Latest / Straumann® ProTalk / I learned the most from failures: Dr. David Norre on full-arch dentistry and robotics (video version)

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I learned the most from failures: Dr. David Norre on full-arch dentistry and robotics (video version) · Straumann® ProTalk

0:00
I think with the age you know better what you don't want than what you want.
0:04
Where is the industry going?
0:06
what are for you the big trends?
0:09
So if you talk about dentistry and predictability, I think
0:12
robotics will be the future.
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What do you think is totally over-hyped today and will not be existing in the
0:19
industry in 10 years from now anymore?
0:20
Navigation.
0:21
Because or you're going to do the static or you're going to do robotic.
0:25
I don't see any added value from dynamic navigation if you have a robot.
0:44
Welcome to ProTalk.
0:45
Welcome to the Pulse of the Industry.
0:48
Today, this episode we are recording from the International
0:51
Aesthetic Days here in Copenhagen.
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We welcome, more than 1,500 participants in the beautiful city of Copenhagen, and
0:59
everybody's engaged around the future of aesthetic dentistry, about innovation, and
1:06
about sharing and challenging each other.
1:08
And I think this is also why today's guest is fitting into this very well.
1:15
Dr. David Norre is really becoming passionate when it starts to
1:19
become difficult and thinks ahead, creates new concepts.
1:22
So thinking about the future of the industry, David, you're
1:25
just the right person to have.
1:27
So thanks a lot for joining me today, David.
1:29
Thank you for the invitation.
1:30
Yes.
1:31
David, today we will speak about your journey.
1:34
We will speak about innovation and a bit also what made you come to some
1:40
observations and doing the next steps.
1:42
We speak about digital dentistry, and I'm sure we, have to speak about
1:46
the future of dentistry as well.
1:49
But becau- before we start, David, who is David Norre in one minute?
1:53
Oh, very difficult because I think you have, three Davids.
1:57
Okay.
1:57
So yeah, the father of five kids, so I think it's one of the
2:00
most important parts of my life.
2:02
Then I'm a dentist and entrepreneur, so I don't know if a lot of people
2:06
know, but I'm also co-owner of a DSO, so I also like the business side.
2:10
So but my biggest passion is dentistry for sure, 100%.
2:13
Yeah.
2:13
And
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every-
2:14
and everybody can feel it when you're on stage, David- Yeah.
2:16
Thank you … I have to tell you.
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and today, David, everybody you know, brings you in connection with
2:23
very demanding cases, super powerful aesthetic outcomes, treating failures
2:32
and- creating concepts, but there was a start also with you, David.
2:37
if you take us 25 years back, how did you start your journey?
2:41
Oh, I'm a prosthodontist.
2:42
I don't know if people know that, but I'm- de facto prosthodontist, and, someone
2:47
who was very important in my life was my grandmother, and she taught me two
2:51
things: I'm never rich enough to pay cheap and never treat someone differently
2:58
than you want to treated yourself.
2:59
So when I started, I was always like, I want to deliver my patient things
3:03
I would accept in my own mouth.
3:05
And I try to teach to every student I have is always treat a patient as it
3:09
was your sister, your mother, yourself.
3:11
So I… These two concepts for me is in my life, in everything with my children.
3:15
For me, that's very important.
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That's the most important.
3:17
So if you ask the journey, I will start prosthodontist, and I try to
3:20
be better, and I was not very happy with the implant positioning with
3:25
the surgeon I worked at that moment.
3:27
I said, "Yes, but this one I didn't really want in my mouth. I think I
3:29
can do it better myself." And then I trained in implantology, and it's why
3:33
I grow every day to become better.
3:36
Yeah.
3:36
So you started on the restorative side.
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Yes.
3:39
You went into oral implantology then.
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Yes.
3:41
But I saw you, you've also been active in research in, in, in
3:45
the field of periodontology.
3:46
Ugh.
3:46
I tried a PhD, yes.
3:49
I had an idea that I want to do a PhD. I don't know why, but I started
3:52
a PhD, but it's nothing for me.
3:54
It's too slow.
3:56
I have ADD with ADHD, so it was way too slow for me.
4:00
I could not finish it, so I have a big, respect for the guys with a
4:02
PhD because I couldn't finish it.
4:04
Yeah.
4:04
I think it's the only thing in my life I never finished.
4:06
Yeah.
4:07
it's, too demanding, too slow.
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Too annoying.
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So yes, I did some research, but I stopped it quite fast.
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Yeah, but I think that's also, an achievement in life to, sometimes to
4:18
observe, when there is a path that you don't want to continue following.
4:21
Yeah.
4:21
And, because life is not always linear.
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So I think that's also-
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I think with the age, you know better what you don't want than what you want.
4:28
Yeah, exactly.
4:29
Exactly.
4:30
So if you look back in, into your career, have there been, and I have an idea of
4:35
one person, but have there been some people that have been more influential
4:39
than others to you and that really shaped the David that we see today?
4:41
Yeah.
4:42
Again, there's three people.
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it's not one, just three.
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I know it's my pros- professor in prosthodontist when I was at
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University of Leuven, Professor Naert.
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He was the one who always say, "It's not good enough." He pushed you always.
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He pushed you always better, to be better, more precise.
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He shaped the, the real dentist David.
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Yeah.
4:58
Then Professor Rompen, Eric Rompen- Yeah … who opened a new door for me- Yeah
5:01
… like surgery about gingiva, something I didn't learn at University of Leuven.
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And of course, I cannot forget Papa, Eric Van Dooren, of course, because he opened
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the world in my eyes it was like, whoa.
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I was in Belgium with the University of Leuven, quite cocky university because
5:18
Catholic, so we are the best in the world.
5:20
We went to Liège.
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It, I opened a new door, but still I thought Belgium was like
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the Valhalla of, of dentistry.
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But then Eric opens me the eyes of our Brazilian guys, like I'm sure Gustavo,
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everybody knows Gustavo, Victor, all the Brazilian teams, but also the East
5:36
European team, like Florin- was for me one of the biggest motivators also.
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And now I have a lot of mentors now.
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I have Florin, I have Venci, who's lecturing with me.
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I learn from everybody.
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Everybody on stage, everybody who's asking me something, I learn.
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Yeah.
5:49
Lecturing is about learning because you push yourself.
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And often in courses you receive a question from the audience-
5:56
and it starts you thinking.
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So I learn from everybody.
5:58
Yeah.
5:59
No, that's also my observation, all the network that you just
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mentioned, Venci maybe to add, and Gutto, as you said- Yeah … Florin.
6:05
It, Wael, not to forget Wael- Of course.
6:07
Of course … also.
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you guys, it's like a, a big, let's say, neural network that, everybody's- Family.
6:15
It's family … everybody's learning from each other, right?
6:17
And you guys are so curious and, I understand the point that you said
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before, you're very quick and fast and, move on and have ideas and
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vision, and try to progress very fast.
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So, I, get the point- Yeah … for, from, from earlier.
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So what is it that you learned from Eric Van Dooren, beyond the clinical part?
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I mean about the, the mentoring and teaching part, because he's been one
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of your mentors, and Eric Rompen- Yeah … is another great mentor,
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but let's stay with, Eric Van Dooren.
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Certainly you learn clinical stuff, but today you are mentor to many.
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So what is it that you learned from him?
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For me, it was more like, sharing.
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He's the one who shared the most I ever know.
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So it's never I again, going to word again, cocky.
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He's someone who likes to share everything.
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So he's not too keen to say, "Look to this guy, he's very good." He's the
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one bringing all of us to stage because we're talking about a neural network.
7:10
But basically we are all connected to Eric.
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He was the one who put on stage.
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He's the one who finds talent in his eyes.
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And he push you a little bit.
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He push you very hard.
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He working in my clinic.
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I know Eric very well.
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So he can push you, and if you push back or you continue,
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he will continue pushing you.
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But he can also push people who don't do anything with the push,
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and then- it's not in the group.
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So I think all of us are like, ones who like to be pushed by Eric.
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He's pushing us out of our comfort zone, and when you are out of
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the comfort zone, you learn.
7:39
Yeah.
7:39
And that's Eric.
7:40
He's the one who push you.
7:41
Yeah.
7:42
No, that's a, a beautiful thing to have a mentor like this- Yeah … that, that
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pushes you and that he also gives you the opportunity to shine and to, to, develop.
7:50
Yes,
7:50
because if you ask him something, it's never good.
7:53
And I have to say this is also, and we spoke about this before
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the podcast, David, that's something I observe with you.
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When you're on stage and you do courses, y- you give everything.
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There's nothing you keep back, right?
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And, you share all the tricks and all the, challenges and, also the
8:10
failures you did, and, I think this is why people learn a lot, from you.
8:14
So you're broad, you're restorative, oral implantology.
8:18
you've had this interest in periodontology.
8:20
So how do you look at your implant cases first, as a restorative or as a surgical?
8:27
I receive this question a lot.
8:28
It's what ask people.
8:30
Patient, what does he ask?
8:31
Nobody ever came to me and ask an implant.
8:35
Yeah.
8:35
So how can you do implantology without, looking to restorative first?
8:39
Ah.
8:40
Ah, so this is where you naturally start.
8:42
Always start.
8:42
Yeah.
8:43
So let's speak a bit about a bit you as an educator and as, as a mentor.
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you, were with just about being on stage with Benchy.
8:53
at the Aesthetic Days.
8:54
We saw the rooms quite packed.
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1,200 people.
8:57
Nice.
8:57
After so many years of stage, honestly, are you still nervous
9:00
when you get to go on stage?
9:02
Of course.
9:02
Yeah?
9:02
If you are not nervous… My worst lecture ever Was the one I was overconfident.
9:07
When you say, "Oh, easy. Again, a lecture. I'm used to it." Yeah.
9:10
Worst ever.
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Yeah.
9:11
So if I don't have the feeling, and unless there's a feeling when I go on
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stage, "Why am I doing this?" Yeah.
9:16
"Why do I have this… Why I'm lecturing?
9:18
Why can- Yeah … why can I not stay just in my room and just doing
9:21
patients?" It's just maybe a little bit my dopamine ac- addiction to
9:25
have a little kick to do this.
9:27
Yeah, that's… No, I know what you mean.
9:30
You always have to f- if you don't feel it, you will not perform.
9:33
So when you had this observation, and what did you change?
9:36
what is your routines when today when b- when you go on stage, say, "Look,
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if I want to be at my best on a stage like this," what, are the routines to,
9:45
get you to this point before a lecture?
9:47
Oof.
9:47
Nothing special.
9:48
No routines.
9:49
Just being in the room, and you feel it coming the before you lecture.
9:53
Yeah.
9:54
nothing special.
9:55
I just know that the only thing I say when I go to, on stage is
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that, "This thing is what I want to do, so relax and enjoy." Yeah.
10:03
And then I- most of the time after one minute, it's like I do l- a lot of judo.
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Always doing judo.
10:08
The same.
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I was b- I was very, quite, high in the Belgium ranks and, when I go, battle,
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even if was not a g- a known one, if I was too as, as too self, Confident
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confident- … I lost the match.
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Yeah, and that's a good learning, right?
10:26
There's a- Yeah, big
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learning
10:27
… as usual, there's a huge, transfer-
10:29
Yes … corresponds- And then you learn by
10:30
age … to, to our profession.
10:32
Yes, exactly.
10:32
Yeah.
10:33
Th- then you- Less
10:33
overconfident.
10:34
Yeah, exactly.
10:35
So if, a young, let's say, well-trained clinician- would approach this and look,
10:42
"David, I would like to follow your example, share my knowledge, become a
10:46
good teacher, educator, speaker," what would be your recommendation to this
10:51
person how to get the journey started?
10:54
To be a speaker?
10:56
An educator.
10:56
Oh,
10:56
I think, you should document every case first.
10:59
Train yourself in documentation.
11:01
Documentation everything.
11:02
If you don't have a good documentation, you cannot teach.
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Very difficult.
11:05
So you at least you have cases and, when the young guys in my clinic, are
11:09
coming, I always say, "You are not a good dentist. You can become a good
11:13
one. It takes at least five years."
11:15
So lecturing before you have five-year experience, it's a little
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bit strange because then you come from university, and you have the
11:22
idea that you know everything, and basically you don't know nothing.
11:24
And I know because I'm teaching from 2007 at university.
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I, with, also integration from University of Leuven.
11:31
And, Maybe I was too young in the beginning.
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And now I know I, maybe I told guys things that I don't do anymore today.
11:41
So it's, yeah.
11:42
Teaching is dangerous.
11:43
Yeah.
11:44
Yeah.
11:44
Teach, no, and you need to not only be confident, but there
11:48
needs to be also substance-
11:49
Yes
11:50
… at, the end of the-
11:50
Yes, and know and see what your own problems are and where,
11:53
and learn from your problems.
11:55
I'm asking because I observed a bit also the speaker group here at Aesthetic Days,
11:59
and, you, you mentioned Eric Rompen, Eric Van Dooren as being your mentors.
12:04
But now, there's also, even though, you're still young, but there's already the next
12:08
generation of speakers coming, and they are here on stage that, that they see you
12:13
and Venci and Florin as their mentors.
12:15
And they already start teaching, right?
12:17
So that's why I was asking, 'cause it's very, very
12:21
interesting to, to observe them.
12:22
Yeah.
12:23
Normally I always say, "Don't believe us." I, because dentistry- Stay critical.
12:27
Yeah, because everybody in dentistry, most of the things in dentistry are dogmatic.
12:33
We have a lot of dogmas, and we don't want to become a dogma.
12:36
It's not because I tell something that it's true.
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I believe what I tell today, it's true, but tomorrow I don't know.
12:42
So at least only believe your own eyes.
12:45
That's one thing what I always do.
12:46
Only believe your own cases.
12:48
Yeah.
12:48
Because, you know now with everything within AI, I see a lot of smile designs
12:53
on Instagram were made by ChatGPT.
12:56
So now why would you use a, a, a DSD software or Smilecloud to
13:00
present the case to a patient?
13:01
You can just put in ChatGPT and ask a beautiful smile- and it
13:04
generates it, but it's fake.
13:05
Yeah, and, the world is evolving, The, restorative materials you were choosing
13:10
confidently- maybe 10 years ago-
13:12
Oh, yeah
13:13
… it's very different, right?
13:14
What you do today and the learnings.
13:16
So staying critical, is very important because otherwise, you miss the
13:21
progress, Yes … in, in a way.
13:24
So if the, the 25-year-old David Norre would walk into your door, what would
13:28
you t- would you tell him, "Look, don't waste the next 10 years doing this"?
13:32
Trying to be famous on Instagram.
13:34
Okay, and okay.
13:36
Don't try it.
13:37
Just do your cases, do your case for the patient.
13:40
You can post it on Instagram or not, but it's not important.
13:43
it's something fancy.
13:45
If you want to have a golf score centrum, it's easy to, market your courses.
13:48
It's much easier than before.
13:50
You can become much more popular.
13:52
But you just don't put time on it.
13:54
Just try to do your cases well, document them well- and the rest is a follow.
13:58
And also don't try to earn a lot of money.
14:01
I see young guys now, the biggest difference with my generation,
14:05
they come in the clinic and they want to earn a lot of money.
14:07
I always try to s- to explain them that money is a consequence of an act.
14:12
It's not a purpose of the act.
14:14
It's a big difference.
14:15
And that's a big challenge for the young guys.
14:18
Yeah, I like what you're saying.
14:19
it's not about trying to impress and shine, but doing great work, meticulous
14:26
execution, as Urs Belser said today.
14:29
And then results will come, and with results, then- Results comes
14:33
… everything else will follow automatically.
14:35
I re- I really like this, and I share your philosophy- Yeah … on, on, on this one.
14:42
let's speak about- When it bec- when it gets difficult and then failures.
14:47
It's interesting, I looked at your Instagram profile, and I
14:50
think you have all the rights to, have a, great Instagram profile.
14:54
People ask you also, to, to, to- Yes … be inspired, and it's
14:58
good that you share, what you do.
15:00
But you're not only sharing the great cases, but y- you're writing, "I'm helping
15:06
dentists to master failures, implant cases, and complex cases." And it's okay.
15:11
Everybody would say, "Look, I help dentists master
15:14
implant and complex cases."
15:16
Mastering failures is special, right?
15:18
And, you're very, open about this.
15:22
W- why is it so important for you?
15:24
Everything fails.
15:25
Life fails.
15:26
Everything fails.
15:27
So whatever you do today, it will fail if the patient lives long enough.
15:31
Yeah.
15:32
It will always fail, so it's the, basic of everything.
15:34
Did you ever learn something for what went well?
15:38
I never le- learned something for something what went well.
15:40
I learned the most from failures because then you know, "Oh, what did we do here?"
15:44
Today with Venci, the most epic things we can have is a problem on FP1.
15:48
We love it because then we learn.
15:50
Yeah.
15:50
Again, having a great case is again a nice one.
15:53
Yeah.
15:53
It's maybe… It's not so nice.
15:55
I prefer the failures.
15:56
Yeah.
15:56
So much… You learn much more from failures.
15:58
Yeah.
15:58
So document the failures.
16:00
Yeah.
16:00
And then, and learn from it.
16:02
And learn.
16:02
So-
16:02
That's why… And I think I receive so many messages on Instagram, "Oh,
16:05
thank you for showing cases, failures, because I thought I was the only one."
16:10
no, you're not the only one.
16:11
Everybody has failures.
16:12
No, If you-
16:13
The only one who say, "I don't have failures," or is a
16:15
liar or he doesn't do enough.
16:17
Yeah, Not pushing the limits.
16:18
Yeah.
16:19
No, that, that's for sure.
16:21
No, I like this.
16:21
I think it's also this, you need to also in your practice, establish also, I would
16:28
say, a culture Of accepting failure and, and also l-learning from this and, and,
16:36
not feeling bad about these failures.
16:39
And so we also lose, then the question, how long does implant last?
16:43
Are implants forever?
16:44
Because I know Straumann or big companies say, lifetime guarantee.
16:48
Yeah.
16:48
The patient ask me, "How long, does implant stay? It's for life?"
16:52
I always say, "No, it's never for life.
16:54
You had your own, lost your own teeth.
16:55
I'm not God."
16:57
How can you expect that I do something-"
16:58
Yeah
16:59
… will last forever?" No.
17:00
Of course not.
17:00
It will not last forever.
17:01
No.
17:01
How for you it will not last forever, it means you outaged my treatment.
17:06
But we try to give you 10, 15, 20 years, and then we see afterwards.
17:10
Yeah.
17:10
So that's a little bit the topic of our lecture is give patient 20
17:13
years more of natural treatment.
17:16
Yeah.
17:16
That's the m- biggest, point.
17:18
And I think it's, important that, I hear this also often, and we have to underline
17:23
this to be honest to the patient here.
17:24
Yes.
17:25
You do your best to make it a long-term stable outcome, also the neighboring
17:31
dentition, if you do a single tooth implant, also the neighboring
17:34
dentition is aging and it's changing.
17:37
So, the implant-
17:37
Medication.
17:38
Yes.
17:39
Stress.
17:39
I see a lot of problem with patients with stress.
17:41
Yeah.
17:41
More peri-implantitis.
17:42
Everything go well for 10 years.
17:44
A horrible thing happens to the patient.
17:46
The pa- daughter or son dies, then you, perio starts everywhere
17:50
and again on, on the implants.
17:52
So I think we don't know everything.
17:54
No, and we, cannot predict the future.
17:57
So going back to, failures and what to learn from this, what was… Speaking
18:03
about the STAR concept, we had Wael Art- last year here in the podcast, and we
18:08
also spoke about the STAR concept with him because, I think you had the initial
18:12
idea you brought on- Wael and you guys together developed it and laid a very
18:17
nice, foundation and documentation.
18:21
What was the very first starting point for you when you had
18:24
the idea for the STAR concept?
18:25
what was the observation where you thought, "Look, there is
18:27
something we can do better"?
18:29
Oh, there's different ways.
18:30
The first one was the fact I'm a prostho.
18:33
So at the beginning of my immediate loadings, I do
18:35
immediate loadings for 2001.
18:37
I'm grow with, Nobel time, with all-on-ones, Novum, so I was the
18:41
prostho guy at university doing all these cases, so I become big.
18:44
I, know myself, immediate loading for me is something I always known.
18:48
It's nothing new.
18:48
So it's for me, full arches, I do it for 25 years.
18:52
But the problem was, as a prostho guy, you're sitting next to the surgeon.
18:55
The surgeon do two-hour surgery.
18:57
You are still very eager to do the immediate loading.
18:59
You do the loading because you're full of energy.
19:01
Everything, happens, very easily.
19:04
You're happy.
19:05
The moment I started doing surgery, after my surgery, I want to stop the patient.
19:10
I didn't have the energy anymore to do the loading because I was already
19:13
tired of two hours of surgery.
19:14
Yeah.
19:15
So that was the first time I need to do this better.
19:20
or faster.
19:21
So it's why I start with guides.
19:23
So I start to keep four teeth to have a guide stabilization because we know
19:27
the best guides are tooth supported.
19:29
So before extracting all the teeth and make mucosal supported guide like I did
19:32
for 10, 15 years, we start keeping teeth STAR: safe- three acceptable roots.
19:38
First step, just the tooth supported guides to place six to eight implants.
19:42
Then yeah, we have a guide, then the process why How do we do the plane
19:46
of occlusion, the occlusion with an index and all these things, Gallucci
19:50
guides, but you always have a deviation.
19:52
I was never happy about the midline, so I have to make a second time, a third
19:56
time to have the good, result at the end.
19:58
Then I say, "Can we do it better?" And then if we do the implants guided,
20:01
why don't we do the pros guided?
20:03
And so it's going to further and further into the SAR concept, just
20:07
to have more, say, more convenient, journey for the patient and for myself.
20:12
So you re- literally stacked, the layers of the concept- Yes
20:15
over time.
20:16
Yes,
20:17
and so mental load was a, a, a big driver when I listen to you, right?
20:22
Yes, because when you do surgery, you are
20:22
not like the biggest surgeon in the world because
20:26
you just start doing implantology.
20:28
You are quite stressed about the surgery.
20:29
Yeah.
20:30
The surgery went well, and then you had to do the pickup and everything,
20:33
and it's like,
20:33
" Ugh."
20:34
Which is not a straightforward, clean process, right?
20:37
No.
20:37
No.
20:37
It, No, can be messy.
20:39
Yeah.
20:39
Yeah.
20:39
Even with, if you pick up or you scan it, in the beginning it was like a denture
20:43
conversion system with analog impressions.
20:45
The stitches came loose.
20:47
You have to restitch afterwards.
20:48
Like phew.
20:49
Takes four or five hours.
20:50
Yeah.
20:50
It was quite demanding.
20:51
Yeah.
20:53
Personally, I have to say I'm, about the SAR concept, I'm, very happy
20:56
seeing you guys driving also the adoption of more FP1 treatments.
21:03
I, think from my observation, FP3 had been, the go-to treatment for
21:08
many, in a very unconscious way.
21:11
And, I feel the, the discussion is more about a better
21:14
distribution of FP1, FP3 cases.
21:17
It's about our lecture we're going to show you today in Aesthetic Days.
21:20
The fact is that so everybody say, "Yeah, you do FP1. You are the FP1
21:23
guy." No, I do maybe more FP3s.
21:26
Sure.
21:26
But every patient has an indication.
21:28
We just want to give one option more.
21:30
Yeah.
21:31
Just to be, it's how you're going to show today, the decision making.
21:34
Yeah.
21:34
Is this case FP1 case, yes or not?
21:36
Yeah.
21:37
Maybe trying to go from FP3 to FP1, why would we do that?
21:41
Why would you do a patient with bone grafts- tissue grafts to have an FP1
21:45
when he doesn't smile the tissue?
21:47
FP3 is a very valid option.
21:49
I don't want to be put in the, in the- No … room against a
21:51
fight about FP1 against FP3.
21:52
Exactly.
21:53
Yeah.
21:53
I just want to give the patient an extra 20
21:55
years.
21:56
Yeah.
21:56
That you don't have to remove everything.
21:58
and this is what I mean, I think.
21:59
W-what's your guess how many FP, 1 treatments are possible?
22:02
Is it like 15, 25%?
22:04
It's depending of region.
22:05
In Europe, we are a lot of cla- Class II, skeletal Class II.
22:08
Yeah.
22:08
So these one are more prone to have FP1 in upper jaw.
22:10
If you have more Class IIIs, it's most of the time a contraindication for FP1.
22:14
So it depends on the region in the world.
22:16
So how many of your patients, do you master to have an FP1?
22:20
If it's a filling dentition, if it's a
22:25
filling dentition-
22:26
if they have teeth, 50%.
22:27
Okay.
22:27
If it's a edentulous, it's like more 10 to 15.
22:30
Yeah.
22:30
So in, in summary, th- this is what it's about.
22:33
It's about, being mindful about, is an FP1 possible, then we go for an FP1,
22:38
but FP3 is a valid option, absolutely.
22:40
FP2 also.
22:41
FP2
22:42
as well, but, making 100% an FP3 patient is, that, that's not the way to go.
22:47
But you give them another 20-
22:49
Yes
22:49
… years with doing the right, Yes … selection.
22:52
and I think you, are aware, huh, you, triggered a, a really good conversation
22:57
about, this, let's say choosing the right- treatment for, the right patients, which,
23:02
I think is a good development that we see.
23:06
let's speak about digital a bit.
23:08
my observation is that probably this full arch treatment have,
23:12
benefited from, digital dentistry the most, I, would almost say.
23:17
Would you agree?
23:18
Yes.
23:18
Predictability is- Yeah … much higher.
23:20
Yeah.
23:21
It's one of the reasons that I mainly see Sorry if I'm wrong,
23:25
that FP3 guys who were doing a lot of FP3s are mainly not digital-
23:29
in design and decision-making.
23:32
FP1 is a pure prostho design-
23:35
concept.
23:36
So if you don't do a design up front with the tissue and the
23:38
bone, it's FP3 is much easier.
23:41
It's much easier.
23:42
The loading of FP3 is much easier.
23:45
So I know I'll discuss with a lot of friends in the US and they say,
23:47
"Yeah, but my patient this," because they're not confident that- the
23:50
tissue will heal like we guide it.
23:52
So it's more about this.
23:54
Yeah.
23:54
So digital is more about decision-making.
23:56
Yeah.
23:56
Yeah.
23:56
It's a… But I observe it's, you combine digital dentistry with a,
24:01
a very protocolized, way to do it.
24:05
you always have the, the, the, same rhythm- how you capture data, how you put
24:10
it- Always … into Smilecloud, right?
24:11
So at the end, having this clear protocol, I imagine also makes it, once you have
24:16
learned it and adopted it, makes it very reliable and easy as well, no?
24:20
If you know the constraints of the technique.
24:22
Yeah.
24:23
That's, good, yeah.
24:24
You always have constraints.
24:25
Yeah.
24:25
What are the constraints of-
24:26
If you don't have a papilla.
24:27
Yeah.
24:28
If you have one papilla, you cannot create.
24:30
one I can create, but if I miss six papilla, so why would I create them?
24:33
No.
24:33
FP3.
24:33
Yeah.
24:34
Maybe you don't have a good bone.
24:37
Maybe the bone is too thin.
24:38
Maybe you have a lot of constraints, depending, case dependent.
24:43
Sometimes you have roots who are anchylotic.
24:44
You cannot place the implant in that position.
24:47
Yeah.
24:47
So you always have constraints.
24:48
As long as you know the constraints about the cases, that's the most important.
24:52
And we going to give you a gift, Aesthetic Days today.
24:55
Okay.
24:55
I'm really looking forward.
24:57
And, by the way, to the listeners, we are recording the, the Aesthetic Days- Yeah
25:01
… and we'll also make this available.
25:03
So you have to watch my lecture with Fancy.
25:06
So, these are, of course, patient-specific constraints that, that you have to be
25:10
very mindful in, diagnosing and planning.
25:14
If you look on the, the, flow today in, in your full arch cases with
25:19
the digital technology, what are the steps that today you still think,
25:22
"What is… w- we must do better. There's still too much of a hiccup"?
25:26
My full arch treatments are one, FP1- are only reliable with my
25:32
technician The biggest constraint is my lab tech for everybody.
25:37
Everybody's asking, "Yeah, I want to have the same result as
25:39
you," but it's not about surgery.
25:41
It's not about digital tooling.
25:42
It's about the lab tech.
25:44
He has to understand the concept.
25:46
And, I'm lucky that I tr- that, me and Vensi work with the same
25:49
technician, so he learns very fast.
25:51
He's very good.
25:52
And, that's the thing, if we can have some AI to, follow the ideas he has,
25:57
because he's also very protocolized.
25:59
He's very easy to, follow the concept, but the, the technician has to follow it-
26:04
to understand biology.
26:05
Another problem may be the biggest problem on these big stages of
26:08
dentistry, there is no lab techs.
26:11
They are not here.
26:12
That's, my full agree, yeah.
26:14
And then lab technician follow courses from lab techs, how
26:16
to design an exocad, how to- Yeah … but it's not about biology.
26:18
Yeah.
26:19
Yeah.
26:19
They don't have the knowledge about the biology.
26:21
It's big issue.
26:21
Yeah.
26:23
maybe that's a, a thought we, we can keep when, designing the next,
26:27
edition of the Aesthetic Days together because, we announced this, you
26:32
and Wael will be the host of next year's edition of the Aesthetic Days.
26:35
Yes, yeah.
26:35
And maybe that's a, a flavor w- we should bring in because whenever you
26:40
have pairs on stage, it's, very powerful.
26:43
It's very powerful.
26:43
Yeah,
26:44
because the lab-
26:45
But I think that's a philosophy I also, if I listen to, the community
26:48
we mentioned earlier, around the Smilecloud community, you know, playing
26:54
as a team, is something that is a very strong theme that I think- Yes
26:59
you, you're playing, I think, and making this, very visible.
27:03
let's look ahead a bit, David.
27:06
So w- where is dentistry going?
27:09
what, what are for you the, big trends that, we will see
27:14
coming and at the moment?
27:15
Or what is a big trend at the moment that look this will change dentistry forever?
27:19
robotics.
27:20
Robotics, okay.
27:21
I think, there's a big trend now coming.
27:24
It's still early age.
27:26
it's like I see it like the intraoral scanners-
27:28
who exist from 2006, '7.
27:30
It only at mar- market penetration 2017, I think, '19 maybe now.
27:34
Yes.
27:35
but robotics, I think it will be, the combination that we have today already.
27:39
What's robotics?
27:40
Is static guide and navigation together.
27:43
Yeah.
27:43
Because you don't have the problem from navigation is that you still
27:46
have operator dependent, and guides has its known, issues.
27:52
Yeah.
27:52
So if you talk about dentistry and predictability, I think
27:54
robotics will be the future.
27:56
What is, if you're saying this, what is the, the end vision that you have in mind?
28:00
That you can still have… In my head, I don't think automatic robotics, I don't
28:03
think that's the t- way I want to go.
28:06
But it's like in my car.
28:08
I love my autopilot on my Volvo.
28:10
I love it.
28:11
Just put it on the car, clicked, and then it drives.
28:13
When I want to do something, I can still do it, but I feel-
28:16
Yeah
28:16
that my car say, are you sure you want to do this?"
28:19
Yes.
28:19
this one's something I think it's more I'm a big gamer.
28:22
I like the force feedback joystick.
28:23
Yeah.
28:23
So I would love to have something will guides me follow my plan.
28:27
But if I don't want to follow the plan- ah, I have to… I should
28:31
have the, ability to change it.
28:34
So I would love to have, an enhanced, robotics, like a force feedback robot.
28:39
But in this picture, you stay in the driver's seat in terms of- Yes.
28:42
Yes … receiving a patient- Yes … diagnosing- Of course
28:45
… understanding the patient- Of
28:46
course
28:46
… planning, and you're still also in execution.
28:49
You stay in the driver's seat- Yes
28:50
supported by a device.
28:51
I
28:51
will still do it myself- Yeah … because it's, like a big da
28:55
Venci, someone is still handling it.
28:56
Exactly.
28:57
Yeah.
28:57
I want to have, the, accuracy from a robot, but I want to feel if I say,
29:02
because we know the data is not accurate.
29:04
So I don't-- we have a, we have discrepancy about between the matching.
29:08
Because I don't know everything you have to match, you have a discrepancy
29:11
because our intraoral scans and CBCT are not perfectly matching.
29:15
We know everything has deformation.
29:16
Yeah.
29:16
So it's an approximately matching.
29:18
Yeah.
29:19
And if it's a narrow, thin bone, I would like to see it at least.
29:22
Yeah.
29:22
That, that, that makes sense.
29:23
Yeah.
29:23
Yeah.
29:24
So
29:24
as long as the data is not 100% accurate-
29:26
No
29:27
… I would prefer to see
29:28
it.
29:28
And there's big benefits in guides, but there's also a downside to
29:31
having physical guides, right?
29:33
Yes … getting rid of physical guides is probably also for, for
29:37
your procedures a, a benefit.
29:40
the biggest advantage for guides is that it guides you.
29:42
Navigation gives you an idea, but it doesn't guide you-
29:45
because it's very difficult.
29:46
It's like, for me I'm, you, have to move it, and then you see that
29:49
the arrow is not in the middle.
29:51
Yeah.
29:51
Then you say, "Oh, no." It's an, it's, something you need to be used to but-
29:54
It's a dynamic guidance.
29:55
Yeah,
29:56
yeah.
29:56
Then you can even go if the bone is hard, you can, always go off.
29:59
You know that you go off.
30:00
Yeah.
30:01
Static guide, you're sure you are in a planned position, but if the guide is not
30:04
well placed, the implant is not in place.
30:05
Yeah.
30:06
What, is your hope on AI, along, if you think about along a, a full treatment
30:11
journey from start to finish, what is your hope on AI where I say, "Look,
30:15
I really hope that this AI takes this task away, which I, I don't like,
30:19
or I'm not good at, or whatever"?
30:21
Matching iOS and STL- planning my implants, guide design.
30:25
But I saw today with COPEplanix.
30:27
That's something for me, the close future, that it go very fast,
30:31
instant- Yeah … matching, and then we can export to everything.
30:35
Fast, reliable, cloud-based of course-
30:38
that I can do plannings on, whatever I want to do.
30:41
Yeah.
30:41
That's the future.
30:42
But again, you stay in the driver's seat.
30:44
You have some- Yes … technology supporting you based on-
30:47
Yes … your knowledge.
30:48
Yes.
30:48
You can still change, and you have to approve at the end, but
30:50
you have something that like-
30:52
I think AI can give you 10 years of experience, but I don't think it
30:55
can give you 30 years of experience.
30:59
Thinking.
30:59
Just maybe I'm wrong.
31:00
Maybe in 10 years I would say it gives you 30 years of experience.
31:02
Yeah.
31:04
but it's again about constraints, which means that the AI… if the AI can,
31:08
and should be I think, can identify the constraints and give you some
31:12
treatment plannings- then it can help you
31:15
a lot.
31:16
Yeah.
31:16
Yeah.
31:18
on the flip side, what do you think is totally overhyped today and will
31:23
not be existing in the industry in 10 years from now anymore?
31:27
Navigation
31:29
What do you mean by navigation?
31:30
Than dynamic navigation.
31:32
Dynamic navigation.
31:33
Because it-- or you're going to do the static- or you're
31:35
going to the, to robotic.
31:37
I think s- I don't see any added value from dynamic
31:40
navigation if you have a robot.
31:43
If you don't have the robot, it's too expensive, then you
31:45
have still static guides.
31:47
I think the navigation is somewhere just in between two worlds.
31:50
It's just a step to the robotics.
31:52
So navigation, you mean, you're still having, holding the handpiece but-
31:54
Yeah, do everything and you have to look a mirror how the implant will be placed.
31:57
And by robotics, you mean really you're not holding the handpiece, but
32:00
there's a- No, you can hold it, but you f- you feel the force feedback.
32:04
There's an arm- Yes … exactly that.
32:06
There- Yes … there is a- Yeah … a, a fixed arm- Yes … or
32:08
a robot that gives you the-
32:09
Yes
32:10
… the, this force, the, feedback.
32:12
Yes.
32:13
Okay.
32:13
But I think but I don't know.
32:16
Yeah.
32:17
Okay.
32:17
It's a feeling.
32:18
You, said before also what, I, liked is, you also learn from the young generation.
32:23
What is it that you, learn from the young generation?
32:25
What particular talent do you see in the young generation?
32:28
Because, you see a lot of those guys.
32:30
You do the courses and I imagine usually when they go to your courses, this is,
32:35
probably a very particular curious group of people that you have in the room.
32:42
What, is it that you learn from those guys?
32:43
the g- that you learn from these guys is that you never can, stay for granted
32:48
because these guys growing very fast.
32:49
You have talents everywhere.
32:50
You have very rare pearls everywhere because everybody's saying, "Yeah,
32:55
Gen Z is a lost generation," and all these things, but these
32:58
guys, they are also, be amazing.
33:00
They learn different things.
33:01
They are very good in social media.
33:04
they want to learn.
33:05
Some guys want to learn.
33:06
If you see the, to the Eastern Europe, man, I can give you
33:09
10 names of great dentists.
33:11
They're amazing.
33:12
And, they push you because these guys become better.
33:15
And it's oh, you l- you teach them, you mentor them.
33:19
They are very quick, and they have maybe sometimes better results than me.
33:23
Then I say, "Hola."
33:24
Oh.
33:26
I have to be- Okay … ahead of them- Yeah, exactly … because they are
33:28
pushing you.
33:29
Yeah.
33:29
Yeah.
33:29
True.
33:29
And that's … I love it.
33:30
I love it.
33:31
I love these guys.
33:32
Yeah.
33:32
Yeah.
33:32
And I learned also something from, from the past is you
33:36
always better be surrounded by people who are better than you.
33:38
I think that's the, the biggest benefit of our group.
33:40
Everybody thinks the other one is better than him.
33:42
Yeah.
33:43
So it's why we always become better.
33:45
Yeah.
33:45
Because it doesn't make any sense to stay with people who you think are less
33:49
good than you or don't- Yeah … are so motivated, so- Yeah … if
33:51
the
33:51
young guys are pushing you in the back-
33:53
Yeah
33:54
… ah.
33:54
Yeah.
33:54
That's
33:55
good.
33:55
No, it's good.
33:56
And I, wanna link this also to, to us as an industry, David, because I, you know,
34:03
I see a very dynamic group around you.
34:06
Okay?
34:07
And then a lot of young guys being very dynamic, and they wanna push ahead.
34:11
So as an industry partner, it's sometimes also not easy to, keep following you
34:16
and your ideas and demands, W- from your point of view, what are the topics
34:21
that we as an industry provider should really focus more on over the next,
34:25
years and say, "Look, this, I would wish you invest more into this area"?
34:29
Workflows.
34:30
Workflows?
34:30
Only workflows.
34:32
I think you, with material, you already have everything.
34:35
Okay, we have workarounds.
34:36
We agree.
34:37
Yes, I want to have a longer drill.
34:38
I want to have a narrower sleeve.
34:39
I want to have a longer sleeve.
34:41
I want to have more offset, blah, blah.
34:42
But you have all workarounds.
34:44
But you don't have real workflows.
34:46
What do you mean by workflows?
34:47
it's a topic close to my heart.
34:48
This is why I'm asking.
34:50
Is it like that steps Before and after connect better to each other?
34:55
What do you mean?
34:55
One, for example.
34:57
Or that you say look, patients come in, wh-which things can
35:00
I ha- give to the dentist?
35:02
For example, I saw an AI tool to find courses.
35:05
But I would love to have someone who, where I can put, pictures, X-rays,
35:09
that they give me diagnostics.
35:11
Or I say, look to this," just to, refresh myself.
35:14
So that you put in that, for example, like in Smilecloud, you pu- upload,
35:18
STL cone beams, and that automatically it's putting good diagnostics.
35:22
It would help a lot.
35:24
Automatic connections.
35:25
Yeah.
35:27
helping dentists, for example, if you say, we have a flow to do immediate molars.
35:33
Fast and fix or things like this, just workflows.
35:35
Yeah.
35:35
Develop them.
35:36
And just give a lot of workflows and people can decide.
35:40
I don't think you should say to a dentist, "You need to do like this."
35:42
No.
35:43
Just give them signature workflows.
35:44
Yeah.
35:44
It's like star concepts.
35:45
Exactly.
35:45
It's just a signature.
35:46
It's what I do.
35:47
You want to do it, follow it.
35:48
No.
35:49
But what you cannot do, and as I see often, is they say, yeah,
35:52
but I did it like this way.
35:54
And then say it doesn't work.
35:55
No.
35:56
No.
35:56
Your concept, your workflow didn't work.
35:59
if you have a workflow, you have to follow from A to Z.
36:02
And if you, in middle of the workflow you change and you say it doesn't
36:04
work, come on, it's not a workflow.
36:06
No.
36:06
I
36:06
know.
36:06
I see it every day.
36:07
Yeah.
36:07
No, I agree, but it's, what we have today is we give a lot of freedom.
36:13
So in every step you would have five different ways-
36:15
That's
36:16
why it's not a workflow … to do it, and it's your freedom.
36:18
And in the next step, another five options.
36:21
by 20 steps you have like hundreds or millions- You have to
36:25
have … of permutations how to do this workflow, and it gives you
36:26
a lot of freedom to be an artist.
36:29
But I agree what we are missing is workflows where say, look, you do
36:32
exactly this, and in the next step you do exactly this, and there's only
36:35
one option- Yes … in every step.
36:37
It will in a way limit you, but still there's options.
36:40
It will limit you, but it will also guide you more, right?
36:42
I
36:42
think it's a decision.
36:43
Yeah.
36:43
It's a-
36:43
I think in the beginning, if you have a decision tree to say, "Look,
36:46
what do you want to have?" And it's why I love the stack tool from ITI.
36:49
For young dentists it's amazing.
36:50
It's just click the constraints, click the problems.
36:53
These are the two, three, four options you have.
36:55
Yeah.
36:56
Something like this.
36:57
Yeah.
36:57
It would be beautiful to say you have different concept about full arch.
37:00
Now let's talk about full arch.
37:01
And you say, okay, good, what is the constraint of this case?
37:04
Then click, At the end they say, ah, maybe this case is an FP3 case, so
37:09
you need to do this, and this step.
37:11
You can follow fast and fix or I don't know, pro arch or I don't
37:14
know what the just correct names of star concept is possible.
37:17
Yeah.
37:18
If you don't have teeth, maybe this one is better.
37:20
But if you go far, if you go, let's say star concept, then
37:23
you know this is now- Yes.
37:24
Follow step by step
37:24
… the trail of, steps that, that, you have to, follow, yeah.
37:29
No, I, agree and it's a topic actually, we are working on because now, if we would
37:34
have done this 10 years ago, it would be almost impossible because today it's also
37:38
cloud technology is really enabling us to, facilitate something like this, right?
37:44
Because you need to have a platform that, that- Exactly … connects these
37:48
steps to each other- Exactly … and recommends the right next step to you
37:51
and connects the different software pieces and steps to each other.
37:55
So I, think that's a big step forward.
37:56
Yeah.
37:57
And also we have one big question.
37:59
What material do we use in full arch?
38:00
Yeah.
38:01
Nobody knows.
38:02
No.
38:03
You have 1,000 opinions.
38:05
So maybe in five years we can say you implant this version is like XYZ.
38:10
This material is better choice one because we know it's going
38:12
to give you less problems.
38:13
Yeah.
38:15
Because what's material of choice?
38:16
I don't know.
38:16
Yeah.
38:17
Makes sense.
38:17
But, also for this, I think then we to come with a recommendation,
38:21
we need to have data points.
38:22
Yes.
38:24
do, you measure bite force today?
38:25
No.
38:26
No?
38:27
He's biting very hard.
38:28
Patient can bite
38:30
very hard
38:30
so you prepare for the-
38:31
Night guards
38:33
For night guards.
38:33
Always.
38:35
Good.
38:35
Cool.
38:35
Thanks a lot-
38:36
Pleasure
38:37
… David.
38:38
I know, it's also busy for you here being a lecturer, and,
38:41
you have a big network here.
38:43
So thanks a lot for taking the time.
38:45
I think that was a very exciting, conversation, and I think people, learned
38:51
about you, how passionate you are.
38:54
I, like, how you learned starting from your grandmother that taught
38:57
you some very basic truths, But if you follow those principles, it, it
39:02
will always guide you well in life.
39:05
You had some great mentors, and I think what really stands out, with you is, your
39:09
network and, in this network that, you, you share th- this curiosity to progress
39:16
and to question yourself as well- Yes.
39:18
Yes, for sure … to always question yourself.
39:20
I think that stood out and, questioning yourself, accepting failure as an
39:24
opportunity to learn is in a way the platform also, for, progress.
39:31
so I think that's a, a very interesting journey, and thanks for
39:34
sharing your, vision of the future.
39:36
I think we, we share a lot of this, especially on robotics and on the
39:39
workflows- and yeah, looking forward for a continuous fruitful collaboration.
39:43
So- Yeah, of
39:44
course.
39:44
Me too
39:45
… thanks a lot,
39:45
David.
39:45
Thank you very much.
39:47
Yes, and for all the listeners, if you liked this, episode with David and you got
39:52
some inspiration out of it, go recommend it, to your friends and colleagues.
39:56
And for all the other episode and also this one, we're always happy to
39:59
have your comments, on, on, Instagram best, but you can also leave the
40:04
comments on the, podcast platforms.
40:07
And if you like Straumann ProTalk, go and, subscribe to one of the
40:11
platforms and, follow us and the channel, and looking forward to
40:14
many future exciting conversations.
40:17
Thanks.