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Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today.
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Mastering Aesthetic Case Selection
Transform your dental practice by mastering the art of aesthetic case selection and treatment. The Pacific Aesthetic Continuum (PAC) offers a unique approach to aesthetic dentistry that revolutionizes how you identify, present, and deliver smile transformations. This comprehensive overview walks you through everything you need to know to successfully navigate aesthetic courses and implement what you learn into your practice.
Aesthetic dentistry often seems intimidating to many practitioners, but the PAC methodology breaks it down into manageable levels that build upon each other. Level One focuses on straightforward 10-unit veneer cases, perfect for addressing issues like discoloration, black triangles, diastemas, or worn teeth. As you gain confidence, Levels Two and Three introduce functional components, allowing you to tackle complex occlusal issues alongside aesthetics.
What truly sets the PAC experience apart is its focus on three essential elements: systems, vision, and encouragement. The systems provide step-by-step protocols for case selection, patient presentation, laboratory communication, and clinical execution. The vision comes from working alongside experienced clinicians who've built thriving practices centered on comprehensive aesthetic care. The encouragement creates a collegial atmosphere where participants support each other, making the learning process enjoyable rather than stressful.
Patient presentation represents a critical skill you'll develop through the program. Through strategic photography and communication techniques, you'll learn to help patients recognize aesthetic issues they've become habituated to over time. When patients see their magnified smile on a screen, they naturally become curious about possible improvements. This approach transforms the conversation from "selling" to simply offering solutions for problems patients now recognize themselves.
Ready to expand your practice horizons? Join us to discover how aesthetic dentistry can revitalize your career while providing life-changing results for your patients. The skills you develop won't just enhance your technical abilities – they'll fundamentally change how you practice dentistry and the impact you have on your patients' lives.
Hey everybody, dr Michael Miyazaki, again here with Garrett Caldwell, ceo of the PAC and Core Dental Lab, and this video or this recording is going to be about case selection. So the Pacific Aesthetic Continuum we refer to it as a PAC that is kind of powered by the laboratory work of Core Dental Laboratory puts on live patient courses, and one of the questions that we often get is what kind of patients do you treat? How do I find a patient? How do I present this to a patient? And so this recording is going to answer all those questions. You know, why should you be interested in taking a live patient treatment course? And if you're going to take one, why the Pacific Aesthetic Continuums course? And what will you learn when you take this course? And then how to pick a case. We'll talk about case selection. Then from that we'll talk about once you have the case selected, kind of logistics. So once you select a case, then the way that we work at the pack is you would have somebody look at that case, an instructor or the course director, who would then approve the case. And then, once it's approved, what we're also going to talk about today is how to get your records together to send that case to the laboratory to get everything set up. So when you do the live patient treatment preparation session together as a group, that everything is ready to go. So this is really kind of the nuts and bolts of just the preparation.
Speaker 1:I know when people take these courses and Garrett's seen this happen over the last 30 years you know there's always a little trepidation Should I sign up? Should I not sign up? What's it going to be like? How do I prepare? So this time that we have during this recording is really to answer those questions and make it so the whole experience becomes enjoyable.
Speaker 1:We're going to stress on how, when you take a course from the Pacific Aesthetic Continuum, you're really learning the systems of how to approach a case like this and that's what makes it, I think, a lot less stressful. We'll talk about the vision. One of the things that you get working with your instructors and the mentors and the course directors of these courses is you get to kind of listen to their vision that they have for their practices and many times that their vision is much different than the average dentist's vision and so they are able to achieve, I think, above average results and then the encouragement you know whenever you learn something new. You could study this course on YouTube and not have any encouragement and you really don't go anywhere. And what the Pacific Aesthetic Continuum Experience is really all about is everybody is there to encourage you, to help you actually achieve success, and so that's what this program is going to be about. Garrett, I know I did a lot, so what thoughts do you have?
Speaker 2:For our viewers and the thanks. We're looking forward to presenting this because, like you said like you said, mike a lot of our doctors have questions and they want to know about these, this case selection, what our group's about what's exciting about tonight is viewing this, is we're doing it with our actual students that will be coming into the next three courses. So, if you're viewing the video, understand that this is actually being presented for doctors that have already signed up for the program this year, in 2025.
Speaker 1:Yeah, yeah, you're absolutely right. This isn't going to just be a recording. This is going to be a little bit of of we can have some live interaction, because we will have. We've got, uh well, we finished one course this year and it was held in sacramento area. Then we do have a group, but the that we'll be doing in, uh well, late summer I guess that's the bay area, and then we have another group that we're going to be going through in Sacramento later this year, and then another group that will be working in Chicago. So 2025 turned out to be a pretty busy year, which is a good thing.
Speaker 2:Yeah, and we could have. I'm not sure how many are attending tonight, but we have a large group of doctors that are very interested in answering that question how do I select a case for a program and what's the program all about? And so this is going to be a great introduction video for anybody considering the programs.
Speaker 3:Yeah, we hope. Hopefully it's good.
Speaker 1:All right, so now we'll get into it. Ok, so I'm going to get started. Just to kind of give you a little bit of the background about this evening Is this presentations about preparing for the live patient aesthetic mini residency. So many of you already know what these courses are about. They're live patient treatment courses. They're the Pacific Aesthetic Continuum is providing the instruction and then CORE Dental Lab is providing the dental work, and so we have the lab technicians with Core. We have Gary Vaughn and Ryan Core.
Speaker 1:On this evening we have Jimmy. Jimmy organized our Bay Area group. So thank you very much to Jimmy for doing that. And what I'm going to go through is talk about case selection, what we look for, what kind of cases are ideal for these live patient courses, what we look for, what kind of cases are ideal for these live patient courses. Then we are going to talk about how to present the cases to your patients so that they cannot not do the course with you. And then we'll be talking about lab communication, because the lab communication part is how to get ready for the actual preparation session. So by the end of this presentation, hopefully we'll get all done in an hour. Hopefully all your anxieties and trepidation are all kind of set aside and you'll feel very comfortable about saying, yes, I'm ready to take the course, I'll be able to find a patient, and this is life-changing dentistry, so I'm really excited about presenting this to you. So I'm watching as I'm laying more doctors in. We're almost up to 30 tonight, so that's that's a great number to have. So let me jump ahead and we'll get started now.
Speaker 1:Okay, there we go, and I can't. I'm trying to get rid of that, trying to erase that I want to erase. So sorry about that squeaky line up there. All right, oh, let me just check. I'm just checking chat. It's going through. Okay, cool, all right.
Speaker 1:So one of the things that dentists sometimes will say is I don't have patients that need any aesthetic work. And I will tell you one of the things that you'll learn from this course is, once your eyes change, you'll see a ton of patients that need aesthetics, and aesthetics I'll talk about it can mean a lot of different things today, but if you can, if your eyes can see this and you can actually do the work, it will unlock this goldmine within your offices, within your practice, and if you're an associate, it's going to make you so much more valuable. If you are a practice owner, you're just going to have greater revenue. So we hope that that's what you experienced from the course. And I don't know Garrett. I know I didn't introduce you. We have Garrett, the CEO of Coral Dental Lab and the PAC, so just want to say hi, garrett. So everyone knows who you are. You're the important person here, all right.
Speaker 1:So one of the things about this course is to prepare you to do aesthetic work, because, again, a lot of doctors will tell me I don't have patients that need this type of work, and that's. It's not that their patients don't need this type of work, it's just that the doctors can't see the opportunity to recommend this type of work. Their hands aren't trained to do this type of work, and that's what this course is really all about. So I want you to remember a couple of things. What the pack is really about is to give you systems, and I'll explain those systems to you during this next hour is provide you with the vision. As I was saying, you're going to be around other clinicians that are doing this type of work all the time, and so, even when I same thing, I fall into the rut of doing my regular dentistry and then I hang out with the instructors at the pack and I hear the type of dentistry they're doing and it motivates me to do more of this type of dentistry. And then the other thing is you can take, you can read the books, you can watch webinars and YouTubes and you can get some of the information, but the thing that you don't get is you don't get the encouragement.
Speaker 1:So what the pack is all about is to encourage you. It's not like going back to dental school, nothing like that at all. What we're going to do is we're going to work together as colleagues. We're going to share ideas, we're going to share how to to achieve success, and from that our heart gains a lot of joy. I'm going to see if I can. Sounds like there's dishes being done there. We go, all right.
Speaker 1:So once you can do this type of work, you change lives, because if you've ever done an aesthetic case, like a veneer case, patients will come back and every time they come back and they tell you how much they love their smile and they give you hugs and kisses. Almost every time they come back, every six months, you get more positive reinforcement. It's really fun, you know. Know, when you do a root canal on the crown, you're lucky if they ever mention that to you again. So, um, doing aesthetic work is is really kind of refreshing. So the more you learn, the more you'll see, and then the more you'll do. We can guarantee it. So, systems, vision encouragement that's the key part of what the pack's all about.
Speaker 1:So you look at these veneer, veneer pre. So on the front, two teeth 8 and 9, we have crown preps and we've had some soft tissue recontouring. If you look at the other parts of this, sorry, we've got the conservative veneer preps with slice preps on these laterals. So you can see it's a very conservative veneer prep but we have slice preps. And then, as we go through, here we have a cuspid with a chevron on the other side. Let me let me go to a pointer and let me go back. So here we have a cuspid with the chevron. Here we have a cuspid with a bevel. Here we have two crown preps because we took off two crowns. Here you have the soft tissue recontour and the soft tissue dot laser. Here you have the cuspids with the chevron over the buccal cusp, all things that we talk about. Here you have the cuspid with the elbow. So hopefully those are things that you already know, but if you don't know those things, those are all things that we'll cover as we do the course. Let me see I got to admit more. We have surpassed the 30 mark, I think now Getting really close. All right, yeah, we're at 30. So these are all the things that we teach during the course, all the little nuances of the preps.
Speaker 1:And the other big thing is we do 10 units. So a lot of us don't do 10 units of dentistry on a regular basis, but in this case we're able to do 10 units and it kind of expands what you see as what's possible in your practice. So why do you want to do this type of dentistry? Because it's really fun. We get back, maybe, to our first molar when we're doing an aesthetic case, but we're usually not trying to work on a second or third molar.
Speaker 1:Everything today is aesthetics. If I place an implant, it has to be aesthetic. If I place, if I'm making a denture, it has to be aesthetic. If I do a composite, it has to be aesthetic. So we talk about color, we talk about contour, and this type of dentistry, as I mentioned, is what really changes patients' lives. It also allows you to make a better living because instead of doing one tooth dentistry, you're doing tooth dentistry, which ultimately makes you happier, and I don't know. We have a great time. We've got friends that are lifelong friends that we've made through our experiences with the Pacific Aesthetic Continuum.
Speaker 1:So this course, I really believe, will change your career for the better, change your life. You can reach out to any of these people and ask questions, material questions. My periodontist reached out to me today, asked me about composite glaze. It really you become this collegial body of clinicians. So that's why I'm encouraging you all to take these courses. But the next question is well, what kind of cases do I treat? And it sort of depends on where you are. So I want to talk about case selection. Oops, sorry, the case selection.
Speaker 1:We've got three different levels. Level one is just your straightforward aesthetic improvement. So typically what we're going to do is we're going to do 10 aesthetic restorations, so 10 veneers. Level two is we're looking at the aesthetics, but we're also looking at possibly make a functional improvement. So level two doesn't necessarily have to involve functional improvement, but oftentimes it does. You have that patient that has that worn dentition and you want to place veneers on their upper arch but they've lost vertical. So what you're going to do is you're going to restore their vertical the anterior posterior position of the mandible against the maxillary restorations to improve the aesthetics, level out the occlusal plane and ultimately it may require that you do two arches. But in level two, what we do is we do two arches and two different visits. So the first appointments we would do the upper arch and the second appointments we do the lower arch.
Speaker 1:Level three is where we do aesthetics and functional improvement. But we just treat two arches in one visit. So we set the case up, we prep out all 28 units and then we bond all 28 units in a different session. So it's really a lot about efficiency setting up the cases so you understand the occlusal outcome that you're you're you're looking for and then working with the lab to achieve that. So I'm going to really focus on level one mostly today.
Speaker 1:That's just a straightforward 10 unit aesthetic restorations. So level one again, it's just straightforward aesthetics Somebody comes in, you can have a crown in that, in those 10 units you can even have two crowns. But try not to do 10 units of crowns, because most of you learned how to do crown preps in dental school, but you didn't learn how to do veneer preps in dental school. So the more veneer preps we have a chance to show you how to do all those different types of preps, I think the more you'll get out of it. So the more of those 10 units that are veneers, the better you know. Preferably you're going to do 10 units of veneers, but if you have a crown here or there, that's fine. So this is Angelo's case. I just threw this in here, angelo, because I think you did a wonderful job. But he was in our Sacramento course and if you look, the top two pictures are his pre-op photos and the bottom pictures are his post-op photos. Really nice job. Angela's going to be on that instructor track for us because he does a great job, handles the patients really well and knows everything.
Speaker 1:So, level one we go through photography, smile design, talk about case presentation, lab communication, materials, treatment planning. Are we going to do no prep, minimal prep or just a full prep type of case With conservative set of preparations? We talk about the elbows, slice preps, bevels, the chevron, shoulders, the bicuspidization of molars. We could talk about midline shifts. We talk about soft tissue recontouring, multi-unit temporization and multi-unit cementation. So level one has a lot in it. This was Dr Yazzie's case, the patient on the left-hand side. He had two crowns on eight and nine. So we did those two crowns, the veneers across the upper, and then during another session did the tenuants on the lower anterior. So down here you see he has this nice smile that he's always wanted all right.
Speaker 1:Level two and three two arches typically treated for aesthetic and or functional reasons. Level two again is a full arch prepped and seated and then typically what we'll do is we'll place a lower orthotic, and a lower orthotic may not mean a lot to you right now but don't worry, we go through that during level one. So you know how to prepare for level two and three. Level three is doing both arches, top and bottom, where we prep both arches in one session and then we seat both arches in a. During a cementation session we use an orthotic with these two levels, two and three, to to determine the bite position and confirm that we have a good, stable position to restore patients to. One of the biggest parts of levels two and three is how we communicate to the lab, how to set our cases up, because this is a big part. Prepping out 28 units and cementing 28 units is one thing, but being able to work at the lab so that everything goes smoothly, you know, that's kind of the important part of what we can learn in the course. I'm just looking down, I'm going to take one little. I'm just checking the chats to make sure I'm not missing anything. Okay, good, all right.
Speaker 1:So level two is just a two-step full mouth rehab. So what we talk about is a TMD examination. We have to be really thorough to make sure we have the patient set up right. We then take a bite registration, get the patient orthotic to confirm we have the bite right where we need it to be. We then select the smile design. We do a full mouth diagnostic wax up. So lab usually waxes up the upper and lower arches.
Speaker 1:During the course we talk about how to prepare the upper arch, how to temporize the upper arch. But one of the big things is how do we record the bites? We don't want to lose that maxillomandibular relationship. And then we will typically prep out the full upper arch 14 teeth, typically in one session, fabricate an orthotic on the lower arch and then the patient will come back, will bond in those top 14 minutes and then sometimes make a new lower orthotic.
Speaker 1:So this was one of the patients during the last course. You can see Vince has a kind of reverse smile line so the doc had to level out the upper arch and the lower orthotic is in the mouth right now. So if you look at on the left-hand photo how the lower teeth had that wear, we don't see that here on the right-hand side because there was a lower orthotic and these were the photos taken during the cementation session. So the patient's still kind of getting used to everything. But just want to show you how that works. So in level two we cover everything that we covered in level one. I know kind of reinforce it. But now we stress more occlusion, bite registration and the use of orthotics. We talk about the bite transfer, the bite registration and then how to prep everything out.
Speaker 3:Doctor, I have a question. Yes, so I have a patient that's upper and lower. We're going to have to do it for this sessions, so does that means that I will do the first 10 unit first and then use the level two for the second? Uh, or do you want me to complete both upper and lower in one sessions?
Speaker 1:no, you know I, you know you don't have to do upper and lower in one session. So yeah, we'd probably do like that. We'll look at the case, but we probably do the the 10 uppers first and then do the yeah, okay, okay, Thank you.
Speaker 1:No, thank you. So then level three again is just to show you what we're stressing the TMD exam, and then now it's down here on the bottom prepping out 28 teeth in one session and bonding in 28 teeth in one session. So it just depends level one, two and three. You know to what extent you want to carry your learning experiences. We have a lot of doctors that will do level ones five times. You know all they want to really do is just do aesthetic cases. They don't want to worry about the occlusion and so. But they want a lot of experience, and so what they'll do is they'll come back and do level one and level one, level one and, and that's fine. Then we have other doctors that want to learn how to do level two and level three. So it really, um, you can take this to whatever level you want to involve yourself with. So this was a case that was done in the PACS level three course, where the doctor came in. He had this patient with this very worn dentition, had lost vertical, and then the doctor figured out the occlusion and on the right-hand side, the day that the case was seated, that's what you see over there and so it made a huge change within this patient's smile, patient's life. So that's the type of dentistry If you want to go to level two and three that you can take, this education. So that's just kind of a so we covered is why I think it's really important to take this type of training. And then I just want to show you how the different levels work One, two and three. Don't let it scare you. You don't have to do two and three if you don't want to, or some of you will find it very exciting and some of you will get in there and say, okay, I don't want to do two or three yet. But when you get really comfortable with level one, you'll say, okay, now I'm ready to go level two. And then, when you get comfortable level two, you'll say, okay, now I want to go level three. And that's where it gets really exciting, because I think it We've all been there.
Speaker 1:When I took my first live patient treatment course, I remember I had never worked on 10 teeth at one time, like if I did a three-unit bridge or maybe I'd done a five-unit bridge in my career. That to me at the time was a lot of dentistry and I remember I signed up to take a live patient treatment course and I was getting ready to go and I thought, wow, I'm going to have to work on 10 teeth and I get three hours of time to do that. I've never done anything like that before and once we got to the point where I took the course, nothing in dentistry was ever the same. After that Everything else seems so easy. It's like, okay, I'm just doing 10 now and doing 28. Okay, I'm going to do 28 units. But when you reach this level of comfort where you understand how to change things, what you need to change and how to plan for that change, it does take all that anxiety out. So tonight we're going through the orientation.
Speaker 1:After tonight's presentation, hopefully you have a better idea of your case selection then how to present that case to your patient. So patient says I'm ready to go. Then, if you are doing level two or three, we would have you figure out their occlusal framework scheme. So if you're doing level two and three, we'd have you get the patient orthotic and then do case approval. So at that point you go to your instructor, mentor or the course director and have the case approved and then what we do is we send that case to lab to have everything, all the workup done, then the first session. So the sessions run in two days.
Speaker 1:The prep weekend we have day one, which is a lecture about what we're going to do when we get into the clinic, and then day two of that session we do the live patient treatment. What I recommend the doctors do is, after we get the temporaries in the patient's mouth, get the patient back a week later just to be sure that they like the way everything looks, they like the way everything feels and kind of get the patient's approval to move on Session two. What we do is it's two days again. The first day of that second session we go through multi-unit cementation as far as lecture. Then day two we do the live patient treatment, where we're going to bond all the units in and then at some point after that we usually do a case review where we talk about what we learned from the cases that we did and then the doctors will then progress up to the next level. So it is really fun. It's just friends helping friends. It's nothing like, as I mentioned before, our experiences in dental school.
Speaker 1:So today I'm kind of focusing on the top part just how to get through those first lines, everything up to that preparation lecture. So here we're talking about level one, two and three. So the difference is in level one, usually we take three hours. Level two is four hours. In level five, we're doing both upper and lower arches. We take five hours.
Speaker 1:What I would do in all three levels is encourage you to find a patient that is super cooperative, right, you don't want to have somebody that is difficult to work with, constantly talking constantly, have I put down? You don't want to have somebody that is difficult to work with, constantly talking constantly, have I put down? You don't want TWB, which is teeny, weeny bladder disease. You know where, every every five minutes they're, they're like, oh, can I go use the restroom? That type of thing. So you don't want it to have a patient that makes it difficult for you to focus on what you need to do. You want somebody that's periodontally healthy. Why is that? Because if their gums are swollen or if they're bleeding, you're not going to be able to place your margins exactly where your margins need to be and if, when they come back for cementation, if there's a lot of blood or saliva all over, you're going to have a really hard time doing your cementation, isolating that area, so you don't have blood going up underneath your margins. So you need to have a cooperative patient, somebody who basically just sits in the chair and says, hey, doc, I trust you and you know, and all the other docs that are going to be coming in, they don't mind us talking over their mouth, so to speak, as as we're doing the work and that the periodontally and TMJ occlusally stable. So level one, because we're only doing the anterior, usually the upper 10 anterior teeth. You want to have stable occlusion. Level two and three if they don't have stable occlusion, even if they've got TMD symptoms, that's okay, because what we're going to do is we're going to use the orthotic to stabilize the bite and then we're going to rebuild their bite to that orthotic bite. In all three sessions we can do soft tissue gingival recontouring.
Speaker 1:Level one, as I mentioned, we prefer you do veneers. Level two and three can be really a combination because when we start doing 28 teeth, you could have bridges, you could have crowns, you could have veneers. We're really focused on bite management more than veneers. We're really focused on bite management more than veneers. Veneers were level one. So level one, as I mentioned, when it comes to crowns and bridges. Try to avoid bridges because you'd rather just focus on smile design and veneers. So try to keep even the number of crowns to a minimum. Whereas in level two and three, doing crowns and bridges or even implants, you know that's okay. Level one try to stay focused on veneers.
Speaker 1:Level one again, just to kind of quickly review we cover photography, small design, case presentation, lab communication, materials, conservative site preparation, saw tissue, econ, terrain, multi-unit temporization and cementation. Level two all of the above from level one, but now we really get into occlusion bite registration and the use of orthotics how to do the bite transfer, how to use a bite registration stent, how to prepare the entire upper arch without losing the bite, how to temporize the entire upper arch and then how to do full arch cementation and deal with an orthotic again. Level three is everything that you learned in level one and two occlusion. But now we're working two arches, temporizing two arches and cementing two arches, and then we'll go deeper into chronoplasty, which chronoplasty for me is really all about. It's equilibration, but maintaining the anatomy and tooth shape of the restorations. So I'm very excited to get into all of that. All right, now you're going. Okay, I'm going to sign up right. I need to reinvigorate my career. I need to take my career to a different level. This sounds great because these are friendly people. We're going to have a lot of fun together. And now I understand.
Speaker 1:Level one is really about aesthetic cases. So now I want you to think about the cases you have in your practice. Do you have somebody wants color changes? You know where? They've got dark teeth and maybe they have tetracycline stain. And they've come to you before and they said, hey, I'm tired of my gray teeth, my brown teeth, can I have that Hollywood white smile? They would be perfect.
Speaker 1:Let's say you have a patient that has some black triangles in between their teeth and you've thought about maybe doing it, doing closure with composites. But they've got a lot of them and they want to change the shape of their teeth and the color of the teeth. That would be great. Let's say you have somebody who has diastemas and they you know they they have done, or they don't want to do, ortho, or maybe they've done ortho and now they have diastemas. That would be perfect. If you've got a patient that close this up. If you've got a patient that close this up. If you've got a patient that has rotated teeth and they don't want to do ortho, hey, we can prep those teeth and make them look straight.
Speaker 1:If they've got a midline discrepancy of no more than four millimeters, we may be able to correct that midline discrepancy if it's really bothering them. It's kind of that Tom Cruise type of issue. If they've got peg laterals or they've got some small teeth and, you know, just not a very aesthetic smile because of the tooth size discrepancy, that would be a perfect case. As you saw before. If they've got the reverse smile line where their anterior teeth are worn and look short, that would be a good case. If they're class two or three possible cases right. So you know your instructor or your mentor would be somebody good to say okay, here's my patient, what do you think Would this be a good case to do? And if you have patients, sometimes they've got a lot of composites in their anterior teeth and when they smile they might even have composite veneers that would be an okay case. If somebody has a lot of porcelain veneers, those are a little bit harder to take off, so maybe not as ideal, but if they've got like a lot of composite restorations, we could probably deal with that.
Speaker 1:So any questions on. On case selection, we're pretty open to things as long as it's, you know, reasonable. The only caveat I would tell you is sometimes I get doctors who they want to bring their worst patient to the course because they figure, well, I'm going to bring the worst case, because I've got help to do this case, so I'm going to bring the worst case. Usually doesn't work out too well, not that we can't get through the case, but it's not easy to do and we do have time constraints, you know, during these courses. So don't try not to bring your worst case. Bring one that you can manage within the time frame of the course. Anybody have any questions or tips? You're all good, all right.
Speaker 1:So I just want to explain, because I told you how we all we're all very collegial. You know the way the leadership part works is we have the doctors and team taking the course and then we have the instructors and the mentors and then we have the course director and and the only reason there's a little bit of a hierarchy levels there is that if the doctor has a question, the instructor is probably going to be able to answer that question, but if the instructor instructor is stumped, then we go to the course director. So the course director, if we're thinking, you know, we're not quite sure how to handle this case, usually we'll just go to the top and say, okay, you decide what to do. But when it comes to the participation part of the course like we're actually in the clinic working with you and your patients we're all on the same level. You know, we're just all colleagues working with each other, and that's what makes this really fun. It's as I mentioned before. You know we have some young doctors that will come and take these courses and I don't know, when I think about dental school, it makes my palms sweaty, right, but with these kinds of courses it's not like that at all. We are just working together, all right. So what I want you to understand is now you understand levels one, two and three. Now you understand what we're looking for for each of those different levels and the importance of taking these courses.
Speaker 1:Now I want to talk a little bit about case presentation, because it's really hard to go up to your best friend and say, hey, you know, we've known each other for the last 20 years and you know you've got a really ugly smile and I had this great opportunity. You know we can bring it to this course and we can actually rejuvenate your smile. Some people will take that offensively. So the way that we do it in our practice, we always have our patient fill out this intake form and the intake form is like do you like the appearance of your teeth or your smile? And if they check off no, then all I have to do now is go in and provide a solution. You know, mrs Jones, you checked off. You don't like the appearance of your smile, that your teeth aren't aligned, that you've got spaces between teeth. You don't like the color, you don't like the shape, your teeth are chipped and you have these dark things in the back, on the chewing surface of your back teeth. Well, I've got a solution for that we can replace all those and improve your smile with veneers On the right-hand side. That's our intake form where we vet out their TMD issues. So you know, mrs Jones, I see you've got clicking and popping your jaw joints, head pain, neck pain. You clench and grind and you don't have a comfortable bite. You know, guess what? I could take care of that. We were doing this course and during this course we can actually take care of the aesthetics of your teeth give you better function, more comfortable bite and maybe take care of your headaches. Oh, so now your patient's kind of intrigued by this. These are the things that we'll go through again during the course just to make it so you're able to do more aesthetic cases.
Speaker 1:Another thing we'll talk about is the photography. And why the photography? Because sometimes patients you know all of us have things about us that if somebody looked at us our appearance, our hair, our face or whatever they can nitpick things right Now he's got a blemish here, he's got a blemish there, his teeth aren't straight or whatever, but when we look at ourselves we don't see those blemishes. So you know, we've just I say we've become habituated to it. You know, it's like when you go in a smelly room, when you walk in a smelly room, you smell the smell and then once you sit there for five minutes, you don't smell anymore because your nose becomes habituated to that smile. And a lot of us get to be like that visually.
Speaker 1:But imagine this patient comes in and she says you know, my smile is fine. So she feels on the questionnaire my smile is fine, I like the appearance of my teeth. No, I don't have anything I don't like looking at. And then you take a good photo and you put this photo up on your 55 inch screen in your consultation room or your operatory. And now the patient looks at that and says, wow, you know, now that I see it as big as it is up on the screen, I can see how my teeth are chipped and worn. And you know, wow, what's this dark thing in there? And you tell them well, that's just a filling, but it's just stained over time and you can see how thin these teeth are here because they're wearing down. Well, you've got some bite issues. Look how you're wearing these teeth.
Speaker 1:And this patient actually was only in her 30s, the low 30s, and so when you look at all that wear and tear and then the other thing I point out is well, here's the middle of your top teeth, right here, and the middle of your bottom teeth is like way over here, they're not even one over the other. So then you really start to look into the functional issues, because is that a skeletal thing, a joint thing or a dental thing, right? So we have to figure all that out. But now the patient's more likely to say so what can I do about that? You're not even selling this to the patient. What you're doing is you're just pointing out what's there and you point out some of the things, the wear and tear and the discoloration and now the patient's asking you questions and all you're going to do is offer them solutions. So you know, mrs Jones, what I can do is I can make all these teeth the same color and these teeth where they're worn, I can restore that worn tooth structure to make everything look uniform.
Speaker 1:Remember that smile that you had, probably when you're in high school, but now you've destroyed it? Basically, we can restore that for you. So here you pick out the type of smile that you want. You know, do you want it where the edges of your new teeth go straight across? Do you want it where the edges of your new teeth are nice and round, to create like a soft look, or do you want something in between? And the patient's like, wow, one, I didn't even realize I had a problem. Two, now that I see the problem, I'm glad you have the solution and I'd like door number six right. So now they're on board and all you had to do is you had to show them what's going on. You had to offer them the solutions. I say it's forming a gap, right, because they didn't even know where they were starting. But now you've shown them, with that photo, where they're starting. Now you're showing them where they could end up, like just on this one sheet, and now they're starting to put some value on this. They're like, wow, you know, that could change my life if my teeth look like that, versus how they looked like in that other photo. So we start to.
Speaker 1:One thing as we talk about is smile design. We have to get into the patient's mind what is it that they're seeking? What do they want in the final restorations and that's part of the system I talked about, that you'll learn at the pack, because when we send it our models in for the diagnostic wax up, we're going to guide the lab and tell them how we want the wax ups to be done. When we make the temporaries, our temporaries are going to reflect that wax up and then we're going to ask the patient so what do you think? And most of the time the patient's going to say, hey, I love my temporaries. But if you get that one case where the patient says you know what? I wish the teeth were more straight across, or I wish this tooth was more pointed. Just look at the patient and say, hey, no worries, because this is why I got you back, because I want to make sure we give you the smile that you want, not the smile that I think you want, and that goes a long way.
Speaker 1:So what we do now is we have selected a cooperative patient and the financial incentive now is that if you were to do the veneers in our practice, is that if you were to do the veneers in our practice, those 10 veneers would cost you $17,500. Let's just say you're charging $1750 per unit, right? So it's $17,500, throw in a diagnostic wax up, now we're up to $18,000. I can do that case for you for $10,000. I can give it half off, 50% off. I can do it for $9,000. And why can you do that? Because the cost of taking the course is basically $5,000. And that $5,000 isn't to pay your instructors, it's basically your lab fee. So you're doing 10 units, and so you get 10 aesthetic units, you get the diagnostic wax ups, you get all the lab preparation, lab communication, you get the text there during your prep session and your cementation session. All for that one low, single price and that fee you then can charge to your patients, and so that fee will be covered by your patients. You're not going to lose money.
Speaker 1:And if you want to charge them $20,000, I've done these courses. That's up to the discretion of the doctor. I've done these cases or these courses, cases during the courses, where the lab fees $5,000 and the doctors come in and they charge the patient $25,000. And I go well, how much is a veneer in your practice? They go $2,000. I go okay, so $2,000 times 10 is $20,000. And you're charging the patient $25,000. And the doctor says, yeah, I go. Why? And they said because I told the patient you're going to have all these eyes while we do this case. You're going to have internationally renowned instructors that are going to help us make sure that we get the smile that you want, and so you're going to pay a premium, and so the doctors will charge the patient more than it would be for them to do the case in their practice. So when, again, when I have doctors that are interested in taking these courses and they go, but I can't find a patient that needs aesthetics, when I went to that case selection sheet, we all have patients that have those types of smiles. And then I have doctors that say, well, I can't afford to take the course. And I go well, you can, because in this case your patient's paying for the course, so there really aren't any obstacles to taking this course. So we're selling the opportunity? Well, we're not selling the opportunity, we're just selling them the ability to take care of their wants. So they want a nicer smile, and we get there through education.
Speaker 1:Garrett, I put this slide in for you. This was a couple of weekends ago, so here's the course photos. This is just showing how you know we're working with the doctors. The doctors are prepping, we're watching over the shoulders to make sure you know if there's something that we want to change a line angle on or a margin on we've got an instructor and myself looking to just double check everything. Right, triple checking. And that's why some doctors say, hey, I'm going to charge you extra because you're going to have extra eyes on this case, and you can see that we're all working together. You know we're. We're discussing the cases, we're discussing If there's anything that can be improved, improved.
Speaker 1:The lab technicians come over and they, they, if they see something that they want to have changed, they'll ask you hey, can we just move this margin over here or maybe do a slice prep or whatever it may be, so it really is interactive. So you have your patient, you've got your smile design selected. You want the nice soft and size ledges that are slightly rounded. So we felt the lab slip. The lab slip is going to say, hey, how long do you want eight, nine to be? I'm going to let somebody else in here. So how long are the stencils going to be? So you write down tooth number eight is going to be 11 millimeters long, tooth number nine is going to be 11 millimeters long. Whatever it is that you deem that you selected Down here. You tell the lab what's your small design. Or maybe you have some photos or magazine pictures. They send that to lab and tell the lab please match this shape of these teeth to the diagnostic wax up Down here. It's a great question on the left.
Speaker 1:So the goals of the new smile design like are we trying to adjust the midline? Are we trying to widen the buccal corridor to get rid of negative space? Are we trying to lengthen teeth, change shades, close the asthmas? Whatever's appropriate? Just check that off. It just gives the lab more insight. What are we trying to achieve with our diagnostic wax up?
Speaker 1:And then even on the diagnostic wax up we can ask for different surface textures because that will be reflected in our temporaries, because our temporaries are so accurate that if the lab and the diagnostic wax puts periclomata in there or whatever surface texture, that will be reflected in our temporaries and it lets the patient get used to it. So if we envision the patient wants a medium amount of surface texture on their teeth, their final veneers, and we make the temporaries that way and the patient comes back the next week and says, hey, these teeth aren't smooth. You know, I want smooth teeth and these teeth have all these little it's like texture in it. You know, we as dentists we look at that like, yeah, I love that. That texture is what a natural tooth looks like. And your patient comes back and says, no, but I want a chiclet like something really smooth. So we learn that while the patient's in the temporaries that's okay. If the patient wants smooth chiclet teeth, I mean it's their teeth and that's what they want, that's what you give them.
Speaker 1:And then down here so we check off the small design. So this is a checklist, so we check off. We would have selected a small design that we put over here. We take a bite registration, maybe with a stick. So if we have to level out the occlusal plane, take a bite registration, maybe with a stick. So if we have to level out the occlusal plane, we take a stick bite that has a vertical and a horizontal stick on it so the lab knows where to level out the maxilloclusal plane. And then anything else miscellaneous we put over here.
Speaker 1:So if you say, hey, I want tooth number seven and 10 not to be symmetrical, or hey, I want you know whatever you want, you would just put that over there. So now I just want to show you kind of the application of this. So we've got a case patient comes in. This patient has spacing between the teeth and you can see like number six, kind of a funky shape to it. So we had a diagnostic wax up done, get the diagnostic wax up done, nicely done by core dental lab, and then we're going to do a smile preview.
Speaker 1:What does that mean is, before we get the patient into the that live patient prep session, I called the patient back in the office and the patient in this case had crowns on eight, nine. So I told the patient come on back in and we'll just do an acrylic overlay over your teeth. And you know, if you look at his teeth, his teeth aren't that bad. You know, these are crowns eight, nine. The other teeth, you know, maybe doesn't pop. Uh, we talked about whitening. The patient tried whitening and this is the whitest his, his natural teeth will get. And he wants a pretty white smile. So, um, I was thinking this is going to be tough because there's not much wrong with that smile. So you start to look at the models. We take our photos so we can communicate to the lab what kind of shade that we want to take. And I will tell you, in this case, what I did is I did my own lab work, and the reason why is because this patient had come in a year previous and I had sent in to the lab for a diagnostic wax up it's probably about two years before and the patient never came back.
Speaker 1:And so I had this diagnostic wax up. It sat there for a year, patient didn't come back, and I just never thought the patient was going to come back. So I actually threw the diagnostic wax up away and then, another year after that, the patient came back and I was like I'm not spending that money again. I'm sure the patient's going to come back. So all this, the lab work that you see that cord is going to do, will look even better than this. But this is just lab work I did because I wasn't going to send it all back in again. So what I did is I got him back in and from this temporization stent. I just told him I said I'm going to do an acrylic overlay over your teeth. So we did an acrylic overlay over the teeth just to kind of even things out, soften things up a little bit. So just let him take a look at what the smile could look like. I peel those off. I want to see how thick it was that I made that wax and you can see that I made them fairly thin. So then we do the 50-50, where we take off the acrylic overlay from eight back, and so from nine back you can see the acrylic, the color change and just a little bit of the shape change.
Speaker 1:So we do our photography and when it comes to photography, if you don't have, I use a digital SLR. If you have one of those, great. If you don't have one, you can use your iPhones or Androids, whatever it is that you have. You don't have to buy a special camera just for this course. But the photos that I recommend that you take when you submit your cases to your mentor, instructor and to laboratory would be at least this set. So this is a full face smile, a close-up smile, a close-up right and left side patient smiling. A close-up of the anterior teeth, a close-up of the patient's right from a lateral view, the left from a lateral view and then the occlusal views. So those nine photos I'd recommend that you take. They don't have to be beautiful or anything like that.
Speaker 1:What I saw during the courses that we've done is the first time, our first course, where the doctors sent their photos in. I was looking at them on my phone and I was joking, because I was like turning my phone all different ways, trying to figure out where the teeth were, and I was trying to figure out if my eyesight had gotten that bad. Nothing was in focus and nothing was framed very well, but we were able to at least see the teeth, so we were cool with it. You know, it's just part of the learning of what you're supposed to do. So then we come up with a plan and so at this point you come up with a diagnosis Am I going to do 10 veneers? Am I going to do slice preps? What are we going to do? So, once you have your treatment plan and your records, you got your models, you got your photos. Now we go to the course director or to the mentor and we have the case approved. Now it goes to the lab.
Speaker 1:So the lab you know we've got all these different materials we can use, depending on the strength, the aesthetics. What the lab? You know we've got all these different materials we can use, depending on the strength, the aesthetics. What I do is I rely on our technicians advice. So I would go to Ryan or Gary and say, hey, I've got this tetracycline case, but I want to do really minimal preps. What type of material would I use to accomplish that? And so you know they would. They would be mixing opacity with translucency and trying to figure out okay, how do we get the nicest aesthetics with what we have to work with? We have to figure out do we want to take, uh, more tooth away, do deeper preps, or do we not want to do that we?
Speaker 1:So this is what, um, I recommend send to lab you send either analog or digital impressions a bite registration. So one of the bite registrations we use is we use the Kois Dental Facial Analyzer. So with this one you have the vertical stick and you have a horizontal stick. If you have one of these, that would be ideal to send to lab with your case. That would be ideal to send to lab with your case Photographs, the treatment plan, as I mentioned, the smile design selection and any other instructions that you have. So that's how we set it up. Again, very easy and it's a system.
Speaker 1:So when we get into the clinic, we've got everything. We've got our models, we've got our wax up, we've got our temporization stents, we have our prep guys, we have our bite registration stents and everything's measured and accurate and we are ready to go. So when we get all this done from our lab, it's going to make the case rather easy, although when I say you know we're going to do 14 or 28 units, it sounds kind of scary. So with the proper planning, it's going to lower the stress for you. It's going to help you achieve what your patient wants. It's going to help the whole procedure, the process, to go much more efficiently, and that's why to do 10 units where we can get it done, and usually way under three hours. It's going to be a team thing. It's going to be you, an instructor and a lab technician working to be sure that we get everything the way we need it to be, because if we plan everything properly, we're going to have great success. We're not going to have that poor performance that we're trying to avoid.
Speaker 1:When you come and take the course, I outline everything. I have the time all figured out what you should be able to do within that hour and a half here, within the next 15 minutes here. So it kind of is. I give you a list to kind of pace yourself. I don't want you to get way behind, and sometimes you'll get way ahead, which is preferable In this case.
Speaker 1:What I want you to start to do we talked about this during our other sessions is really think about the whole arch, not just one tooth, meaning when you put your recontouring. If you're going to do some arch recontouring, you're going to put your big fat diamond on real coarse diamond and we're going to go across all 10 teeth. And if we've got a lot of tooth rotations, we're going to cut those parts of the tooth that are sticking too far out. We're going to just cut all that back. We're going to go across all 10 teeth. Then we're going to take our depth cutting burr, we're going to put that in our handpiece and we're going to go across all 10 teeth, unlike how a lot of us do our traditional dentistry where we might prep out one tooth and then, let's say, we have a tooth on the other side of the arch, then we prep out that tooth.
Speaker 1:Well, in this case we've got 10 teeth and we're they're just one big tooth, and so that's a little bit of a technique change for some of you, but I just want to show you that we have everything mapped out when it comes to the prep session and to the cementation session. So what you'll do is you'll get kind of these pacing lists and what I'll actually do is just stay really close to that on time and don't worry like if you're starting to get way behind. Let's say you're, we've got three hours and you start to look at this checklist and you're like a half hour behind and then you just call the instructor over and say, hey, can you show me how to do this and what your instructor will do is your instructor will get you back on the timeline. So, again, no need to stress. So when we, when we get the preps done, you know you have your reduction guides you'll be able to get your impressions, your bite registrations, and then we'll take our temporization stent, we'll make our temporaries across all the teeth. When it comes to cementation, we'll take the temporaries off and then we'll do the multi-sementation. We'll go through how to do this so that you're not going to be struggling with the cleanup, that you get everything seated the way it needs to be. We'll give you a little tip, like the tacking tip, just to tack into place so it doesn't move, and then you can floss in between all the other teeth before you do your final cure. Sometimes we do get cement that sets up in the contact area, so then we take a little separate separating discs and get in there. So we'll, we talk about all that. So this patient he got the smile that he wanted. He's super happy. Every time I see him it would be hugs and kisses, but I try not to get the kisses from him, but he loves a smile and he's chomping at the bit he wants to do his lowers, and so we're just trying to figure out when we're going to do his lowers. So again, here's the case selection choices. Just as a reminder, I want you to think how many patients do you have that fall into one of these categories? You, you know, you have patients that fit into here.
Speaker 1:And then just kind of a quick review of how the sequence works. Um, it's just laid out, it's really efficient. Um, it looks like a lot. But then what we do is we just chunk it down. And because we chunk it down, you'll get through it and it won't seem like a lot of work at all. It's really fun.
Speaker 1:And so now I hope you see that from taking these courses, you get the systems. And when you get the systems, you just take that back to your office. You know what materials we use, what furs we use. Everything is laid out for you. Just go back to your office and tell your assistant here, just order this stuff, and we're just going to start doing a set of cases. We give you the vision. You have guys like Dr Griffin, who he's retired twice, you know, he's made it big twice and you have a chance to sit shoulder to shoulder with him and say okay, now how do I do what you just did or what you've done twice? And then we're all going to encourage you. You know we've we've been doing this for decades. We want to make sure that, um, that you take the information from these courses and again, it may be an investment of $5,000. And I hope you make money doing the course because you charge your patients more than the 5,000, but it's one of those things. There's no better investment and we talked about this during a recording that we did recently Because a lot of us, when you get to our age, you look back and you go man, I should have invested in Amazon, or I should invest in Google, or I should invest in Apple.
Speaker 1:If I had invested in Apple back in the day, I'd be a trillionaire by now. One of the things that you don't want to look back on at the end of your career is where you say, wow, I should have invested in myself in my career. Because if you invest $5,000 in a course like this, you're going to make, during the course of your career, $5 million back. It's way more than a 10 to one return, because aesthetics will affect everything that you do and when patients see that you understand aesthetics and you understand function, they will seek you do. And when patients see that you understand aesthetics and you understand function, they will seek you out. And that's one of the crazy things that in our office we have patients that come in every day because they have functional issues. I'm treating my youngest patient I'm treating right now. He's 14. He's got TMD. And the oldest patient I have right now I saw today she's 91. So these patients will seek you out because you just provide a totally different level of service than anybody else in your community. And that's what you want to be, you.
Speaker 1:I was talking to my daughter today and I said you know, you don't want to compete, so to speak, against everybody else that's doing crowns and fillings. You, you want to find your niche, something you enjoy doing, and for me I you know it's implants, it's aesthetics, it's occlusion. Um, my daughter, I'm gonna let her do airway, and so you know, I just like to do certain things aesthetics, implants and, uh, tmd is kind of where I focus a lot of my attention to now. Uh, but those of you that you that because I didn't do any kind of introduction you know I teach endo courses, I teach laser courses. I teach aesthetic courses and restorative courses and so much more. So I just like all parts of dentistry. So I just wanted to go through that part and I know I covered a lot. I was trying to cover it fairly fast because it is a weeknight. I don't want to keep all of you up too late. I know if you're watching from Chicago it's getting late, but I'm going to open up to questions now. What questions do you all have?
Speaker 4:you have some questions in the chat okay, let me open it up.
Speaker 1:I know you know when you do these things there's just so much to keep track of. I was trying to let everybody in and does core lab do orthotic? Uh, ryan and gary, are you guys doing orthotics now?
Speaker 5:it's not our forte, but we know how to do them okay, so we can also, we can also do.
Speaker 1:Uh, hoisty programmers if that's right, something that opened the bite yeah, yeah, I don't use hoisty programmers, but if some of you do, then yeah, you could send it to to core, and it's one of those things where it's kind of a tricky question. Um, because it depends on what kind of orthotic you want, if you want a fixed, if you want a fixed if you want a fixed orthotic, then core can make that for you, right, because it's just made out for your diagnostic wax up if you want a mild liner orthotic, something that's more anatomic we have to send that to mild liner and then, if you want a removal orthotic that's kind of what we're talking about if you want to remove orthotic, you can use a lot of different labs.
Speaker 1:All right. Another question what tools, materials or equipment do we need to have? That's a good question. So what we, what we have, is we have the impression materials, we have the temporization material, temporary materials, we have, like hemostatic agents, curing lights and all that. What we do ask the doctors to do is bring your your you know your favorite uniform. Bring your loops, bring your favorite favorite uniform, bring your loops, bring your favorite instrument. So I bring like a at least a basic instrument tray, just so you have all the instruments that you need to have. Typically we have the hand pieces, um, we have the burrs. So as the course gets closer, lisa will reach out to you and let you know what you need to bring and what we'll be able to provide. But typically it's just the basic instruments, because we do. We provide the soft tissue lasers, we provide the hand pieces and burrs and the restorative materials and the impression materials. So there's not much that you need to bring. And then I know some of you had your favorite like pillows and blankets. So if you have a favorite pillow blanket, either for yourself or your patient, you know, bring it. Um, how?
Speaker 1:Other good question how many cases will be will be done in one day and where will they be done? So I will defer the second part of that question. Where will they be done? It depends on which group you're um signed up for. You know Sacramento, bay area, chicago. So again, lisa will send that information out to you to give you the right Chicago. So again, lisa will send that information out to you to give you the right address. I don't want to send you to the wrong place. How many cases will be done depends on the number of doctors that are enrolled in the course. So in the Sacramento and Bay Area courses we we max out at 10 docs and so what we do is we will have five doctors working and five doctors assisting. That way you get to see two cases your case and another doctor's case and then usually you have a chance to walk around and see the other cases. So you have a chance to kind of observe 10 cases being done, but it's 10 cases during each session and usually it's five doctors working at a time.
Speaker 1:Let's see, I have a patient for full mouth reconstruction and most likely would want to start. Do I have to start with veneers and can I bring her in? Yeah, it depends. So on that, dr Parsa, I think what we would do is cause I know you know I'll do the stuff and I know you've been doing this. So on that one, I think we would do on a case by case basis where we would talk with you, look at the case and figure out how much time we need to have to have you do that case. So I don't want to say no to it, I just would say we are open to seeing what the case looks like and then we could make a decision together. So that's a great question.
Speaker 1:Another great question is I don't have a patient. Can I still be part of the course? That depends, because we're kind of limited by space. So we've done courses where we had some doctors that didn't have patients and they were able to observe, but that's because we didn't have as many bodies. What we're afraid of with these courses is that we're going to have full courses and so if you don't have a patient and you're not doing the course, it's going to be hard to have more bodies in the area. So I hope that makes sense. It's just we're limited by the number of bodies we can have in whatever clinic that we're working in. So it's not that we don't want to have you there, it's just we're limited. We can't have 40 bodies in somebody's office that you know. Let's say, you have a five op office that we're using to do the course, where you all can imagine what it'd be like to have 40 bodies in that space. So that's the limiting factor.
Speaker 1:What I would just say is just find a patient right. We all have patients that look like one of those cases that I showed you. They got dark teeth, worn teeth, whatever, and so that's the hard part is we need to just have you sit down with the patient and I get it. It's hard to do, but that's that's one of the things that we're trying to teach you during this course. We're trying to teach you how to present, how to identify cases and how to present the case to get the patient to say yes, and in this case we're taking out all the financial obstacles. Well, potentially right, so tell the patient those 10 veneers in my practice would be $20,000, but I'm going to do it for you for half of that, for 10,000. That way you get the course paid for and you make money and you don't have to pay for office overhead because you're not doing the case you know in your office.
Speaker 1:Yeah, the other, the other question was the barrier course will be held somewhere in San Jose and, as Jimmy was saying, and the dates, we have the dates and we can have Lisa send the dates out to everybody once once again. So we do have the dates. We do have the dates for Chicago. We do have the dates for uh. Thanks Jimmy. Yeah, the 22nd, 23rd, we do have the dates and we do have uh for all the different areas. Let's see.
Speaker 1:Do we need to bring assistance, since the doctors will assist each other? That's a great question. So what we recommend that you do bring your assistant. Why? Because then your assistant is trained to help you. When you go back on Monday, if you have a veneer case in your office, your assistant will be able to pick it up.
Speaker 1:So what happens to the doctor that I said was assisting that doctor is helping the assistant assist basically. So typically, what will happen is we have two doctors per operatory. One doctor will work in that operatory in the morning. The other doctor will work in that operatory in the morning. The other doctor will work in that operatory in the afternoon. If you, if the doctor that's working has their assistant, I'd recommend that assistant assist the doctor, and then what we'll do is the doctor that could have been the assistant can just look over the shoulder, so it's it's easier for that doctor. But I'll tell you, it's like all hands on deck, you know, because the assistant may be looking for cotton rolls and so the extra doc runs around to find the cotton rolls, that type of thing. So it's really fun, you know, we're all kind of helping each other out.
Speaker 3:Doctor, I just want to confirm it's August 23rd and 24, Saturday and Sunday, correct.
Speaker 1:Saturday and Sunday. Yeah, is that 22nd?
Speaker 3:That has to be on the 23rd and the 24th of August.
Speaker 1:Okay, so it'd be 23rd, 24th. Sorry, it is 23, 24.
Speaker 5:Yeah, okay, mike, can I make one more comment? Yes, along the lines of bringing your assistance there, you'd be amazed at how empowering this becomes for them. They get excited because they learn the same information you learn on Friday. And then they see the cases delivered and they realize now I know my doc can deliver these kinds of cases, so it's pretty exciting.
Speaker 1:Yeah, correct. You know, as I was going through with my career, I got into level three types of cases and when I would leave my office on a Friday to go lecture somewhere, I would come back and I would look at my schedule and my schedule would be full mouth consultation. I'm like where did that? Where did this patient come from? My assistant would say, oh, you know, so-and-so came in during a hygiene visit, had warranty, so we told him that they need a full mouth rehab and so he's coming in to talk to you about that. And I'm like, wow. So you know, my team had taken the courses with me, they had sat through the lectures, they had assisted me when I was doing my level three cases and so, as Gary's saying, they're trained, they know what to look for when.
Speaker 1:When an assistant walks in and says, hey, you need a full mouth rehab, the patients are less apt to not believe them. You know they're like really, do you think I need that? And your assistant says, oh, yeah, you know, dr Mike, he does these cases all the time. What we need to do is do this, this and this and we need to get you set up for that. And the patient's like, oh, okay, let's go ahead and do it. Whereas, you know, sometimes when the doctor comes in, uh, the patients are like, hmm, you know, do I really need to do this, or is this just something you want to do to me, that type of thing? So it's kind of not. It's nice when your team is on board.
Speaker 2:Hey, mike, yeah, can I jump in just to qualify and clarify the course fee? Yeah, really, the course fee is being sponsored with a scholarship through the Pacific Aesthetic Continuum. There is no course fee. The clinical fees and the fee for the program have been waived. The only expenses for the program are the cost for the case, which is a flat rate of $5,000, which includes the preliminary wax up and all of the stents, et cetera, et cetera. So, for those of the doctors that are wondering what the cost for the program is, the hard cost is only the laboratory work and that's a flat rate. The rest of this is limited. The rest of this is limited to the scholarship expense which is being provided to you by the path.
Speaker 1:Yeah, now, great, great way to explain it. And so, Garrett, one of the questions was the course fee for, you know, level one, two and three. So the course fee for level one is $5,000. And for level like, when we get to level three, that would probably be twice that.
Speaker 2:right, because we're doing it upper and lower. That's correct.
Speaker 1:Yeah, that's correct good, will patients be coming both days? No, they only have to come the second day of the prep session, which is a live patient treatment session, and the second day of the cementation session, because that's a live patient. The first day of each of the prep session and the cementation session or those weekends, those are just lecture for the doctors and the team, so the patient does not need to come. So the patients are only there for one of the four or one of each two day session. So two out of the four days We'll see.
Speaker 3:Oh good, Just in case, if they have more than 10 teeth, do we have to pay the extra fees for lab for that? Just in case, like just say, pretend that they have a bridge and it's go all the way to the you know the molar, for example.
Speaker 2:Like number two, huh yeah, or even like first molar, yeah, yeah first of all, yeah, you're right, um garrett, you want to ask that one. Yeah, the answer is yes and we we will typically see rarely but that can happen. Or you might choose to do an onlay in the back of the mouth and we leave that up to the discretion of the doctor. But the answer is yes. The the laboratory fee is based on um doing 10 units. We generally will never do less than eight ever, and normally we'll do 10 to 12. So figure that in your in your discussion with your patient and, and that's great.
Speaker 3:That's a great question, though, and then how much more does do you charge per unit, since it's a five thousands for a whole entire 10? So then, so then that we know, let's just say you know, for example, I only charged five thousand so I can get all the patients to do to do the course, and so, for example, if they have extra unit that they wanted to add on there, or we need to add it on there how much?
Speaker 2:Great question, yeah, it would be, depending on the unit. It would just be the posted lab fee for that extra work for the lab.
Speaker 1:So, garrett, what is that about? 350. 350, okay, like 350 extra.
Speaker 3:Okay, so 350 bucks.
Speaker 1:Yeah, because part of the fight, the reason why I'm doing the 10 units, is a little bit more than their usual Cause. That includes, like, the diagnostic wax up and everything like that. And if you, if you, were doing more units, yeah, it wouldn't add a lot. It wouldn't add $500 for each tooth into that fee, correct? Yeah, lisa, you're on here, right? I don't have the. Lisa, you're on here, right? I don't have the. One of the questions is CE units, and CE units are given. But Lisa, do you know the number of CE? Or Garrett, do you know the number?
Speaker 2:I can answer that or you can answer it, lisa. It's a 32, 32 CE credits for the program Okay, credits for the program, and it's AGD California CE and there's CE for each of the areas that we're working. Okay cool.
Speaker 7:Okay, it's up to 32, just in case, if we only do a morning session, that could be a little less, but it is up to 32, most times 32.
Speaker 1:Okay, thank you. Most times 32. Okay, thank you. So the August 23rd is a lecture and August 24th is the patient treatment day, so the other patients only there on the 24th. That's correct. And when will the second session be, lisa? What's the second session? I don't have my calendar.
Speaker 7:It's Saturday, the September 20th, and Sunday, the 21st for San Jose. All right.
Speaker 1:Well, garrett, I know I missed something, and thanks for filling in on how the fees work and how the tuition works and the sponsorship. Do you have anything else you want to add in?
Speaker 2:No, I think you did really well there. The only thing I would say is that the patient is the real winner here. Normally these courses can be anywhere from $5,000 to $9,000 for the doctor, plus the lab work, plus travel, which is pretty typical to see $20,000 to $23,000 spent traveling to a program two times, covering the patient's expenses for hotels and flights, blah, blah, blah. So I think what's really unique about this? It's so unique. We are limiting it to 10 per area and I know that we had about 18 interested for San Jose.
Speaker 2:Chicago is a closed program and I think we have three spots available for Chicago for outside doctors yet to be determined as well as Sacramento. So I would just really encourage you to try to register early, because we are going to take the first 10. And understand, if you do register for the program and the scholarship is awarded, that place is locked in for you and you would be responsible for that $5,000 lab fee, because we can't fill that spot with only a few weeks left in the course or a month left in the course. So what we're trying to do tonight is to really encourage, for example in San Jose, the 18 that said that we're interested. We are only going to issue 10 for the summer program and then for the spring program we'll open up another 10 as well as level two.
Speaker 1:Yeah, thanks. Hey, Garrett, I was just thinking out loud in my mind.
Speaker 3:If we have open space in Sacramento out of those 18 doctors that you know if we get, if we book San Jose, if they're willing to come up to Sacramento, would that be okay?
Speaker 2:Absolutely. If somebody wants to come up from San Jose, they're more than welcome. We, if we have space, good point. And just looking at, uh, the only other thing, mike, I wanted to mention is the armamentarium, and just looking at, uh, the, only other thing mike I wanted to mention is the armamentarium.
Speaker 2:Yeah, he says lisa will. It was a great question. What do we have to bring? I think you. I think you said we have to look back at the recording. I think you said we provide hand pieces, but we do not provide hand pieces.
Speaker 2:Oh, yeah no, so the? So they aren't. The full armamentarium will be provided to you by lisa and we will always bring backup whenever we can. For Chicago, Teal and Robin are making sure that everything that needs to be there will be there. For San Jose, Lisa will provide a detailed armamentarium and the expectation is that all of those supplies are brought by the clinician.
Speaker 2:In the case where we have an issue, where something's missing or we need something extra, we'll bring generally one or two setups, but there are some specific things that the doctors will be required to bring. For example, there'll be hand pieces in the clinic, but we encourage the doctors to bring their favorite hand piece high speed, low speed, contra angle, et cetera, et cetera, Things like burrs and burr kits. Those will be provided to the doctor in the armamentarium, but we will also bring some of those things. So if there are things that are out of reach or there are things that you have difficulty finding or, for example, the clinic doesn't have a laser, then of course Lisa will make sure that that's there on site.
Speaker 7:Okay Sounds great, we are encouraged to bring anything that is your favorite. I mean, if you come up and go, I need this. I don't carry, you know, extra little favorite things. You know, if you have something that you've been using for years, bring it, because you won't find it in my supplies. So think about that. Just little things that you want all the time, please do bring.
Speaker 2:So think about that. Just little things that you want all the time, please do bring. And Lisa, when do you?
Speaker 7:send out the armamentarium once we have the registration fulfilled.
Speaker 2:Pardon me, when do you send out the armamentarium once we have the registration fulfilled?
Speaker 7:That's correct.
Speaker 2:yes, Okay, so we'll be taking registrations for the next week, we'll be awarding those scholarships and then Lisa will be. The course will be handed off to Lisa and to Dr Miyazaki and to Gary and Ryan from that point on, and you'll have a lot of communication with them.
Speaker 1:Sounds good.
Speaker 3:Yeah, who do we submit the cases to? To Lisa or to you, doctor? The?
Speaker 1:cases the cases, yeah, you can send.
Speaker 3:If you've got one already, you can send it to me okay, uh, you want the cast to be sent it to the lab and the picture should be sent it to you, or how do you want it?
Speaker 1:um, yeah, you know, what we could do is, if you guys are all starting to get cases right now and you want to get everything planned because that's why we're doing this so quickly what we should do is probably take your photos. You can send the cast to the lab just so they can start working on it, and then I can do a call with the doctors and we can go over the photos and the case those in the case.
Speaker 3:Okay, Can you? How do we get? The lab paperwork to send it to the lab or the boxes to send it to the lab.
Speaker 2:Yeah, so so once. So after tonight we'll be working on registration for the next week. Those of you in San Jose will be working directly with Jimmy and once those registrations were fulfilled, Lisa will be getting a hold of you. She's our clinic director and she'll coordinate all of that with you personally. Make sure that you have boxes. Make sure you have everything you need. Answer any questions.
Speaker 6:Do you provide consent forms and release of liabilities since patients are going to be out of our practices? Do you have any forms specific to that, or we need to come up with one?
Speaker 7:I do have a form that is just for our laboratory. It's not for the doctor. It's our consent to be able to do the work with you and the patient. But if you're going to need one for your own personal, then that would be something that you're going to take care of. But we're covering the laboratory.
Speaker 6:So if, for example, which they're going to be in a doctor's practice here in San Jose, right?
Speaker 7:Yes.
Speaker 6:So do we need to contact, for example, TDIC to get something so that doctor is covered in case patient falls or something happens in that practice?
Speaker 7:I don't know, Mike, help me out here, because I'm only thinking about the laboratory.
Speaker 1:As far as doing the work with us. Yeah, you know, I don't know. I mean, it's a good question, I don't know.
Speaker 2:Mike, I can jump in. We spent a lot of time on this and on the regulatory part, we really focus on making sure that the licensed doctor working on the patient is in a licensed clinic and the license for the doctor that's worked, the patient of record for that doctor, is being covered by their own malpractice insurance obviously, and which is why we try to keep the programs California doctors in California, illinois doctors in Illinois we try not to transition those licensures. We've been doing this for a lot of years. We fortunately have not run into that problem ever in the past, primarily because of the quality of the patient care delivered. What Lisa will do is provide a patient release form, which will help you and obviously cover all the liability for putting the program on, and a release form for photography, because it's going to be shared publicly. Thank you.
Speaker 2:So, as a licensed doctor in California working in an approved clinic, there shouldn't be an issue.
Speaker 3:So the clinic that you guys will be working on it's under a malpractice, under medical protective, and I have the entity protective for that as well, for all the associates under the umbrella, for that, if anyone is afraid of anything, it is fully protected. I have my own and then I have the entity for the practice as well to malpractice Great.
Speaker 1:Yeah, no, thank you.
Speaker 4:Dr Miyazaki, some of the doctors were asking if they can get your new patient form and also the smile catalog to help them present to their patients yeah, the the aesthetic questionnaire form yeah, and then the smile, the catalog, and which smile they can choose okay yeah, I could.
Speaker 1:I could send that to um. I'll send that to you and then you can give it to whatever doctors want. Okay, okay.
Speaker 4:And then for San Jose. Right now we only actually have six spots left. Doctors are already confirming with patients right now.
Speaker 1:Okay, cool, all right. No, that's good Cause I know we just were talking about it two weeks ago, so it's good, all right, everybody get on board, we'll have fun Looking forward to it.
Speaker 1:So now I just want to say thank you everybody for your time and if you have more questions, you know that last slide had my email address on it. Please feel free to. I was looking at. Yeah, Thanks, angela, just on it. Please feel free to. Um, I'm just looking at. Yeah, thanks, angela, the um.
Speaker 1:One last question just came through the chat is if a patient asks how long does a veneer last, what is your answer? Um, who knows? You know, it's one of those things where if a patient asks you how long does a crown last, you know I tell them it's. It should go at least five, five years, ten years. I have patients that have had the same veneers for over 30 years. So you know, when somebody asks, well, how long should it last? I tell them it can last for a long time. It really depends on how well they take care of them. You know, if the if you look at their natural dentition, natural teeth, and they're just worn flat and you don't take care of the occlusal issues, or maybe they're a Bruxer grinder and you don't give them a night guard, you know they're probably gonna do the same thing. And I just let them know that. Look at your natural dentition, your natural teeth. You've worn them, you've chipped them, you've broken them. A veneer has like the same strength as their natural tooth does. So if you destroy your natural teeth, you can destroy the veneers, so we have to protect them. So that that question is you know, I think a lot of doctors are really anxious about how long veneers last, and so that's why that question scares them. But you know veneers should last as long as your crowns, and so you know how you answer that when a patient says how long is this crown going to last? They can last a long time. So every case is different.
Speaker 1:And one question is do you give the patients a night guard after treatment? Only if they need it? I don't. I personally don't give every aesthetic case a night guard. Um, I know some doctors that do do that. And why do they do that? Because it just kind of protects your rear end if a patient you give.
Speaker 1:So you know you give a patient a night guard and they come in and they've chipped their veneer or they have a crack in a veneer or they pop it off. You just ask them were you wearing a night guard? And most of the time they'll say no, and you go see it's your fault. So you know it's kind of a way to for the dentist to deflect that. But when I look at it I go well, it's kind of my responsibility to make sure we minimize the chances that they damage their veneers. So I'm going to take a look at that and saying that I do have patients that do have night guards.
Speaker 1:You know there are patients that come in and they just we're not going to do a full mouth rehab, they're just going to have veneers for the aesthetics. They don't have a very stable bite but they clinch and grind. So I'm going to say here you've got to wear them. And that's one of the things we talk about when you do your comprehensive exam. If you see signs of wear and tear, you tell the patient.
Speaker 1:Ideally we put in orthotic, stabilize your bite, then restore you. Patients sometimes can't afford it or they're not interested in doing that much work, and so you just let them know I can do your veneers. But it's kind of a compromised outcome because we didn't really take care of all the functional issues that are going on. Like, let's say, they have a deep overbite and now you do veneers and you made the teeth longer. Well, now they have a more extreme overbite, which means there could be more interferences, but now they have the correct width to length ratio of their of their front teeth. So where's that compromise? Where is that going to take them? That'd be a case that I'd make a night guard for them. So those are all things that we would talk about during the level one course.
Speaker 3:I know there's a lot to share, Doctor.
Speaker 1:The second session start at what time? The second session, I mean the second clinic session.
Speaker 3:Yes, yeah, like you know how you have the morning for five and the afternoon for five. So then, because my patient is from Vallejo, so I need to know, what you know.
Speaker 1:Again, it would depend on what level we're going to do that. Level one level one usually start at 1230. So we start, so we have the patient come in at 1230. Then we start the the case at one and we get done by four.
Speaker 3:Gotcha, thank you.
Speaker 1:All right. Well, thanks everyone again for your time, I know. I'll sign up before more questions come through All right. Thanks Gary, Thanks Ryan, Thanks Lisa, Thanks team for being here and thank you everybody for being on. I hope you all sign up. We fill the course and we just have a lot of fun together anybody has any questions, please just contact Lisa.
Speaker 2:She's our program and clinical director and she'll answer all the questions, and if she can't, she'll get those questions over to Mike and herself. Yeah, I'd be happy to answer those for you, all right, okay?
Speaker 1:Good night everyone, Good night Thank you. Thank you.
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