Evan Kinnear: Are you looking to attract more full arch patients? SIN360 is offering a professional marketing video package. Their production team comes to your office, documents a case from A to Z, including patient testimonials and final delivery. It captures an in-office tour, creates a high impact case study that you can deploy across your website and your social media. The full package, $12,995. Oh, but there's more. It includes $5,000 of free SIN product. If you're serious about expanding your reach and maximizing ROI, email videos at Adam Hogan, DDS: Oh no, so wait, yesterday you did a full arch and then you thought you were going to pod at like 11 a.m.? Marq Sams: I had the time, I had the time. It was just one, it was just one. Adam Hogan, DDS: Was it one or two? Evan Kinnear: SIN360.US them the All-in All-on-X Pod sent you. Adam Hogan, DDS: Oh, okay. You started at six, seven, eight. What do you start at? Okay. Yeah, there you go, man. Good time. You got, you're going to be, start by eight sedation and on a pod by 11. I love it. I love the enthusiasm. Marq Sams: I hate ⁓ I don't know if the team likes it and I screwed that one up too, so. Adam Hogan, DDS: Look, I've been there so many times. mean, I've done like 12, 13 hour days and then run a podcast at the end or try to jam in a lunch meeting at, you know, 11, 12 after a double arch. Marq Sams: Right. I know, right? Adam Hogan, DDS: And we just apologize. I'll, you know, just like, ⁓ sorry. ran long. No, you ran it. Like I ran my normal time. Marq Sams: Exactly. Adam Hogan, DDS: Uh, so is cool, man. I, so Saturday morning, I'm kind of running around on a Saturday morning. Uh, I prepared yesterday. Marq Sams: Right. ⁓ huh. I know. I know. felt bad. was like, hey, you're fine. Take as much time as you need. Adam Hogan, DDS: No, I'm not trying to make you feel bad. I'm trying to apologize for my brain fog right now. Like, where am I? What day of the week is it? Marq Sams: No, I totally get it. Yesterday I probably would have been the same way. I so, I wasn't tired yesterday, the day before yesterday. I was so tired because I was taking this doctor out trying to wine and dine him. And... ⁓ Yeah, I guess the week caught away. think I got four hours of sleep, maybe four and a half hours of sleep the night before. And I was like, geez. I was like, I got to go to bed early on Thursday. And I was like, sorry, I got to ⁓ leave early for dinner. Cause I got a case tomorrow. I got a podcast to do. I need to be like functional somewhat. Adam Hogan, DDS: That's awesome. You were whining and dying to expand your practice, or what are you doing? Marq Sams: Right, right, trying to bring an associate in. I mean, correct, correct. You know, go ahead. No, it's like if I was younger and smarter, I would have tried to get all specialties. That's what I wanted to do, like get all the specialties together, but a lot of them ventured out and sold off and things like that. So it's harder to get people together like that, do something. Adam Hogan, DDS: Uh-huh. Another periodontist? Yeah. I guess I... Go ahead. Yeah, everybody seems to have their own, like life just kind of takes toll, the years get away from us. Everybody's got their own plan. Nobody wants to work for anybody else, but they're having trouble putting it together to do it themselves in the first place. Marq Sams: Alright. I know. Correct. I agree. It's insane. Adam Hogan, DDS: This is you, man, the Implant Imperio Center of Kansas, Wichita, Kansas. Two offices in Wichita. I'm talking to Mark Sams, who was cool enough to get ⁓ a name with a Q in it. ⁓ He's like, Honey Badger, you know what Honey Badger is? ⁓ Marq Sams: I don't know about that. I don't know a honey badger is. Indeed, honey badger. Adam Hogan, DDS: Yeah, honey badger. It's a firearm. It's made by somebody called Q. Yeah. Mark Q. Is that a marketing play or were you originally M-A-R-K and you're just now M-A-R-Q now? Marq Sams: ⁓ yes! Right, right. You know, the story is my dad's name is Mark with a K and he's junior. So my mom actually was my aunt. She named me Mark Quetz. And I was like, mom, why did you name me that? Like I was supposed to be like the third, like Trey or whatever. And so we thought about switching a name and I was like, you know what? I'm just going to drop the U-E-Z and add a Q or just keep it Q. Adam Hogan, DDS: ⁓ huh. That's cool. Cool, man. Marq Sams: Just, and then like, you know, girls calling me Mark Hugh and all this other stuff. So I was like, yeah, this is cool. Exactly. ⁓ Adam Hogan, DDS: Anyway, you can get them to remember you, right, brother? mean, I'll take what I can get. Well, let's continue your introduction. 2006, Doctor of Dental Medicine, ⁓ University of Louisville. You went down to Palmetto, I believe, for perio. Is that 2010? And then American Board of Periodontology. And then obviously, but you're Marq Sams: Okay. Adam Hogan, DDS: You're a recovering football addict, is that right? Marq Sams: Somewhat, You know, I played football. I'm from Georgia originally, and that's a big football country. And I played football and did all the little state championship stuff and almost like I wanted to go and I was like, I wanted to play for the NFL. And I was like, I don't think I'm good enough. And you know what? That's kind of like how I wind up going down the road of a period because I didn't take the leap. Couple of scholarships, went to Louisville, Baylor, and those are the bigger schools. And Naval Academy was recruiting me at that time. And I was like, you know, I'm all broke up from high school and I don't think I'm gonna make it to the league. And now looking back, I look at the biggest thing for me, I was fast. And I was like, man. Adam Hogan, DDS: Mm-hmm. Marq Sams: I'm still as fast as those dudes back at that play right now. I was like, maybe I could have made it, who knows? So when I went to dental school, I had graduated and I had gotten to hospital residency. And I was actually walking down the hall and the dean of the school and the perio director. Adam Hogan, DDS: Yeah. Marq Sams: was in the halls in the Dean of Schools, like, that's your new resident. And I was like, what are you talking about? And I was like, I already got my thing set up. So I go back home and I was like, I wonder where they're for real, you know? And I said, I don't want to regret and come back and look back at another opportunity that I had and regret it. So I went back and asked the director, Henry Greenwell, at that time. Were you serious? He said, yep. And I said, well, let's get this show on the road. And it was a done deal. I got into Imperial residency because I didn't chase my dream of football. Adam Hogan, DDS: Hey, you know what? mean, everything happens for a reason. know, God lays it all out, I guess. You know? Yeah. Just following the dream. I got a, you know, I love Perio, man. I almost thought about doing it myself. got, yeah, one of my clinical years, I got their Excellence in Perio Award, a little scholarship in dental school. Yeah, yeah. I guess I was good at picking the teeth. ⁓ Marq Sams: That's right. That's right. That's right. ⁓ really? ⁓ No way. Hahaha! Adam Hogan, DDS: But that was a long story. I lost my fancy after a little while. probably had my mind set on the wrong things at the time. ⁓ just still developing who I was. But yeah, I should have followed that along. But ⁓ that's cool, man. From football, people from non-traditional ⁓ avenues into dentistry, football into dentistry, Marine Corps into dentistry. Marq Sams: done. Right. Bye. Adam Hogan, DDS: I mean, you just can't plot that journey. Can you really like, you were there ever six years old and you said, is where I want to go. Marq Sams: You know what? Everybody asked me how that story came about. And I was in college, and I think it had to be my junior year. beginning of the summer, I had finished my junior year and I worked at a gym and this lady used to come in, older lady used to come in and she never really said anything, we waved in the center of vibe, but I went to the water fountain and she was like, hey, I was like, hey, and she was like, what are you doing? I was like, I'm going into my senior year, she's like, what are you doing next year? I was like, after school, I was like, I don't know, something in medicine or. I don't know. And she's like, don't you think it's time for you to it out? I was like, yeah, I should. And the story goes along and she's like, how about dentistry? And I was like, that's disgusting. And she was like, it's not that bad once you get in the mouth. And I was like, I don't know. She's like, what do you got to lose? And that's how my dental journey. Adam Hogan, DDS: Yeah. Marq Sams: went about, I was like, you're right. And she's like, come out to my practice. She was a hygienist. She was like, come out to my practice. My doctor would love for you to shadow him. And he is amazing, dude. Old Jewish guy, John Wiener. he knew all his patients. You know, I like the aspect that you can talk to people, you can move around and use your hands. And he tried to teach me even though I had no idea what these meso and distal was. He was like, come here, I'm gonna show you how to do this crown prep. They're not gonna show you this in school. And I just thought he was so cool. I was like, you know what, this is, I was built for this, so. Adam Hogan, DDS: That's cool, man. You know what? We have a lot of similarities. And for you guys listening out there on the pod, we're going to get into some dentistry later. So stay tuned because we're going to talk about peri-implantitis and all on four, practice and full arts. But let's continue with this for a second because we have a lot of similarities. I was in the Marine Corps, went to college, was going to medical school, was coaching the hockey team and I was in the lobby. Marq Sams: It's okay. Right. What? Adam Hogan, DDS: leaving after losing a playoff game in an undefeated season, exiting early. was so mad. I was coaching these 14 year olds. Nope, no kid of my own on the team. I'm just coaching for fun. And this guy stops me and he goes, what are you going to do after graduation? I said, go to medical school. Why do you want to do that? ⁓ I want to help people. I want to do a little procedures, my little business, be a big part of my community. He goes, yeah, you're not going to do any of that medicine. You're going to want to do what I do. What do you do? Marq Sams: Right. Hahaha Adam Hogan, DDS: What do you do? He goes, I'm a dentist. I go, you're out of your fucking mind. literally, I go, you're out of your fucking mind. go, there's no fucking way. I'm I'm cussing, drop, I'm like this guy. I'm like, he's like, no, I'm serious. Come by my office one day. And I'm like, boom, this like voice at back of my head goes, why is this guy standing in front of me right now? And why did this happen? So I go to his office. Marq Sams: Exactly! late. Exactly. Adam Hogan, DDS: It's snowing blizzard in Michigan. expect them to be closed. And I go, where's Dr. Heiss? I get there, where's Dr. Heiss? He's outside shoveling snow. I'm like, you got a shovel? They're like, he said to stay in here. I said, if he's shoveling snow, I'm shoveling snow. came here to see him. He ends up being a dean at the dental school. Marq Sams: Yeah. That's super cool. No way! That's freaking awesome. Adam Hogan, DDS: And no clue, he was just there watching his best friend's son who was my all-star player on the team. Marq Sams: No way, that's crazy story. Adam Hogan, DDS: He goes, I, I, I, I've been watching the all season. I knew you had this desire to go to medicine, but I think, you know, you should go to dentistry. I'm like, I'm going to come by here every Wednesday for a while until I make a decision. But. You know, I don't know. It was like weird. Like why it's like a guardian angel, I guess, if you, if you think that, you know, if you think about it. Right. Marq Sams: Right. That's it's about. Right. I know, even like coming here, people are like, how did you wind up in Wichita? I was like, man, I don't even freaking know. I would never in my life. I cut out the whole, I beat out that whole middle section of the United States. You take me to Oregon, California, Texas, New York, maybe not New York, Maine, ⁓ Virginia, North Carolina. mean, but Iowa. ⁓ Adam Hogan, DDS: Ha Yeah. Marq Sams: South Dakota, Kansas, Mark knows all out. Adam Hogan, DDS: So there must have been, guess, either a mentor or a girl or something. I don't know. What is it? Marq Sams: You know what? It was a recession. I was looking for a job. It was an opportunity. Adam Hogan, DDS: Okay. Okay. That's all right. There's nothing wrong with that. This is, but you end up with, where is this? Where are you at here? I'm looking for your screen. You are, ⁓ I was looking for your staff. ⁓ It's quite a team. You got a lot of people and where's this picture at? Marq Sams: Right. ⁓ yeah, it's a lot. I got it. Adam Hogan, DDS: You're, ⁓ here, probably under the team. ⁓ there's a picture of you guys. I don't know. It looks like you got about 20 people in that office. Marq Sams: Rotate. Yeah, it's like, uh, I want to say it's 24 of us now. Adam Hogan, DDS: Yeah, it's a nice impressive office photo. looked like, ⁓ if I could find it, it looked like it was, ⁓ some reality TV show. It looked like the little episode of the bachelor or something. ⁓ Marq Sams: That's the look I was going for for sure. Adam Hogan, DDS: Yeah, here we go. Look at all these people here. ⁓ I'm not sure what this guy signed up for, but who's your partner? Marq Sams: ⁓ yeah! ⁓ that was Dr. Sean. He actually just left a while ago, so we need to take him out of the picture. But you know what? That dude's famous. He's a dancing dentist. Look him up. He's a big time periodontist. He actually moved down to Phoenix. He needed to be in the limelight. This is too slow and country for him, I believe. Adam Hogan, DDS: Oh, I see. I see what you're... Yeah, staff and pictures. I have the best staff in the world, but I looked back at my website a few weeks ago, months ago, and I'm like, there was a picture of the About Us, and there was like 12 girls, and there was maybe 10 of them were gone. You know? I went... Marq Sams: Right. I know, right? Probably that picture, half of those are gone to be honest, but it was, I guess it's a, know, that's a whole nother topic. It's a different day and age from what it used to be when I started. now like people don't say long. And so you have to change your training regimen. Like you have to be way more organized and expect from the leave in less than two years. And Adam Hogan, DDS: Yeah. Yeah. Marq Sams: I always tell everybody, if we keep this whole team together two years, we'll dominate, because nobody could keep anybody long enough to do that. And so that's the, I've had it where I've had people seven plus years, and that was like it, and we're just growing, and the new people were, because I just brought them in to grow. And I've had it recently where it was like, Adam Hogan, DDS: Mm-hmm. Marq Sams: new person every year and a half, every two years, just trading them in and trading them out. Some for the better, some for the worse. I mean, got some going on hygiene school, nursing school, and it's like I push my team to always be better. So I don't argue against those ones. I also tell some people, I tell everybody when they come into the job. Adam Hogan, DDS: Yeah. Marq Sams: This is unlike anything. If you know what working hard is, it's a whole different beast and every single one of them say, I just had a girl say she was leaving to go be an office manager. So she was moving up in a position to be an office manager. She's like, I worked at a lot of practices, but this is a beast. I was like, I know, I told you when you came in. And so, yeah, we. ⁓ You know, we have our little core values, but one is hunger and everybody that comes in. If you're not hungry, you don't last for very long here. So, ⁓ but it is different dynamics than it used to be. It's not as much loyalty, which is fine. And people are moving and feel like they got to go other places, but, ⁓ it's a good ride. like to see people grow and that's the. Adam Hogan, DDS: Yeah. Yeah. Marq Sams: That's the like people are like, what do you like the most? I was like, you know, I do all these cool procedures and I help people out, but it's the people that you're with every single day for, I mean, you're with these people longer than you are with your family. it's like, I've seen people have kids and like move up into different positions. I had this one young lady, I was a hygienist. She went to go play professional golf. mean, it's like, you get to see these dynamics with individuals where they're Adam Hogan, DDS: Mm-hmm. Yeah. Marq Sams: 20 and now they're like 35 and they got kids and they're growing up and their party stages are over with or somebody that was super motivated aggressive move up in the business and it's just a beautiful thing. I just love seeing that Adam Hogan, DDS: Yeah. Yeah, you said a lot of things that are similar to my life parallel and my staff or my journey and my philosophy. the staff, for 10 years or more, I used to beat myself up that people would leave in two or three years. Like, what am I doing wrong? And patients sometimes would say, hey, I don't know anybody at the front desk anymore. What did you do to them? What did you run them off? And you're like, I don't know. Marq Sams: No. Yes. Adam Hogan, DDS: Really? Well, I pay them really well. treat them really well, but you know, life happens. mean, I'm in a Navy community, first of all, so we lose a third of them when their husbands transfer every three years. A lot of people, you know, I've put people into dental school or into other professions, found things we want to do. We've helped them grow. And then a lot of people, I think the human nature, there's this element of people just get tired, grow hungry, grow thirsty, want to something else. And they'll, they're like, uh, it's time for me to move on. You know, three years. I think that's a number. Marq Sams: Okay. I've had that. Right. Yeah. That's right. Adam Hogan, DDS: What? Why? You're like, I don't know. didn't see what else is out there. You're like, OK. Did I pay you well? Regular? You understand the job? Half the time they call you up in a year or two and be like, I never should have left. Marq Sams: I know it's the craziest thing. Right. You know the big. Yes. That's the biggest win right there. I was like I love when it's like always tell them don't make a sideways move. Don't go somewhere for a dollar or something like that. Like or whatever. I mean make sure it's like substantial and I can cheer you along for that. And but the biggest win is when they come back and like you know what? That was a really good practice or you know. I have had some people say, hey, can I come back? And for whatever reason, was like, no, I can't really do that. But that's the win is when they congratulate you and they realize, OK, that was a good place. Or they're like, hey, let me come back. Adam Hogan, DDS: the Yeah. I went to a Chris, a big area Christmas party this last year, a role surgeon put on, and I saw at least three or four former employees that left and some of them left because they kind of just went cuckoo and they, they all were like, can I come back? Can I, but I was like, you know, I also don't date ex-girlfriends. Marq Sams: Ha ha! Right. Hahaha! Right exactly. That's the point. Right, right. It never works out. Adam Hogan, DDS: So it's not you, it's me. It's all happened for a reason, right? ⁓ That's cool. ⁓ But culture is a huge thing, man. I'm writing this morning, I'm doing a business seminar in a couple of weeks, and I'm rewriting some of the systems. You were talking about systems and culture, and I'm rewriting my presentations. And that's huge, because if you've got to replace a staff member every two years, Marq Sams: Yep. Adam Hogan, DDS: You better have systems and a culture in place that just kind of grooms that new employee and helps bring them on board or else you're Batman. You'll never get anywhere, right? Marq Sams: It's difficult, you know, like, I think we have enough players and core people that's been here. I I just actually saw this lady, she retired, she was here for 30 years. She was longer here than I was. She was here for 30 years. I have another lady, she's 28 years. And, you know, I think like the core, if you got like out of my team, I got 24 and I got like... six or eight cores and they're able to maintain it and I recently lost my lead to she went to nursing school and And two assistants and so I have this new like hungry ⁓ Adam Hogan, DDS: and Marq Sams: clinical lead now, but I can see her like fighting struggling trying to figure it out and She's figured it out and it's hard for me to like back off like I like I'm not gonna back off because this is what she has to go through to like be what she needs to be. And so she's like fighting all these different things, learning all the materials and learning how the process is supposed to go, but also learning how to work with people. no, it's a... It's a new clinical team. got some older clinical team there, but it's like I got so many new people now that I'm having to like implement. It's not just them getting inundated with all the knowledge from other people. It's like, okay, now you got to hear it from me, which I'm sure they don't like one bit. Adam Hogan, DDS: Yeah. Yeah. This is what I was talking about. I mean, I do this once a year, a two-day thing. I'm going to open up this two. Everyone's going to come and ask about marketing and advertising, but I'm going to spend the first four hours talking about team, team building culture, SOP systems, ORM, CRM, KPIs, you name it. Because everybody comes to me and they're like, how much do I spend per implant? Or how much do I spend per arch? And where do I advertise? And I'm like, Marq Sams: That's pretty cool. ⁓ no. Adam Hogan, DDS: What kind of systems do you have in place? know, it's wasting your money if you don't have that. Right. So. Marq Sams: Right. Is that? You run off the EOS system. The EOS. Adam Hogan, DDS: I run off what? Oh, yeah, we got, we got systems on systems. We got systems on systems. Uh, ORM, CRM. Yeah. Everything is KPI, you know, like how do you measure people's success? mean, people come to you and they're like, well, I want to raise. I've been here a year. And it's like, well, let's look at your numbers, you know, let's look at your success. You know, being here another year doesn't mean you get a raise. Yeah. Marq Sams: Ha ha ha ha ha! Exactly. Yep. Correct. Exactly, exactly. Adam Hogan, DDS: So ⁓ this is how we got into it. I got it. So I read this. I was into Dental Town. I read this article on the laser approach to peri-implantitis management by Mark Q. Sams. I'm talking to Harry Herring, and I'm like, hey, have you ever heard of a guy named Mark Sams? He goes, yeah. I saw him speak. He's phenomenal. He's a really good presenter, and he's funny. He had the audience rolling. Marq Sams: Ha ha ha. Right. Hahaha No. Adam Hogan, DDS: I said, good, I want to hear some good jokes. I'm like, I said, so you had my end value is one. I had one friend, the first friend I talked to that I asked about you and he knew you. And I said, I got to get, I like this article. Tell me about this. This is kind of, let's talk about peri-implantitis. You're a periodontist doing peri-implantitis. Let's talk about it. What did, yeah. Marq Sams: Not a comedian, my friend. Right. Well, cool. Yes. So, you know, like periodontism treat teeth. But, you know, this day and age, implants are the big boom. It's the norm at this time. And when I was in residency, I told my director, was like, I want to learn how to treat ⁓ period implantitis, because it's going to be a thing and everybody's placing implants. So it's going to be even more of a thing to be able to. treat, maintain, and try to save and to replace. And so that's always been a big thing of mine because I knew that that was going to be a new area of focus. It's like its own little niche. So. with treating teeth and versus treating implants, it's a significant difference. Like it's way harder to treat implants than treat teeth because you got a lack of blood supply because of your loss of PDL. You're losing immune ⁓ cells to Hilda site and the inflammation is way aggressive around implants. And so it's like, how do I treat these sites in a conservative, minimally invasive approach that I could get something that is predictable? It's hard to do it with teeth. It's even harder to do it with implants. And it's just, my school was involved. It was University of Louisville. It was involved in a multi-center study. Adam Hogan, DDS: you Marq Sams: And I think it was Michigan. I want to say Rutgers or Tufts. And two private practice. The dean of the school at that time was Henry Greenwell, as I said before. And I remember him coming to the class, and this was like my third year, so I was almost done. And he's like, we're going to participate in the study so we can disprove the laser. So. Adam Hogan, DDS: Okay. Marq Sams: you know, you use it or whatever. I graduate, the study's going on, and I call him up and I'm like, so how's that laser study almost done? He's like, Mark, I don't know how to, I don't know how it works, but it works. And he is one of the hardest core directors, perio, god, dude that I know, and I said, if he says that. Adam Hogan, DDS: Yeah. Marq Sams: It must work, it must have something to it. that's when I took off with the lasers. I got it then, I think it's been 13 years, 14 years I've had it. And I've gotten other lasers to supplement it. And so that's kind of the journey. He also said another thing, he was really influential as you can tell in my life. He said, the more clubs you have in the bag, the better clinician you'll be. I don't think lasers are to treat everything in every situation. There's certain situations that it has been super beneficial for me. Like, I was like, I couldn't do this clinically. And if I did, it would have took so long and caused the patient so much agony. Adam Hogan, DDS: Mm-hmm. Mm-hmm. Marq Sams: that I don't know if it would have been worth it and I would have maybe fatigued out and not been able to get the result I wanted. And the lasers allowed me to do some of those things, but like I said, it's not meant for every single case. Every patient has to be individualized as far as their treatment. And so it's worked well. Adam Hogan, DDS: Mm-hmm. Mm-hmm. Marq Sams: when I've used it. Have I had times that it didn't work? Of course. Have I had times that traditional bone grafting and all that didn't work? Yes. So I was like trying to figure out which application or modality is going to be best for that patient. Adam Hogan, DDS: Sure. Yeah, I I just taken, I I read your article and I thought I couldn't agree with you more on this and laid the use of lasers, but particular wavelength of lasers and in particular circumstances, would you agree? Okay. I bought a ER YAG laser, the water lace, I plus water lace, I think in 2010, plus or minus. And the only reason I did it and Marq Sams: ⁓ for sure, for sure. That's so it. Adam Hogan, DDS: was for peri-implantitis because I bought a practice from a gentleman who's old gentleman from the ⁓ going way back. He learned how to place implants with Hiltatum. He's a pioneer. And my practice had thousands of implants in it with peri-implantitis and hundreds at least, hundreds. And nobody knew what to do with these implants. mean, it was just all anecdotal and Marq Sams: Right. Right, Right. Adam Hogan, DDS: ⁓ we're going to flap this one, and we're going to try to bone graft that, and we're going to demineralize bone this, and we're going to, you know, de-bride that implant and polish those. And there was no, I think in 2010, I don't think there was really SOP. Would you agree? Marq Sams: I totally agree with that. Adam Hogan, DDS: Yeah. So I saw interesting ⁓ literature on the ER YAG and I have this I plus still it's still it's 15, 16 years old. I think it broke once. I had it once. Yep. And everyone bought wanted to use it for the turbo handpiece and make crown perhaps and cavity. I just wanted it for implants. That was it. Marq Sams: Yes. Really? Right. Right. That's super like, you're futuristic in that aspect. I don't know any oral surgeon that was doing that at that time just to treat it. You know what I mean? That's pretty impressive. Adam Hogan, DDS: Ha ha ha. Yeah. Well, thanks. I'm a GP. Yeah, I appreciate that. I appreciate that. And I'm proud to say that, too. I wanted to be an oral surgeon or a periodontist, but I had a baby, and I was out of the Marine Corps, and I felt old. And I was like, I'm just going to get into it, and I'll do whatever the hell I want. I'll just go to extra training. Marq Sams: ⁓ I didn't know that. That's cool. Right. Right. Right, right. Adam Hogan, DDS: So yeah, but anyway, ⁓ one thing that's really important, it says here, when appropriate wavelengths are combined with meticulous mechanical debridement and enhanced visualization, take me through that. What do you mean by that? Marq Sams: So you you have your steps and everybody, mean, I don't think it's one ⁓ protocol that's like set. I mean, I know that the Millennium has, the LNAP has this protocol and with me combining it, I can't really say it's LNAP, anyway, it's our lip hip, but LNAP. I try to de-uphelialize the open up the site with the NDAG and then we use the endoscope which is direct visualization and like that component of my practice that I was able to add to it, it's like helped out so much to be able to utilize that. My hygienists love it and you you could get up to 25 % better results with that endoscope. And so that direct visualization, we've been able to be even more mentally evasive. It's actually cut down on my periodontal surgeries because we were able to treat so many sites effectively. I don't say it, but we've even seen some, I don't advertise it. We've seen some bone growth with the endoscope because you're getting it and you're cleaning up so well, you're changing the biological response of the patient. And so that's the meticulous, the bribe that we're talking about. It's hard to get in between those little threads of the implant and making sure you're the bribe unless you can see it. And so that's, like I said, that's made a big impact, not only on the parent and title side, parent implant, title side, but even my parent on a Adam Hogan, DDS: and You're Marq Sams: practice as far as doing traditional treating traditional period. Once we do that, then we can go in with the erbium detoxify the site. And so you got two lasers that we're utilizing. We got one, the NDAG that's causing D-epil, those that like D-epil, dang it, I can't even talk to that. You know what I'm Exactly, I'm off. Adam Hogan, DDS: Mm-hmm. It's a Saturday. Marq Sams: So it's keeping soft tissue downgrowth, but also it's treating that bacteria that gets embedded into the soft tissue, which we forget about sometimes, and then that's not treated because it's more light source. The erbium is more water source, and that allows you to treat the surface of the implant without causing damage to it or thermal damage as long as you're using appropriate. Adam Hogan, DDS: Bye. Marq Sams: techniques doing that. So you got one treating the surface, one treating the soft tissue. And so that combination is what offers to get ⁓ some nice results. ⁓ We actually just, I shouldn't say just, but we're using ozone therapy as well as an adjunct treatment. And the reason for all this is like, Adam Hogan, DDS: Right. Mm-hmm. Marq Sams: The only reason I'm using all this is because I use it in my practice. I would... It's hard to tell people unless they have a implant practice to invest $150,000 in lasers and all this other stuff. I use this stuff all the time in my practice. This is part of my practice. have... It's probably 50-50. We do a lot of implants, but we do a lot of perio treatment and a lot of these toys that I have or have been able to utilize in other areas of the practice. Like we got a T-scan. I use that for full arch, but I also use that for the nap. It's like I'm utilizing them in most different areas, so I'm able to get a... return on volume. If you're only doing 100 implants and you don't have that many implants coming through, do not. That's the $150,000 on two lasers and ⁓ all this other stuff. If you don't do implants, go ahead and do them and yeah, it makes sense. Adam Hogan, DDS: Yeah. Yeah. My hat's off to you. I've been looking at an ND laser for a while. I just have the ER YAG laser. I just use two tips. ⁓ I'll use a long, like MZ5 to de-epithelialize everything and go down. And then I'll treat the implant. Marq Sams: Right, right. Adam Hogan, DDS: depending on the situation, to deprive that. But then the EREI, I use a radial firing tip that with the energy going out the sides, is that your modality? Marq Sams: Yeah. Correct. Yep. ⁓ So it's like, I was going to say this. You can, you that laser, you're able to use. the NDI component of it so I have a photonon I could use that and I have used both I mean I have the Moenium and I have that and I could use both I've used just the photonon as well just because it has everything on it and so it's not I guess you don't technically have to buy two lasers because you could use that component of it so Adam Hogan, DDS: Okay. If a guy if a a gal or guy was to get one laser you think the Patono would laser that is that what you're telling me would be a good way to go. Yeah. Okay. I think that's important or if you're only doing 100 implants a year just send your people to Wichita, Kansas. Marq Sams: Yeah, think so. ⁓ You know what, with those lasers you can do so much stuff with them, I mean, I don't technically do trinolentheny with them, but I you could do it, gingivectomies, you got root canal therapy, could do it, curies, I mean, if you're gonna use that laser, just don't use it for peri-implantitis, use it full force and get the value out of it. I mean, you got so many, I always talk to the team about... Adam Hogan, DDS: ⁓ yeah. Yeah. ⁓ yeah. Marq Sams: You got the direct use of it, but you got the indirect. That's a great marketing using like up-to-date technology as far as the laser. It's minimally invasive, it helps with it. You got bio-stem that comes with it. I mean, there's so many components to that laser that you can utilize, not directly just for treatment, but also to grow your business, and so you can get a good return on your investment. Adam Hogan, DDS: ⁓ yeah. Yeah, I think it's phenomenal. And I would much rather have a laser used on me. And I've used it for all kinds of off-label uses as well. I've done vestibuloplasty with no anesthetic, just topical. you know, that's the thing. Yeah, it works. So young people, can buy a laser. It's more than just peri-implant. I like what you said. There's 100 indications for use of a laser. Easy. And the endotips. I haven't done a root canal since 2007. Marq Sams: Exactly, it's insane. Correct. Same. ⁓ Adam Hogan, DDS: I'm not going to do one now. ⁓ These are impressive x-rays, though. ⁓ Going back to mechanical debridement, so you leave the threads on there, use your endoscope, and you ⁓ intimately debride every thread? You don't polish and laser? OK. OK. What's the indication for one versus the other? Marq Sams: Yes. I have. I'm not alone. You know, so yesterday actually, I had a case, a guy had a full arched case and you know, he had an implant. It just wasn't healing up. The bone in between two of the implants wasn't healing up and I was like, oh, we're gonna have to get this one out because it was so much horizontal bone loss. was the defect, the bone defect, we were missing the buccal, bone on the buccal distal, it was a three wall defect. Adam Hogan, DDS: Mm-hmm. Marq Sams: And so I was just like, this one won't work, but this other one we could probably save. So that one, had horizontal bone loss. So it's hard to get vertical unless you have a vertical defect. Adam Hogan, DDS: Mm-hmm. Marq Sams: So what I did was polish the exposed part that was coronal or horizontal component of it, polish that and then left the part where it was the thread exposed and the defect, the bone defect. And so I knew I could get that part grown back, but I knew the part that was exposed above the vileucrits, I wasn't going to get anything. So I polished that off. Adam Hogan, DDS: Mm-hmm. Marq Sams: And so that was the time that I polished. I polished it all the way down, even though I had a defect and it's just trying to figure out what works best for ⁓ the individual. And I really liked removing the threads because it just removes that component of it, but it's way more invasive. That's when I'm flapping it. And this is more of a aggressive defect. Correct. Correct. Adam Hogan, DDS: Yeah, and of course you have to take probably take the restoration off to get a good debridement. You're right. Yeah. And then how do you feel about bone grafting after laser therapy and debridement? Marq Sams: I've done it that way as well. I've gotten similar results and so my, maybe my biggest indication is how, what the defect looks like. How severe the defect is, how wide the base of the defect is. So with the laser it typically grows from underneath or it grows up. And when you're a bone graft it doesn't grow down mostly. So. Adam Hogan, DDS: Mm-hmm. Marq Sams: I like to bone grab those bigger defects, the ones that have a wider span. And I'll take off the crown and do all that stuff and open it up. I still use the laser. And we do like scarring of the bone and we grab that tissue. I use PRP quite a bit. Adam Hogan, DDS: Mm-hmm. Marq Sams: I was just talking to a young lady, that young lady that was looking at the practice about it and she was like, some of my instructors don't believe in PRP and it's like, I don't know how it can't be, there's so many studies out there. Adam Hogan, DDS: Yeah. Marq Sams: Is it really gonna help with the bone graft? It has a antimicrobial component to it, so it's at least keeping it clean. And it has, it stimulates the endogenesis and it has veg in it, so it's helping the soft tissue grow over it faster so you're protecting the site. So I was like, I don't know, but everybody has their own philosophies, you know. Adam Hogan, DDS: Yeah. Thank Yeah, I don't want to say, you know, I believe in PRP profoundly. I was using Harvest PRP in 2003, 2011. I mean, shoot, it cost us like $600 to pull PRP, and we still did it. Now it costs $6 or $12. Why would you not do it? Marq Sams: Right. I know. Right. Exactly. Adam Hogan, DDS: Yeah, this is an incredible case. ⁓ love, mean, this implant, I'll tell you, I'll be honest with you. I'd look at that before picture and I would just start talking to the patient while pulling the implant out. Yeah. How does. Marq Sams: We had those discussions. Yeah, you know what, patients come in and they're like, I'm like, this implant doesn't look good. We got two options. I was like, I could try to save it. You know, I try to tell them, yeah, I think I could get this versus that. And I had those situations. I do not think this thing's gonna work. And... they do not want to do that implant over a lot of the times. So they're like, you know, I want to save it. So I'm like, okay. And I'm pretty sure this probably was one of those cases. Hey, you know, we could go either way. I mean, I think as long as it's not past 50%, I'm like, yeah, we got to get a chance either way. And... Adam Hogan, DDS: Mm-hmm. Mm-hmm. Marq Sams: But I give them the choice and say, hey, this, I try to educate them as much as I can about what's the pros and cons. We could take this implant out. A lot of times we take implant out, so you lose ground. You have to do some significant grafting more than you would normally have to do. And so talking about that component, it's not going to be the same. We can get this implant and try to save it. Adam Hogan, DDS: Yeah. Marq Sams: The likelihood you're probably gonna have to be in treatment, you're gonna have to watch this thing for years, it's gonna be your problem child for sure. And a lot of times we'll get results like that. That's why I'm like, how can people not wanna go against the laser? I didn't use anything except for the lasers on this. No PRP. Yep. Right, exactly, The protocol, the uppercut laser, the bright head. Adam Hogan, DDS: Mm-hmm. Yeah. No kidding. Well, debridement, I'm sure, Okay. But Marq Sams: then use the laser and just went back. Adam Hogan, DDS: Yeah, those people that are listening, by the way, you should be on YouTube if you want to see these pictures, checking this lecture out on YouTube. But this before picture, I imagine there's a lingual wall, and then you got this bone that's on the root, the distal at number 30. That's key, right? Yeah. Marq Sams: Correct, correct. I was adding some little blood supply to the area at least. Adam Hogan, DDS: Right. Because if you see this implant, and for those that are watching on YouTube, and that bone is not laid up against the distal root of 30, what are your thoughts there? Is it still the same thought? Marq Sams: Oh, I've had that and it never really turns out. It has, but one of the most, it doesn't turn out. I don't know why it is. It's just not getting enough blood supply to the area. That defect, even if I do get a good response from the implant, the defect on that too never really responds correctly. And I do not know why. the response to the bacteria in the mouth and I mean I really don't know. Adam Hogan, DDS: I think you said a blood supply earlier. this is a wall of that defect. So if you take off this crown and you see basically just a big crater and it's got four walls, you're in better shape, obviously. So this is an awesome result. People are going to ask, and I hate these questions, but people out there right now are like, what does he charge for peri-implantitis in a laser treatment? Marq Sams: Correct. Yes. Ahem. Adam Hogan, DDS: And just in a range, I know you probably don't want to give your fees over the area. Marq Sams: I mean, I don't really care. I it doesn't matter. We're in Wichita, so our fees are pretty cheap. Adam Hogan, DDS: Yeah. Marq Sams: I can't really remember though, because I only look at the fees once a year, but I would say probably $1,500, maybe $2,000, maybe. Last time I looked at it was, it's probably $17 now. Adam Hogan, DDS: Yeah. Yeah. Yeah, I'm like you. ⁓ huh. Yeah, probably. Like I'm with you. People ask me my fees and I'm like, ⁓ I don't know. ⁓ I set that fee and then every year they go, should we raise a max percent? I'm like, they'll come to me like, doc, you're losing money. I'm like, okay, fine. ⁓ move it off. ⁓ You know, I mean, that's, I got a little more oversight than that, but you know, they got. Marq Sams: That's exactly what I said. And I truly don't know. Right. That's actually... Adam Hogan, DDS: It's not something I look at every single day. Marq Sams: Right, right exactly. I'm not quoting patients fees, so. Adam Hogan, DDS: Right. Cause with that, are you going to add bone? Did you use a laser? Are you going to add bone? Did you have to flap it? Did you have to take the crown off? Did you put a healing cap on? Do you get primary closure? Do you have to do soft tissue grafting on top of that? Right. There's the whole, it's a big question. Marq Sams: Right, right. So I guess when you brought up soft tissue, I guess that's another component because if you look at a lot of these cases, there's decent amount, probably 50 % of these cases is due to like lack of keratinized tissue around the site. And that's a huge... Adam Hogan, DDS: Yeah. Marq Sams: or thinking implant. I tell patients like, why do we have to a soft tissue graft? Because you're going to come to me in about two to five years and your implant's going be having issues. And that's why we're doing the graft, end up picking out those tissues that create a better long-term success for you. But I have, and I do decently often, do a gingerbread graft or free gingerbread graft around those sites if necessary. speaking out of those tissues. But not every case. I didn't do it on this case. Adam Hogan, DDS: OK. Yeah, think that ⁓ one thing, this implant had a couple issues from the get-go. One, probably the connection. ⁓ Like that bone, if you're looking at my cursor, I'm sure when that clinician put in this implant, it was at the level of the bone at the time. And it probably lost bone to about the first thread in a year. Yeah. And then the rest is just relying upon Marq Sams: Yep. right. Immediately, Adam Hogan, DDS: Hygiene and quality of keratinized ginger, but I guess after that if it's going to develop into anything is that is that about it? Yeah Marq Sams: Correct. That's about it. You can expect that one. Every case is different and you know, like I always tell the patient, was like, you know what? I think we only know the surface of the body. So how you react might not be the same way. I've had smokers that smoke two packs a day and have implants done and it looks way better than a person that I'm like, you take nothing. What's wrong with this implant? What did you do? Did you bite on this thing or what? Like, and sometimes it baffles me, but I mean, most people fit in the Adam Hogan, DDS: Mm-hmm. Yeah. Marq Sams: bell's curve but it is those cases and you know we have people taking so many things and putting in their bodies and stuff like that and I think it plays a big part. ⁓ I will give you this little tidbit like if we have an implant fail then we probably should do it for every patient we just really do it for bigger cases one than two implants but we check vitamin D and it has significantly ⁓ been a factor. Like I would say probably 75 % of the people that have a failed implant, their vitamin D is low. And then you know you got all the other factors. You have diabetes and just because diabetes or hemoglobin A1c is in range, I think it's still getting packed. Some people, it's just like the smoking effect. Somebody could smoke a half a pack of cigarettes and their implant looks perfect, never have any issues. But you can have a person that smokes one or not at all and still have issues. Adam Hogan, DDS: Right. Yeah. Yeah, have vitamin D. know, Bashara and Picos did a little article, all place, I think it was in Dentistry Today or somewhere, not like a highly, you know, peer-reviewed journal or anything, but they talked about that. I think I've been prescribing vitamin D. So when my patients accept implant treatment, they instantly get vitamin D prescriptions pretty much. I mean, you can't really get a toxic dose of vitamin D at the levels we're giving it. So I just... Marq Sams: There's nothing. Adam Hogan, DDS: I'm like, I don't even test it anymore. Five years ago, we were talking about testing it. Now I'm just like, hey, you're going to take vitamin D until the implants are stored, and then you're going to go get it from the physician, not me. Marq Sams: Right. this. Right, right. You know who told me about that too? Pika. I saw him in the airport one time, I think we were going to the same place and you know, you're just talking to the legend, the god of oral surgery. And he was telling me about it, I was like, I think I had this implant issue or problem. And he was like, did you check vitamin D? I was like, no. Adam Hogan, DDS: Yeah. Who? What? ⁓ yeah. Uh-huh. Marq Sams: came back home, checked the ladies vitamin D and it was like 16, something crazy. And I knew I had done every single thing I possibly could have. We switched it and it worked like magic. It was like, okay, this thing has something to do with it. yeah, vitamin D is a big deal. And people like, argue against me, like, why are you doing that? I'm like, guys, just read the research that's out there. Adam Hogan, DDS: Yeah. Yeah. Yeah. it does, I mean, I hate saying making comments like this in medicine, but how can it hurt? mean, for like, how can a little vitamin D hurt? I haven't, I've been asking that question for a long time. have yet anybody to challenge me on that. ⁓ because you know, just give us such a small dose for weekly for four months until it integrates and you restore it. You know, or through the bone graft and then four months. So eight months, maybe. ⁓ yeah. Marq Sams: Right. Peace and good luck. Correct. Right, Adam Hogan, DDS: It's funny because 70 some percent of the population in United States is deficient, I think. Yeah. Marq Sams: Yeah, exactly. That matches up with what I get as far as a failure too. It's like if it's a failure, vitamin D is 70 % of the time low. Adam Hogan, DDS: Yeah. Do you ever, going back to peri-implantitis, looking at this image, I had this up on the screen for a little bit. You know, I learned so much in, through the 2000s with implant crustal bone loss. And I've got a longer story on this where I challenged a bunch of the old guard on this back when I was, before my time, before I even knew what was up, right? You know, as they say, I didn't know what I didn't know, but I noticed the engineering was a problem in implants, but also I... Marq Sams: Right. Right. Adam Hogan, DDS: I started to notice how like in here that the bone always paralleled the crown abutment shape. Like you see this here and you see this here. I think I was noticing that trend in 2008 maybe and I didn't even know why, but I was like, it's funny. It's like, so even before they came up with the concave profiles, I was noticing that trend. And would you consider Marq Sams: Right. Correct. Yep. Right. Adam Hogan, DDS: when you're treating a parent plantitis convincing them to change out the prosthetic. Marq Sams: Yes, I just had a case today and I was like, we are not gonna win. With this connection that you have with the implant, we're gonna have to change this if you don't want this to be an issue. No, that's all the time. This was a tissue level, I believe, so it would be difficult to get that one out. Adam Hogan, DDS: Yeah, yeah, true. Marq Sams: Yeah, I see it all the time. I hate Tybase especially. I'm like, if you don't get it, make sure you get the highest one. Take it away because it's too close to the bone. It'll cause peri-implantitis easily. I know the lab's gonna dictate a lot of the stuff, but like I said, I actually had a patient this week and I'm like, we had treated it. and it was fine for a year and it started coming back as far as the, I think it's periomycositis. And it's like, you're getting stuff trapped in there and I'm showing you the design of this crown and where this abutment is and that's the biggest issue. So it's like, you know what, I want to take it off and we can like try to modify it, but you might have to get a new crown on this thing and a new abutment attachment to it. Adam Hogan, DDS: Yeah, I think that that's important. The tie bases you brought up important. I just hired a new associate as a prosthodontist. He sent me a picture of an implant not doing well. it's in my practice. And it's on a 0.08 tie base. yeah, so when I first switched over to the Neodent brand back in 2017 or 18, Marq Sams: ⁓ nice. Hope. Adam Hogan, DDS: I had some crowns come back on 0.08 tie bases. before I really realized, it took a year or so to start seeing bone loss. yeah, and I was like, oh my god, it's all on those 0.08s. And I'm like, duh, it's like, we need a biologic width. We need 1.5, 2.0, 3.0 even better. And now I restore almost everything on a long profile abutment or a custom abutment. I do not like tie bases. Marq Sams: That's right. Right. Correct. Correct. Adam Hogan, DDS: called that company, another company, said throw away your .085A, stop selling it. Yeah. But I mean, you've seen that, I guess, true? Marq Sams: ⁓ my gosh, so many times. Do you get away with it? Yeah, sometimes you get away with it, but that's a lot of times when they come in, I'm like, this is not gonna work. I can do whatever I want to it. It can come out for a little bit, but it's gonna come back and it's not gonna be a good situation. And sometimes it's hard to get a good result right off the bat because it's right there. Like it's bacteria right there. So. Adam Hogan, DDS: Yeah. Yeah. Marq Sams: Yeah, as tie bassist, like a periodontist nightmare. Adam Hogan, DDS: Yeah, true. stay, if I get back, if I already get back a crown from the lab at a tie base, I'm returning it. I'm not doing it. And there's a lot of pressure too with dentistry, the screw, everything, the feeling that everything has to be screw retained, right? And angulated screw channels. You had much experience one way or the other with that, with angulated screw channels at tie bases? Marq Sams: Right. Yep. Yeah, like I said with the tie bases, I only know that component of it that is just invasive biological width because of the issue. A lot of times it can lead to peri-implantitis. far as angulated screw channels, yes. I like screw retainers because if you don't know how to clean the semen off, you don't know how to clean it off and if you don't have the right tools or... Adam Hogan, DDS: I'm gonna move. Marq Sams: you're not skilled in that area, don't let you see that. You know, if you don't have to. And most of the cases you don't have to unless it's misalignment or misangled. And ⁓ yeah, I'd rather have the ⁓ screw retained. But I think you have to do it all the ways. Now I know patients hate that feeling on those anterior teeth, like naked feel, the access hole. And so, or is... Adam Hogan, DDS: Yeah. Marq Sams: ankle then you have to see because the access holes coming out the facial and I don't really have too much experience like it's causing any issues with the ankle screw channel. How about yourself? Adam Hogan, DDS: Well. ASCs, so tie bases on ASCs are traditionally, I mean, they're kind of short usually. And you see a lot of de-bonding of superstructures on those. So you've got to be prepared for that. you're going to speak into the general population out there, not really you, but if you're going to put everything in a screw retain restoration, you're probably going to set yourself up for some de-bonding of some superstructures, especially in the anterior. Um, I've, you know, I found that out the hard way because you had such a short retentive mechanism and then you've got all these shearing forces and lateral forces on your anterior teeth and you know, patients come back and they've got that crown in their hands sometimes. So, uh, I personally, I've gone back to more of the cement retained restorations with the custom abutment. just, I think it's better for the bone and I'm, I can clean up the cement and you know, I'm not, I'm not going to probably see that crown come back. Marq Sams: Thanks. Right. You definitely have to have a custom abutment as well. That definitely helps a ton. Adam Hogan, DDS: Yeah, absolutely. Who's restoring? Are you restoring as well in your office? Marq Sams: Generally not, generally not. So referring doctors and so that makes it a little bit more difficult as far as control, but that's the way it is and that's how it goes. But I do get the component which is saying about the ACS. They are shorter normally and they can. Adam Hogan, DDS: Yeah. Yeah. Marq Sams: debond from that restoration which could be his own nightmare. Adam Hogan, DDS: Yeah. Yeah. I just, anytime, you know, you're going to say, ⁓ someone's going to say, I always do this, you know, you just know that occasionally there's going to be a problem. Let's look at this, this, ⁓ all on four. know this was done by a period on us because we saved the bottom teeth. Congratulations. ⁓ I've got nothing, no problem with that. I'm just, you know, in this world of all on four, people are like so quick to pull them out and you got to. Marq Sams: Hahaha! Adam Hogan, DDS: You got a pretty good stable periodontal bass here, you know, so I commend you on that. That's good. Marq Sams: Right. No, you know, like, I could save the arch or I think it's a chance, I mean, sometimes it's just not possible, but if I think I could save it, it's just the proprioception and... you know, patients complain when they have the zirconia against zirconia, and they're like, ⁓ it's clicking. I'm like, do you want teeth or what? You're killing me right now. So if I can do it, I can, but that's not always possible. It just depends on patient's hygiene, how they got to that spot in the first place. Did they have decay or did they have period and situations like that, so. Adam Hogan, DDS: Yeah. Yeah. Yeah, I know these are big judgment calls. think that, you know, the case turned out great. You know, guy looks natural, realistic, right? ⁓ it's probably pretty happy with it. Marq Sams: Yeah, that was a good... Yeah, it was, it's few and far between patients that say they're not happy with the full ARS to be honest, from what I've seen, it was, I mean, I really don't hear that. I've had one patient that was like, eh, I wish I didn't get this. And I was like, really? Like, really needed it. Adam Hogan, DDS: Yeah. Yeah. Marq Sams: It was the old style where we're using like the denture and trying to, was, what is it, FP3 and it was a lot of material. So it was just trying to get used to it, I guess. But I try to make it minimal. I try to do the FP1s if I can, if it's ideal for the case, depending on the situation. patients tend to do a lot better with those cases. Adam Hogan, DDS: Yeah. Mm-hmm. Yeah. No, mean, if I can count on half of one hand how many people say they wish they didn't do it. it was always, well, first of all, I think that goes back to my analog days where it took a year to finish a case and 20 visits. But a lot of times it was a head case too. Probably the patient was not the right psychological profile to go through comprehensive work. was backed up against a corner. And these days I'm just... Marq Sams: you Right. Right. Adam Hogan, DDS: more likely to say, you your alternative is dentures. You know, like it's, and I use this a lot. say it's only 2026. Like we're still in the medieval ages. We just got through the bubonic plague. it's, dentistry is not, it's not your natural teeth. Like this is the best you can get. So I apologize on behalf of all of humanity that we're not there yet. You know. Marq Sams: Right. Thank Right. Not really deep, like a little garden. I know, it's crazy. Adam Hogan, DDS: Yeah. it's ⁓ unfortunately you just gotta, sometimes you gotta reel people back in. Marq Sams: Oh my gosh, I was just talking about that. What they, I think an employee, I was just like, no, it was a doctor coming in and I had this one lady that came in and it was like when we were still doing analogs and she has some kind of bone disease and she knew it. And you know, they come out of sedation and she gets home and she's like, teeth are, I got an over jet and I was like. you were over close in the first place. I was like, and she was really religious, and I was like. You know, you take it a lot more personal when you're involved in it. Adam Hogan, DDS: Uh-huh. Marq Sams: I don't know, I felt myself getting upset because I knew how hard that case was. Like, I probably put 12 implants in the lady and ended up with like seven. Because they're like trading them in and I ain't trading them out, putting bigger ones in and trying to, I was trying to like her, because she did not want to leave without teeth. And I was trying to make it so she could get what she could leave with teeth. Adam Hogan, DDS: Yeah. Marq Sams: And I could probably count on like one hand that I haven't said, I normally can tell a patient, hey, we're not gonna be able to pick it up or we are gonna be able to. And I knew she really, really wanted these teeth. And so we got it done. She comes in for the little check and she's complaining about it. And I was like, you believe in God, right? And she's like, yeah. Adam Hogan, DDS: Mm-hmm. Marq Sams: I was like, well, this was a freaking miracle that we got this. I don't really don't get like that with patients, but I was like, you don't even know how hard this case was. I had the lab tech down here and we were just like grinding through this thing. Man, Adam Hogan, DDS: Thank ⁓ Yeah. Yeah. Marq Sams: was crazy. actually, is one of those that the case I did wind up restoring because she went to the general dentist and I don't work with them that much and I told him that guy had a... Throat cancer actually. ⁓ I went to, I told the general dentist, hey, use this lab because they really know they were, they've been following this case and they know what they're doing. Like they are the top notch one that we have here that's local, that's going to be able to help you out with this case. He used some other labs. She, like I said, she was one of those patients and she came back fiery angry, like. Adam Hogan, DDS: Okay. Marq Sams: a demon out of hell. She was like, you got to fix me. I was like, I really don't want to do it. But you know what? I'm not going to let you hang in there. It looked horrid. And so we wound up fixing the case and getting it done with the lab. And yeah, it wound up turning out pretty good. Adam Hogan, DDS: ⁓ jeez. Yeah. Yeah. I'm sure it did. It's hard because I'm a GP, but I get referrals. And about half of my business is by referrals. I've got a few oral surgeons that send here, a couple of prosthodontists with some GPs. And sometimes when the GPs want to restore it themselves, they don't understand the prosths and the vertical. And those are the hardest cases that I have. And I'm just like, I just give me the Let me just finish it. Marq Sams: Right. Correct. Alright. Adam Hogan, DDS: this in like three weeks, know, like we'll be done with this case. But you know, I'm not trying to discourage anybody from doing this, but these are complex cases. And so what I'm saying is somebody that's in your position where you're getting referrals from all corners of Wichita, Like various levels of experience and knowledge and this unawareness of the complexity of these cases, right? Marq Sams: Right. Alright. Right, right. You know, like people, they're like, man, look at these GPs doing these implants. I was like, I think it's the best thing. I was like, first they didn't know what the difficulties are. And if you do have an implant issue, they're like, well, I had one too. You know what I mean? Secondly, they're able to see it better than somebody that doesn't do implants. They're like, okay, this person needs a sinus lift or this person needs the implant or they're gonna sell the implant. Adam Hogan, DDS: Yeah. Yeah. Yeah. Yeah. Yeah. Marq Sams: more than somebody that just does traditional crown and bridge. ⁓ So I think that helps. It is a lack of, it's a fear of doing these cases as well. I have some that's like, I don't want to do it. You can do it, finish it out. I have some that's like, they want to do it and you you get a prosthetic screw broken. It's like, God dang it. Adam Hogan, DDS: Yeah. Marq Sams: I'm gonna have to replace this whole multi unit above us 250 bucks or whatever it costs and take this off or you know, it's just it's room for education and I think because Adam Hogan, DDS: Mm-hmm. Marq Sams: they don't do as many is that they don't invest in maybe some of the CE education for it. So, I mean, I try to do some of those educational courses. It's just trying to get everybody to it. Because everybody has these cases in their practice and they are, for me, they're super fulfilling. Adam Hogan, DDS: Mm-hmm. Marq Sams: at the point at the time of analog, I was like, I'm losing money doing these cases, but it's so like impactful to people's lives that I get the joy out of it. And you know, we've, we've went to digital, we got the photogrammetry and all that other stuff. So it makes it really smooth and time efficient, but ⁓ they don't, like you said, Adam Hogan, DDS: Mm-hmm. Yeah. Marq Sams: They're not introduced to these cases very often, so it makes it intimidating for them and they can make a lot of mistakes with it that they're not looking at, or they might not understand it, or they might have a lab that they're using that don't understand how to design them, which becomes, it can be a hiccup later on. And so, it's just figuring out those cases. This old lady right here would barely even talk to me. ⁓ She... think she was told by several dentists that she had a drug problem or when is she gonna stop doing meth. And she probably for four months she smoked too. So this was one of those cases I didn't pick up right off. Adam Hogan, DDS: Thank Mm-hmm. Marq Sams: and she hated it and I was like, told her, oh you gotta do a stop smoker for a couple of months and we'll get it done, but she didn't want to and she finally started speaking to me when we delivered those little guys and she is the best, that was like the most impactful. She brought her husband, he was super cool. Adam Hogan, DDS: Mm-hmm. Okay. Marq Sams: to 75 % of her appointments or appointments. Nitrous at least, if not oral sedation, like I think we had to let her go because she was so emotional, like crying and wouldn't open her mouth. Like I said, she wouldn't talk to me. She would write stuff down sometimes to describe what was going on. Cause I was like, is it hurting? Like how's your bite? Adam Hogan, DDS: Mm-hmm. ⁓ yeah. Marq Sams: And so she was wondering the reason why we got a T scan. Because she could talk to me. So I was like, well, at this digitized information I could get real time will help. So yeah, she is. Adam Hogan, DDS: Okay. It's one of those people that you say, it, how's it feel? What do you mean? Is it balanced? I don't understand the question. Do you hit on your right side first, left side first, or both same time? I still don't understand the question. Just start to close and tell me where it touches first. And she's like, it doesn't touch anywhere. You're like, ⁓ my God. ⁓ Marq Sams: Exactly. Exactly! That's exactly what she said! I think. Adam Hogan, DDS: All let me just ask you this way. Does it hurt or feel wrong? No, it feels fine. All right, holding shim stock, holding shim stock doesn't hurt. Let's try it. ⁓ Marq Sams: Hahaha! I love that. Right exactly. It was a task but we got through it and it was like I said those are the ones that will make an impression on you and stick with you forever. Adam Hogan, DDS: For sure. Well, know, Mark you Mark you. ⁓ I think we've successfully scared everybody about implants with peri-implantitis and all out for psychological and prosthetic challenges today. Marq Sams: Yeah. Hahaha Hahaha! ⁓ man, you're probably right. That was the intent, right? That's why you invited me on. Adam Hogan, DDS: ⁓ well, Harry said you were a funny guy, so I was waiting to some jokes. Marq Sams: ⁓ I'm not funny like that. I'm not the comedian, man. You don't want to hear my jokes. These dad jokes I got. mean, the team makes fun of me all the time. Like, ⁓ that's a cute little dad joke again. Adam Hogan, DDS: Okay, I probably... I got my dad jokes here, here, listen. to put down. Marq Sams: Ha ha ha ha! Adam Hogan, DDS: I got that, I was given that recently because I'm a new dad. Marq Sams: Dude. ⁓ that's so cool, man. Congrats. That's like the most beautiful thing in the world. Congratulations. ⁓ I was going say something about your name. That's like you have to have been called Hulk. Hulk Hogan. I saw some pictures. was like. Exactly, exactly. I saw the pictures on your Insta. Adam Hogan, DDS: That's cool, yeah. I got my dad jokes. ⁓ But for a little, the reason, what? ⁓ yeah. Can't you see? I got my muscles on this arm. These are my muscles. ⁓ Marq Sams: And I was like, he's kind of stacked. And I was like, man, he had to be called Hulk Hogan. Yeah, Moslemania group out there. was like, he had to be one of those kids, 1990s, like, Moslemania all day. Adam Hogan, DDS: you ⁓ man, I didn't pack on weight till I was in my twenties. So I was, you know, I wanted to be a professional football player, but that was a dream because I was like a twig, man. I was a stick, you know, I'll tell you real quick. I was like, I was a fat middle schooler who was on the offensive line and we won a city championship. And then I went to high school and I just strung out. Like I just got Marq Sams: Yeah. Really? ⁓ really? Adam Hogan, DDS: It's like a string bean, man. I just grew like straight up and didn't gain a pound. So, yeah. Marq Sams: Oh man, hey, let's go that way to the other way. You don't want to grow out and not grow up. Adam Hogan, DDS: Yeah, exactly. Right now I'm trying to grow back in just a little bit. ⁓ Shit, this has been great. Saturday morning, I gotta let you go soon. Are you teaching? ⁓ Harry said he heard you had a lecture. Where are you teaching? You teaching anywhere? Marq Sams: Me too, bro. Me too. I mean, people ask me here and there to do some presentations and I got one coming up in October, but I don't think I have anything coming up anytime soon. But yeah, I mean, I like to do speaking engagements every now and then. Nothing too crazy. I mean, I got kiddos too and I'm running all around with those guys. Got two baseball games in a tournament this weekend and had gymnastics last night. So I don't do it as much as I would like, but. You know, near there. Adam Hogan, DDS: Yeah. Well, I wanted you on here for a lot of reasons. But one, you're regular stand up Joe, like a periodontist in Wichita, Kansas. I mean, think expertise is not, ⁓ it's not built on the podium. You know, there's a lot of people that just make a living in education. And I think you're building expertise. There's a lot of value in this peri-implantitis ⁓ lecture that we got and just in practice in general. So I encourage you to get up there and share with other people. Sure. Marq Sams: Yeah, for sure. For sure. Any opportunity I get, I'll take it. Adam Hogan, DDS: Yeah, let me know if you want to come out and check out the Institute one day here in Virginia Beach. We'll come out for sure. ⁓ This has been great. You got any other things you want to share today? Marq Sams: That was good. Man, that was a great podcast, man. I like what you're doing. We need more of that. And I've seen some people that I know as members of your group. So it's pretty cool that you're spreading the knowledge and they need to. And I think it's cool that you're doing it in a relaxed environment. Paradontists especially tend to be little bit uptight sometimes. can scare people off and talk over people's heads. So having this base definitely helps like make it real life for people. So I liked what you were doing and what you're doing with it. So kudos to you. Adam Hogan, DDS: Thanks, man. If there's one thing I excel at, it's being average. Marq Sams: ⁓ My dope beats are your average, my man. Adam Hogan, DDS: I'm working on it. Elevating, elevating for sure. I appreciate that. Great for listeners. If you guys are enjoying this, please subscribe and check the YouTube out so you can see these images and subscribe on Pod App as well. And with that, we'll be dropping this probably on a Tuesday coming up soon. So thank you very much for sharing your morning with me, Mr. Mark Q. Sams. Marq Sams: Right. Thanks for hanging out, my friend. Thanks for hanging out. Adam Hogan, DDS: All right, all right, I've got a baby back here and a wife still recovering from surgery. So I'm gonna split and what are you doing today? Marq Sams: I got two baseball games about an hour and a half away, my friend. It's going to be fun. It's a nice day. Adam Hogan, DDS: Enjoy it out there in God's country and Kansas. right. And we'll check in soon. Stay in touch. All right. You too. Bye. Marq Sams: All right, brother. You take it easy. All right, take it easy. Bye bye.