Prominence of Technical Advisors: St. Patrick’s Day Special

Senior Technical Advisor, Brandon Fetters, joins us to demonstrate his passion for dentistry and the importance of his role in communication with dentists. As the middle man of advisement, Brandon, keeps a positive relationship with dentists and ensures that cases are flowing smoothly. His expertise of dentisrty and laboratory products boosts dentists’ experience and advances the result of restorations.

Shaun Keating:                   Hey, everybody. I’d like to welcome you to this week’s Dental Up podcast here at Keating Dental Arts. I want to thank you for tunin’ in. Today we’re going to talk with Brandon Fetters. He’s our senior technical advisor here at Keating Dental Arts, and he’s been in the industry for about 18 years. Most of ’em have been with me, and thank you so much for comin’ in today. I know it was a little last notice, it’s a little crazy around here. March Madness we’re real busy and just got a late start doin’ this podcast, but we’re excited to do it up here with Brandon.

You know, I always start off with talkin’ a little bit about sports and current events and things like that. Did you get into our pool at all, or no?

Brandon Fetters:               Nah.

Shaun Keating:                   No March Madness?

Brandon Fetters:               I saw that, I took a good look at it, but I never actually filled out the bracket as

Shaun Keating:                   Why, are you not a big basketball guy, or you don’t really know?

Brandon Fetters:               Not really a big basketball guy, but it’s a great sport to watch. I love it ’cause it’s high pay, so keeps the entertainment moving quick, you know, it’s [crosstalk 00:00:56]

Shaun Keating:                   You’re like that right brainer with the ADD like me, like you gotta have stuff movin’, man. I love basketball this time of season. I’m like 4 and 0 right now baby, but it’s only a couple hours in. [inaudible 00:01:09] 4, but I have my Florida team is like, they’re gettin’ handled a little bit, but they might be comin’ back a little bit right now.

I guess they say 95% of the brackets will have at least one loss by the first night of the tournament. I’m like, “Dang, it’s just so hard to pick.” We did this thing for free labwork, and all this stuff, and at first I was gonna do, if you do 20 grand a month, that’s fine. So we sat down and we thought about it. We kinda did it to where if you get a perfect bracket, it’s 100 grand. Sure, the odds are tough to get it, real tough, but I still just worry that someone’s gonna, not worry, yet it would be really kinda cool if we did get someone to do it. We had to be in reality, I mean I’m not like Warren Buffett. I think he offers a billion dollars. He’s got that like, that’s like $25 in his pocketbook. With me 100 grand, that’s gonna be a tough

Brandon Fetters:               The percentage value.

Shaun Keating:                   “I’m gonna pull that out of a few accounts,” no. The hundred grand was, it’s reality. I could pay that if we had to, and we’d love to. The labwork, we went down to five grand because the 20 grand, that’s a quarter million dollars every couple months. At six months or so, it’s just, it’s a lot, but in reality, I truly believe someone could get it. In reality, five grand a month, hopefully I can get that dentist up to 10 grand a month so he can actually make some money.

Brandon Fetters:               There you go.

Shaun Keating:                   It’s just something we’re excited about. I think we’ve got up to 160 people that joined it this year, so that’s pretty cool. I hope a dentist wins it, and like I said, if someone that’s not a dentist wins it, whoever the top dentist is in our pool will get that free labwork for life. Real excited there. I hope and pray that someone does get it, ’cause it would be the greatest thing in the world. Again, can you imagine the marketing we’d get out of that if someone happened to win this dental lab? This dental dude put on his dental lab thing for 100 grand and free labwork for life, and lo and behold, someone wins it. It’s like, I think I’d be on an inner web or whatever. I’d be a little bit of everywhere, I’m thinkin’.

Brandon Fetters:               If we get, we gotta get some more requests for other similar type programs.

Shaun Keating:                   Yes other offers. It’s hard to find, our audience is like, when we get on social media, it’s like were talkin’ to different people out there, but it’s that rare dentist, there’s only a certain amount of dentists out there. I wish I could go straight to the public and say, “You know what? If you go to your dentist, you should be askin’ for Keating Dental Arts, ’cause we make the best teeth out there.” When you get the masses kinda talking about your work, that would be kind of a neat thing, but you gotta earn it. That’s what we’re trying to do, we’re trying to earn it here.

March Madness is going, I know the Rams hired a bigtime left tackle, big Rams guy here, and they took this guy from Cincinnati, a pro bowler, a Bengal, and he’s a stud. He’s like 6’8″, 300 and some odd pounds, like pro bowl the last few years. I’m surprised the Bengals let him go. We picked him up, and I think we have a first rounder that was our left tackle from like two years ago, and that guy’s just been horrible. We’re gonna put him over the right side.

So we got that, and we got another DB signed, so we’re lookin’ forward to football comin’ up again. It’s not for a few months, but we do have the draft comin’ up. We don’t really have many picks for the Rams. We gotta get back up there against the Patriots and other top teams in the NFL so we can at least compete. Last year we had the worst offense in the NFL. Our defense was pretty good, we had Wade Phillips comin’ over to run the defense. I’m excited about that.

We’ll kinda get done with that. We got St Patrick’s Day comin’ up. You gonna do anything for this weekend? What do got goin’?

Brandon Fetters:               I stay inside, stay safe, stay off the roads on drinking holidays.

Shaun Keating:                   For the Irish, it’s almost every day, the holiday is what I say!

Brandon Fetters:               I got plenty of booze at home.

Shaun Keating:                   It’s safe. Stay safe and stay smart. It is true, but it falls on a Friday, so it’s gonna be pretty crazy this weekend for sure. It’ll prob’ly go Friday Saturday Sunday, you know the Irish. We have this little place at our house called Patsy’s, and I’m a big corned beef guy as you could tell, or maybe you can’t tell. Love me my corned beef and cabbage.

Brandon Fetters:               We’re gonna have to go over to Malarkey’s here sometime.

Shaun Keating:                   Malarkey’s is good too. I’ve thrown a few pints back in that place. I’m a Larkey. I love that, and there are a few places around town that are really good Irish places around here. I’m excited about that.

So dude, let’s talk about, you were so important with our doctor. ‘Cause a lot of times, you’re on the bad end of talkin’ to the doctor’s office, ’cause a lot of our division managers, they’ll take care of calls with certain cases, but moreso than not, a lot of ’em come back into your office, and you’re doin’ a lot of calls daily on cases, treatment planning, and/or problems with what we received. It’s a hard thing to really fine-tune it when you’re talking with dentists, especially some that we don’t have a relationship with. We’re tellin’ him everything that he prob’ly doesn’t want to hear, but it’s just somethin’ that it’s a fine line. I know through the years, we have lost quite a few accounts, prob’ly comin’ across too hard maybe, or not really too hard, but they didn’t want to hear what they wanted to hear from us, because they wanted it done. At the end of the day, we don’t charge for remakes. We start a case, we kinda end up marrying this case til it’s done.

Brandon Fetters:               Absolutely.

Shaun Keating:                   Tell me a little bit about what you do in the company, and how your day kinda consists startin’ off in the morning.

Brandon Fetters:               It’s kinda interesting, like you said, about just right off the bat with that whole comin’ into the idea of “Here’s a certain conflict that we’re gonna have.” The way I like to look at it, the way that I’ve kinda had a philosophy about it for awhile now, is that despite the fact that it may be addressing a problem or taking a concern from a customer, is that in the end, really you’re there to find a solution to the problem. That kind of becomes my target, at the end of it, you know, you just keep your eye on the target kind of a thing. Yeah, we gotta go through these rapids, but by the time we’re done, this is gonna end in a result that’s gonna work out best for everybody, all parties involved. In the end, we’re all workin’ for the patient. Like you were sayin’, yeah if we could actually get it to becoming a household name, that would be awesome.

Shaun Keating:                   Yeah. You work on that, we’re gonna work on that right?

Brandon Fetters:               Yeah! Yeah, we’re doin’ it now. To answer your direct question there, working starting the day off, just comin’ in, gettin’ the phone turned on, goin’ through the caseload, seein’ what’s there, what might just be a concern from a login team individual who didn’t understand quite what was technically written out on a prescription. Just clarification like that, trying to get those cases back into production as quickly as possible. Following up on emails, voicemails, anything that you had from the previous day or while I wasn’t there and while I wasn’t here, I should say. Trying to address those.

After that, I kinda break it down, start looking at arrival dates, ’cause I wanna make sure that we’re trying to get in contact as quickly as possible, so we don’t have cases sittin’ around. Sometimes when you get in, a case comes in and another one, and sometimes that case with higher priority can get somethin’ else on top of it. You gotta really try and keep ’em separated or segregated out into prioritizing what really needs to be hit on first. That’s definitely one of those big things to do, to always keep an eye on, is that arrival date of the case, to make sure that we are in contact within a decent amount of time.

Shaun Keating:                   That’s my big pet peeve. You know, our thing here is turnaround. We like to do things like three days in lab, four days and five days at the most. Implants can be a little bit longer if there’s hardware to be ordered and stuff like that, how they get seven to nine days. It’s all about turnaround for us, so when you get cases that even our ceramist and our waxers, and all our different technicians, we don’t allow rollover of cases. It’s so important. There’s a patient that needs that restoration done, and we don’t need to sit around for a day or two by lack of organization on our part. We like to be organized. Turnaround, that sets ourselves apart really with us, we like to do things, not that we’re rushin’ the case, but we have the people in their positions. It’s just ready to go, man, and we rock and roll this. We do cases in 24 hour turnover. We do all these over-the-shoulder programs, and we bring ’em in that lab at night, we do ’em at night and we see them the next day. For somebody to sit around for three or four days on a call cart or on a desk with someone, that doesn’t happen here. When it does, it’s rare.

Brandon Fetters:               Yeah. Unless you’re callin’ me right now. Sorry.

Shaun Keating:                   It’s gonna be a quick one today, ’cause I got a pub see, it’s got my name on it here in a minute. “I’ll be home in a little bit, honey.”

The doctors get on the phone with you, it’s really a great thing ’cause with you, through the years as all of us, and I think our growth kinda just shows it, it’s relationships. We’ve had doctors with us since the start of our company and beyond. They’re longterm guys and it’s just a really great thing, but what’s it from? It’s from that relationship.

I always say, if we have a doctor we work with, we’re gonna screw up on cases, no doubt. We’re still humans, we mess up some things here and there. It’s rare, but we do. It could be a contact, being a pinpoint contact, and not broad and full like a football. “I’m a big football shaped contact, and our merge profile is so important.” Little things get me really irked when we don’t do that right.

That relationship, if we do screw up a case, I remember when we did an immediate, and we didn’t do something properly or we had a full roundhouse. We did something that was completely wrong, extracting the wrong pontic area, there’s root tips or somethin’. Somethin’ is completely wrong that the doctor just looked at it and goes, “What the heck are you thinking?” We kind of misinterpreted the lab strip, but we rolled with it. We don’t ever do that anymore, but we messed up.

There’s guys that literally want to jump through the phone and rip my head off, or yours, or whoever they get ahold of when we do mess up the case. But you know what, when you have that relationship, they give you another chance, and usually we always make good on ’em. Whenever we mess up, we make sure we make good on it. The relationship’s so important, but so many times with newer doctors that have only been with us for a few months or a few cases, and we mess up for whatever it is, if it’s a turnaround time, if it’s an aspect of the lab strip that wasn’t followed, they think “What the heck,” they’re not going to give it a shot. Your shot is done, and it’s like, you could do everything you can to market to them to try to get you to try again, but it’s just one and done, or two and done, and without that relationship, so it’s so important that we get things right at the beginning.

Tell me a little bit about your relationships. I know you worked for several years here, you left for a little while. Then you came back, and I just know so many of our doctors were so excited. Tell me a little bit about the relationships and the importance of that.

Brandon Fetters:               Actually, just like you were sayin’, “I’ve talked to quite a few customers that were excited to be back and vice versa,” I was really excited to be talkin’ to these doctors again, ’cause I thought of a lot of them as friends.

Shaun Keating:                   Family, because in a way, you kind of know about their children, you know what college they go to, you know if they like sports, you know this one likes to drink, this one is very studious, and this one likes to throw F-bombs, and it’s like a lot of different guys. It’s weird how everyone’s different in life I know, but relationships. I know a lot of the women dentists were happy to see Brandon Fetters is back. They’re like, “Yay! Brandon is back!”

Brandon Fetters:               You’re just sayin’ that.

Shaun Keating:                   You know it’s true. “I didn’t wanta put names up there,” no.

Brandon Fetters:               They’ve prob’ly heard me say it before, that I got a great face for radio, but this is what I look like.

Shaun Keating:                   We got a face only a mother could love, but our mothers love us. So go ahead and tell me a little bit on the difficult cases, like are some of the common issues when a lot of your calls, what you’re doin’, what you’re seein’. I know there’s a lot of room stuff, but tell me a little bit about your day and some of the stuff you get through and get every day. Tell me a little bit about that.

Brandon Fetters:               I was havin’ a conversation about the mountings and room concerns earlier today about properly conveying that to us, and when I was going over with this doctor, we were basically coming to the conclusion of trying to take a bite registration before they even begin prepping, as well as a study model for that, which is especially huge on the maxillary because of the fact that then we can also index the hard palate, to then really confirm that we are at the correct VDO.

Shaun Keating:                   Exactly.

Brandon Fetters:               ‘Cause that seems to be lost quite often, and a lot of times canting will take place, or just where the left side’s collapsed and down, something of that sort.

Shaun Keating:                   The palate and even tissue borders, if there’s [mishinthedentulist 00:01:09] areas. You could take that registration in there, go in against that opposing. It’s kind of a neat thing. It’s kinda like, in a way, a mush bite a little bit, technique. It’s so important. I did a video years ago, and it was so kinda hokey and stupid in a way, but it was a real quick thing. I did these videos, we just did it on the flip phone. It was just for content, ’cause we were just startin’ to get in the social media, so I have some pretty funny ones that just, I kinda see it in my pants, kinda like we’re doin’ here. It’s what we do.

So anyway, as I was just talkin’ about, there’s like 30,000 views on this little thing and it was just like a minute thing, and it was like, “Take a bite before you even prep it.” If you’re workin’ on 30 31, and it’s even a quadrant, just go over to the canine at 27 at least, try to go to the canine if you’re only goin’ quadrant dentistry on the triple tray. Go in with that, and then triple trays work great. You get the opposing, you get the bite, and you get the prep all in one shot. A lot of times, when the patients are all numbed up and you inject ’em, they’re not real comfortable, and they’re not bitin’ real accurately. We always say, “Maybe take a little study model on the opposing or what you’re workin’ on. Take a bite with it before you prep it. If you’re on 30 or 31, go to 27 and bring it all the way back to 31 before you prep it, before they’re even temptin’ the chair. Patients relax and do a good little Blu-mousse bite, throw that in the box. Then, go ahead, do your triple tray, do your prep, do the opposing with it and everything else, and we’re gonna go ahead and just cross reference that bite registration that we took at the very beginning, with what you get on the triple tray.

It’s really kind of a neat thing. It really works good because the teeth are really in a natural relaxed blank that the doctor can go through when the patient’s not all jacked up. A lot of doctors are kinda, “Let’s give ’em a whole block on this thing,” where guys that are good, you don’t have to get a block. I’m seein’ that more and more as I watch more over-the-shoulder dentistry in this little magic chair. We’ve done so many crowns in this chair right here. Kinda cool.

‘Kay, I’ll shut up. But anyways.

Brandon Fetters:               Again, coming back to you before the preparation, or before even starting on the patient, I’d also like to throw out too, be checking the shades at those times, ’cause fairly commonly we’ll run into situations where the shades are being taken afterward or after the patient’s being prepped, and the teeth begin to dehydrate. So the value starts to raise in the appearance of the shading. Then we end up, the case is now coming back, we gotta stain a little bit darker.

Shaun Keating:                   That is so good! so yeah. Not only do that bite, but because teeth hydrate and get dehydrated, as soon as they sit in their chair, it’d prob’ly be good to take that shade. Right then and there, get that shade tab up in there. It’s really important to get color corrected lights if you could. We like even the one outside, a little bit, in the natural sun, but to get ’em before they’re all not dehydrated, right when they’re sitting in the chair, is kind of an important thing to do that shade taking. It’s just somethin’ too, that when you’re doin’ the shade taking, if you could, get a camera and try to get the tab up in the mouth

Brandon Fetters:               True.

Shaun Keating:                   And also, we have it to where doctors, dentists, the male dentists aren’t really great in color. Some are really natural with it, but we find that the women pick colors pretty good, and the assistants, so I had a lot of dentists in the past, I would say, “Get a couple of your girls in there, the dental assistant of maybe it’s just your hygienist or whatever, to get a second and third opinion on the colors.” Usually the women are really good at pickin’ out that shade.

Brandon Fetters:               Definitely.

Shaun Keating:                   I usually tell them, “If you’re really hit and miss on the shades, give me a picture of it in the mouth, but get ’em right when they get in the chair, but also get a couple of your female workers in there, because they seem to pick color pretty good. I don’t have the science behind it, but it works out pretty well, so when that happens,

Brandon Fetters:               Yeah. it’s actually not too uncommon for men to be colorblind. I forget the actual number on it, somewhere around the 30 percentile or so, that reds and greens, men aren’t very prone to picking up on. Definitely, females are far superior in being able to see color. Pretty evident. That’s why we wear white shirts.

Shaun Keating:                   Yeah, exactly.

Brandon Fetters:               Oh my God. I lost my train of thought.

Shaun Keating:                   I thought it was goin’ on right there, now we’re goin’! Yeah, I’m about to shade take, and it’s so important.

Tell me a little bit on

Brandon Fetters:               Oh! That’s what it was, it was about when you’re doin’ the photos on ’em, too, if you’re able to go and get the incisal portion of your shade tap up against the incisal of the tooth that you’re matching, is hugely important. That way, we’re getting it on the same plane as that tooth. The light’s reflecting back at the camera the same, and that way we don’t have that tab in front, casting a shadow on the tooth, or vice versa, with the tooth casting a shadow on the tab. That way it gives us a far better reference point, when they’re matched up incisal to incisal.

Shaun Keating:                   A lot of times they don’t want to do it because they’re trying to get the number of the tab, like a C1. Don’t worry about that, ’cause you can just write it in. If you can’t see if it’s an A1 or an A2 because you have to turn the tooth around on the middle tab, don’t worry about that. Just write it in that, “This shade tab is a C1” that you’re lookin’ at, or it’s an A3.5. Turn it around and get that incisal, incisal to it and stuff like that. And the stump shade, how important is that if you’re all ceramics? So many guys are sending me stuff or cuttin’ out abutments, and they’re not givin’ a stump shade. It’s important to get a stump shade, but there’s not many stump shade things out there, other than the VITA stump shade, or is it the

Brandon Fetters:               Yeah, the Ivoclar, the ND shades.

Shaun Keating:                   Yeah. We get those, but they’re a couple hundred bucks are they, or a hundred bucks, or I’m not sure.

Brandon Fetters:               I’m not sure how much they are, I wanta say about a hundred, but they’re

Shaun Keating:                   I think we had three guys that had some issues with some shades, and we actually even purchased it for them. It was like, “It’s worth it for a couple hundred bucks, give me the stab.” We don’t have to keep redoing the shades for us, because time is money. Whenever we can deal with the tools, we can help out.

We also have our own Noritake Shade Guide, too, that we can give out to doctors, that we can cross reference of fa VITA 3D, or a regular Vitapan, or pretty much any shade guide, we’ll cross reference it and go off of that shade and transfer it to the Noritake. We do have our own Noritake shade guides. The values are a little bit different than the VITA shade. It’s kinda neat. A lot of you, if you are using this, and you’d like to get a shade guide from us, let us know, and we’ll get one out to you. If you do a little bit of work with us, we won’t charge you. We’ll just take care of that.

If you have two or three ops, you know what? I’ll give you two or three, because you don’t need to be goin’ to this op to get it. Just have one there, but if you can get the right shade guide, when all we use is Noritake here, we get EX-3 for our high fusing, PFM’s in our stacked veneers that we’re doin’ off foil, but then we do the CZR, the Cerabien by Noritake for all of our ultra and stuff. It’s pretty neat on material, it’s prob’ly one of the most experience ceramics on the market. Again, we kinda use the best products here. We’re not a Ceramco 3 type lab, or some of these other. There’s some ugly lookin’ porcelains out there, but our porcelain is really lifelike and really beautiful lookin’.

Tell me a little bit about some of the combinations that you’re seeing though. Tell me, 50% of your calls are for room, or what? Tell me what you get, and what are you getting the most of, mostly?

Brandon Fetters:               I’d still say that prob’ly the most common is clearance concerns, interocclusal clearance. Aside from that, it would prob’ly be undercut situations, and it seems like that’s most common when it almost appears as though the prep reduction is happened, and the doctor’s going back and redefining the margin and then creating this undercut. Sometimes they’re lookin’ for a porcelain butt margin, or somethin’ like that, a nice shoulder, but that undercut is just gonna end up being blocked out. And every once in awhile, it ends up actually creating a draw concern so I’d really have to say just to come from those margins, and make sure axial walls have at least a six, seven degree taper to ’em.

Shaun Keating:                   It’s always such a nightmare for, I remember when I used to call the doctors a lot, it’s like, “Dude you frickin’ turned us into a light bulb,” ’cause basically it’s convex at the middle third and then concave as you get down to the gingival, and you’re trying to give me a 90 degree, sloping chamfer, a 90 degree shoulder, millimeter depth. It’s just kinda overkill, but if you can try to keep your axial walls nice and parallel, and just a good prep, it almost needs no cement if you do it properly.

It’s just somethin’ that, if you can, because there’s just so many voids, and so many guys like to build up their preps, they’ll cut it down and then they’ll fill in with material to make the prep beautiful, polish it up. It’s like, “Why don’t we see those guys doing it more? I think they’re doin’ it for photographs more than anything. Nah, it’s just good practice in dentistry

But I always say too, for the dentist, get that margin and all that. Try to go through and maybe base out a little bit of those undercuts, because takin’ that impression out, if you got a rigid polyether like an Impregum, it’s a rebound effect that I don’t think it’s going to mesh up too much, as long as it’s not that close to the margin with those undercuts.

We have a lot of blockin’ out to do. I have a lot of guys that’ll go in and clean up those undercuts a little bit, but then they’ll go and soften all the edges, you know. Instead of all these super sharp corners on the tops of preps, it’s like, “Give me 20 seconds of a nice diamond and go and round off every corner.” It’s like sharpness breaks, and with the substructure, it’s Riconi, it doesn’t matter, or an alloy, it doesn’t matter.

Try to get rid of those little sharp angles and stuff if you can. Just take a little bit of a finesse of a diamond burr at the end of it, and clean up all your rough edges, and smooth things out a little bit. Undercuts we can do all day. I always tell doctors, “Back in,” you know, I could have preps that are off-angle here and there. I don’t know if you’re gonna see red, you’re dead, is endo there? So many cases that when we get to the bigger roundhouse, and the bigger cases, I got a tooth off whack, and the whole case is compromised, because of this one tooth. The dude can’t afford $1500 for the endo or somethin’, and it’s almost like, “I wanna send that guy to my brother, we’ll do the endo to salvage this case,” but it’s so easy for us to do a reduction coping.

A lot of doctors, they’re gettin’ used to us, “Oh, if it’s off whack a little bit, give me a coping here, give me a coping there.” It’s not our problem, but sometimes we’re gonna get in that “Our stone feels no pain.” It’s like, “Yeeaaah! But it’s off?” That’s just freakin’ upright. That thing’s straight up.  God only knows that those doctors, no way he can do that, unless he does a full endo on this guy.

It’s tough. Occlusal clearance, moreso than not, can we reduce it off the opposing, or can I just take it off the prep? We like to do the little coping, it’s a metal coping that you get, and you put it over the prep and you’ll have part of that prep exposed, and you’ll take it down flush, and then you’ll take that coping off, then take it down a little bit more. And then the cases go together. Teeth also like to move, you know, the periodontal ligament. These teeth are mobile kinda, so a lot of doctors say, “No, it won’t be a problem ’cause he can get in there and torque it in a little bit, maybe it shifts a little bit so he doesn’t have to touch it.” We used to have some doctors that do all the big roundies and stuff. They’d go through and around the preps, right before they’re going to cement a bridge in, and just kinda go relieve all the angles a little bit more, and then it drops to place.

Lot of the calls, what other kind of calls are you getting?

Brandon Fetters:               Yeah, and that’s a good hit on that one too, the parallelism factor, what I sometimes have made a joke of as the five finger path of insertion, the old OJ Simpson.

Shaun Keating:                   It doesn’t fit, yeah! You gotta squeeze it.

Brandon Fetters:               Other than that, I’d say by far most commonly is just a request to call, just to review the case and go over the treatment plan like you were saying earlier, just to verify that and the different steps that we’re gonna take. And material selection, everything of that sort. What’s gonna work out best for the patient tends to, really I’d say overall, prob’ly the doctor request to call is the most common reason why I have cases,

Shaun Keating:                   Yeah. And that’s awesome!

Brandon Fetters:               Which is a good thing!

Shaun Keating:                   That’s a good thing that they’re askin’ more. We always say that too. When a doctor’ll get through to me finally, if they’re havin’ issues or he just wants to talk to me, I’ll just say, “You know what? We’re not into the flavor of the month,” we’re not gonna pick a product. I’m not gonna say “Use my KDZ Bruxer,” because that’s my Bruxer, and I make four dollars more per unit.” It’s not about the money. It’s about what works with what case and what patient, and what their ideal objectives is, to “What kind of porcelain are you thinkin’, what kind of restoration,” and we see this day in and day out. For those kind of calls, it’s a great thing, where you can give an honest opinion on what you think will work best. I think that’s any good company that has different product choices, really let the consumer know that what they think is best and that, ’cause we see this every day, that’s awesome, and you’ll pick somethin’ that works. I got a lot of guys that are, “No, I’ve gotta have Emax, here here and here,” and it’s like, “You know what dude, that’s only about 400 megapascals of flexural strength. We don’t wanna be doin’ three inner bridges really, if we don’t have to. Let’s go to maybe an ultra or even our KDZ Bruxer® Aesthetic is stronger and just almost as aesthetic as that Emax, nowadays. It’s pretty nice, isn’t it?

Brandon Fetters:               Yeah, and then you’re goin’ with a monolithic, so you’re eliminating the interfaces, which the more interfaces you have is just more probability for fracture. If you can go monolithic, you’re gonna see greater longevity.

Shaun Keating:                   The breakage is kinda gone. The only time you’ll get some breakage, is maybe some connector areas, if you got three by three, and you got a wall that’s only four tenths. I got these heavy connectors. It’s very rare, but man, I think I got my gray hair in the last ten years of PFMs, because we did a lot of PFMs, we still do, but you’re gonna get some fractures with PFMs here and there, when those teeth are off angle, this and that. It’s somethin’ that we call the tin can effect, ’cause it’s like a little Pepsi can, where you think you have to, you put an opaquer over that and bake it, and then you put this porcelain over that and you bake that, and you have this tin can under there, ’cause we’re at three tenths, four tenths. It’s very very thin, so when they go in the patient loads up on that or tries to get into a centric, “Check your bite, check your bite.” If we’re a little too thin in an area, on that metal, it likes to go crunch a little bit, and “Pop,” it’ll pop at that margin and the doctor is like, “Argh,” at breakage.

We didn’t have much remakes with PFMs, but when we did, 95% of it was not for color, was not for anything but breakage. It’s always been a nightmare for a lot of labs, especially when the CTE, coeffecient of thermal expansion and you have to match the CTEs of your alloys exactly to the ceramic that you’re puttin’ upon. It’s like a science equation. You really can’t mix and match. I don’t wanna pick this porcelain, because I can get it for a buck a dram, and I got this alloy from this dude from God knows where, and I’m gonna put ’em together and see if it works. ‘Cause it’s like these guys try to do this, and you’re wondering why none of their stuff, and we did, and we measured liquid powder ratios, we measure oven tabs, we do all the stuff you have to do to try to predictably get the best result. It’d still come back and bite you in the ass in these bigger cases, ’cause it’s a frickin’ PFM, man.

It could be on my end too, where we’re at three, four tenths by the time the ceramist sandblasts it for the third time through all the different cycles of buildup, then glazing. You get a little hard on that aluminous oxide sandblasts, you’re gonna get a little thinness in there on our end. It could be our end as much as the path of draw being a problem. There’s a lot of variables that can go wrong in this field, and we try to eliminate as many as we can.

The doctor has variables. He has impression materials that are contractin’ and shrinkin’. He has patients that have periodontal problems that are frickin’, “You need to see an orthodontist first, you need to go see a periodontist next to get these gums tightened up, and then we need three root canals, and then let’s do the case properly!” Does that happen a lot of times? No. It’s like, “Let’s cut these down and see what we can do to get somethin’ on it.”

Brandon Fetters:               That’s true too, ’cause we do run into that pretty often, where the doctor is trying to get the patient to go through ortho, to get him set up properly to then do the final prosthesis, and the patient’s really anxious, doesn’t want to do it. They want to go straight forward with the case, so we’re trying to correct these crowding situations and that. Cases can be pretty challenging, especially when it’s that type of a situation for the doctor to be limited on the room, and doing that with the overlapping teeth

Shaun Keating:                   All those options, “They can’t afford this Shaun, we gotta do this, let’s see what we can do,” and we’re sittin’ here with a can of worms or whatever, and we gotta try to make it,

Brandon Fetters:               I was gonna say peroxide there for a second!

Shaun Keating:                   That’s another, that’s our podcast for bleaching, you know. The podcast for gettin’ teeth white.

Hey, we’re runnin’ out of time here. I wanta thank everybody from this week’s Dental Up podcast, so thank you for tuning in. If you could, go to the iTunes area and Dental Up and subscribe to us. Leave a review if you could. I want to thank you all for listening. Brandon Fetters, you are the man.

Brandon Fetters:               Thanks for having me.

Shaun Keating:                   I want to thank you for all the hard work you do, man. I’m so appreciative, and I really am thankful that you’re with us and you’ve been with us a long time. I know you do a great job, you do it with passion, you really care about these cases and these doctors. I can’t thank you enough. You can’t teach what you have, man. You got a good heart and everything else, and I wanna thank you for all that you do here.

Brandon Fetters:               It’s certainly my pleasure. Appreciate you callin’ me back sayin’ “Come on home!”

Shaun Keating:                   You got it man.

Brandon Fetters:               It’s great to be here.

Shaun Keating:                   Thank you everybody, I really appreciate it, have a great weekend and we’ll see you next week.

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