mean, 99.9 % of time. This, if you have really saw like very thin palatal bone, you might get like a six degree can or something like that. Or if you're very, if you're not careful in your surgical technique. But I would argue that you're going to get the same digital alignment problem with a single fiducial marker if you have that paper thin palette anyway. So this just enhances and makes it just a little bit better. But here's. I put them far back in the palate, off the rugae and far enough down that hopefully I'm not going to reflect and cause it to move. Of course, if I do notice any like six degree or can't, it's always like you're too aggressive or you didn't have enough room to manipulate and maneuver around or you had some surgical edema at the end of the case. you can fix, in digital workflow, you can fix that in an hour. You just scan and reprint. So it's not a problem. Chris Barrett: Mm. Adam Hogan, DDS: Also, I made these really low profile so when I was doing the zygomas, you don't come across and hit them. So I'll be bringing those down to JB on June 5 and 6. So it'll be good. Chris Barrett: Yep. That'd be great. that's just looking at that. Yeah, the low profile with the Zygos is very beneficial because you'll run into, hey, you put a tall one in and before you know it, your bird or something is hitting it. The nice thing about your aim screw, if you do need to use it, if you have a tall palatal vault, ⁓ sometimes it can be difficult to scan something that's really low profile. So between the two, seems like you can ⁓ choose the correct one for the... ⁓ Adam Hogan, DDS: ⁓ Chris Barrett: for the situation. Adam Hogan, DDS: So with this one, ⁓ on that point, I made one of these ⁓ to be sort flatter than the other ⁓ for the shallow That way you wouldn't get a space below. ⁓ This is why putty is for, right? Yeah, it gets cut off. ⁓ And then if you have a high-vaulted pallet where I have a tank that has a much steeper profile, more like a pyramid, so it fits in there. And the ⁓ main reason I that isn't just the Chris Barrett: gets cut off. Yeah. Adam Hogan, DDS: vaulted profile, the steep vaulted profile. But we noticed that if you, if you had a flat, uh, two point fiducial right here and you tried to wedge it into, know, you tried to wedge it into a canoe and then you, you had a lot of edema from the flat pushing on the side, you know, it became unstable. So I tried to get, um, I tried to make one that was deeper so that the tissue inside the, uh, inside the vault of the pallet on the, on the palatal walls, Chris Barrett: Hmm. Adam Hogan, DDS: didn't compress and push on that with edema during your procedure. So it helped with scanning and with mid-surgical intraoperative edema as well. I have two, but I don't think that there's any perfect system. It's really in the technique of how you use it. I mean, you just got to use it correctly and know the limitations of them all. Yeah. Chris Barrett: Got you. Yeah, for sure. And I know a number of guys that don't use fiducials and they'll do a denture pickup and they like to do it that way for their cases for some of the same reasons that we talked about, know, potential movement of fiducials, incision line as far as where you have to deviate that, ⁓ you know, your plasty. So number of different ways to do it. Just, it's helpful to know all of them for sure. Adam Hogan, DDS: Have you used the SIN Micromapper reverse scan bodies when you do a denture pickup to digitize it? So you got your denture and you can put them on the underside. you done that yet? I don't have them. Chris Barrett: I haven't, I've seen Blake do that as far as to make sure that the zirconia is passive as far as to check your photogrammetry. I haven't done that, but you know, I love Blake and all his ⁓ unique things that he brings to the game for sure. Adam Hogan, DDS: He's a different cat. He's a smart one though, that's for sure. I suppose, I mean, with SIN being probably within 10 miles of Tempe, I haven't talked to them yet, but I'm sure we're probably gonna see some of them out there. I know they are sponsoring the course. I don't know who's coming, to be honest with you. We'll figure that out later. Chris Barrett: Yeah, there's only one Blake. I like him. Yeah. Yeah, we'll have to go down and check out HQ. ⁓ It's a nice facility down there. Adam Hogan, DDS: Yeah, I definitely need to go. I'm definitely going to go. ⁓ So I didn't see Paola try to chime in. She probably just busy. I'm talking about Paola at JB Dental Lab. We were going to invite her in to come in ⁓ on this episode, but she's obviously busy making teeth. ⁓ So you'll meet her when we go down there. So the two days, kind of run through it. Friday morning, surgery. Friday afternoon, we're gonna talk about fundamentals of all on four and we're going to deliver teeth. We're gonna do digital workflow, by the way. We're gonna deliver teeth that afternoon, so you're see how beautiful that is and how good it comes out. Or if for some reason it comes out a little less to be desired, which I'm never 100 % happy with my first teeth. I mean, I can always do better. We can revise them and bring the patient back the next day for that perfect set, show you how easy that is. And theoretically you could do that revision in just like 60 or 90 minutes. ⁓ But yeah, I'm very picky. I call that first set of teeth a 90 percenter. I look at them and I'm like, I could do a little better. So scan them, patient goes home, they sleep it off, they come back tomorrow, we screw in that 95 percenter. And then we're usually done on design as we wait for everything to heal and go through final. ⁓ And that's my workflow. What's your workflow like? Chris Barrett: Yeah, this will be a little unique. I'd say I'm very similar to that as far as my verbiage to the patient. like, we're, unless they have a setup that for some reason we're just trying to replicate, we're typically, they're starting in a spot that's not great. And so I'm hey, we're gonna get you 80 % of the way there with this first one and we're gonna make subsequent adjustments. which it sounds like you're just saying, hey, this is the 90 percenter. Something that I think will be beneficial to the students or the docs that are going to be at the course is that Adam Hogan, DDS: you Chris Barrett: I find it more challenging when the patients are double jawed denturals. And so I'm going to be seeing the patient ahead of time. I'm going to try to get them into ⁓ a correct vertical and set up as far as what their dentures. And when we're doing fiducials and scanning, as far as a double jaw denturals, I find that a little bit more challenging than a partially dentate or dentate case as far as maintaining the vertical. So I would say the number one thing I see with those cases is that the upper will be correct and then depending on the bite or the vertical as far as how we have it based off of those dentures, ⁓ we might want to rescan and reprint a lower or something like that, which is always very beneficial for the docs to see. Adam Hogan, DDS: Yeah. You don't always have to go expert mode right away. I mean, I think in my evolution, I definitely went through sometimes some trial steps in the fabrication process. And I think that that's good for them to see. So if ⁓ you're going to see the patient do the preoperative prosthetics, let's get those out to me. ⁓ after we do the case, we'll lecture about you know what went into the pre surgical prosthetic phase and how we came to you know this preoperative design and how we came to ⁓ know how it played into the interoperative so people are going to see this all a to z it's going to come through and then saturday ⁓ type it on and we've got some i've got some business i want to talk to them about and i'm going to ask i'm going to ask you to talk some business too because you've got a completely different perspective on it having set up multiple offices in different places that you play smaller parts in, but you still manage and run and own. That's a great perspective as well. So I can't wait to pick your brain on that. Chris Barrett: Yeah, looking forward to it. Adam Hogan, DDS: for sure. Well, this is great, man. ⁓ All right. Anything, parting words? Can they find you anywhere before June 5th and 6th, or anywhere else you're teaching this summer? Chris Barrett: I think July I'll be back at Pathway helping be me and Barry Matthews leading the charge there as far as doing their full arch fix course They get to do some live surgery there if they want to get into that other than that I'll just be doing arches in in Kentucky in Colorado and then random When they throw up the bat signal, Anita's I go and some other state I'll run out there and drop some in as far as helping some docs out. Adam Hogan, DDS: Great. the airlines in business. Thanks, buddy. this will be great. I'm sure we're going to talk multiple times before then. But I want to thank you for coming on, man. And I'm looking forward. I think this will be a great segue into doing more together. keep in mind, I got something coming in Brazil with a mutual friend. I'm going to keep you in mind as co-faculty on that for the crucible. By the way, you know what the crucible means? You're familiar with the term the crucible? Chris Barrett: Yeah, for sure. Yeah. Yeah. I don't know if I do. Go ahead and educate me. Adam Hogan, DDS: ⁓ So I first learned about it, it's a biblical term as well, but I first learned about it in the Marine Corps. In the boot camp, you spend three and a half months learning all this Marine Corps drills, combat training, everything. You learn by the numbers like you do in all on four right surgery prosthetics, know diagnosis dream plan all that and then at the end of it We have a three-day crucible. It's you're awake for three days and you do everything all the combat skills from A to Z I mean land nav to shooting and ambush and all that you don't get to sleep and it's grueling but the crucible in biblical terms is a test by the way that God you know, gives you to, if you can go through the transformation from this life to heaven. And just in Merriam-Webster's dictionary, the crucible in general is just the ultimate test of your skills and everything that you know. So it really, as I look at the full arch continuum of learning everything FP3, when you go to live surgery, that's your ultimate test. And I may talk to you about coming in on that at the Institute as a faculty member, so. Chris Barrett: Okay. Adam Hogan, DDS: It would be great. We've aligned in so many respects with our careers and the implants we use and everything else, it probably would only make sense. Chris Barrett: Okay. Cool, we're looking forward to it. Yeah, for sure. Adam Hogan, DDS: All right, man. Any last words? Chris Barrett: I'll see you soon in Tempe. Looking forward to it. Adam Hogan, DDS: All right, let me close out. say, hey, you know what? If you're listening to this and you're about folars, not just placing implants, but actually building systems that work and treating people right and transforming lives, you need to be in Phoenix, Arizona with us at JB Dental Lab on June 5th and 6th. Special ⁓ shout out to some of our sponsors, obviously JB Dental Lab, SIN360, XNAV, ⁓ W &H Motors, to name a few. Thanks to you guys for all your support. And we look forward to seeing you out there. very soon. this isn't just a theory but this is execution. All right guys, Chris thanks for spending your time with me. Chris Barrett: All right, Seattle. Adam Hogan, DDS: Take care, man. All right. See you soon. Chris Barrett: Later.