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Straumann® ProTalk with Dr. Alex Fibishenko · Straumann® ProTalk

0:00
You graduated from Melbourne.
0:01
You are running a very successful business today.
0:05
What happened in between, what have been the big decisions and the defining
0:08
moments in your career where you say, look, this changed everything.
0:12
When I started dentistry, I became interested in dental implants.
0:15
I thought there must be something better than dentures.
0:18
But really what I do on a day-to-day basis.
0:21
Is is not just dentistry.
0:23
It's really helping patients achieve an improved quality of life.
0:41
Welcome to Pro Talk.
0:42
Welcome to the Pulse of Dentistry.
0:45
Welcome to the ideas.
0:46
We are recording this podcast directly from the ideas, and today,
0:50
this morning we have a guest.
0:51
We welcome a guest that had a long travel to come to the ideas straight from
0:55
Australia, Melbourne, Dr. Alex Fibishenko.
0:58
Good morning, Alex.
0:59
Good morning.
0:59
Yes, good morning, Alex.
1:01
Good morning.
1:01
Great to have you.
1:02
Thanks for making all the way.
1:04
From Melbourne, Australia to the I Ideas and to Cologne.
1:07
Yeah.
1:08
We're used to it in Australia, we always travel very far.
1:12
Everything is far for us.
1:13
First you have to get off the island, right?
1:15
Yes.
1:16
A big island.
1:16
Exactly.
1:17
It's
1:17
not an island.
1:18
It is an island.
1:18
Everything's an island, isn't it?
1:20
That's true.
1:21
So Alex, you are a trained dental surgeon.
1:24
You're focusing on oral surgery, and we will see this on quite complex cases.
1:29
You've been trained and graduated in Melbourne.
1:32
Yes.
1:33
What I found very interesting after.
1:35
You you gave yourself a very extensive training, international residency program.
1:40
You saw a lot of great clinicians and learned from a lot of great clinicians
1:44
like Paolo Malo, Craig m Karl m Andre, tricker, and just to name a few of them.
1:50
James Charles.
1:51
So you embarked on quite a learning journey and since more
1:55
than 25 years you are running very successfully, your own clinic.
1:58
Yes.
1:59
You've been awarded by I have to.
2:01
Look this up by the title of Leading Dental Centers of the
2:04
World, which is very prestigious.
2:06
And in the meantime you are also helping more than 20
2:09
other clinics to be successful.
2:10
And we come to this later.
2:12
So Alex, to introduce yourself.
2:14
Where's your passion?
2:15
Where's your focus today?
2:16
Who is Alex Fibishenko in one minute?
2:18
Look, we're I mean I'm all about the patients and and trying to really keep
2:22
a balance between right now it's about keeping a balance between the family
2:26
and the business and the patients.
2:28
This is sometimes a difficult balance to strike.
2:31
I. But but really what I do on a day-to-day basis is is not just dentistry.
2:36
It's really helping patients achieve an improved quality of life.
2:40
This is what we think about, not just the technical side of things
2:44
or the dental side of things.
2:45
It's more about helping them improve what they do on a daily basis.
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And and it's really.
2:51
Satisfying to do that because you're not focusing on the procedure.
2:55
You're focusing on on the satisfaction that the patient shares with you at the
2:59
end of the treatment, which is helpful not just for me, but also for the staff.
3:04
It really motivates everyone to keep doing better and to keep
3:08
producing these kinds of results.
3:09
So it's it's something that we are always motivated.
3:13
To keep doing.
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And it's something that's taken a long time to to establish, to
3:17
get to that point, to establish point, and to and to perfect.
3:20
And to develop the right team.
3:22
And all those sorts of things are not we try to make it very
3:25
simple for the patient, but.
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Leonardo da Vinci said, simplicity is the ultimate sophistication.
3:32
It takes a lot of sophistication.
3:33
It takes, the people, the processes, the product to, to make it all happen.
3:38
And and but we have it now and it's and it's really right now we're in a good
3:42
place where we have all that, we put all that together and and we can offer
3:46
those type of trans, those types of transformative solutions for our patients.
3:50
Yeah, it takes a lot of dimensions, a lot of topics to bring the success, I imagine.
3:55
But it seems you are very mindful starting with the purpose and with the patients,
3:59
and I think that's really motivating for the team and the people surrounding you.
4:03
That's a very strong motivation for them.
4:07
Today what we will cover is we'll cover very complex, full large
4:11
surgery that you are passionate about.
4:13
We will cover education and we'll speak about your business model.
4:16
I'm very curious to learn more about the way you bring this
4:20
business model to success.
4:21
I think the first bit we heard already, which is the patient and
4:24
the purpose part to, to motivate the people surrounding you.
4:29
So tell us a bit more about your story.
4:31
You graduated from Melbourne.
4:33
You are running a very successful business today.
4:36
What happened in between, what have been the big decisions and the defining
4:40
moments in your career where you say, look, this changed everything?
4:44
I'm not sure if there was something specific that changed
4:47
everything, but I became interested in implants very early on.
4:50
Those who follow me on Instagram and some of the social media that
4:55
would already know this story's already been told too many times.
4:59
But one of the time, one of the important things that motivated
5:02
me was, it was even before I was in dentistry when I was a child.
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My grandmother had this this loose denture that used to traumatize
5:09
me every time she'd fall asleep.
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The denture.
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Would fall out of her mouth because if her head fell back and a denture fall out.
5:15
So as a child, this is like very traumatic to see something I
5:19
can't imagine move in the mouth.
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You don't expect that.
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You expect the teeth to be like teeth and suddenly something moves in the mouth,
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you don't understand what is happening.
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So this was quite quite traumatic for me as a child and when I started dentistry,
5:30
I became interested in dental implants.
5:32
I thought there must be something better.
5:34
Than dentures because she was suffering with that concept.
5:37
And and I I looked, I started looking through studies and research in that area,
5:42
and there was really not a lot around in terms of support or in terms of university
5:47
education or any type of education.
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Actually at that time.
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We're talking 91 to 95.
5:53
Those are the years at university.
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And during that time I was I spent a lot of time, so at the same
5:57
time I was studying, amalgams.
5:59
I was also doing a lot of looking into the research and development in
6:04
the implant world in pathology, and I was motivated by a lot of a lot
6:08
of the people who were actually on the, in the studies during that time.
6:12
And from that point, that gave me a point of where I wanted to go once I
6:16
graduated, who I wanted to visit and where I wanted to go, and how I wanted
6:19
to pursue those further further education and development in my own career.
6:24
And then once I started it was actually difficult to find
6:27
a course to find a mentor.
6:28
I. To find someone to help you to do your first implant.
6:32
And I placed my first implant within within six months from graduating.
6:36
And and within that six months, it took I had to undertake some training
6:40
because there was no training at university, so I had to pursue.
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So I took, I, there, there was really no training available.
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There was only available for some specialists.
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And had to so through the.
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I tried to, I got into some courses and they let me in and together
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with some specialists and I managed to get in and did some courses.
7:01
And then I used to attend every case I used to refer.
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I used to attend together with my patient.
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And I used to watch the case and I used to, that was my condition for referral, to
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learn from the system, to learn from it.
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And I said I would refer the case and sometimes the periodontist
7:14
would say, look, I'm not really, I don't work that way.
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I'm not.
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I don't accept the dentist to come in.
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I want watch the surgery.
7:22
Yeah.
7:23
And I would say, oh that's fine.
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No problem.
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I would refer to another periodontist who would allow me.
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So is also the reason why you embarked on such a significant learning journey
7:31
after with the all the great clinicians?
7:33
Absolutely.
7:34
Yeah, so this, this was the start of very quickly after that I became
7:38
so that's what motivated me to start the training programs because there
7:43
was not a lot available at that time.
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There was some didactic training that has.
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That has emerged over time for especially in Australia for learning the basics of
7:53
osseointegration and things like that.
7:55
But not a lot about the skills and the techniques and and those sorts of things.
8:01
There was not a lot around, especially for general dentists.
8:03
How did you select.
8:04
These people that you learn from, like Pal Malo the M Brothers, Andre?
8:09
Were there like specific techniques you were looking for or?
8:12
Yeah, so those people were generally through techniques.
8:15
With with Pal Malo, there was we at I've attended the the Marlo
8:19
clinic essentially was the for a collaboration on the educational front.
8:24
So we were already doing our, all in four procedures in
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Australia in a different way.
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So our technique is different to the Malo technique, the way we
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do our all in four procedures.
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But he had a very impressive training center in Lisbon.
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And and for me, I wanted it because we were building a a
8:40
training center also in Australia.
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I was quite interested in in what, in seeing the one, seeing what
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they're doing, how they're doing it.
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And also we were building a, a. A bigger training institute.
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So we were interested in doing a collaboration and for
8:56
a few years we were doing a collaboration with Marlo Education.
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So I attended the Marlo clinic for, to explore that collab
9:03
collaboration between our two centers.
9:05
I.
9:07
You also, over the last years, you transitioned from another
9:09
implant provider to Straumann.
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What prompted this change and what did it do to your practice?
9:14
So changing implants is difficult, especially if you are implant
9:20
surgeon and if you are, your staff are used to one type of implant.
9:23
You don't want to have.
9:25
10, 20 different brands on your shelf, different types of implants.
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It's difficult.
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You want everyone to be aware of what they're doing, all the, you
9:33
want your staff to know the item numbers of the implants without
9:36
even looking them up in the catalog.
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So it's a difficult decision and everything changed when BLX came about.
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And BLX was was really a game changer for me because it I recognized very early
9:50
on just by seeing the design without actually even manipulating the implant.
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Just by seeing the design, I became interested in it because I could see
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that it allowed me the control that.
10:01
I always talk about in all of my lectures, I talk about, in my
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training, I always talk about control.
10:08
Keeping
10:08
control.
10:08
Yeah,
10:09
keeping control.
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You have to have control of the surgery.
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You can't just put the implant in and hope for it to integrate.
10:17
Hope is unreliable.
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I want to control the surgery.
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So you control it through the technique, you control it.
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Also.
10:24
This became now.
10:26
The possibility to control it with the implant.
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And that implant gave me the ability to have that additional control.
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So that was, that, that was very impressive for me.
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And as soon as I started using it very quickly, I realized that
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control was indeed possible.
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It was possible.
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And I have there is of course, a protocol that you need to follow, and
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I have modified that protocol in a number of ways over time because, you
10:49
can, that implant is very versatile.
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I also like the fact that it's got it's rock solid and it's and it's got the
10:56
SL active surface, which is a very well documented and a very and a surface, which
11:01
can be used in many situations in patients who are diabetics who are smokers.
11:06
We don't advocate for patients to start smoking, of course, just to test
11:11
the surface, but in case it helps us.
11:14
Yeah.
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But but.
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We do ask our patients to quit, but we don't.
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But it's nice to have an implant which has a in the literature or some
11:22
track, a surface with a track record of a better success with, in those
11:26
types of more challenging situations.
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So that's really helpful.
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It's also got a very nice.
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Platform shift.
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The platform shift is allows for a more soft tissue biological space.
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For the soft tissues which is nice which means that the bone can retain itself
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over time for a much longer duration.
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And not, and that's a big advantage.
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And, so this is the reason why I decided to switch to BLX.
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That was, those were the main types of reasons
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the.
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Personal.
11:56
Alex, how do you keep balance?
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You are very busy.
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You are an international speaker.
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People ask you on stage you do a lot of education yourself, training you,
12:06
you have one clinic running yourself.
12:08
You have some others that you are supporting heavily.
12:10
How do you keep balance?
12:12
It's that it's tough.
12:14
It's tough.
12:15
The good thing is that over time you get quicker.
12:17
So I'm able to helps help.
12:20
Yep.
12:20
Knock off surgeries very quickly, so we're able, so when I am on, I'm on,
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I do a lot of surgeries and we can and the patients get treated very
12:30
quickly and then and in between.
12:32
So I, I don't actually only work four days.
12:35
I dropped Fridays.
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Probably about six years ago, I stopped working Fridays altogether, so I only
12:41
work, I only see patients for four days.
12:44
So I always tell everyone I, oh, I dropped Fridays.
12:47
I don't work Fridays anymore.
12:48
But my wife always goes back behind my back and just says he dropped Fridays,
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but he picked up Friday, Saturday, and Sunday for doing more work,
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for doing more work, for preparing courses, for working
12:59
on the business, for doing, on
13:00
the education, on that side of things.
13:02
So from that perspective it is difficult.
13:04
But but look, you try to do your best.
13:06
This is it's it motivates me to, it's what's kept me I think when I'm when
13:10
I'm not doing things like you get bored.
13:12
Yeah.
13:13
So I'm one of those people.
13:14
I just need to keep doing things.
13:15
So yeah.
13:16
Any
13:16
routine
13:17
for mental health that you developed for yourself?
13:21
I think just to keep moving.
13:22
I think once you stop, you just there's a risk there.
13:25
But look, mental health is I have friends who who suffer from mental
13:30
health and I'm very I. Sensitive to that.
13:32
It's a problem in our profession and it's something that we need
13:35
to be aware of and we need to support our colleagues, of course.
13:38
And and this is this is an illness that needs to be recognized and dealt
13:43
with, but I don't at the moment, I don't have a great deal of it.
13:47
Maybe a little bit of it in the background, I don't know, but I'm
13:51
just trying to be too busy to.
13:54
To have a focus on, on, on that part of my, yeah.
13:59
Before we move over to your passion, which is complex full arch
14:03
rehabilitation you spent two or three days, I think now on the ideas and
14:07
the ideas is a place of innovation.
14:09
What stood out for you?
14:10
Anything that you, I. Would underline.
14:14
Firstly this thing is massive.
14:15
This idea s and is just, I've never expected to be this.
14:19
It is this big, is just overwhelming.
14:21
And I am, I'm just so impressed this Straumann booth and the lecture for
14:27
unbelievable what you've done here.
14:29
So really congratulations on this.
14:31
You are like standout here at the IDS.
14:33
This is really a great achievement to.
14:35
To have this type of to be seen in that way in the ideas, which is so massive
14:40
and Straumann stands out in such a way.
14:42
But what stood out for me look, I think just the variety of the new.
14:48
Introduction of products and and the range of products that you have for going
14:54
from implants themselves, but also now to integrating the digital workflow to
15:00
having like on the bench printers and and scanners and all that sort of stuff.
15:05
I think it just gives the patients this.
15:07
It gives the dentist this opportunity to provide these types of solutions and work
15:12
with a partner who not only provides them with the implants themselves, but now can
15:17
also support them in those other ways.
15:20
And I think partnerships are important.
15:22
So if you develop a partnership with a brand, with a company that.
15:27
That helps you in one aspect.
15:29
I find it's always nice to grow that relationship as much as possible.
15:33
And if they can provide other stuff as well, it's important to cherish
15:36
and to grow that relationship as opposed to having a hundred
15:40
relationships with many other companies.
15:42
So I think it's really nice that that Straumann has that view
15:45
to introduce introduce other components to, to what they do.
15:50
And a lot happened, this idea.
15:52
Yeah, that was a very good week.
15:54
So maybe let's move on a bit to one of your big passions
15:57
fixed full arch rehabilitations.
15:59
Yeah.
16:00
And you, you gave a bit of insights on how you came to Implantology, but I think from
16:04
that point on, it developed much further.
16:06
You're a world leading specialist actually, of very.
16:09
Complex rehabilitation.
16:11
You treat patients with severe bone atrophies and if anyone looks at your
16:15
cases before and after, I believe that these are really life transforming
16:20
interventions for the patients.
16:22
Where we started with you're looking at.
16:24
Trying to achieve a goal for the patient.
16:26
I think that really materializes with the searches you're, you are
16:29
doing, what brought you to this step.
16:31
These are probably one of the most complex interventions that you can do.
16:35
And it's a lot is at stake.
16:38
Yeah.
16:39
How did you come to that point?
16:41
To actually be specialized in those kind of very complex treatments.
16:45
I just want to clarify firstly that I'm not a specialist.
16:48
I'm a general dentist but I do specialize in a very specific type of treatment.
16:54
So I do a I spent I. For the, for many years already, because there
16:59
is no specialty in dental implants.
17:02
Dental implants is is something that the periodontists, the oral
17:05
surgeons, dentists do as well.
17:07
And it just depends on the type of training that you receive and
17:10
who you receive the training from.
17:12
So I'm not a dental specialist as in a registrable specialty.
17:16
But yes, you're quite right that my, my practice is very
17:19
focused on a very specific area.
17:21
Which is full arch and not only full arch, but also full arch surgery only.
17:26
So that's what I do on a daily basis is the actual surgical component.
17:30
And today most of what I do is the complex cases because I am also supported.
17:35
I'm lucky to have around me other associates who do all
17:39
the simpler types of cases.
17:40
So I end up with the more complex types of cases.
17:43
But how I ended up.
17:45
Here is that it is through that model of of when we started our our business.
17:50
I know you were gonna get to the business side of things a little bit
17:53
later on but part of that model was to.
17:56
To develop a relationship with people where I can help them achieve certain
18:01
goals, but then they would help me also take less responsibilities in the
18:06
early stages and the simpler cases so that I can do the more complex cases.
18:10
So that was part of the plan from the beginning.
18:13
So now I end up.
18:14
With only the most complex cases.
18:17
And and for me, this is fine.
18:19
This was something that helped me in my, in the growth of my
18:22
own skills and my own career.
18:24
So I don't mind the simple cases.
18:25
The complex cases don't stress me out.
18:27
What causes me the stress nowadays is to do more with dealing with people
18:32
and the business side of things, not so much the surgery itself.
18:35
In fact, the surgeries are the most relaxing part, my interesting day.
18:39
Okay.
18:39
From the outside.
18:40
I yeah.
18:41
I can follow, but it's probably.
18:44
Quite exceptional that you can relax during such a surgery.
18:46
So
18:46
yeah they're complex surgeries, but the sur there is no complexity
18:50
that it's all in the planning.
18:51
So if you plan and you've prepared for it, and you know what the limitations are,
18:56
and you accept those limitations because sometimes you can't achieve something.
19:01
So the worst thing you can do is that try to achieve the unachievable.
19:05
And then fail.
19:06
So you know you're gonna fail, but if you're prepared for that,
19:09
if you already know you won't be able to achieve it, then you will.
19:12
Y you will try to do something that you can achieve and you then you will succeed.
19:17
So that's what I do on a daily basis is I look at the plan, I reevaluate it even
19:22
before surgery, during the surgery, and I always make those changes to make sure
19:27
that we achieve a successful outcome.
19:29
So I don't always rigidly stick specifically to what I planned,
19:33
just because I planned it that way.
19:34
We always are.
19:36
I always try to, I. To be open to what I need to do to achieve the
19:41
success for that particular case.
19:43
Always bearing in mind the cons, the original basic concepts of implantology.
19:48
This is not a mechanical process, that we're not putting screws into concrete,
19:53
we are, or into timber, into steel.
19:55
We're putting screws into biological tissues.
19:58
The tissues.
19:59
They need to heal around the implants.
20:02
And it's not just something that happens once, it's something that
20:04
recurs, it keeps on happening over time.
20:07
And we need to not only achieve osseointegration, we have to maintain it.
20:11
Maintain over time.
20:12
Yeah.
20:12
So these are the concepts that I think about the very, very basic
20:16
concepts of osseointegration that I think about in every case.
20:20
When, whenever I do surgery in the planning and then.
20:22
As I execute the treatments
20:24
in terms of learning and adaptability, I think this is something very innate
20:28
to you and I vividly remember one of your lectures in Konos where you quite
20:33
openly shared your learning curve over the last one and a half decades on these
20:38
complex procedures, and you gave also the audience a chance to understand that.
20:42
You.
20:42
It's not something that you learn one day and then it remains.
20:45
You have to constantly evolve.
20:47
And one of the things that struck me, and you mentioned it also in the
20:50
beginning, is how important the team is.
20:53
Maybe you can speak a little bit more about how you design your professional
20:57
environment for success, because I know you have a purpose-built practice, but
21:02
I think there is much more behind that.
21:04
This actually, continues success.
21:07
Happens.
21:08
Yeah.
21:09
So you need to have people that that can support you and that you can trust.
21:13
This is really, this is critical to have people you can trust.
21:17
And obviously they need to be skillful enough.
21:20
Some of the people that I didn't think were going to turn out as the most, as
21:24
the best kind of nurses have ended up being my senior surgical assistants.
21:28
And didn't show a lot of promise at the start, but.
21:31
Ended up being stars in the end.
21:33
But look it's staff is difficult.
21:35
Dealing with people is difficult.
21:36
Knowing who is the right person is a difficult thing.
21:39
But it's something that we try to also promote from within the clinic.
21:43
So people start with in other areas which are the most simpler general dental areas.
21:48
And then slowly they try to reach a point where they can.
21:52
Help with surgery.
21:53
They need to fully understand, we do all our procedures fully sterile,
21:57
so they're like heart surgeries.
21:59
They're like fully sterile procedures.
22:01
These are not the way that that the procedures are done in every practice.
22:04
I'm very conscious of that.
22:06
I have seen this is not the way that many practices are set up.
22:08
That are fully sterile, but this is just the way we do things.
22:11
We also do things under general anesthetic.
22:13
So this is this is something that was critical for me that I recognized
22:17
very early on that for patients it was important for the type of workflow that
22:21
we do and the speed that we do it in.
22:24
It was important for our patients to receive the
22:27
treatment while they're asleep.
22:29
And s. Sedation was problematic because sedation from my perspective,
22:36
is like a general aesthetic.
22:38
But on a l, on a, it's much less safe.
22:41
Less deep.
22:41
No, it's less deep, but it's also less safe because it's unprotected airway.
22:47
So the only difference between general anesthetic and sedation
22:53
is the protection level.
22:54
It's the same drugs, it's just.
22:57
Your airways not protected.
23:00
So we use general, an anesthetists in an environment which is like a hospital
23:06
and an aesthetic nurses, and then we.
23:08
Produce this environment where it's a hospital environment for the patient.
23:13
So it's very safe and it's much safer than doing it like under sedation
23:17
where the airway's not protected.
23:19
And you can inhale, you can drop in, you can drop components, or water can trickle
23:23
down into the throat, into the airway.
23:26
So we created that very early on we wanted to make sure that this forms
23:29
part of our workflow of being able to create this 24 hour final teeth.
23:35
General anesthetic provision of a general anesthetic was a very
23:38
important component of that.
23:40
Building facilities.
23:41
So part of our.
23:43
Business model and growing it is that all our associates, all our partner
23:47
clinics, they need to have access to these types of environments.
23:51
So either they need to invest in their own facility and expand.
23:56
And we have a branch of our business, which helps them expand into the
24:00
general anesthetic side of things.
24:02
And, so yeah.
24:04
So this is how we try to collaborate with our partners.
24:08
Very impressive.
24:09
So you basically control or try to control as much as you can from
24:13
anesthetics to, to clinic out layout and also then staff selection.
24:17
Yeah.
24:17
And I have to say, also we're talking about we're covering those
24:22
specific elements, but there's so much more that goes into it.
24:25
Of course, it's the laboratory support.
24:28
One of the points.
24:29
Yeah.
24:29
One of the biggest challenges I find that some clinicians raise with me is
24:34
they feel like they can't do it because they don't have a laboratory on site.
24:38
But things have changed.
24:40
We now have access to full digital.
24:43
You can now do a fully digital workflow.
24:46
You can do what I do.
24:48
And use any lab in any part of the world.
24:51
And the only timeframe that's going to be the delay is the freight.
24:55
So even if you have a laboratory which is 50 kilometers away,
24:59
it's still going to be okay.
25:01
You don't, doesn't have to be on site.
25:02
Even if you have a laboratory in the next city, even in the next country,
25:07
you can get it delivered the next day.
25:09
So as long as the laboratory understands the steps that need to be done.
25:14
Today with a digital workflow, you are able to use any facility because
25:20
all the information is now digital.
25:22
So you're able to create the same, you don't need to have a laboratory on site
25:25
to be able to do exactly what I do.
25:28
That's a perfect segue also to talk a little bit about digital workflows.
25:32
You are very digitally equipped, so what has been the game changer in
25:37
the last, I dunno, two, three years for you in terms of digitalization
25:41
of your clinical operation?
25:44
I think the introduction of, intraoral scanners was nice, but
25:48
the intraoral scanners initially had a limited application for
25:52
us until we had photogrammetry.
25:55
So photogrammetry was really what changed everything for us because
26:00
with with the digital scanner, especially the first models.
26:05
There was also always a concern with how accurate it is for a full
26:10
arch restoration, in my world, there is no levels of accuracy.
26:16
There is only one level.
26:18
It's either accurate or it's not accurate.
26:20
There's no different levels.
26:22
It can't be 90% accurate.
26:23
It is either accurate or it's inaccurate.
26:26
So with the digital scanners, there was there was always because the way
26:31
that the that it works because of this technology and the images put together
26:35
that there's always a discrepancy and we.
26:38
With photogrammetry because you're not relying on combining images together.
26:43
It's a very accurate, precise way to connect the, to take a correlation
26:49
between the implants to each other.
26:51
So once that came about, I. Then using the intraoral scanner together with
26:57
photogrammetry then enabled us to move into this fully digital workflow.
27:02
And it's worked particularly well with our with my specific workflow from
27:07
which we've been doing for many years, which is the workflow of maintaining.
27:11
Certain teeth as references so that those teeth are used as references for
27:16
positioning the implants in the best possible spot so that it's comfortable for
27:20
the patient and that very same technique that I advocated so many years ago.
27:27
It's still now useful for the digital workflow because it enables this
27:30
correlation from the preoperative work to the smile design and
27:35
to the implant positions now.
27:38
Yeah, that, that's a very interesting topic also then, looking at the
27:41
future what are your predictions?
27:43
Could photogrammetry be actually made obsolete by more and more
27:46
precise interoral scanners?
27:48
And would that be a benefit?
27:50
Look I think
27:51
photogrammetry has, it needs to become cheaper.
27:56
It needs to become cheaper.
27:57
And because the problem with photogrammetry is
28:00
that it applies for people.
28:02
For people like me, photogrammetry is an investment that's worthwhile.
28:06
Because we do a lot of implants.
28:08
We have multiple photo multiple scanners.
28:11
These, the cameras.
28:12
And and so for me it's absolutely worthwhile.
28:15
But for a person who might do only a few implants, a few full arches in
28:19
a year it's additional investment.
28:21
It's a big investment because they don't do any other dentistry with this device.
28:24
It is only purely for implants.
28:26
So it is a difficult decision to come to make this type of investment.
28:30
So something has to be done about that.
28:32
But I think the concept of photogrammetry really makes sense.
28:36
And I think in my personal view, I understand that there is a lot of emphasis
28:41
on on digital scanners and all that sort of stuff, but I still feel at this point.
28:47
Photogrammetry is still the strongest and the most accurate, the most
28:52
precise way to record multiple implants to each other, especially in
28:56
an arch when we're talking about two implants separated only by by a space.
29:01
One space.
29:02
That's one thing.
29:03
But when we're talking about a full arch, that is a completely
29:06
different ball game, and I think.
29:09
From my perspective today, photogrammetry is still the most accurate way
29:14
to be able to achieve accuracy.
29:17
Maybe last question we, we could still continue a long time for
29:20
very interesting, but what's your opinion on subpar steel implants?
29:25
So sub steel implants is I've read about them.
29:28
I've seen them.
29:29
I have not personally done them, so I don't have any experience with them.
29:32
So I couldn't comment from a from an experience viewpoint.
29:36
I. Generally, I think there is a place for any treatment.
29:41
Look it's obviously been done many years ago and it's making a little bit of a
29:45
comeback in some parts of the world.
29:47
And some people, including myself, just feel like maybe it's a reinvention,
29:52
trying to reinvent the wheel, trying to reintroduce something
29:56
that has already been tried before and with certain improvements.
30:00
But I think why not?
30:01
Yeah.
30:02
There are if there are improvements, if there are ways to to achieve another
30:07
outcome for those patients who are severely atrophic or patients who are
30:11
not able to get standard implants.
30:14
Why not explore treatments that have the ability to give
30:18
patients a fixed prosthesis?
30:21
And there has been some technological advances in the last, 10 years
30:25
that really make this potentially also more precise and less prone
30:29
for let's say complications.
30:31
So yeah.
30:32
Interesting area to explore.
30:33
Yeah, if that's if the complications that are known in the past can be
30:37
reduced, that would be a great advantage.
30:40
The same thing happened with zygoma implants.
30:42
So with zygoma implants the reason I was reluctant to be using them for a long
30:47
time was because the technique was wrong.
30:49
I was not supportive of the technique.
30:52
I could not inflict this on my patients to do this procedure on my patients.
30:59
When we started to, I. To get into Zygoma, I actually developed the technique.
31:05
I improved the technique to a point that I considered that
31:09
it was going to be appropriate.
31:11
It was going to work in the same way that standard implants
31:15
would work in my practice.
31:16
So I took models, I took skulls, and I tried to refine the technique
31:21
to a point where it could work.
31:23
And this is when we started to do.
31:25
The zygoma treatment, and that's when they started also to improve
31:29
the surfaces, to improve the the way that these zygoma implants are.
31:35
A maid and and especially with the introduction of the Zaga implants
31:39
I became, obviously it's a lot it's more it's a, you can be a lot more
31:43
confident putting the implants in.
31:45
So with those improvements, zygoma now is something that is a predictable treatment.
31:51
It is something that's, you don't have to be skeptical about it, like you
31:56
were with the older, the techniques.
31:59
And in the same way with the subperiosteal implants, if those
32:02
complications, if the technique can be adjusted the complications
32:06
reduced through the technique and through the design of the implants.
32:09
Because with Zago and both things happen, we change the technique.
32:13
And we changed the design and the product design.
32:15
So both of those things changed and that hugely improved the outcomes.
32:20
And if both of those things can be done with superior steel implants, especially
32:24
for those types of patients who are severely resolved and pa possibly
32:29
patients who have had failures with zygoma as a failure, they can't have
32:33
other treatments then for those patients.
32:35
Absolutely.
32:36
Either against dentures.
32:37
So for those patients, who would,
32:39
that's the last land of resort then.
32:40
Yes, for those patients, let's switch a bit to your.
32:43
Business for to the business side, which I think is very exciting
32:46
to, to speak about this with you.
32:48
Yeah.
32:48
So I understand you have a, you're running a big clinic in Melbourne,
32:51
which is, I think the heart and soul of what you're doing.
32:54
How big is this clinic?
32:56
So the clinic is, it hub big in space.
32:58
It's got a two theaters and and four other operatives.
33:02
So it's not a massive clinic, but it's more of a training center as well.
33:06
So this is where we do all our residency programs.
33:10
We've got a training so the theaters are big because we we allow for 10 to.
33:15
12 people to be able to attend Shadow.
33:18
Yeah.
33:18
And to attend the surgeries.
33:20
And to participate during the sur the actual sur surgery itself.
33:24
And then we have a conference room where we've got the
33:27
lectures and the presentations.
33:29
And we've got the onsite laboratory and and the car spaces.
33:32
And we're currently going through a process where we're building another
33:35
theater with five additional recovery beds and all that sort of stuff.
33:39
This is just happening now.
33:40
We're just about to start this construction as well.
33:43
But I also work with so this is my.
33:46
Clinic.
33:47
And I, like I said, I work there four days and but I also work
33:50
with, within other clinics where we establish this connection.
33:54
We attach an annex a a facility, a general anesthetic or
33:59
something like that where we can.
34:01
Produce the same types of treatments local to the patients
34:04
so they don't have to travel.
34:05
We used to see a lot of patients traveling from all over Australia
34:08
and all over the world, actually into Melbourne to receive this treatment,
34:12
but now we can offer it locally.
34:14
So we use our brand name, we use our brand strength, we use our all
34:19
of our the system and and we now.
34:22
Offering it in more and more locations so it's convenient for the patients.
34:26
So these are also full large centers using your name, using your concept.
34:30
How many are those?
34:31
How many are you doing?
34:32
There's 23 in Australia.
34:33
Two, three, okay.
34:34
Yes.
34:34
So all over the country.
34:35
Yes.
34:36
And we're actually going through a process now where we we have now
34:40
the ability, because part of the concept of this network of clinics is.
34:45
Is the training and the systemization of the clinics.
34:49
It does, it takes time to onboard new clinicians.
34:52
I can imagine that.
34:53
So it's not something that that can happen, that we can just sign up
34:57
every clinician that's interested.
34:59
It does take some time and it takes effort.
35:01
But now we have a team, which is dedicated.
35:04
To that.
35:05
And we also have additional also we have all the associates who are now,
35:10
who've been with us for more than 10 years, who are now senior associates,
35:14
they're also helpful or also, and then they're also trained, are able to train.
35:20
Other associates are newer, and so everybody's now helping
35:24
to try and grow the network.
35:27
How is the model built from, let's say, from a relationship perspective?
35:30
Is it fair to say it's a franchise model?
35:33
Is the clinics owned by these associates or.
35:35
Yes.
35:36
So it's precisely how it works.
35:39
I don't own any of those clinics.
35:41
Those are independently owned clinics and they're essentially
35:45
become part of the franchise.
35:47
And what I. When they become part of the franchise, they get
35:51
access to the systems that we have and the resources that we have.
35:55
The systems involve firstly a the brand name, and and the next thing is going
36:01
to be the the resources which include, all of the the protocols and and we
36:08
have a patient management system as well, which allows the the communication
36:13
and collaboration with the patient, the production of the treatment plans,
36:17
the, production of risk profiling for the patient so that the clinician
36:22
and their staff are able to actually create a risk profile for any patient.
36:27
And that, that is a software.
36:29
We actually have as many software developers in my team as we have dentists.
36:35
Really?
36:35
In my team.
36:36
Yes.
36:38
So it is really a focus so that you want to get to this risk
36:40
profile of the patient Yes.
36:42
To continuously also.
36:43
Evolve and become better as a group?
36:45
Yes.
36:45
The risk
36:46
profiling is really important because the data can be collected from different
36:51
points of the patient's journey, and every time you collect a certain data,
36:56
any part of that data can sometimes be critical to the patient's risk profile.
37:00
So it's important to draw that data from the right points and to use an
37:05
AI generated tool to be able to create that risk profile and to be able to.
37:10
To show it not just to the patient or to the dentist, but also the treatment
37:15
coordinator to the other collaborators, to the anesthetists so that everybody's
37:20
aware of what are the factors surrounding the management of this patient.
37:26
You're
37:26
probably seeing a lot of patients with comorbidities, right?
37:29
Yes.
37:29
That's, so the patients that come to you, they're, these are complex also general
37:32
health topics that you have to consider
37:34
of Yes, and sometime and quite often.
37:36
I, if you just come with a comorbidity or a certain problem, it would be a hard no.
37:41
But once you've got a system which can evaluate everything else, then you
37:46
can see that there are ways around it.
37:48
Yeah.
37:48
There are ways to overcome certain things.
37:50
And
37:51
so you are back to the topic of, controlling, knowing the risks.
37:54
That's right.
37:54
And being able to control them.
37:55
Yes.
37:55
It's all about
37:56
control.
37:57
Everything we do is about controlling the outcome.
38:00
Makes a lot of sense for the patient.
38:01
Yeah.
38:03
I could continue on the other half an hour to speak about your business
38:06
model, because I know also you are very strong in terms of the marketing
38:10
side and patient marketing side of it.
38:12
Yes.
38:12
But I would like to move on to the topic of education.
38:14
I looked into your Instagram channel, which I would recommend
38:17
everybody to, to follow.
38:18
It's a very interesting and lively Instagram journal, and there was one
38:22
format that you know, particularly caught my attention, which was the
38:26
plan and recap format where Oh yeah.
38:28
Which I find a very interesting, educational.
38:31
Snippet, let's call it.
38:33
Yeah.
38:33
So how did you start this and why do you do this?
38:36
The plan and recap was something that it just came about
38:39
randomly because we just did.
38:40
There was a period of time where we, we suddenly got inundated with questions
38:45
about, so this case that you did this and that why did you change it?
38:49
And then there was other questions.
38:50
People started, a lot of people questioned why I made certain
38:54
decisions during the surgery.
38:56
And I thought because of the consistency of the questions being asked, I thought
39:01
it would be nice to maybe just regularly talk about certain cases and talk about.
39:07
Why I, why we plan certain things and then why I change the plan during the surgery.
39:14
Why, what are the reasons to change it?
39:16
Because that's really important.
39:17
Some people feel like some surgeons are feel like they're obligated.
39:22
To fulfill what is, what it is that, that they promised on the
39:27
treatment plan for the patient.
39:28
So if they said they're gonna put four implants on a patient that is, that
39:32
means they have to put four implants because that's what they plan to charge.
39:35
But I have a different perspective.
39:37
I feel I'm obligated to fulfill what I promised to the patient, which
39:40
means to get them a full set of teeth, not to get them the four implants.
39:45
So I need to do what I need to do to be able to establish that.
39:49
I need to achieve those parameters.
39:51
I need to, if I need to put an extra implant in, if I need to undertake certain
39:56
amount of grafting, if I need to do some other procedures, I will do that and
40:00
I will change that with no hesitation and the patient is aware of that.
40:04
So it's all about setting the patient's expectations before
40:07
the surgery so that you are free to do that during the surgery.
40:11
And then.
40:12
Make those changes.
40:13
I really like it because it's a very short and crisp and
40:15
regular way of, educating people.
40:17
But I know you have much more depth to this.
40:20
You do your master classes and I think the lighthouse format, and I think
40:24
everything seems to come together.
40:25
I. With you your purpose, the passion for this, complex rehabilitation, your
40:30
passion for education, everything comes together in your full large summit that
40:35
you created that is happening every year in Konos or every two years in Konos.
40:39
And we are really the.
40:41
The community of, these people that, that are professionals and doing this whole
40:45
large rehabilitation are coming together.
40:48
How did you come to this idea and what can people expect from the
40:51
next summit happening in 2026?
40:53
I.
40:53
So look, originally the McKenna Summit was designed for the people who attended
40:59
my residencies in the early days.
41:02
They wanted to come back for another residency, for another program, and
41:05
we couldn't accommodate them because we already had residencies booked for
41:09
other countries and for other people.
41:12
So I decided, look, why not just make one conference, which is more involves
41:15
everyone just slightly bigger conference.
41:18
So it was so we decided, okay, if we're gonna do that, then why not do it in
41:22
a, an exotic location so that people can also bring their families, they
41:26
can to make a little bit of a holiday out of it and they can interact and
41:31
with the other people who attended because they all have similar interests.
41:35
So that was the idea, is to focus on the people who.
41:39
I had a relationship with already.
41:41
But very, so the first Ano summit, we had 70 people.
41:44
And that was that was really nice.
41:47
And then, but then everybody else started to hear about it
41:51
and started to want to come.
41:52
And how come we didn't know about it?
41:54
And why didn't we?
41:55
That's the best recipe, best feedback.
41:57
Where did I, why was, didn't I read about it?
42:00
Where was it?
42:01
Why wasn't it advertised?
42:02
Why wasn't this?
42:03
So then we decided to open it up.
42:05
Then the next time it was double the size.
42:08
And of course, last year it was the third McCan of summit.
42:10
It was again, double the size.
42:12
It was the capacity which was 250.
42:15
And and already for the 2026, we had the pre-registration and
42:19
that is already almost so the pre-registration is almost full.
42:22
Yep.
42:23
So that means as soon as we fill the hotel that completes the pre-registration,
42:27
we'll then open the registration, but then they will not have a guaranteed hotel.
42:31
They will have to stay in other places.
42:32
Wow.
42:33
But this, the theme for this year is, so last year the
42:36
theme was the digital workflow.
42:38
And all the speakers that I selected were more focused on digital workflow and with
42:44
all kinds of surgeries for full arch.
42:47
So it's always full arch.
42:48
Next year we're going to try and have a little bit of a spin on complications.
42:54
So we want to try and have preventions of prevention, of complications
42:58
and management of complications.
43:00
So I'm going to talk to speakers who are who are going to add value in that
43:07
area on management of complications and.
43:10
Prevention.
43:11
No, very much looking forward to this.
43:13
And I think it's a great format also for, I would say a very specific field of
43:18
indications where I think it's great to bring all the greatest clinicians of the
43:21
world together into a beautiful place.
43:23
I. So starting with the idea series, we created a new habits and we invite
43:29
our guests also to ask a question.
43:31
And I know you brought a very interesting one, Alex.
43:34
Yes.
43:34
Let me have a look at my phone because I think I had a couple of I have
43:38
posted oh, you even posted them.
43:40
I have posted some questions.
43:43
For some.
43:44
For my community to see if anybody else has any types of questions for you.
43:50
And I think,
43:56
right.
43:57
So one of the questions is to do with, do you have any plans for any
44:02
type of expansion in the portfolio?
44:05
In Straumann?
44:06
Any further?
44:07
Many, yeah.
44:08
Maybe I can take this question then you extend Andreas.
44:10
We see this type of fixed full art rehabilitation as
44:13
something very important.
44:14
So there is a own development stream, so we call it innovation
44:18
clusters, where we work on those.
44:20
Kind of products that are specifically needed.
44:23
And to also be honest, we were not the first one to be the
44:27
best one in this category.
44:29
We had to learn quite a bit.
44:30
And it takes a bit of time to also, raise to to level
44:34
expectation of these complex cases.
44:36
But we see potential in further developing let's sayari good implants.
44:40
We see potential in further developing also sarcoma implants.
44:43
And as we discussed before, there might be an opportunity for sub pair steel implants
44:48
for specific cases as technology evolves.
44:51
For example, also very accurate.
44:53
Cts combined with additive manufacturing or hybrid manufacturing
44:58
opens up new possibilities for.
45:00
Really providing to you as dentists that do those special cases, the
45:05
oratory, to treat these patients and really help them to go through this
45:10
life-changing experience for from having no teeth to having fixed teeth again.
45:15
Yes, I. Definitely there is a lot that is ongoing with us, but yeah.
45:19
That's nice
45:19
to hear because like it's like I said, it's it's always preferable
45:22
for for a dentist like me or anyone out there to try and consolidate
45:26
their, especially if they do a lot, is to consolidate their everything.
45:29
With, to partner with one trusted.
45:32
Partner.
45:33
And and if you're able, if you're able to then expand to the option of Al implant
45:38
and also at the same time maybe offer some training, some of the questions were
45:41
also to do with education and training.
45:43
That I noticed some of the questions in the on Instagram were
45:47
in the poll that we're asking.
45:48
Yeah.
45:49
So if you can incorporate some training in that area as well where
45:53
that would be important, I think.
45:55
Yeah, no, we are super strong believers in, pushing the boundaries
45:58
and evolving technologies.
45:59
And there, as George alluded, we have a lot of ideas, but always combined
46:04
with really, let's say, world class education and where we need people
46:08
like you and other great clinicians because we cannot deliver this.
46:11
That's where we need thet and a lot of other skilled clinicians to provide
46:16
this education because only then.
46:18
You can be successful as a clinician in, in, especially in
46:21
cases like you are doing them, huh?
46:23
That are really world changing.
46:26
So for me today, what stood out?
46:28
I have to say, I, I met a very passionate person, a great clinician.
46:32
I think you are very purpose driven.
46:34
I like this, Alex.
46:36
I think it's a way where you start, grabbing the motivation of the people
46:40
surrounding you, that, that are the fundamental for your success.
46:43
And you have this passion for evolving and for changing lives of people.
46:48
Which is I think a great purpose to have, and I like your purpose of
46:53
or your passion for education and evolving the field and, helping the
46:57
people around you to evolve and to be, become better clinicians over time.
47:01
Thanks a lot for being with us.
47:02
It was a very, I. Exciting 45 minutes with you Alex.
47:06
Thanks To make all thank.
47:07
Thanks so much, Lord
47:08
Alex.
47:08
And can I just plug something very quickly?
47:10
Sure, yeah, absolutely.
47:11
So we've got ano summit happening is going to be between the fifth
47:15
and the 10th of July in 2026.
47:17
Like I said, the pre-registration is almost full.
47:19
I think there's a few more spots.
47:21
If anyone is interested, probably in the next two weeks it will be finished.
47:25
So please put yourself on that pre-registration list.
47:28
The wines who on the pre-registration will be guaranteed a room
47:31
within the conference, hotel.
47:34
Anyone who's not successful in the pre-registration will, will have to
47:37
wait for the registration to open and there will they might not be
47:40
able to get a room in the hotel.
47:42
They will need to get elsewhere.
47:43
So fifth to 10th of July.
47:45
You can't miss that one.
47:46
And I think you already know it's limited to 250 people.
47:50
It was full.
47:51
Last time it will be full again, even quicker this time.
47:54
So get yourself on it if you want to be in it.
47:57
And hope to see you there.
47:58
So thank you very much guys also for this opportunity.
48:00
No thanks.
48:01
And I can only underline what you said and recommend for everyone that is
48:04
interested in this field of complex, full large rehabilitation to sign in for Konos
48:09
because you will not regret being there and learn a lot from great clinicians.
48:12
I know that.
48:13
So thanks a lot, Alex, for Thank you for being there.
48:16
Thanks a lot for listening in to our listeners please continue to sub
48:19
subscribe to our podcast so that you're not missing the next episodes as well.
48:24
And if you want to engage with us, if you wanna ask some questions,
48:27
if you have some comments, we are always very happy to have them on our
48:31
Strongman Global Instagram account.
48:33
So thanks for listening in.
48:34
Thanks George for co-hosting, Alex.
48:36
Thanks and hope to see you soon.
48:38
Thank you.
48:38
Was a pleasure.