Latest / Straumann® ProTalk / Evolution, not a revolution: Dr. Jay Neugarten on technology, complications, and dental robotics (video version)

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Evolution, not a revolution: Dr. Jay Neugarten on technology, complications, and dental robotics (video version) · Straumann® ProTalk

0:00
It was an evolution, not a revolution.
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I'm impressed how you look at technology and, how you're willing
0:08
to adopt technology and also go through the learning curve.
0:11
So what makes an experienced clinician like you having the openness and
0:15
willingness to actually change a protocol that is up until today successful?
0:19
'Cause I am driven by technology to get us better outcomes.
0:24
I want less pain, quicker recovery, smaller flaps, prosthetically positioned.
0:29
I want that when I look at my patient's post-op, I want the
0:34
bullseye every single time.
0:50
Welcome to Straumann ProTalk.
0:51
Welcome to the Pulse of Dentistry.
0:53
My name is Georg Raeber, and together with Andreas, my co-host today, we
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are very pleased and honored actually to welcome you, Dr. Jay Neurgarten,
1:01
here directly from New York City.
1:02
Welcome, Jay.
1:03
It's a pleasure.
1:04
Thank you to the two of you.
1:05
Thank you to Straumann, and I look forward to spending this time with you
1:08
and, having a little fireside chat.
1:10
I'm sure we're going to touch upon a lot of interesting topics.
1:14
Jay has been an oral fa- maxillofacial surgeon for more than two decades.
1:19
you're also holding an assistant, clinical professorship at two universities in
1:23
the US, and you have been operating on a lot of difficult cases, I have to say.
1:29
So you started experimenting already in 2001 with zygomatic implants, and
1:34
you treat a lot of orthognathic cases.
1:36
You're treating even newborns, with breathing disorders based on, let's
1:41
say, skeletal structure defects.
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So you're treating the complex cases, and we are going to touch
1:46
upon this, and I'm sure we're going to learn a lot from you today.
1:50
So the topics that we would like to dive into, dear listeners, are, first of
1:53
all, the journey of Jay Neurgarten as a surgeon: how you evolved in those decades
1:59
as a human but also as a clinician.
2:01
Then secondly, we would like to touch upon technology, what technology
2:06
can do, but also where we need to be careful and how to apply it.
2:09
And last but not least, we should also talk about, let's say, the skills and
2:13
mindset that future generations would need to have, future generations of
2:17
surgeons in a world where AI and robotics is becoming more and more prominent.
2:22
But before we dive into this, Jay, for those who don't know you,
2:27
who are you in just one minute?
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Oof.
2:30
Okay, daunting task.
2:32
I am an oral maxillofacial surgeon.
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I practice in New York City.
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I'm part of a group.
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my journey, I would say, really began at home, with my parents.
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my parents came over during the war.
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my dad and mother inspired in me and my brother and my sister good dental care.
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and then from there, I was working in my dad's butcher shop and was always, wanting
2:56
to be, cutting the meats, and I was never told I was allowed to cut the meats.
3:01
Okay.
3:01
And, from there I went to, undergraduate and then I went to dental school, and I
3:06
was hoping that I was in dental school that I'd be able to cut the meats, and
3:08
I was still-- I got the German hand.
3:10
It was the, "No, you're not allowed to do that." And then I went into
3:13
my residency, and then I was in my residency for oral maxillofacial surgery.
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I said, "Dad, it's time." And every Christmas and Thanksgiving
3:22
and Easter, my mother and father, it was a mom-and-pop operation.
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They would work through the night taking care of all of the,
3:28
the customers- The customers
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to give them the turkeys and the crowned pork and the roasts and everything else.
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And it was at that point that I finally got to cut the filet and string it up and
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do it all right, and the first customer comes in and he says so proudly, my
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father, he says, "I want to know that your filet was butchered by a surgeon."
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And I said, "Dad, we can't-- We, we can't say that." You cannot say that.
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So that was really my-- It really began, I would say, with my mother and my
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father just inspiring those good family values to be able to begin the journey.
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And then, at, in my residency, and we'll get into this later when
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we talk about next generation, a lot of it was mentorship.
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And I met an ama- still in my life today, Steven Sax, who was part of
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my mentor when I was in residency, and I finished my residency in '01.
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And as opposed to going to the hospital, I joined him in practice.
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I've been with him for twenty-six years, and we just, every--
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We-- He's still practicing.
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We sit down, we have little chats and talk about patient care, and
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he's been a major mentor to me.
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So I would say that my journey and every day is, is-- I love-- I feel like
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I'm the luckiest guy in the world to do what I do and what we do every day.
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but it was really through mentorship and parenting that really has allowed
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me to evolve to who I am today.
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Okay.
4:48
So b- before we go into zygomatics and AI and the evolution of
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technology and complex cases, let's dive into your journey a bit more.
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Has it been very clear for you that you become a oral maxillofacial surgeon from
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the beginning, or did you just start, say, "Look, I would like to enter the
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field of dentistry," and left it open?
5:07
For sure.
5:07
So when I was at dental school, at Columbia, I started with anatomy, and I
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would say that when I was in that first month of anatomy, my journey was destined.
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I, loved that, and plus bringing in what I had seen my father
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do- in his line of business.
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I had a mentor that I did a job, a day in life when I was, in, in high school.
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I was able to spend time with a dentist.
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And really teeth had always been instilled in me through my parents
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having bad dinner ca- ba- bad dental care in Germany, that home care started.
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So the, the seed for dentistry was planted by my parents.
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Already in the family.
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Yeah.
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In the family.
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And then when I went to dental school and I started anatomy and the whole just
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understanding that the detail that's involved in understanding the human body
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from a surgical perspective, I really just thrived from that perspective,
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and that's when I finished Columbia and went on to my residency and that,
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that was really where it began for me.
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do you still remember one patient that probably changed everything
6:14
for you, where you say, "Look, th- this was the one patient I still
6:17
think about after so many years"?
6:18
Yeah, what George was saying before, it was one of those babies.
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it was, First name is Jacob.
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I will keep his last name out of this conversation for HIPAA.
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and I had one of my-- I have three kids, and one of my children was their age, and
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I had to take care of this baby from an airway perspective, and this goes back
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about almost six- 15, 16 years ago, and I had a one-year-old less at home, and I
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literally had to confront the challenge of taking care of this baby from a neonatal
6:56
distraction perspective, in order to get them breathing so that we did not have
7:00
to put a trach in their throat- Sure.
7:03
because they had severe sleep apnea.
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And I, at that point, I'd really had to, buckle down and just
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completely separate my mind.
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Your private life and then, and that's one of the things that I
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think as a surgeon, you have to be able to create barriers in your mind
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and separate of what you're doing.
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I almost consider it like going- to war on some level, right?
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I was going to surgical battle to help this young patient survive and live,
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and really I had to keep all of that suppression 'cause… and I left my
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house, and I gave my daughter a kiss and went, "Here I am off." And I'm like- Oof.
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Yeah.
7:39
Yeah.
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It was, a big moment for me.
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D- do you have, some routines or habits that you use to manage getting
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prepared for such cases, or also then to, let's say, digest those cases after?
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Because, I remember I read through this post and, after you had also
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a quite demanding surgery to be performed, after this little baby.
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So how, do you manage getting ready for the surgery and then having a break
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and getting ready for the next surgery?
8:07
A lot of coffee.
8:10
That's okay.
8:10
If that's, okay, if that's
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helping, No, I would say, I- it's about being prepared.
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really, I think that reading, educating, learning, it's a lifelong process, and
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there's no such thing as an easy surgery.
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I will never use the word easy, and these kind of situations.
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And one of the things that I teach my residents is being prepared,
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going in, understanding, reviewing.
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Don't just show up.
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making sure that you are ready to do the procedure, and I spent a lot of
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time really studying this and learning.
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And then when I come out of that, I have to, flip a switch and now
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come out of that and see patients to be able to do that, and a lot of
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that is a mindset that I think comes through your training, coming through.
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and, I think that the biggest thing for me is caring, and I think that once
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you care- you can change the world.
9:07
We come back to this, in a second, but because I think in many ways you as a
9:11
surgeon, it's like a high-level sports athlete y- you just have- to perform.
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It's a lot of- You have to
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perform
9:17
the, mental preparation for demanding cases like this that
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you just have to get right.
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So- so I imagine, you need to be quite mindful to, to get ready for, such cases.
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And in your post you were also saying, "Look, medicine for me is
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a privilege, and, being trusted with a life this small is something
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I will never take for granted."
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that really struck me.
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So, how do you-
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Yeah.
9:42
I, like I said, I think I'm the luckiest person alive, and I think
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that, for me, I'm humbled by it.
9:47
I think the, gift that somebody allows me to be able to take care of them, who
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has challenges of feeding or breathing or emotional or just don't… They want a
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better quality of life, and they've chosen me to care for them, I think is something
10:09
to me that I don't take for granted.
10:12
I look at every patient when I take of that, take care of them, and I
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talk about this all the time, it's like taking care of your mother.
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Because if you take care of your mother to the highest… Consider you're taking
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care of your mother, you take care of your mother to the highest level, or your
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father- to the highest level- then you'll take care of your patients to that level.
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And for me, it is like being, I think- a high performance athlete
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because you can never be off, right?
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You always have to be on because I- Absolutely … I, the good enough
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mentality to me as a surgeon-
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Is not acceptable
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… it's not acceptable.
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No.
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Like I can't say, "Oh, George, look, I operated on your mom today, and I'm sorry
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the surgery was just- good enough." And-
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I could have done better, but,
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Yeah.
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It's like- that's just not, that's not- That's not acceptable.
10:54
Yeah … that's not, that cannot be acceptable.
10:56
And Jay, I would like to, link this back on, on a behavior that I see on your
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social media account a lot, and, knowing you personally from many discussions,
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I know this is close to your heart.
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I observe that you're not on your social media account like everybody else,
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just, publish your successful cases.
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But you're also vocal on criticizing or let's say, commenting- on
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false advice- patients get.
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And we, when you see patients and with this the surgeon, is getting,
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is taking this, the wrong route.
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And I know you're a busy guy, and it takes a lot of, time and effort
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to do this and, you also could mind.
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Why, does this matter to you?
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' cause I care, and I think that I care about patients.
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I want the best for them, and I think that sometimes there's stuff that's out
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there that just does not make sense.
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And I think as clinicians, it's important for us to talk openly and really being
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able to demystify and break down some of these things that are not true.
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And people will go out there and just because it seems realistic, I feel
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like they prey on the public sometimes.
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And I just, it hits me at my heart, and I feel it's an important calling for me
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to break down some of these, these areas.
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and as far as the ability to be able to do this, I, think a lot
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of it is because I surround myself with a lot of amazing people.
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A- and I have to thank my team for that because I'm only one as, one
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person here, and I really define myself by the people that I put
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around me, and that is so important.
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but still you're setting the direction as the leader of the-
12:46
Yes … of the team.
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you have to be- It starts at the top It starts at the top.
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I, and listen, when things go bad- Yeah.
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Yeah … I take the fall, and when things go good, I give it to them.
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Yeah.
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So maybe to close on your personal journey, how would you say is the
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Jay that we see today as a surgeon and as a person different from the
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Jay that started, in this profession many years ago, 20-plus years ago?
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I'd like to think that I'm still that same person.
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That's, good.
13:11
I, I would really like… I,
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like I said, I, think I am the luckiest person alive.
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I love what I do.
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but I think I'd like to believe I'm still that same passionate, driven,
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motivated team player that I was then.
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Obviously, we have a little bit more experience, so we have more knowledge now.
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But I, don't ever wanna lose the zest.
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I don't wanna lose the passion.
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I don't ever wanna get complacent.
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And the, thing for me I think that has changed a little bit is to look to
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the youth and to look to my residents and inspire that energy and passion.
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I want them to love what they do.
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I want the youth oral maxillofacial surgeons and dentists and periodontists
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that I work with and, orthodontists and the team base of dentistry to
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really rise up because I think we as dentists are, like I said, I
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think we have the best profession of anybody, and we, live on that
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Jay, so I think it's a perfect segue, so your, passion and your care about
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patients to also talk about your care for the profession, as you mentioned before,
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so the, the youth as you called it.
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I, perceive you as someone that, that really tries to communicate
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as clearly as possible to patients, be it now in social media, but
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also I'm sure in, in your practice.
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I think, that's, building a- also a lot of trust, and I see the
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same tendency of transparency when it comes to clinical education.
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So you're not just about the successful cases, you're also about, what did
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not go well or, according to plan.
14:53
And it has nothing to do with, "Oh, I, I just didn't do a good
14:56
job." And sometimes still in, in medical- there can be failures.
15:00
so you helped organize the congress called Complexities- Yeah
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if I'm pronouncing this correctly.
15:05
and I think it's already, second or third installment- in, in New York- Yeah.
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that you're doing also in conjunction with your being a ZAGA center.
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So why is it that you wanted for this congress to- focus on failures-
15:20
Yeah
15:20
… instead of just the successes?
15:22
Yeah, great question.
15:23
So I, I've-- my feeling and one of the things that I live by is you're defined
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by how you handle your failures, not by your how you handle your successes.
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And as I looked into the world of zygomatic implant therapy, there was
15:41
a li- every time I went to a course or a meeting, there was a one-hour
15:47
lecture on complications.
15:50
And if we look at through time, we see that there's more and more zygoma
15:54
implants being placed through various entities, restorative dentists,
16:00
prosthodontists included, periodontists, and oral maxillofacial surgeons.
16:05
And I was seeing a lot on social media, as you were saying, people really
16:09
talking about a lot of their successes.
16:12
But in my practice, I started to get a lot of referrals of zygoma complications.
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And I felt it was really important to collaborate with Carlos Aparicio and the
16:23
ZAGA community and really rise up and be able to focus a whole day on complications
16:32
associated with zygomatic therapy.
16:35
And that was really where the seed was, laid down from that aspect.
16:42
And then it grew from that, and we've broadened out into other areas of
16:48
complications from remote anchorage and looking at pterygoids and,
16:53
trans-sinus, and subperiosteals.
16:56
And, again, I think that, as you said, it's not that something went wrong.
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there's often the patient didn't get you the outcome that, or the patient
17:05
didn't give us the outcome that we want.
17:07
We did everything we wanted correctly.
17:09
But it didn't, the patient didn't read the book, right?
17:11
Where it didn't get us a favorable outcome.
17:13
How do you manage that?
17:15
And the goal is that if you're gonna be able-- if you're going
17:18
to do a surgical modality, you really should be able to handle the
17:23
complications associated with it.
17:25
The complication of it too.
17:25
Yeah.
17:26
Or at least know where to get help.
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Do I refer it?
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How do I handle that?
17:31
And I think that as we get into more complex care, we
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need to have that pathway.
17:35
And that's where complexities for me and, Carlos Aparicio and David Pazmino,
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it began in that ilk- where we, a- and, even, Costa, with, as well, was with us
17:51
to be able to come along this journey.
17:55
I think it's very-- It's you make it sound as, as if it would be natural
17:59
that everyone can deal with their own complications quite freely.
18:03
But probably it still, it takes a bit of courage to, go out.
18:08
What did you learn basically from your own complications that your successes
18:12
would not be able to teach you?
18:14
Yeah, it's experience.
18:16
it's the voice of reason, right?
18:17
And I think that for me, I am driven by getting better outcomes.
18:27
And I mean by that, I think to just do a surgery and to say, "Oh, I
18:32
did an amazing work," we don't need to beat our chest on that level.
18:36
But when I lecture, I often ask how many of the clinicians in the room
18:42
have taken their patient care that they provided, whether it's an implant
18:47
placement or restorative or orthognathic surgery or some modality in the max face
18:52
space, and did you do a deep dive and really analyze what you did on that,
18:57
and then put all that data together to be able to get better outcomes and
19:02
better feedback, to be able so that you can be a better clinician, right?
19:07
And along those lines, there are complications that arise, right?
19:10
And to be able to talk openly.
19:11
Now, you have to be comfortable in your skin- to be able to
19:14
do that, and not everybody is.
19:16
But I think, managing those complications is really important because patients
19:21
want it, they need it, and as we know in twenty twenty-six, they're demanding it.
19:28
And it's really important that we can discuss that openly and be comfortable
19:33
to be able to talk about complications.
19:36
And it could also be much more data-based.
19:40
I'm sure you're analyzing retrospectively your cases, and based on this,
19:44
you're taking also decisions.
19:46
is there an example that you could make where based on some of the analytics
19:50
that you did with your own cases, you actually started to change your protocol?
19:56
I'll give you an example.
19:57
Yeah, so what-- And I'll give it to you in the orthognathic space for a minute
20:01
'cause I'm in the jaw surgery world.
20:02
So the use of Botox.
20:04
So as the world is clenching and grinding and really being… And I even
20:09
use this now, and I'll even s- w- I'll even bring this into implant dentistry.
20:13
Full-arch solutions for me, all of my patients get Botox.
20:17
Really?
20:18
Okay.
20:18
Now, we're also using bite forcing w- and we're using technology, which
20:23
we'll talk about in a minute, to be able to empower that and to be able
20:26
to look at the analytics on that.
20:28
So my full-arch patients get Botox to help to reduce the amount of power because
20:33
we know patients are clenching- they're grinding, they're bruxing, but we never
20:38
had a way to be able to quantify it- from a power perspective, and that's where
20:43
we're using Botox to help reduce that to get better outcomes for our patients.
20:48
So I, I-- In talking to patients and talking to them and just getting to
20:53
know them, a lot of people are stressed.
20:56
The world is stressed, right?
20:58
And we're using the modality of Botox to get us what I perceive as better outcomes
21:06
in the full-arch implant solutions as well as in our orthognathic space.
21:09
No, that's fascinating.
21:11
It, could also be an, almost a separate, topic.
21:13
Discussion.
21:13
Yeah.
21:14
So-
21:14
Yeah
21:14
… may- maybe let's, dive a little bit into your, passion for getting
21:19
better and, doing improvements.
21:21
So when I, when I look a little bit back on, on your clinical development,
21:27
you started relatively early, for example, with zygomatic implants, as
21:30
we s- talked in the beginning, 2001.
21:33
Then you adapted also, let's say, clinical digital planning.
21:37
You started to look into robotics, as one of the really early adopters.
21:42
To me, very interesting is that you would not have needed it because
21:46
you are a very experienced surgeon.
21:47
you can place- an implant- freehand.
21:50
So what makes an experienced clinician like you having the openness and
21:54
willingness- to actually change a protocol that is up until today successful?
21:59
So I'm driven by technology.
22:01
I think that when you look even at a company like Straumann, right?
22:06
And you look at your evolution in the technological world, and if we go back
22:12
to dental implants and how back in the '50s and in the '60s, we were just
22:17
happy- … that a piece of titanium, a piece of metal was placed in a
22:23
bone- Could integrate and not fall out
22:23
and it just integrate, and it worked.
22:23
Like the brilliance- That's it … that evolved.
22:24
And then we said, "You know what?
22:32
We want better." We want better.
22:34
Now we're gonna get into the world of hold on.
22:36
We've overcome the osseointegrative process.
22:41
Can we now make it effective with the relationship to a tooth who
22:45
became prosthetically minded?
22:47
Okay, now all of a sudden comes CBCTs, right?
22:52
And we get out of the 2D world, and now we go into the 3D world.
22:56
And then all of a sudden comes intraoral scanning, and we take the synergy between
23:01
intraoral scanning and CBCTs, and we now get three-dimensional treatment planning.
23:06
And all of a sudden, we now get surgical guides.
23:09
And this is where the brilliant minds and the experience of Straumann bringing
23:15
these products to the forefront that allows us to be better clinicians.
23:20
And a lot of this comes organic, de novo, so forth and so on, but all of a sudden,
23:25
we are part of a, a bigger process, right?
23:28
You look across the medical aisle, and you have the medical community.
23:31
And you look across the aisle, what do we see?
23:34
We begin to see a lot of technological innovations over there as well,
23:37
and you see the world of robotics.
23:39
Now we, I live on both sides.
23:41
And I'm looking across the aisle on the medical side, and I'm
23:44
seeing robotics begin to develop.
23:47
And all of a sudden comes out navigation.
23:51
And I use navigation in a lot of my surgery in the hospital.
23:55
So all of a sudden I'm like, wait a second.
23:57
Can navigation make us better clinicians?"
24:00
And then all of a sudden we get into the world of robotics and
24:03
technology, and that's where I got on board because I am driven by
24:08
technology to get us better outcomes.
24:12
I want less pain, quicker recovery, smaller flaps, prosthetically positioned.
24:17
I want that when I look at my patient's post-op- I want the
24:22
bullseye every single time.
24:24
I want it exactly where we want it, and that's where part of that post-assessment,
24:29
do we hit it every single time?
24:31
No.
24:31
Can we do better?
24:33
Yes.
24:33
Can we get it to the point where we are consistently accurate,
24:38
reproducible Where we-- And consistent of where we want to be.
24:42
And that's where I see the world of robotics to be able to support us
24:47
clinicians to make us better doctors.
24:51
And I, think that's, wonderful and actually it, now that we're talking
24:55
about it, I think it, it connects really well with what you said before
24:59
that your greater mission is to advance also, the, the people behind the field.
25:04
And a related question that comes to mind is, how much do you expect from
25:08
a technology to already bring- Ah
25:10
to the table before you invest into it?
25:13
Ah.
25:13
Because I perceive you as an early adopter- but I think also for you, you
25:18
run a successful clinical practice.
25:20
So you cannot just spend time in playing around with stuff that
25:23
actually does not make sense and takes too much of your time.
25:28
what is the tipping point where you say, "Now it's time for me
25:31
to actually invest into this?"
25:32
For sure.
25:32
So it's a lot of investigative work, right?
25:34
And I talk about the wand or the wizard.
25:37
Yes.
25:38
And it's always About the wizard Yeah.
25:44
It's always about the wizard, right?
25:45
The wands are there to help us be better doctors.
25:51
But I can never blame the wand.
25:54
Now, based upon your question, though, I need to investigate that wand to make
26:01
sure it is effective, and I have a slide when I lecture about exactly this piece.
26:07
Does it-- Is it adoptable?
26:10
Does it give me better outcomes?
26:13
Is it affordable?
26:14
And will it allow my team to incorporate, and is it scalable for me?
26:20
So the-- when I look at a technology, if I have those pieces, that's
26:24
something that I would highly consider.
26:26
Every piece of technology that comes across me that reaches that,
26:30
it might not be for me, right?
26:31
But when I look at the world of robotics, of what it can be doing to get me
26:35
consistent, accurate, reproducible, and makes me scalable and more efficient-
26:41
because the time- that I'm spending on patient care in the surgical
26:46
arena, in the robotic space from J. Neugart in twenty twenty-six, is less.
26:52
It
26:52
really makes you more efficient.
26:53
Yes.
26:55
I--
26:55
Now, it took me time to get there.
26:57
So what's the role today of robotics in your practice?
26:59
Just to help the, the listeners understand.
27:01
Yeah.
27:01
So the world of robotics, all my implants, all my traditional implants
27:06
and pterygoids and trans-sinus implants, I place robotically.
27:13
Zygomas, I do not.
27:14
We're not there yet.
27:15
It's coming- but we're not there yet.
27:17
so m- all my implants are placed robotically, consistently across the
27:23
board, and that's, where I am, and my s- team knows it, my staff knows it.
27:28
It's part of my DNA and my fabric 'cause I believe that passionately about it.
27:35
You're definitely at the forefront, and I know that you invested
27:38
also quite a bit to get it there.
27:40
I think it's, it's not yet, I would say, commonly available in
27:44
clinical practice, to be at the level that you are with robotics.
27:48
I, agree with that.
27:49
It w- for me- Yeah … I'm a, it use an, it was an evolution-
27:52
Yeah.
27:52
not a revolution, right?
27:54
It took time to get to this point where we are now, and it's, an
27:58
evolution where I made mistakes.
28:01
We, my team, and we looked, and we dive in, and we're looking for solutions
28:06
to these problems to make it better.
28:09
Is it for everybody?
28:10
No.
28:11
But I think as time evolves, as we know in the world and in the industry, right?
28:16
You have early adopters mid-adopters, late adopters- And the
28:22
laggards … and the never adopters.
28:23
The laggards.
28:23
Yeah.
28:23
And the laggards and the never adopters.
28:25
And, I think that aspect is one that you will see in the robotic space as well.
28:30
It's not for everybody, but I think that the future, if we could look down
28:34
the lens of life, at some point they
28:40
will be heavily, involved in medicine.
28:41
They're gonna be heavily, involved in f- all facets of dentistry beyond implants.
28:46
And I really share this, this passion.
28:47
So it's a- as you said, when, we look at, other medical fields like ophthalmology
28:53
or neurosurgery, it's no- For sure … question that- Yeah … actually
28:56
you augment the surgeon and it's not for making the surgeon obsolete- but
28:59
really for getting a consistent quality and having probably also, the, the
29:05
implementation of a previously planned execution really flawlessly- gone through.
29:11
I wonder, Jay, how do you see the patients reacting to robotics differently
29:16
to when you did freehand surgery?
29:18
Yeah.
29:19
And I've had some patients who have gone to both, both modalities.
29:23
Okay,
29:23
yeah.
29:24
Yeah.
29:24
Sure, yeah.
29:24
And they are enamored.
29:25
they are very much in it.
29:28
They are really enamored by the technology to the point where they're proud of it.
29:34
they really are because now they see what's involved from a technology
29:38
perspective, high level, synergy within the space of how this interplays with my
29:45
staff and with me, and then when we show them th- what the outcome, one aspect.
29:51
But then the recovery, when they look at the recovery of freehand versus What
29:57
you've gone through on the robotics- That's interesting … the recovery
30:00
is a, is… Look, the recovery in all these implants is not lengthy.
30:05
It's not lengthy.
30:06
it's a very short-term recovery- for the most part.
30:09
For the most part.
30:10
And, I think that we're calling days, we're not talking
30:13
weeks, of differences here.
30:15
But- But it's still
30:15
more
30:16
minimally invasive- But still it… Yeah, because I can do
30:18
flapless … sort of recovery.
30:18
Yeah If the soft tissue is well, and we've got good attached tissue, and
30:22
we like the bone and everything is set up, I can really do minimally
30:25
invasive, a flapless approach, where a patient doesn't even have a stitch.
30:30
I can almost just, they leave with a healing abutment on.
30:34
but that's not every patient.
30:35
But certainly it is in a directionality that I think is very much glass is
30:41
more half full- than it is half empty.
30:44
And I think we, need those, early adopters to actually help us as the
30:48
industry to make- these technologies also better, so I'm, Thanks a
30:51
lot for also being in that space.
30:53
it's, Please … we're, really driven by those people.
30:56
what's the next step are you looking forward to?
30:58
Ah.
30:59
To, let's say in the, if you continuously see that the progression
31:03
of robotics, AI, and stuff, so what's the next step you can't wait for?
31:06
Yeah.
31:06
I, educate.
31:07
I'm really just, I want to inspire people.
31:11
I- From a technology perspective.
31:12
Oh, what's the next in technology?
31:13
Yeah.
31:14
I think you're gonna see more in the robotic space.
31:16
I think you're gonna see more involvement of the prosthetic side.
31:21
I think you're gonna see zygomas within the robotic space.
31:25
I… Not only that, I think you're gonna see the AI really allow us to
31:30
be able to personalize a lot of the care that a clinician gives in the
31:36
treatment planning space, right?
31:37
Where if they do a full arch, and you can take 50 cases, 50 patients from
31:43
them, and we bring it into a treatment planning, that can, that model can
31:47
learn how that clinician works- and then bring that into that space.
31:52
So and that I think is gonna happen i, in the near term.
31:55
I think in the more longer term, I think we're going to get better
32:00
I think you're gonna have more robotic companies in the world.
32:02
There's no doubt that there's going to be… It's, like a race to the moon.
32:06
Yes.
32:07
it's a race to the moon, right?
32:08
To the lunar landing.
32:09
And I think you're gonna see more companies getting involved in the,
32:13
implant space and in the dental space.
32:15
You're gonna have a crown that's gonna be prepped with a robot as
32:19
they're milling, r- robot-assisted, as they're milling a, prosthesis.
32:22
I think you're gonna see orthodontics getting in the
32:24
space where they already are.
32:26
You're gonna see, even a, a sinus lift and bone grafting.
32:30
Prosthetics, imagine that the prosthesis comes in and is held
32:34
in three-dimensionally- Exactly.
32:35
Yeah … of where it needs to be, right?
32:37
Yeah.
32:37
So I think that it is going to complement a lot of what we're doing,
32:41
allowing us to be more accurate, reproducible, and predictable.
32:45
Yeah.
32:46
Let's quickly go back to this- … this, this sentence of, or this question.
32:51
what is, was it, the wizard or the wand?
32:53
And I, really like this because I think it's going to become even
32:56
more important for the future.
32:58
Yeah.
32:58
Sure.
32:58
And, the, question here that interests me, Jay, is, when is the
33:02
wizard good enough for a new wand?
33:05
So because we were also talking about, you were a early adopter, and you
33:11
spent quite some time in evaluating also these technologies before you
33:15
fully bet on them, but there is many more people that will not do this.
33:19
So how do you help people to understand when is it a good time
33:24
to invest into a new technology?
33:26
Yeah.
33:27
but I think that goes for, any technology.
33:29
Look at something like a cone beam CT.
33:31
take a cone beam CT, which for the industry was so hard for people.
33:35
Oh, I can use a periapical.
33:37
I can use a Panorex, right?
33:39
To get clinicians to move from when we're very set in our ways- To move
33:47
into, move their cheese, if you would.
33:51
To move their cheese into this.
33:53
And I think that you have to want it.
33:56
Because some people say, "Ah, it's not for me." My senior partner,
34:00
Steven Sachs, who I spoke about earlier, he is into robotics.
34:03
He's like, "I wish…" He's like, "This will lengthen my ca-," he
34:06
is in that now, and he, sees that.
34:09
He's an innovator.
34:10
He's, and a, he is just a special man.
34:12
And I think that the more eyes we can open- in this space of the
34:18
wand, I think the more people will potentially consider to be adopters.
34:23
And I think that, again, I think through Straumann and through the entity such
34:28
as, companies such as yours, that through education and through learning and
34:34
through showing how this can help grow a practice, take care of patients better,
34:38
and be an impactful solution, I think that's how people will take on devices.
34:46
Even an intraoral scanner.
34:47
Think about intraoral scanners- and how many dentists- Yeah … have
34:50
intraoral scanners- Not many … and how many don't, right?
34:52
The battle that I see, and I'm in a number of chats, who still live in impressions.
34:58
It's, like, didn't we- move on from that already, right?
35:03
And they're, but again, set in their ways.
35:05
It works well in their hands.
35:06
They're very comfortable in that space.
35:08
But so I think that as we evolve and we go through this technological
35:14
evolution- hopefully some people will adopt and will see the better of good
35:20
to be able to join this journey through all of the technology that we bring
35:25
out and that your company brings out.
35:27
Oh.
35:28
Great conversation.
35:29
Let's, bring in the next, let's say bit and connect the topic of the wizard
35:35
and the wand to the next generation.
35:38
Ooh.
35:38
Because, i- if we speak about technology, as you elaborated, it brings a lot of,
35:42
let's say, planning, benefits, efficiency benefits, clinical consistency benefits.
35:51
But still, there's something that, the young generation- has to learn by hand.
35:56
There are skills that they have to learn and we know that they will probably
35:59
operate and run a practice in a very different setting like you do today.
36:03
So, I would like to discuss this a bit.
36:05
And I think the first question I have is, are you worried with all these new tools?
36:10
And we're not speaking about robotics only, okay?
36:12
Yeah, for sure.
36:13
we can also speak about- We can leave robotics alone … intraoral scanners.
36:16
For sure.
36:16
Sure.
36:16
then- For sure … people don't know how to do a, an impression anymore.
36:19
We can speak about guided surgery.
36:21
Static.
36:22
People don't know how to do a freehand surgery anymore.
36:24
we can use any example, not only- For sure … robotics to the extreme.
36:29
are you worried that sometimes, young clinicians take on complexity way before
36:34
they are actually ready to take it on?
36:36
Yeah, I think we need building blocks, and I was talking to some clinicians
36:42
who were telling me that in dental schools now, they're not even teaching
36:45
students how to make dentures, right?
36:48
So we need the basic building blocks to be able to do this elaborate,
36:53
complicated technological solutions.
36:56
In other words, how to put in a freehand implant.
37:00
Yes.
37:01
To learn.
37:01
How to do freehand full arch.
37:03
Yes.
37:04
How to be able to, take care of patients better and to be
37:08
able to do guided surgery.
37:10
But I think the key for that and how we inspire the youth, for me,
37:15
there's three pillars for this.
37:17
One, number one, they gotta care.
37:20
Yeah.
37:20
It
37:20
has to come from them.
37:22
They have to want to do better.
37:26
Number two, they need to get involved.
37:29
Getting involved with organiz- organization, whether you're an
37:32
oral maxillofacial surgeon, going to meetings, being part of the, the
37:36
Straumann ecosystem and getting educated.
37:39
There are so much opportunity that they have at their fingertips,
37:43
and where do they get educated?
37:44
It can't just be throwing Jell-O at the wall and hoping it sticks.
37:48
They have to get involved with their association on a local level, on a
37:52
state level, and on a national level, whether you're a restorative dentist,
37:56
a periodontist, or an oral surgeon.
37:58
we can't just forget everything and rely on everything in dental
38:01
school because the majority of what they learn in dental school-
38:05
Is outdated by
38:06
the- Is outdated by the time they get there … usually they start to work.
38:08
Yeah.
38:08
And I don't mean, and I don't mean that in a, in a disrespectful way, but a lot of
38:14
what would they get, it's not present day.
38:18
And then the third, and we've been spending a lot of time
38:20
talking about this, mentorship.
38:22
They really need mentorship to be able to be there because you don't have
38:28
all the answers when you come out.
38:29
You're gonna get complicated cases.
38:31
You're gonna make mistakes, and you don't wanna reinvent the wheel.
38:35
And even the mentors, they're learning.
38:37
They're learning.
38:38
I'm still learning.
38:39
I have residents.
38:40
I res- I, teach- Yeah, my residents at Cornell.
38:43
They are the best thing.
38:44
I still learn from them.
38:45
It's as much as they're learning from me, I'm learning from them as well.
38:50
So look, there's this question between, the relation of technology
38:54
and going through a healthy learning curve because, sometimes people make
38:58
you believe if you apply a technology like this, it will prohibit you
39:01
going through the learning curve.
39:03
Do you believe that the technology can also accelerate your learning curve?
39:07
I do, but I think you need to have a good base.
39:10
I think that if you rely solely on the technology, if someone were to tell
39:13
me, "Could I… Would I… I want to get into full-arch guided surgery-
39:21
But I've never done freehand.
39:24
No.
39:25
no.
39:25
It's something that the three of us seem s- very straightforward.
39:29
no, you need to understand the nuances, the pain points, when things
39:33
are not right, how things are… You constantly are getting feedback, right?
39:37
There's the visual feedback, there's the tactile feedback.
39:40
You need to be able to understand- where you wanna be at the end.
39:44
It's always about the end journey, right?
39:46
To know where you're going.
39:47
You have to get there through this journey.
39:51
And full-arch, even a single-tooth guided, you need to do single
39:55
har- f- single implants freehand.
39:59
And then you evolve to multiple, and then you get into full-arch, and
40:03
then you can get into guided, right?
40:05
But you need to be comfortable with that and really understand,
40:08
and not just a matter of one.
40:10
You need to do many.
40:11
And then not only do you do many, but you need to do a retrospective assessment.
40:16
How did I do?
40:17
Compare, overlay, work with the technology.
40:20
The technology should just not help you on the front end.
40:23
No.
40:24
The technology should help you on the back end.
40:26
Yeah.
40:27
So I believe it's what you said earlier, the, the complexity you can
40:31
take on is determined by the, the complications you can manage, right?
40:35
and I think this is pretty much summarizing, what you said.
40:39
So let's move a bit away from technology, still sticking with the next generation.
40:45
I believe discipline is a, a, a big part, of success.
40:50
what are the habits and routines, you would recommend to the next
40:56
generation that, that make you successful today every day?
41:00
I would say be organized, right?
41:03
get a plan, review your surgeries, review your approach.
41:10
Be a part of a team.
41:12
Don't try to do it all by yourself.
41:14
Work in a multidisciplinary approach.
41:18
I know that there are a lot of clinicians out there that are putting implants in
41:21
and doing the restorative side, great.
41:23
H- but also be part of a team.
41:25
Don't be an island, because we can accomplish so much more working together
41:31
in the synergy t- of togetherness than you can of being individual, and
41:37
we can take care of patients better working at it, 'cause there's some
41:40
things that I might see differently than you, and it's okay to disagree.
41:45
It's okay to agree, right?
41:47
But sometimes when you disagree, it allows for collaboration,
41:52
it allows for better care.
41:54
So the youth of today, again, I would say to them, get involved, right?
42:00
Mentorship, get educated, take continuing education, get classes, and go from there.
42:06
Yeah, we could probably continue on this one.
42:08
Yeah.
42:08
So it's, a very passionate discussion.
42:10
Thank you, Jay.
42:10
Yeah, it's, it's great.
42:13
we usually give our, let's say, guests the possibility also to
42:17
ask, Andreas and myself questions.
42:20
And, Jay, is there something that, maybe we can, answer?
42:24
Yeah.
42:25
So as I think about that question, I think about- The world of implant
42:30
dentistry and the world of caring for patients and taking care of them.
42:35
And, as joint relationships with a lot of clinicians that you have, and we
42:40
look about the global, epidemiology of edentulism- and missing teeth, and
42:48
we look to the, challenges that are before us as clinicians, which are,
42:54
I would say, getting out the message of edentulism, that denture wearers,
43:00
access to care- and affordability.
43:03
How does Straumann and the leadership see the future for us to be able
43:10
to break down these barriers and to take care of patients better and
43:15
partner with us clinicians to be able to support that so that we can
43:20
give people a better opportunity, a better quality of life together?
43:27
It's a very broad question, Andreas,
43:29
It's a very broad, but a very good question.
43:31
Yes.
43:31
You had a lot of time in your flight from the north.
43:35
So I can start.
43:36
Yeah.
43:37
If you, want.
43:38
So I, think first, the great news is the potential for implant
43:43
dentistry is still enormous.
43:45
We, know from data that we generated that out of globally 100 potential
43:51
patients for implant dentistry, only seven receive an implant today.
43:55
Meaning 93 patients do not receive an implant when they could get an
44:00
implant, and probably an implant would be the best treatment option.
44:04
So this is very close to our heart, and we think a lot about this question,
44:08
and also together with, let's say the ITI, we think about, this question.
44:15
And for us, I think, one big lever is continue innovating, to make sure we,
44:21
make implants more accessible, to others.
44:24
it's, a matter of technology.
44:26
If you see the number of cases you can do today, Jay, every day, and
44:31
it's not being a contraindication.
44:34
Relative to 25 years ago, there were a lot of patients that were still
44:38
contraindicated to dental implants.
44:39
For sure.
44:40
For sure.
44:40
So we removed a lot of those- Barriers, yeah … contraindications, and
44:43
probably with this, we moved the implant dentistry from three patients to seven
44:47
patients, so maybe we doubled it.
44:50
And, I still believe innovation is a key to, to unlock this potential because
44:55
it will also make you more efficient, as clinicians because you have s- just
44:59
so and so many time, by doing this.
45:03
But beyond innovation, I think one of the big levers is really education, to
45:06
make sure that there are more clinicians out there that know about implant
45:10
dentistry, that know about the benefits of implant dentistry for the sake of the
45:15
patients that really believe in implant dentistry, and then clinicians like
45:19
you training those new clinicians in, how to perform good implant procedures.
45:27
and I think this is, now you live in the US, we live in Germany and Switzerland,
45:33
and those are quite developed, markets in terms of implant dentistry, but still
45:37
there the penetration is still very, low.
45:40
I would say in Europe it's probably 15 out of 100 patients.
45:43
In the US maybe the same.
45:45
But then there are parts of the world where it's only
45:46
maybe two out of 100 patients.
45:48
So there is a lot of education work to be done, and this is m- my big belief
45:53
where we as a company, have to play a big role, but also the ITI plays a big role
46:00
Ma-maybe to add to this, so with, this number that Andreas you mentioned in the
46:03
beginning, the, the seven out of 100, it's, fascinating because it already
46:08
takes into account the affordability.
46:12
So the, the, pool is even larger, but we just, we, had to say, what are those
46:18
patients that are medically indicated and secondly, also could afford an implant
46:23
treatment?" And I think that the … If we can talk about the bottleneck, it's
46:28
really about is there enough trained clinical personnel to serve patients?
46:34
And I think this is where, education comes in.
46:38
This is where we also learned a lot about, let's say growing middle
46:42
class, for example, in China.
46:43
Yeah.
46:44
maybe a next continent that will follow is India.
46:47
And so there, there is more and more patients that actually through different
46:50
means also being, exposed to media, there is a, higher standard of how do I want
46:57
to look like, and, an awareness of how important oral care is that will open up.
47:03
So I think we're basically just scratching the surface of what we can do for
47:08
oral care, and this will hopefully in the next decade even be differently,
47:15
regarded in the medical field itself.
47:17
So it's not just the, the patient is not a mouth.
47:21
it's a whole patient.
47:22
Yeah.
47:22
And this, this understanding that what you're doing to treat, oral complications
47:28
has an impact on general health- 100%
47:31
is still not there yet.
47:33
Yeah.
47:33
And we hope that this will come and, implants is just, one example- A vehicle.
47:38
Yeah … one vehicle to actually achieve this.
47:40
Yeah.
47:40
So I think that the bigger dream is really to become also more of a oral care company
47:46
than- just the, the screw depot that, that provides, some of the, of the metal parts
47:52
that actually you can do the magic with.
47:54
And I, think this, this idea of, caring about oral health and
48:00
thereby also influencing positively general health in patients, I think
48:03
this is something that drives us.
48:05
And if you're asking about, what's the, bigger future, I think it would
48:08
go in, in that direction, as well.
48:11
Maybe last comment to this, Joey, I believe we can only master this
48:14
challenge together as a team.
48:16
I agree.
48:17
We need to team.
48:19
Yes.
48:19
Yeah.
48:19
And I think that we can accomplish this together.
48:21
Yes.
48:21
Because the sum of the total, is greater than each individual.
48:26
When working together, I think we can accomplish these, these
48:29
barriers and provide better care.
48:33
So Jay, thanks a lot first of all, and, before we wrap up, I would
48:37
also like, Andreas to maybe pick out the three things that really stuck
48:43
with you, from the conversation.
48:46
It's always a, a difficult task, but,
48:48
Yeah.
48:48
It, that, that was a very intense, conversation, so thanks a lot, Jay.
48:55
I know the top one quote for you is that you gotta care.
48:58
A- and I think this is for me the first takeaway.
49:01
You really gotta care, and I wanna congratulate you, Jay,
49:04
for having found your passion.
49:07
because the way you describe how you started in the, i- in this specialization
49:12
and this, in this profession and, the way you still have this passion drive is, you
49:17
just gotta care and find your passion.
49:18
And I think this is something I wish just for everybody, because, it, just
49:23
creates so much energy and good for the, people and, also for your mental health.
49:30
you're a happy guy, and that's- … that's also due to the fact that, you find
49:34
your passion and you, and you said it, and also for the young generation, you
49:37
really gotta care about the patient.
49:39
It's the first and foremost.
49:40
If you don't, then I would think about changing the p- profession probably.
49:44
And then I think, the, the second topic is for me, I'm impressed how you
49:49
look at technology and, how, you're willing to, a- adopt technology and
49:55
also go through the learning curve.
49:56
Because today you say, look, robotics is every day in your practice.
50:01
your implants are regularly or almost all placed with robotics, and I'm
50:06
sure this was a steep learning curve.
50:08
And this was painful, and it was a lot of work.
50:10
And in the beginning, you have to invest more than you get back.
50:15
But once you, you go through the learning curve, probably you, gain more now that,
50:20
you invest, the, the return is coming.
50:22
And it's impressive how, you went through this learning curve very
50:25
mindfully, selective, with the right technology and, for that created
50:29
something good for, for the patient And then, last not least, I think for,
50:36
the next generation, I still want to take away, you have to know the basics.
50:42
You
50:42
have to.
50:42
There is no way- There's no way … around knowing the basics,
50:45
and I think we share this view.
50:47
When we come with a new technology, it's not about making someone that
50:50
is not skilled a great surgeon.
50:52
It's about helping an experienced- Enhancing … and great surgeon to
50:55
make him or her more efficient, more consistent, and, just make, life easier.
51:02
But it's not about, jumping a learning curve.
51:04
So thanks for these insights, Jay.
51:06
Thank you.
51:07
Thank you.
51:08
Thanks a lot, Andreas.
51:09
I really liked the, summary.
51:10
And, again, Jay, it was a great conversation to have.
51:14
So much energy, so much passion.
51:15
I really love this.
51:16
And I think, again, personally, I would like to thank you to take
51:20
so much of your time and effort to also improve technology.
51:24
you mentioned it, we need this collaboration, and I think in this
51:27
intersection between medical and industry, I think this is where some
51:31
of the magic can happen to really also make us better for the future.
51:35
And I want to thank the two of you, really.
51:38
this was an incredible opportunity to just talk, have a little fireside chat.
51:45
and one other thing I'd like to just tell and get out is, which I, want to
51:49
just bring out in closing is, what, one of the things I live by is we
51:54
don't have problems, we have solutions.
51:58
And to figure out solutions to problems is really about Straumann, the technology,
52:05
purpose statement, and what we try to do as we grow higher, use the technology
52:11
to take care of our patients better.
52:13
And, the, opportunity for me to be able to come here and talk with the two of you
52:17
and to be able to tell my story, I, thank you, and I thank both of you for that.
52:22
Very welcome.
52:23
Amazing.
52:25
Thanks, Jay.
52:26
Now, to our listeners, I hope that you really liked this
52:29
episode with, Dr. Jay Neugarten.
52:31
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52:34
conversation, that you learned how to responsibly also use technology.
52:38
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52:42
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52:44
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52:52
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52:54
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