«Howard Speaks Podcast #1 Featuring Mike DiTolla Howard Farran: Ladies and gentlemen, it’s our first podcast, audio and video, on Dentaltown, and it ...»
Howard Speaks Podcast #1
Featuring Mike DiTolla
Howard Farran: Ladies and gentlemen, it’s our first podcast, audio and video, on Dentaltown, and it is of
no surprise that my first guest is my idol/rockstar in dentistry, Mike “The Man” DiTolla. I’ve been
listening to DiTolla lecture for 20 years and I have to tell you that every single time I’ve ever lectured and
a dental society either says we’re never having you back or they loved it, and if they loved, says man, is
there anybody out there that’s as exciting as you, and I’ve only referred Mike “The Man” DiTolla. And everyone that I’ve ever referred to you to speak at their meeting has just absolutely loved you. Mike is second generation dentist, his dad is a rockin’ hot dentist and Mike’s…it’s in his blood. He came from University of Mississippi – there’s four D’s that came from University of Mississippi. There’s DiTolla, Dorfman, Dickerson…who’s the fourth one?
Mike DiTolla: Uh… Howard Farran: Dorfman, Dickerson, Bill Dickerson, Dorfman, DiTolla, oh, we’ll say three. I always remember to use the four great ones, but um, he’s now the Clinical Director of Glidewell, which is the largest dental lab in the world, I think 5% of all the crowns in all of America are made at Glidewell, and Jim Glidewell is another one of my idols. He reminds me of the Herb Kelleher/Southwest Airlines, I mean, he was the first guy that said, hey, let’s do this, let’s bring down our cost and lower our prices so that everyone can afford to save their teeth, at a time when everybody else was, oh, you know, always going to high-end classes and, you know, trying to make a mountain out of a molehill and everybody was just taught in the most expensive, slowest process in the world was the best while basically one in four people over 65 didn’t have a tooth in their head, and I’ve always been a huge fan of Jim Glidewell, and Jim Glidewell, with the largest lab in the world could have hired anybody on the planet to be his clinical director, and he absolutely wanted Mike “The Man” DiTolla, and it was also no surprise to me when Gordon Christensen was looking for someone to continue his legacy, and he started bringing in dentists to start helping him on his lecture schedules since he turned 80 year old. He, too, picked Mike “The Man” DiTolla. So, Mike, it is an absolute honor that you decided, you agreed to be my first audio/video podcast interview. How are you doing, buddy?
Mike DiTolla: I’m doing great. I feel honored to be here on your very first podcast, and I actually, you know, I tell people all the time that I went to the Howard Farran School of Lecturing. Um, when I first wanted to get started with this, I, you were nice enough to let me tag along with you, and I probably went to, I don’t know, 15 or 20 different cities and just watched how it all worked, and I found it so inspirational because I didn’t know that you could be entertaining and educational at the same time, because certainly in dental school, there weren’t may entertaining instructors. And even afterwards at CE courses, there weren’t a lot. And the first time I walked into your course, I was just stunned, I was like, I can’t believe this is, you know, that you can do this, and so you were initially my inspiration to start doing that, and I always loved the fact that you simply don’t have a filter, um, and you know, it’s a great thing because you’ll get up and say anything, and I’ve seen you say things that, you know, got people to get up and walk out of the room, and I always thought that was fantastic that you were willing to state your opinions regardless of the results, so thanks, it’s an honor to be here. And you know, it’s funny you mentioned about Jim Glidewell. The way kind of the lab all started was, and it started in Jim’s kitchen. He was just working for a single dentist, and then he moved inside of that dentist’s office, and Howard Speaks Podcast #1 Featuring Mike DiTolla he learned very early that the best way to be able to do quality restorative dentistry or the easiest way to do it, the easiest and the best way was to be right in the doctor’s office. But, then he went out and started to do some work for some other doctors as well, and that’s how the laboratory started, just with local doctors, and he was on vacation in Pennsylvania years and years ago, and he noticed that some of the dentists in rural Pennsylvania, any time he saw a dental office, he would go in and talk to them and tell him that he was a technician from California, and they were having to send their lab work all the way over to, you know, Philadelphia or Pittsburg. There were no local labs where they were, and so he got an idea, you know, there’s a lot of dentists who don’t live in a major metropolitan area, and if they were, you know, willing to send it across the other side of the state, maybe they were willing to send it to the other side of the country, because he noticed his lab fees were lower than that, so he was kind of the first mail-order laboratory, and it all kind of started from noticing that there was this need, this void, that could be filled.
Howard Farran: Well, you know, we joke in dentistry, I mean, it’s like you go to a study club and, you know, every lecture in the study club is the same thing, you know, my series is called Uncomplicate Dentistry, and it’s like, from ’87 to 2014, you go to study club and dentistry is like, uh, well you know, some dentist will stand up and say I just want to let everybody know that I trim my own dyes, and the next dentist can’t be outdone, so he’s got to stand up and say, well, I pour out my models, trim my own dyes, but I quarry my own stone. And then the next dentist has to out beat…he says, not only do I quarry my own stone, pour out my own dyes, trim my own dyes, I have my own beehive, I grow my own wax, and I wax my own crowns, and it just seems like dentistry is just a cult of the longest distance between two points is high quality, and then if you ever raise your hand and say, oh, I know a short cut, I know how we can do this faster, easier, lower cost, I mean, people are just looking at you like you’re a freak. And I just love the fact that, you know, Jim, Jim’s…how long has Jim been in Glidewell? Thirty-five years?
Mike DiTolla: Yeah, a little over that. Closer to 40.
Howard Farran: Yeah, almost 40 years, and he works every day trying to just take out little bit steps, little bitty minuscule steps, and he also rewards the patients where, you know, if you send in a scan of your prep and he says, I don’t have to pour up the impression, I don’t have to do this, he even gives you a lower price, and he’s just like Southwest Airlines, like Wal-Mart, like Ikea, like all the great companies, like Costco, he actually loves to drive down costs so that humans can afford to save their teeth and have dignity. I think…he’s like antigravity in dentistry. So, what I want to ask you, the whole theme of my podcast here is Uncomplicate Dentistry. You have the most amazing mind in dentistry, um, crown and bridge is probably, you know, behind labor, crown and bridges, you know, the highest cost, and then half of that cost would be supplies…so, Mike, why don’t, you know, we got an hour today – tell dentists how they can Uncomplicate their dental life.
Mike DiTolla: Well, certainly, in terms…first of all, don’t trim your own dyes, just to get back to that for a second. We’ve seen that that doesn’t really work very well because a lot of time we’ll send something back, we’ll look, pour it up, and we’ll look at it…we can’t tell exactly where the margin is, and so we’ll call the dentist and say, would you like to trim it yourself. You know, what a lot of dentists don’t know is Howard Speaks Podcast #1 Featuring Mike DiTolla that here at the lab, we actually have a no-fault remake policy, so whether the patient didn’t like the crown or it didn’t fit or whatever happens, we actually have a no-fault remake policy where we’ll remake the restoration for free, but if we pour out the model and we just can’t see the margins, we’re going to call the doctor and say, hey, we can’t do the no-fault remake here, would you like to try trimming the dye? And he says sure, we send it back to him, and when you look at it before, it’s kind of a jagged margin with a couple of holes where it doesn’t quite match, and then when you get the dye back, it just looks absolutely perfect, and it’s complete revisionist history is the dentist prepping the dye the way he meant to prep it, too. And so it’s actually very dangerous because you get emotionally attached, you know, to how the margins are going to look, and so to have our people who do nothing but trim dyes all day, every day, having done it for the last 20 years, they will unemotionally trim the dye and actually try to nail the real margin and not try to make it look as good as the dentists wanted to make it in the mouth. So, certainly trimming your own dyes is never going to be a good idea, but there should really never be all that many times where that has to happen. You know, there’s certain ways to go about prepping teeth to treating tissue where 90-95% of the time you can avoid those types of pitfalls where you don’t get into a situation where somebody’s having to decide, you know, where you meant to put the margin and where it connects or doesn’t connect, and as you look at, you know, we get, last month, we probably did about 113,000 crowns, so we probably got about 95,000 impressions coming through the lab just last month, and when you look at a lot of these impressions and a lot of these preparations, you begin to see a common theme because most of us tend to make the same types of mistakes in the same areas on a tooth, and so you can kind of start to narrow it down to this is what happens, and you know, I’m just another one of those dentists because the mistakes that a lot of our dentists make are exactly the same ones that I make. And the fact… Howard Farran: Okay, Mike, back to the Uncomplicate Dentistry. You said you did 113,000 crowns, you got 95,000 impressions…I’m assuming that means 18,000 came in optically scanned? And if you were…you know, in Dentaltown, we always say we don’t, we won’t, no dentists ever have to practice level again…what do you say to these individual dentists who are looking at scanning systems from 3M or, there are all kinds of different scanning systems…um, you’ve been talking about trimming dyes, should a dentist be thinking about getting rid of rubber and polyvinyl and polyether impressions and start optically scanning, and is that going to uncomplicate their life, and is that a return on investment, or is that bleeding edge technology, not leading edge technology? What’s your rant on that?
Mike DiTolla: Uh, well, first of all, no, when I said 95,000 impressions, I meant some of those have multiple units on them, but if you…but if you look at the 95,000 impressions that come here in an average month, right around 5,000-6,000 are going to be digital impressions, so it’s growing steadily, but it’s still a very small percent of the impressions that we get in here – about 5% of the impressions that we get in here. Um, it’s interesting to see the difference in quality if you will, between the digital impressions and the traditional impressions. We actually own all the commercially-available digital impression systems here and I’ve had an opportunity to use them all, and they all have one thing in common, and that is you have to treat the tissue better than you do with a conventional polyvinyl siloxane impression, and so with polyvinyl siloxane, you can do things that you probably shouldn’t do, but you can do them, like you can use the polyvinyl material to push blood out of the sulcus, you know, Howard Speaks Podcast #1 Featuring Mike DiTolla if you haven’t treated the tissue well. It’s kind of a hacky thing to do, but you can do it. You can use it to push tissue out of the way, um, because it’s got a physical body to it. When you move to a digital impression system, you’re using, as of today, a laser to scan the preparation from the top down, and any moisture, or any blood around the margin or connecting the soft tissue to the margin, it’s going to ruin the impression, and so you actually have to take better care of the gingiva than you do with polyvinyl, so in that respect, it’s actually a more difficult and, I guess a more complicated way to take an impression because you have to treat the tissue better. Now, dentists who take great polyvinyl impressions today, they’re able to do that, for the most part, because they treat the tissue well. And when I see those dentists buy a digital impression system, they’re able to take great digital impressions, too, because they were already taking great polyvinyl impressions. So, by in large, my feeling, Howard, is that digital impression systems do a lot of things really well. In fact, when a dentist asks me, what’s the one thing I can do to become a better dentist, that’s my first answer, is a digital impression unit will absolutely make you a better dentist if you want to become better.
Howard Farran: And what were the top three systems…I mean, let’s name products. What would the top three be?
Mike DiTolla: Oh, that… Howard Farran: This is out there, practicing alone. You see all the systems. What ones have your attention? Who’s impressing you?
Mike DiTolla: I like the Omnicam from Sirona, I like the TRIOS unit from 3Shape, I just wish it was more affordable. It’s certainly the premium-priced unit out there right now.
Howard Farran: How much?
Mike DiTolla: But…oh, it’s priced in Euros and they have a bunch of different distributors here. Some people put bundle lasers with it, but if it’s an average one, if an Omnicam costs $25,000, for example, the TRIOS from 3Shape is going to be closer to $35,000.
Howard Farran: Okay.
Mike DiTolla: Uh, but they all work really well. The… Howard Farran: 3M has one.