Dental Up Special Podcast: The Dental Clone Wars – |Dental Implants|
In this week's podcast, Tom Olson (President and General Manager) of Nobel Biocare® Dental Implants sits down with Dr. Hornbrook to discuss the importance of authenticity when utilizing dental implants. The discussion also rolls in to the Evolution of dental implants over the years and the future of implant dentistry through 2020. An amazing interview that covers Dental Implants from every angle by the most qualified dental implant experts in the world.
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Sponsor: keatingdentallab.com
Mothtly Zirconia Product: KDZ Bruxer®
David Hornbrook: Hello. I'm Dr. David Hornbrook, the clinical director of education and technology at Keating Dental Lab in Irvine, California. Welcome to our weekly podcast on Dental Up. We're in for a real treat today. We are actually sitting at Nobel in beautiful Yorba Linda, California, and I'm with Tom Olsen. Welcome, Tom.
Tom Olsen: Hi, Dave. Good to see you.
David Hornbrook: I know you're a busy guy, and I appreciate you taking the time out of your crazy schedule. I've got this little slot in between your busyness to spend with me. It means a lot to me.
Tom Olsen: It's a pleasure to be here. Thank you for coming here.
David Hornbrook: Yeah, it made it nice. I'm a practicing clinician. San Diego's home for me. I work with Dr. Peter Nordland among others. You know Peter. The nice thing about it is all he uses is Nobel.
Tom Olsen: I'm grateful for that.
David Hornbrook: I got the tour. It was fabulous. I got a personal directed tour from the president and GM of Nobel. That was made that much more enjoyable. It was very cool, because you said approximate percentage of all the replaced, you said, implants are manufactured here.
Tom Olsen: Produced here. Correct.
David Hornbrook: As far as percentage, and I know I asked you this before, but approximate percentage of the implants [crosstalk 00:01:06].
Tom Olsen: It depends, but half of the production more or less is here, and the other half is in Karlskoga, Sweden, but both facilities can make the full line of products.
David Hornbrook: Okay. Awesome. I was probably looking at some of my implant abutments going on.
Tom Olsen: Hopefully so.
David Hornbrook: I'm sure. I'm sure. I'm going to put you on the spot a little bit. Implants are competitive. It's a competitive market. You have manufacturers that are trying to make it cheaper and all these things, whether it be this country or another country. Being a Nobel user, and I'm a firm believer in that; in fact, even when I send something to a lab I don't routinely work with, based on the surgeon's input or even the patient's input, I always order my Nobel parts and send them to the laboratory because I'm always concerned they're going to … Possibly they would do some clone that was inferior in my opinion.
Knowing that competition and the opportunity maybe for a lab to buy even a cheaper clone, why would a doctor, whether it be the general practitioner who's kind of directing treatment, or the surgeon in the laboratory say, "You know what? We're using Nobel." What would drive that conversation?
Tom Olsen: I think this is a fairly hot topic right now around authenticity. Obviously, there are a lot of clone products there that are really not made according to manufacturer's specifications. I think the backside of this is there is a lot of clinical implications for this when these parts aren't functioning correctly, and unfortunately a lot of this is not seen until the treatment is downstream a few years.
If you listen to a lot of lectures today that are going on by many clinicians, not just ours, but many clinicians, they are starting to talk about the consequences of using components that they believe to be compatible and that are claimed to be compatible.
David Hornbrook: We just had one in my practice. A patient came in and said the implant crown was loose. We thought something where we could make a little hole and screw it back on. We didn't place the implant. We didn't do the restorative [inaudible 00:03:02]. We drilled through it. My associate actually did it. Drilled through it, unscrewed it, and it turns out the implant hex itself was cracked. That's not just a new screw and a new abutment. We called the laboratory because the patient knew the laboratory, and sure enough, they used a cloned part. It was a huge compromise for that patient. Implant comes out. New implant, maybe. To me, it's not worth it whether it be $40 for a screw or $100 for this. It doesn't make sense.
Tom Olsen: Not ultimately that the patient pays the price for this, obviously there's an inconvenience from a clinical perspective when they have to do these remakes, but the patient is the one that bears the risk on this.
David Hornbrook: Again, we had this conversation before we went on air about Branemark. I was at UCLA my third year in 1985, and I saw Branemark. I think that his first tour that he toured around the states, thinking that's not going to work. That's not going to work. Also, where's my next denture going to come from so I could graduate on time? I look back at that moment when I thought this is something, honestly, that this is going to kind of disappear with all these other things that have come.
Obviously, it's a success story. Implants are proven. It's something that I think is ideal treatment versus a bridge in most applications. Where do you see it going from here? You're in a good place now, especially at Nobel. Where do you see … ?
Tom Olsen: All the demographics are trending in the right direction. I think what Professor Branemark created, we're seeing the reality of that today. The unfortunate thing is that dental implants today, even in a well-developed country like the US, is only penetrated about 10%. Today, the numbers are … You've got 35,000,000 people missing all their teeth today in the US. You've got over 178,000,000 missing one or more teeth. A very small percentage of these ultimately are treated with dental implants.
The awareness level is increasing certainly across the industry, and certainly from a patient perspective the awareness level is increasing. Training universities is becoming more focused on this, I think a lot more being done around dental implant training. I think going forward, I think the demographics are working in the direction, because we're seeing a lot more patients. I'm sure you're seeing it in your office with failing dentition, and implants provide a good alternative for that.
David Hornbrook: Absolutely. Let's play the insurance game a little bit, because I know that when I talk to clinicians and say, "You know, my patient chose an implant here. This is why I did an implant." There's always a hand in the audience that goes up and says, "Well, insurance wouldn't cover that. That's why we had to do a bridge." Is Nobel taking any kind of back door [crosstalk 00:05:40]?
Tom Olsen: We're not. No, we're not. We're not engaged there and, obviously, I think when you talk to clinicians, obviously, the majority of implants are outside the insurance system. There are some that are subsidized where they are baked into a plan. But for the most part, that's not something we're engaging at this point.
David Hornbrook: Do you think that's going to change in the near future?
Tom Olsen: It could. It could change. I think there's 2 sides to that. One is obviously increased access and exposure for patients, but then also from the practitioner side, the reimbursement then becomes probably another issue for the specialist.
David Hornbrook: Let's hope that changes, because it's such a benefit for our patients, but we know how insurance makes their money, unfortunately. Let's talk a little bit about the training. It used to be only the surgeons. I don't place implants. I restore them. I lack the expertise of that surgeon, but obviously a lot of general practitioners are now restoring implants.
Tom Olsen: Correct.
David Hornbrook: That's obviously a trend. Do you have any percentages offhand of [crosstalk 00:06:32]?
Tom Olsen: Just from the numbers that I read in published data. I think in 2015, there's probably more implants placed by a general dentist than all the specialists combined.
David Hornbrook: Really.
Tom Olsen: Which is a large number. The difference is, though, the average number of implants placed by the general dentist in that case is probably less than 30. The majority of the specialists, as you know, are involved in placement of dental implants. Obviously, for what we've talked about earlier, from the patient's perspective, we see that trend increasing. Our strategy here particularly in North America has been very much focused around the surgical specialist and supporting that restorative network. That's primarily been our core.
David Hornbrook: I know you're doing a lot of training programs here. How many programs do you do here?
Tom Olsen: We did, not just here, but nationwide last year we did over 10,000 programs, but that's a combination of large-scale programs all the way down to lunch & learn programs done by our sales reps; but when you add all those together, it's over 10,000 educational bits.
David Hornbrook: I saw your new education … So you're actually going to remodel in the very near future, but it's still beautiful, and you have a teaching operatory that they can see that. If someone was interested in furthering their expertise in implant placement or restorative, they go to your website?
Tom Olsen: Sure. Yeah. Right on our website. We have our full educational course catalog, and not only the catalog here, but we also have our global course catalog. If they're traveling and want to tie in a vacation and take courses, we have them all around the world. We also list our full course offering here. They could also just contact their local rep, too, and they could walk them [inaudible 00:08:08].
David Hornbrook: Awesome. You have your big symposium coming up in September.
Tom Olsen: We are. We're a couple weeks away from that. We're sold out at 600. The front end of it is master class program. We have 2 days of a very dynamic program, the back end on Sunday. We're doing the first ever zygoma program. The first time we've done a large scale zygoma program, so all of that happens in the course of [crosstalk 00:08:32].
David Hornbrook: Describe that for our audience here at the radio.
Tom Olsen: Zygoma is implants that go into the zygoma bone itself. The indication for that is, and the reason we're seeing an increase in this treatment is because there is a lot more treatment being done with [inaudible 00:08:45] in edentulous patients. However, in some of those cases now, patients don't have available bone. They don't want to go through grafting procedures, and a good alternative for that is zygoma. It's an advanced treatment protocol, but we have a lot of the specialists that do that, so we're running a first-time ever program in Las Vegas. We'll have the world's best in terms of their clinical treatment protocols there to help [crosstalk 00:09:12].
David Hornbrook: Are there going to be live surgeries as part of the course?
Tom Olsen: Not live surgery there. We're doing hands-on, though, so this will be interesting. We haven't done this before, to do hands-on for 300.
David Hornbrook: Live zygomas.
Tom Olsen: Yeah. On a skull, so that'll be fun.
David Hornbrook: That would be fun. Talking about hands-on courses on skulls or jawbones, because I know that you do a lot of courses on the jawbones. I did that, too, just to get the feel of that, but I was teaching a laser course one time in Costa Rica, and it was a travel destination, and it was on pig jaws. I've done dozens of these programs. The clinicians show up and it happens to be this cool little kind of rustic resort in the south of Costa Rica, right? We went there 3 days before it actually started, and we had sent the pig jaws on dry ice. We get there, and the head of the resort says, "That's where your lecture hall's going to be." It looked like an abandoned building, but we walked in, and literally it smelled like a morgue that the bodies had been rotting. They had no idea that there was pig jaws in there. The pig jaws in 100-degree weather had been sitting there, and they had just gotten rotten.
Now we're kind of screwed, because all these people are flying in to Costa Rica thinking they're going to do surgery on pig jaws. It was funny. The whole time we're trying to get on Internet, and the resort manager says, "We don't have Internet. You can't do Internet."
Well, how are we going to get ahold of either the people and tell them not to come, or to get the implant company, or the laser company to send more pig jaws? He says, "Why do you need to get on the Internet?" I said, "We need some more pig jaws." These, we got to throw away. He says, "You can't get on the Internet, but we can totally get you pig jaws."
Tom Olsen: [crosstalk 00:10:44].
David Hornbrook: We went to the kitchen, and we told the chef, and we said we need like 20 pig jaws. The next day, he called us in. It wasn't just the pig jaw like we're used to, it was the whole head. He said, "Is this what you wanted?" "Yeah, but could you section it a little bit?" Interesting story.
Anything new in Vegas with the symposium other than the zygoma [inaudible 00:11:05]?
Tom Olsen: Yeah. We've got a full … We're going to be showcasing, obviously, a full line of our solutions. We've got full contour zirconia. We've got our angulated screw channel. We've got a full line of paralleled implants with a conical connection, so that's a new line. We introduced a little over, about 290 new articles this year on new part numbers. The company, we spent a little over $90,000,000 last year in research and development, so we're really building up the pipeline. I think we've got a good runway here for the next several years with what we've got in the pipeline today.
David Hornbrook: Good, and that angulated screw, that's amazing.
Tom Olsen: You've seen it.
David Hornbrook: Yeah. We've had some situations. If you haven't seen that, for those that are listening or watching, just go to the website and look at that, or you can email me personally. We're seeing some very cool things with that, especially the [inaudible 00:11:52], where people want to do a screw retainer and the screw will be coming out inside the ledge, and up to 20 …
Tom Olsen: 25 degrees.
David Hornbrook: which is absolutely amazing.
Tom Olsen: We're seeing a big movement more towards screw retained restoration, I'm sure.
David Hornbrook: People used to ask, and I would say, "East Coast, everyone does screw retained. West Coast, everyone cements them." I think now we're starting to see more people screw [crosstalk 00:12:11] in the posterior.
Tom Olsen: And technology. This technology's actually helping that along with it.
David Hornbrook: Good. I'm fired up about that imaging. I'm a huge IPA, not drinker. The immediate provisional abutment on the imp … We're doing some amazing things with that. You're on the forefront. We talked a little bit about the gold adapt, which is your version of the UCLA abutment and what we're doing with the ceramics whether it be zirconia and lithium disilicate. You're definitely on the top of this curve as we're moving forward.
Nobel was recently purchased by Danaher.
David Hornbrook: The conglomerate. Has that changed your focus or your direction at all?
Tom Olsen: Not really. Honestly, we think it's a really good fit. We're learning a lot. Everything so far has been extremely positive. We'd just gone through … I know our leadership team in Zurich has just completed at the end of March 100-day [strap 00:13:04] plan, which was the strategy for the business going forward. I think that was very well accepted by the management down here, and I think we're off and running.
We have a lot of projects that the company's involved in, a lot of different work streams. All of them, of course, patient centered, evidence based, clinically relevant. The fit looks very good. Obviously, if you look at Danaher as a company, a huge commitment in dental, 15 companies within the dental platform. Obviously, if you look at the technology that exists within each of the dental platforms, very exciting, and the challenge, the opportunity is to put that workflow together for the future. I think that's really what will be the exciting part is to look at the different technologies that exist between the platform and how can we create sustainable competitive advantage here for our self and make it easier for patients that are our customers?
David Hornbrook: Yeah, and for those that know Danaher, under that umbrella, obviously Nobel, which is a new acquisition. You've got Kerr, you've got [Cahu 00:14:04], Pelton and Crane.
Tom Olsen: Correct. Ormco.
David Hornbrook: Ormco. That's right. I was just at the Kerr KUL meeting, [inaudible 00:14:11] leaders last weekend, 2 weekends ago. The direction they're moving, I think Danaher has been a good thing for them. I imagine Nobel's going to be moving faster than all of them.
Tom Olsen: Personally, I've been very impressed. The rigor that Danaher has in their operating companies in applying the business systems, Danaher business systems, is extremely impressive. I know for us, even all of us that have been in business quite awhile, we're learning a lot in terms of what these tools are and how to deploy them. We think this is going to help us quite a bit.
David Hornbrook: I hope so. I hope so. Not that you need any help.
Tom Olsen: Well, look, we can always use help.
David Hornbrook: You're doing an awfully great job. Two other things that I think are obviously changing dentistry, and I want to understand your opinion from Nobel or the implant world, and that's the DMSO's. It's affecting us as general practitioner. Corporate dentistry comes in and their overhead is lower and they're seeing a lot of patients. It's affecting us in these private fee-for-service practices. How is that changing the implant world?
Tom Olsen: From our perspective, we're a little bit agnostic here in that we obviously, our focus is on providing premium products to help our customers treat more patients better. That's kind of our purpose, our mission. The values we try to give back are in a few different areas. When it comes to DSO's, we're intimately involved our self with several of these. I think, ultimately, from the service model standpoint, I think it will be the patients that will decide this, but there are some interesting trends that are developing.
We've confirmed this from our customers, so when we surveyed our customers and we asked them what were the common characteristics for growth? What they told us was pretty interesting. The first one was that patients want to get everything done, or most of the things they can get done, by a single provider or in 1 visit if possible. Grant it, that's not possible in every case, but I think this is a little bit where the DSO's have perhaps had some edges. They've had these services contained within their structure, and they've been able to provide that for patients.
Ultimately, I think the level will have to be on the quality that the patients accept, but having those services available for the patients is an advantage.
David Hornbrook: Are most of those programs, the DMSO's or the DSO's, are they bringing a surgeon in-house? Are they training their general dentists to do that?
Tom Olsen: Both. I think certainly what we see from our perspective is, we see DSO's that have surgeons on staff. That is a common procedure. We also see itinerant surgeons traveling. This is outside of just the DSO practices. We see itinerant surgeons, periodontists, traveling to general dentist offices to do it there. It's the referral model in reverse, so to speak.
David Hornbrook: That's kind of interesting. That's awesome. Obviously, the new generation of dentists is going to lead us forward as we move to the next millennium, the next 10+, 20+ years. How as a company Nobel, how are you marketing to these young dentists? They learn so differently.
Tom Olsen: They do.
David Hornbrook: In my courses I have these young dentists, and I'll say, "If you have a question, email me." Before the breaks, I've got a couple of emails from these people that are working their iPhones, and young dentists, they're raising CBCT, they're raising whether it be CAD/CAM technology. How are you marketing to this new generation?
Tom Olsen: It's a great question, and we had this absolute recent experience. This weekend, we were in Laguna Beach, and we had our advisory council meeting, but we also joined together with this group. We identified 30 future leaders that we put together with this group. We got good insight from this group. We plan to do more of these programs, but you're right. They absolutely think different. They don't have some of the same bias from some of the clinicians that have more experience.
I think from our perspective, what we're doing, obviously, it starts with the products and the solutions, so we're trying to have leading edge technology, so at the end of the day it doesn't matter whether you're an advanced surgeon or a general dentist just starting out, you want to use the best products that are going to help you with your patients. We start with that, trying to provide the best products available that can get them where they need to go.
The other part of this is, a lot of that comes from how they're supported in the universities. We spend a lot of time, a lot of money supporting universities so that in the university they have access and exposure to the products. With the sales force that we have … We have a good sized sales team out there and hopefully this team can take care of them when they get out on their own. We are fortunate, our average tenure in our sales team today is a little over 6-1/2 years, so the guys, they get it. They understand.
David Hornbrook: My rep's been excellent.
Tom Olsen: Yeah, most of them understand what needs to be done, and they can really help. They can really be supportive from that standpoint, but you're right. They're thinking differently. They're looking at things different, particularly from an education standpoint.
David Hornbrook: Education is huge. They like on-line learning. They'd rather watch a You Tube than a surgeon place an implant sometimes, so it changed the way you look at education.
Tom Olsen: If it's not on their phone, they're probably not interested. That's their primary source for many of them. Having mobile-friendly apps, having content there, all these things are really important.
David Hornbrook: What do you see as a primary concern, these young dentists coming out? Are they concerned about they want to add implants as a procedure that they're doing in their own practice?
Tom Olsen: Yeah.
David Hornbrook: What are some of the questions that you see [crosstalk 00:19:43]?
Tom Olsen: I guess it depends on where their focused interest is. I think their first concern coming out of dental school is servicing the debt load. That is part of what's, maybe why they're driving into DSO's, obviously because for them, I've heard numbers, average debt load 200-400,000 coming out of school.
David Hornbrook: 390, I think is the average.
Tom Olsen: Is that the number? Yeah. Obviously, that's a concern. Obviously, working in an environment that they can be comfortable in, whether it's in a DSO or whether it's in their private practice, working in a team concept which is pretty much the standard today in the industry. I think it depends on where their priorities are.
David Hornbrook: I told you earlier that I had the opportunity to spend some time with Damien McDonald who is the president of Kerr, another Danaher company. Something he brought up from a manufacturer point of view that I hadn't really thought about, and that was the number of women that are entering the marketplace in ergonomics, whether it be the chairs, how low they are, because on average they're a little shorter, their hands are a little smaller. That's something I didn't even think about as you design a [inaudible 00:20:47] a CR syringe or something. Has that affected the implant world at all?
Tom Olsen: From the standpoint of certainly the demographics are changing. I think today the numbers probably in the US are about 50% probably [crosstalk 00:21:01], something like that. It's a fairly sizable number. I think what that changes is, depending upon how they want to work, there's probably a quality of life, work/life balance there, so for them, depending upon how they want to run a practice, that might change some of their priorities. In terms of our products and the clinical application, we haven't seen anything [crosstalk 00:21:21].
David Hornbrook: Your drivers are already so small [crosstalk 00:21:24].
Tom Olsen: From that perspective, no, but certainly we're working not so much on gender base, but more on future leaders. Our average customer probably is a little more experienced based upon how we started, so certainly identifying and having products and solutions that are applicable for the future leaders is important for us.
David Hornbrook: That's awesome. You've been with Nobel for how long?
Tom Olsen: 21 years.
David Hornbrook: You've seen a lot of changes. I don't place implants, but I was involved looking at a 2-dimensional x-ray sent over to the surgeon, give him a guide [inaudible 00:21:57] stent, and hopefully they put it in the right spot. With guided surgeries and CBCT, that's kind of the standard, in my opinion, standard of care. Where do you see the next generation of technology [crosstalk 00:22:11]?
Tom Olsen: It's coming right now. You see it, I'm sure, in your practice, and that's this digitalization, how fast that's moving, and that's moving across all fronts, I think. There's probably a lot of misunderstanding of what a digital workflow means today, and I think depending on who you talk to they may have a different application for that. Ultimately, I think it's streamlining that process so that dentist specialists can streamline their process to provide a better service for their patient whether it be faster time to teeth, reduced overall cost of treatment, more efficient treatment. I think all of this is moving in that direction.
We've seen some great examples of this with what's happened with CBC technology and [inaudible 00:22:53] scanning, and the capability on things like Nobel clinician, where you can fuse hard and soft tissues together for [00:24:00]
David Hornbrook: I don't know anything about that.
Tom Olsen: See me after this [crosstalk 00:23:03].
David Hornbrook: Oh, we can't talk about it? Episode #2 maybe in the future. That's exciting. If I was a naïve practitioner and I came to one of your reps and said, "Talk to me a little bit about this workflow so that I'm knowledgeable and do things right." A patient comes in and it's #29, let's say, and they need an implant. As their dentist, which I'm going to call myself the quarterback, what is this workflow that's going to [crosstalk 00:23:32]?
Tom Olsen: I think the first thing is, historically there was 2-dimensional technology available to treatment plan. Now there's 3-dimensional technology. I think having access to that and how you can manipulate that data, and how you can plan that data, today it's extremely accurate. A lot of that information now comes away from chair-side, takes all that stress away, can be done computer-based, so everything is done 1 push of a button. One push of a button, a surgical template ordered with absolute precision, and everything being done the way you need to do it surgically.
From a team concept, working in a team concept, obviously the surgeon gets the implant where he wants, the restorative dentist gets it exactly where they want it. You know how this works. This works well even from a communication aspect, from a team approach, in being able to talk through that, particularly on some of the more complex cases.
David Hornbrook: We do. As clinicians, we need as much help as we can get. Keating, Steve [Tapio 00:24:31], he's our head of our implant department. Unbelievable. It absolutely amazes me how many clinicians, they just wing it. They just send over the surgeon with no guided stent, and they get the implant back and they send it to Steve and say, "Okay, what do I do now?"
Tom Olsen: Most surgeons, they've seen so many things. Once they flap … They're obviously very skilled and competent doing anything there, but I think there are certain clinical indications where having that comprehensive diagnostic approach is a benefit for the entire team, not just the surgeon alone.
David Hornbrook: The local reps help with that, right?
Tom Olsen: They can.
David Hornbrook: If I had an implant or a patient that was thinking about an implant, I could call my local Nobel, and they could kind of [crosstalk 00:25:17].
Tom Olsen: They can. They're not going to do the treatment planning, but they can walk you through what needs to be done. They can take you through the protocol on the procedure.
David Hornbrook: Okay. That's awesome. You're a busy guy. What do you do for fun?
Tom Olsen: Play golf poorly. Time with the family. I've been following my son in baseball.
David Hornbrook: He's starting UCLA?
Tom Olsen: He's starting UCLA, yeah, so we're excited to see how that goes.
David Hornbrook: He's a pitcher?
Tom Olsen: Yes, pitcher.
David Hornbrook: Does he have a special pitch that he's …
Tom Olsen: He has a knock-out curve ball, but hopefully it knocks them out in college like it did in high school. We don't know how it's going to work in college.
David Hornbrook: How things sometimes change [crosstalk 00:25:55] everyone is good on the opposite team.
Tom Olsen: Exactly. Exactly.
David Hornbrook: Well, that's exciting. He's playing winter ball.
Tom Olsen: It's starting right now. They're starting school here in a couple of weeks. We'll see how that goes.
David Hornbrook: You're from Southern California.
Tom Olsen: I am. I am, actually. I'm one of these rare natives here, but spent some time running the business for Nobel back in Europe and lived in Sweden for a few years. Asia for a while.
David Hornbrook: I think that most people … I did up until today, thought that the world headquarters was in Sweden, but you informed me it's in Switzerland.
David Hornbrook: Then your Belinda is the head …
Tom Olsen: Belinda's the head for the North American headquarters, which is what I'm responsible. So for the US and Canadian operations, this is the headquarters here. You're sitting in the office.
David Hornbrook: In the headquarters. I like that. In the king's chair. What's interesting is, I graduated in 1986. I remember my first implant. It was 4 implants, but it was like a Hader bar. I don't even remember what kind of implant it was, but implants were not designed for the restorative dentist. First, I had to put a little sleeve on, then I had to screw what I was going to take impressions, but when I screwed that out, that sleeve came off too. I remember taking hemostats and holding onto that sleeve just so I could get the screw out. Now I almost feel guilty charging a patient for what I do for a crown, because it's so easy, whether it be a custom abutment or even a standardized abutment.
As we look, let's say from '85, when Branemark came over and he was doing all these crazy things. If you had to list some hallmark changes over the last almost 30 years, what would be included in that?
Tom Olsen: There's been a lot, and it's not just from our standpoint, but throughout the industry, I think. Obviously, dental implants, we have to give Professor Branemark credit here, I think. We were fortunate to be involved in helping to create that category. I think that was fairly significant. 1982 for us was our first entry into CAT/CAM and Procera. We actually started a lot of the CAD/CAM and Procera abutments.
David Hornbrook: What year was that?
Tom Olsen: 1982.
David Hornbrook: '82?
Tom Olsen: Dr. Matts Andersson was the developer of that in Sweden, and he started that. We had somewhat created that category early on in 1982. I would say that's been a significant change and you see today what happens in that end of CAD/CAM and customized prosthetics. Guided surgery in 2005, that's probably another one. We were involved in that as well, too, so I think that was a milestone.
I think from a treatment standpoint, advanced treatment protocols that allow immediate function, immediate loading, immediate treatment protocols. That's the biggest difference, I think, in dental implants, is today a lot of these procedures that in the past took many, many months, can be done in a relatively short period today. From a patient's perspective, that's what they're looking for.
David Hornbrook: Oh yeah. It used to be, if a patient came in and had a failed endo … the [inaudible 00:28:55] would try to do everything to try to fix that. Now he says it's cheaper to extract the tooth and put an implant because they're predictable and something we can do as a same visit.
Tom Olsen: No, I think that's exactly it. We have predictable treatment now. Today you look at clinical success rate with implants, 98-1/2% probably on average. If you look at the time that patients can get the teeth, it's relatively short now. Yeah, I think from a patient perspective, this is almost … Well, it is standard of care today.
David Hornbrook: No, I totally agree. In the years early on in my career, there was a controversy of whether you should put hydroxyapatite on the titanium or not. Where is that?
Tom Olsen: There's probably not much HA-coated implants out there that I see. We moved all of our production over to [tianide 00:29:46] surface. [tianide 00:29:49] surface today, all of our implants are made with [tianide 00:29:50] surface. The reason for that is because success rates were better. We just see much better success with [tianide 00:29:57] surface. This surface is more than 13,000,000 implants almost over 300 clinical studies documented that. It's a proven surface, so I think that when you have a surface like that … HA was very good in some cases, but obviously there were some problems, I think for us, we sold HA implants for quite some time but, again, moved our entire production over to [tianide 00:30:22] early 2000.
David Hornbrook: Early 2000?
Tom Olsen: Early to mid 2000's.
David Hornbrook: Can we talk a little bit about earlier as I was getting the tour, which was unbelievable, about zirconia implants. I've had 3 come to my practice driven by the patient who was concerned with titanium. Do you think that's a future?
Tom Olsen: I don't really know. Like I was mentioning to you, I know that we had a project at one point in time in Germany which was aborted. We couldn't get it to work. I know there are some out there, which I'm sure do fine. From our perspective, what's in the bone, titanium has been proven to be a very, very good surface, very compatible with bone. Above the surface, above the implant surface, now you've got all the options from zirconia and all the other materials which seem to make sense.
David Hornbrook: We're getting some great results.
David Hornbrook: We're going to wrap up. I call these my treadmill podcasts, or commute for those people that live in LA or New York or Houston, about 30 or so minutes, and we're just about that time. Is there anything you want to tell us about anything that you're excited about?
Tom Olsen: No, I think that when you talk about the future, I think it's interesting to see where the industry's going. I think our insight that we've been able to gather from this from our customers is in a couple specific areas, which may be interesting for some of your listeners, and that is the first of which we talked about, which is from a patient's perspective, what they want is, they're looking for to get services in 1 place if they can, and that puts different pressures on the model the way it works today.
The second thing is that clinicians that use advanced treatment protocols, this seems to be something that adds to faster growth for them. Immediate function, use of CBC technology, immediate [provigilization 00:32:09], all of these kind of advanced treatment procedures. These seem to be additive to help clinicians grow.
The third thing is, the range of direct consumer advertising, or not, that clinicians may use. So anything all the way from simple search engine optimization to advanced direct consumer advertising, these are also things that our customers are telling us that they're using today.
These are kind of 3 of the core things. There are more, but these are 3 of the key things that we're hearing from our customers.
David Hornbrook: Okay. Awesome. I've always … [inaudible 00:32:42] a restored dentist that doesn't want to have to deal with a failed implant down the road. Believe me, I so appreciate what Nobel's doing with their research, and certainly their uncompromising. It's always been like Nobel is here, and then you've got all these other players. Now we're getting some lower players. As a clinician, I know I can speak for other clinicians, thanks for all that you're doing.
Tom Olsen: Thank you. Thank you for [crosstalk 00:33:01].
David Hornbrook: I enjoyed you spending time with me. You can visit us at Dental Up. Again, I want to thank Tom for spending the time with us. This was special. It was a treat. We're going to have to have #2 down the road, as you introduce all these cool things. I want to hear all about that zygoma.
Tom Olsen: We'll come back [crosstalk 00:33:19].
David Hornbrook: Oh yeah. That would be awesome. Have a great day. If you're ever in Irvine near Newport Beach, Laguna, Disneyland, feel free to give us a call at Keating Dental Lab, and I hope to see you soon.