Secure Dental-Patrick Dewey: Audio automatically transcribed by Sonix

Secure Dental-Patrick Dewey: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Dr. Noel Liu:
Welcome to the Secure Dental podcast. Through conversations with the brightest minds in the dental and business communities, we'll share practical tips you can use to scale your practice and create financial freedom for yourself and your family. My name is Dr. Noel Liu, CEO and Dentist at Secure Dental, and also co-founder of DentVia. I'm your host for the Secure Dental podcast, and I'm so glad you're joining in.

Dr. Noel Liu:
Hello, everybody. Welcome to another episode of our Secure Dental podcast, where we bring in many different talents from both inside and outside our industry, which is our dental industry. Today we have a very special guest, Patrick Dewey, the CEO and co-founder of SIN 360. Patrick has been in the dental field for the longest time, as far as I can remember. He has helped launch multiple dental companies as well as dental-related dental implants. So without taking away the thunder from Patrick, I'm going to let him explain what he has been involved in the past with Nobel Biocare, with Neodent, and with Straumann. So without further ado, I'm going to start right off and dive right into and pass the mic off to Patrick. Hey Patrick, thanks for being here, and appreciate you coming along this part of mine. And let's kick it off, man.

Patrick Dewey:
Yeah. Thank you for having me. Where do you want me to begin?

Dr. Noel Liu:
Let's start with your intro. How did you start into dentistry?

Patrick Dewey:
Okay. 2005, one of my close friends actually was chasing a girl out to Northern California. We were both living in Arizona. And he kind of baited me out for, like, a guy's weekend. He's like, Hey, let's spend the weekend in San Francisco. We'll do a bunch of fun stuff. And he's a really good salesman still in the industry today. He kind of bait and switch me. I flew out there and he picked me up from the hotel. I'm ready to kind of go explore, have fun. And he's like, We got to make one stop. So we kind of hit an exit off, go to a hotel, and he's actually has a surgical training course the entire day at a hotel. So I sat in the back of the room. This was at Nobel Biocare. I sat in the back of the room with his manager and kind of hit it off with him. I was a little upset for having to work that day, but I hit it off with a guy named Mark Larimore, and from then I got in the industry. I was 22 years old. Northern California. Started off as a sales rep, kind of slinging titanium and sitting in on surgeries, primarily with oral surgeons, some general dentists. But how long have you been in the industry as far as dentistry goes?

Dr. Noel Liu:
Man, since '98.

Patrick Dewey:
Okay. If you could rewind back to say, 2004, 2005, 2006 up to say 2009, there was a big tug of war between specialty and general dentists on who should be placing implants. And that was a big contention back then. So I kind of got pushed into the oral surgery side. That's the side that I kind of chose just because I didn't know anything about implants. I didn't know anything about full-mouth rehabilitation. And these are the guys who win the big cases, in my neck of the woods, which is the Bay area. So that's kind of how I got into the industry. If you fast forward, I was with the Nobel Biocare until 2015, but I moved my way up into management, relocated to Arizona, built a team, one of the more successful teams in Nobel Biocare within full arch. I don't know if you remember this, but there is a branding of teeth in a day treatment concept or all-on-four concept. Yeah, so I remember talking with the executive management team thinking that they need to go direct to consumer with that back in 2012, 2013, just to keep up the growth. They didn't like it. They wanted to, actually, that was right when they were doing their sell to Danaher. So I came back, thought about it, put my two weeks in, in 2015, and started Neodent with Petra, David Tony, Chris Luder, and Chris Testa was there as well. So at that time, it's 2015. It's a lot of ex-Nobel Biocare employees. Here Straumman just acquired Neodent in Brazil primarily to, yeah, it's primarily to gain access to Brazil. It's such a unique market in Brazil.

Dr. Noel Liu:
You were right at the pinnacle at that time when Neodent was kind of like established in Brazil. But Straumann was starting to get in, right?

Patrick Dewey:
Yeah, I think it was 2011 when they acquired the first 51%, and then around 2014 when they bought 100%. It was basically, to be honest, they had launched it in the US under different management, but it wasn't launched properly in my opinion, and they didn't really have, there's pretty much no sales from an annual perspective. So we basically came in. Petra Rump, who's one of the best leaders in the industry, she just said, Here's a white canvas. You guys build it as you see fit. And we all agreed we would go to people like yourself and many other clinicians in the industry and kind of say, What do you want from an implant company? What do you need from an implant company? And take that feedback and bake it into the portfolio. So we know we're bringing something to the market. That was the concept and the theory at that time. That was around 2015.

Dr. Noel Liu:
How well did that work out with Straumann and Neodent?

Patrick Dewey:
It actually worked out really well in the beginning, in the beginning. And I'll say this because we were very much independent. We were under Petra Rump, who is again one of the best leaders. I don't think you'll find anybody who say anything bad about her, but she's on the board of Straumann group still to this day, very respected from clinicians all the way up to executives. But she's very much a non-micromanager. She's very much, you know, Make decisions. And if you make risk, make sure they're measured risk, and learn from them. That was her mentality. And from there, we basically tried to really build a brand around full-mouth rehabilitation, which we did. I also launched the, in 2017, we rolled out the in-office milling with Zircon Zan, partnered Straumann Group with Zircon Zan, but then things kind of changed. 2017, at the end, in 2018, that's when Straumann kind of put their hands on the business, so to speak, you know. Not to say anything wrong about Straumann. Straumann's a great company. So is Neodent. But they definitely made their mark. For sure.

Dr. Noel Liu:
So this was until 2021. Then you came up with your own brand.

Patrick Dewey:
Well, there's a little more context and I'm very transparent about it. But 2020, I was a vice president at the time of Neodent and Straumann Group. May 29th peak of Covid, they basically laid me off and fired me, so to speak. And I basically just really thought through things with my wife, like, what are we going to do? What should I do? And it was the first time in my whole career that I kind of had no obligation, which was kind of nice. And I just thought about what's the best thing to do. And it didn't last over, say, three days before I started getting emails, contacts from people. And I've known about SIN, but not very much. But they actually reached out to me and said, We know you brought another Brazilian implant company to the US very successfully, and we would like to see if you're interested in doing the same. So it took me about a year to really vet that to see if that's a good portfolio. What are the people like, you know? What's the culture like? And not only that, but an implant system is only an implant these days. It's not about the titanium. It's not about just the screw. Yes, you have to have a certain product just to be at the table. But you also have to have amazing service, amazing support. You have to have other products that like for yourself, right? You own multiple practices, you're proficient in full arch and you want your team to be educated further, as much as they can be on, say, remote Anchorage or new techniques to help treat your patients better. So we have to have a path to take practices through that journey. And it's not just about a piece of titanium. The screw, there's a doctor in California that says, he's coined this phrase, Dr. Ebrahimian. He says, It's not the screw, it's the crew behind the screw. And that's the important piece because as long as the company is there to help you through that journey, the money's going to come, the products they're going to buy from you. What matters is we can get you over those humps and hurdles, and we know what those latent needs are before you even know what those problems are going to be. And that's something where I look back when we started this June 1st, 2021. Almost, we're three years. Yeah, we're going on four here. I'm really grateful and thankful where we are today. But here we are. We have the number one photogrammetry system in the world, the only FDA-approved photogrammetry system in the world. We've got an amazing product portfolio from solutions that Gonzalez would say, One solution to rule them all. Because we can address pterygoid sites, we can address transnasal, palatal approach, zygomatic. We can approach every indication needed for full-mouth rehabilitation, but with a very deep knowledge on every aspect, from photogrammetry to CAM strategies to CAD strategies to education and so on and so forth. So you name it, anything that touches full-mouth rehabilitation, we train, sell, support, and we innovate, and we check those off and we take those four pillars very seriously at SIN 360.

Dr. Noel Liu:
I've kind of gotten a little bit gist of that, let's put it that way, when I was down in Texas.

Patrick Dewey:
Yeah. I'm curious. Give me your side. What have you seen?

Dr. Noel Liu:
You know, I was blown away because of the level of implant support that you guys had and the level of, like, let's say, the influence that you had, like with a number of clinicians nationwide and the support and the system. And I know, Juan, he loves your system for the zygotes and the terrorists. Right? So I'm like, okay, fine. I had Juan like back in my podcast. And he was like, really, really like on all the zygotes and everything. But at that time, I never dove into SIN 360. And when he actually started explaining all the pros and the cons and how you guys take like the inputs from him from Simon and go back to manufacturing and go like, Hey, this is what we want to incorporate, that just blew my mind away. Because honestly man, I have not seen this with any other implant system that would actually take the clinicians' input and go in and incorporate inside, you know, with the manufacturer. Is that something where you kind of got into it after, or was this always a culture with SIN?

Patrick Dewey:
Well, SIN 360 is different than just SIN Global. SIN is a, SIN implant system is a global brand. SIN 360 is paving the way for the global brand. They've been around for a while, 20-plus years, similar to Neodent, and quite frankly, I'll say this here. There's two implant systems that are both Brazilian, and they've been stealing each other's proprietary knowledge for the past 20 years. It's very evident. So the 16-degree Morris taper that you see on the GM helix, SIN had that in 2011, a 16-degree connection. That's a Morris taper as well. So but then if you look at SIN, there's things they've taken from Neodent that, I mean it's not verbalized, but if I look back at the history and you see when one company releases it, oh, and then they release it as well. So and that's gone back and forth pretty often. But back to your point about taking clinicians' input or industry feedback and bringing that back to R&D and executing that in our product portfolio, that is not an easy task. It is absolutely brutal, I would say, because, yeah, I mean, in 2014, I flew to Israel to try to launch my own implant brand. And Israel, I would say Korea, I would say Germany and Brazil are some of the dominant implant kind of innovators, not just in dental but in medical device and technology, but very much so in some sort of implantable device. And it's very difficult. I would say some of the easiest to work with is probably the Koreans, but the Brazilians are great to work with. They're just a different school of thought, a different philosophy. So we have to go back bringing the feedback to them, and we have to reiterate what that feedback is. And we're at a point now where the team in Brazil, you know, they understand. They understand what the shortfalls are, what it is, where the market is going. But if you look at the US things that you are training on, things that you and your team are training on and the direction that a lot of the full-arch customers in the US are going, it's not very common around the world. It really isn't. So the US is kind of kicking things off, and our goal is to dominate that top 1% of the US, which is the tip of the market. So that's where innovation's rapidly changing. And I'll go over some things that aren't even on the market yet that I can kind of showcase here.

Dr. Noel Liu:
I'd love to. We'd love to.

Patrick Dewey:
Yeah. So I'll go into that here.

Dr. Noel Liu:
But before you do that, I just wanted to point one thing out. You know, like how you said 2020 when you were laid off from Straumann. I just want to be like, you know, like, I just appreciate the fact that you were so candid about it because a lot of people, you know, like when they go through hard times, they never try to see for the other the opportunity that's going to open up for them, and you actually embraced it what it was. So I just wanted to like say, hey man, hats off down to you.

Patrick Dewey:
Thank you. Thanks for bringing that up because it's, like I was at the progressive Full Arch course, the big one with Mark Wahlberg over there. What is that? Last week. And I had a conversation with the doc at Affordable Care, Dr. Hasan. She came in from Sudan as an immigrant. Had to go through so many different trials and tribulations. But it's not about what happens to you or what setbacks you're faced with; it's what you do with that. And that's such a cliche saying, but if you actually take it as such, it does, everybody's going to deal with setbacks. But if you find that pearl and work through the hard times and stick to what you're going after, it becomes so valuable and so rewarding during the process. And to be frank, I mean, me being laid off by Neodent was the best thing that's ever happened. That is the.

Dr. Noel Liu:
At the time, it felt like crap, right? Like, .., what happening. Right? Yeah. No. I love it.

Patrick Dewey:
No no. I just, yeah, we just found out my wife was pregnant. We had so many plans on doing things, and then the future just kind of erases in front of you. And it's like, okay, I got to rebuild this, so.

Dr. Noel Liu:
I love it. Yeah. No, thanks for sharing that. That was really, really powerful, Patrick. I mean, like, this is something I truly believe in. All right.

Patrick Dewey:
That's cool. It's the truth. So. Yeah. All right. Onward. So SIN 360, we're focused on that top 1%. Right? And that 1%, it's not like we can peek around the corner or look at consensuses or see where the market's trending. We have to be in surgeries down on the ground level, have an R&D team like throwing things against the wall, trying to figure out what's going to stick next. So it's a constant kind of self-discovery, if you will. If you rewind back around 2021, that's when like photogrammetry just bulldozed the entire market wide open. Photogrammetry changed the game, changed the landscape, and it's still changing today. Although a lot of these systems out there, it's, how do I say this, the processes and workflows, there's a lot of like one-offs or there's offshoots of, Oh, you can approach it this way or you can approach it that way. I don't believe that. But I would say this. If you have a photogrammetry device such as like an eye cam 4D, a micron mapper, tuple is a photogrammetry device, but a lot of indications you have to take multiple scans and stitch them together. So personally, I don't think that's a fully-vetted solution. So I do like pick eye-cam, micro mapper; those are photogrammetry devices. I'm biased with micro mapper. I think there's you know, that's the only one we sell. But at the end of the day, I'm honest that they're all photogrammetry devices. So let's say, let's just stick in that category. If somebody's using a photogrammetry device opposed to like Nexus, OPTISPLINT, Shining Elite, these are not photogrammetry devices. These are scan bodies, and giving you a path to take an intraoral scan via an intraoral jig and transferring that information to a software. But it's not photogrammetry. So for the sake of photogrammetry, if you're on that path, the problems, challenges, and issues that you're dealing with are totally different than those dealing with, say, OPTISPLINT, Nexus, Shining Elite, or even analog workflows. So, and I say that because if you pair that photogrammetry path with remote anchorage products and solutions, quad zygo cases, very extreme remote anchorage stuff, and then you take on on top of that, you deal with milling, printing, hypodense, CAM strategies, changing geos and softwares; this is a lot to understand and deal with and this is the area we live. So we're trying to own that top 1%. We have to master this top 1% workflow with remote anchorage, photogrammetry, CAM strategies, and why the photogrammetry data is important to bring into the construction info when you go to mill out a zirconia framework. They're all interconnected. So I'm giving you this backstory and a little bit of color on this because this is who our target audience is, is that top 1%. If you look at who our customers are not, it's like the general dentist coming out of school looking to get into do their first implant, it's not like we're trying to boycott them. Our solutions just don't even apply to them yet. They don't understand some of the solutions we have and why they're so valuable. So that's why we try to stay hyper-focused on that top 1%. So hopefully that gives you some context. But that's kind of who SIN 360 is at the moment.

Dr. Noel Liu:
In all transparency, Patrick, you know, I'm one of those guys with the clients that I have been staying away from photogrammetry.

Patrick Dewey:
Okay. Yeah. I appreciate the open and honesty.

Dr. Noel Liu:
And for me, it's never, it was never about the accurate records. I mean, photogrammetry, hands down I would say, yes, it's the greatest to get that microns dialed in. But for me about multiple locations, multiple doctors, right, trying to carry that machine over. What would you say for a guy like me or for many others like out there, right, just a short sentence that, Hey, listen, everybody's like, Hey, photogrammetry's future is not looking too great. What about somebody like me? Like, I mean, I'm kind of on the fence, right? Like, I know photogrammetry works, but again, because of the cost factor, and, you know, the ROI wasn't adding up for me. What do you suggest for somebody like me?

Patrick Dewey:
No, no, no, this is great. And the number one thing, it's not just with me. But you'll find this with my team as well. At the end of the day, we're all in this together. We understand what those challenges are. One of those is cost. This is not a cheap machine. We've tried to do things like, for example, we've got a if you buy a micro mapper through SIN 360, it's 6.99 a month for 39 months. We pay all the interest. So we've tried to remove as much margin as we can for the company just so we can get more in the hands of our customers, but at the end of the day, it's still 25-27 grand, depending on how you go about it. So it's expensive, right? A guy like you that's got multiple practices, you've got nine practices. You know, you go do the numbers. He gets 25 grand per office. So I can see how that's a big investment. So what I would do is this. At the end of the day, if your nine practices are going to be focused on full-mouth rehabilitation, you're going to have some inefficiencies by doing analog anyway. So first it's key to understand what those inefficiencies are. For example, if you say you do one arch a month at an office, it's not worth, you're better off doing like an OPTISPLINT or some other option, because the investment and the workflow and all the things that are needed because it's not just a photogrammetry device, you also need a printer, you need to partner up with a digital designer, you need to have the right internal scan to do the pre-op scan, and then adapt that to the post-op vertical scan in Exocad. So there's a lot of steps to it. So it's one of those things you either dive in digital, go all in, or not. So I would say this. If somebody is doing three arches to five arches, that's when it starts to make sense per month for sure financially because you can eliminate titanium cylinders, you eliminate having to get a pre-made denture, you eliminate doing impressions, you eliminate any remakes. Plus, when you're in the digital world, you can carry that all the way through. If somebody's doing ten plus, you're absolutely leaving resources on the table from a cost standpoint, from your monthly expenses and the accuracy remakes, changes that need to be made, having to do that in the physical world, and then bring it to the digital world to mill it out. So I would say we can go into those details if you want, I can, I spell it out for you. But the easy math, if somebody is doing, say, 1 to 3, three, it starts to get interesting, but lower than three financially it doesn't make sense. And it's not the photogrammetry because you can get that for 6.99 a month, so if you look at your monthly expenses. But what it is, is just everything on top of it: the printer, the workflow, the acumen, training of the staff; those are the key things to this.

Dr. Noel Liu:
Cool. So, Patrick, what's your role right now? We met before like three years back. You were, like, hustling, like, you know, down to the ground.

Patrick Dewey:
Oh, yeah.

Dr. Noel Liu:
Now what's your role?

Patrick Dewey:
Yeah. So now president and founder of SIN 360. It's a mix. So the one thing that I definitely do is I want to stay close to the market because I'm definitely heavily involved on the R&D side. I'm close with Blake Roney who runs our digital team. Gus Khalil, I'm very close with. So myself, Gus Blake, Brian Geist, they're the head of our sales; those are like my core people that I rub shoulders with every day. And these individuals, we are just basically tackling problems. What's our next obstacle? What's our next goal? Where are we trying to develop the new product or workflow? So what I do every day is a lot of R&D. There's a lot of, you know, dealing with financials, reporting back to Brazil. We also were acquired by Henry Schein. So we're a Henry Schein company.

Dr. Noel Liu:
Oh, when did that happen?

Patrick Dewey:
June of last year.

Dr. Noel Liu:
Congrats. Wow. That's awesome.

Patrick Dewey:
June of last year, we were acquired the global brand. SIN was acquired by Henry Schein. So there's a lot of strategizing, planning. Not just in the US, in other countries, but I would just say for the sake of understanding the day-to-day, it's a lot of putting out problems, a lot of hiring, a lot of vetting of new strategies, new talents, a lot of management meetings. But it's not uncommon to find me in the warehouse helping the team, you know, just making sure everybody top to bottom in the organization has what they need, they're enjoying what they're doing, or at least having my ear if there's an issue going on. So I do attend a lot of events, but I'll kind of zoom in if that's cool with you on some of the most exciting things. So the R&D stuff is definitely something you'll find me kind of going into surgeries with, say, a new product in my hand or with a team of people with the new product. So for example, like today, the team just landed in Austin, Texas. There's a doctor, Dr. Adam Carter. They're testing out three new solutions tomorrow. So today they're prepping, but they're documenting it, they're testing it all at his office. So it's very common that.

Dr. Noel Liu:
You're heavily involved in this whole operation. Like day to day. Love it.

Patrick Dewey:
Yeah. It's not just, it's definitely not a money thing. This is something that I have a passion for.

Dr. Noel Liu:
It's a passion. Yeah.

Patrick Dewey:
Yeah. Our team loves what they do. There's nobody on the planet doing what we're doing that we know of. So we're the only company that's got this robust digital portfolio. And we have got the full implant side. So we got to stay ahead. So.

Dr. Noel Liu:
Where are based off right now?

Patrick Dewey:
Based in Scottsdale, Arizona.

Dr. Noel Liu:
Scottsdale, okay. And in Brazil, where are you guys?

Patrick Dewey:
Yeah. So in Brazil, we're headquartered out of Sao Paulo, Brazil. We just finished our new building in Brazil. So we've got, imagine three Costcos stacked on top of each other times three. There's three big Costco buildings. And then there's three of those. One of them has a bridge crossing a major street. That's all glass. So it just finished the renovation. So it's beautiful. We host a lot of courses there, a lot of events like this past weekend. We just had a suite at the F1 race in Sao Paulo, right at the edge of the Senna's trip, I guess they call it. Our CFO went. I didn't go this time, but I will be in the Vegas one. So we'll be there as well.

Dr. Noel Liu:
Nice. I love F1. Who's your favorite team?

Patrick Dewey:
You know, I'm not that into it. So I just love watching Max because that guy seems to wait for the finish no matter what.

Dr. Noel Liu:
You know, it's funny because you know, we as entrepreneurs and as hustlers, we love to see like sports where it's challenging, where these guys are going for it, you know, and it's just an internal spirit. Let me ask you about your Brazil. So you said courses. What kind of courses and who is it open for?

Patrick Dewey:
Yeah. So there's a couple different options. We have a very robust site on on the education front, but when it comes to Brazil specifically, there's two courses primarily that were part of right now. One is Dr. Vanderlin, professor Vanderlin. Okay, so how do I say this? Professor Vanderlin is a very unique individual. He's one of those guys where he does something by the book every single time. And he gets very frustrated if you force him to skip a step. He wants things done perfectly. Now it can be maybe uncommon, but it's the best quality you would want in a lecture and a professor. And he's got some amazing cases. So his claim to fame is the Vanderlin technique. You'll see him do the V. He's huge. He's one of the best, in my opinion, for the transnasal technique. So for very remote anchorage atrophic maxillary arches, he has the best technique when it comes to transnasal. He does do zygoma training and in pterygoid training, but that's what he's known for, is his transnasal course. Every year we put around, I would say 30 to 35 doctors through those courses. We run two a year with him, but those are very much open to the public. They're on our website, so those are totally open. We also have a lot of stuff going on with ORCAA in Guatemala. That's quite interesting as well. I think you were with some of that group and at that last course in Austin. And then we also have a hospital not too far from our headquarters in Sao Paulo, where they do full sedation. They have oral maxillofacial surgeons on staff. They've got dentists on staff and prosthodontists. So a lot of times we can create custom courses if we need to. Maybe we have a small DSO or a certain group that wants to learn a certain specific technique or strategy. We can customize those as well.

Dr. Noel Liu:
Oh, I love it. Okay.

Patrick Dewey:
Yeah. What are you seeing as more of the, let's say, interesting CE out there from a clinician's perspective?

Dr. Noel Liu:
Let's put it this way. You know, with our associate doctors, we host our Tijuana trip that we do internally, and we do that twice a year. For our docs, right? And basically, all my single implants and overdentures. Guys who are a little bit more advanced than that, we introduce a sinus lifts and we do full arches. So that is something we do internally. And that is something which Liz and I, we were speaking about last week.

Patrick Dewey:
I like it. Yeah.

Dr. Noel Liu:
So that is one thing. But you know, when it comes to, let's say remote anchorage or it comes to like transnasal, that is something I would love for, you know, some of our more, you know, proficient docs to be down there to attend. And maybe someday we can even plan something for our little group there, like a group of 9 or 10 doctors.

Patrick Dewey:
Yeah, we are open to it. We've done it in the past a few different times. We've got a whole team internally at SIN 360 that will handle all the logistics, because the logistics, when we do those customized courses, get very robust from private transportation to making sure everybody has their meals accommodated for, there's dietary restrictions. But we've done it before. We'll do it again. So it's just a matter of putting some legwork in. But we just finished actually a customized cadaver course with the AOCs Academy in Scottsdale over the weekend. We had 16 participants, and then we had a number of faculty that came in. Dr. Seth Gonzalez, Dr. Saeed at Ace Dental in Chicago. There's a number, of Dr. Drew Phillips came. It was a really good event.

Dr. Noel Liu:
I love it. So lastly, what's the future for SIN 360 and you?

Patrick Dewey:
So I'll kind of put some feelers out there. Those that are in the know on the full-arch digital side. There's a lot of talk on say, CT alignment, which is, so those that are doing digital will know about this. But the, when you do a case 100% modeless meaning in the digital workflow with photogrammetry, historically you'd have to put fiducial markers in the retromolar pads. You have to put some fiducial markers in the palate, which are bone fixation screws. Sometimes you'll have a little sleeve on them, or you'll just manufacture them in titanium. But you put some sort of a marker that stays in place throughout the entire surgery. So by the end, you can relate the post-op situation to the pre-op vertical. That way you've got the proper vertical throughout the whole process. So the key is to eliminate that on the maxillary arch is very simple. Put two in the midline of the palate, take a pre-op scan, stitch it to the pre-op or the post-op to the pre-op. Very easy. On the lower, it gets a challenging in those retromolar pad areas. Sometimes you'll have eggshell bone, sometimes they get you bump them and they move, and if they're bumped, then your bite's off, your midline's off. You got a big can't. So they can be a pain in the butt. So when you look at what's called CT alignment, you're basically doing the same thing with fiducial markers, but you're actually using a CT scan and natural anatomy. So you can use like the nasal spine, you can use the condyles, you can use any sort of natural anatomy in the CT scans. But you have to make sure the patient's in the proper pre-op vertical. And then post-op, if they're fully sedated, you generally need to have either an Xcat from, like, Jeffrey Toobin, or you need to have something like an Icat where you have a Velcro strap because the patients aren't fully awake. But then you'll just take the post-op scan, you'll segment it into two pieces. You'll stitch the maxillary arch to the pre-op and the mandible to the pre-op. And then from there, you'll edit and adapt your wax up and Exocad and then create your design, print it, place it in the patient's mouth and you go. So again everything would be digital. But that's kind of where, I look at 2025, I'm going to see a lot more of that happening. In addition to that, we're building a lot of products and solutions around the CT alignment workflow, because if it was a family member of mine, I would want them to have a CT alignment or some sort of modeless workflow without the fiducial markers because it's more predictable, it's easier, quicker, less traumatic, and you can get the bite every single time with no issues.

Dr. Noel Liu:
I think the downside would probably just be the CT, right? Like trying to get that.

Patrick Dewey:
Yeah, yeah, you're right. Yeah. You got to get the CT right. Yeah. A lot of times that's why you see those doing CT alignment that do not have the mobile CT scan.

Dr. Noel Liu:
Oh, yeah.

Patrick Dewey:
Yeah. Which are expensive, right? That's the drawback. Yeah, a quarter million bucks to get one of those. I know Jeff Toobin's working on getting one for around 120K or somewhere around there. So hopefully that happens. Makes it a little easier. But if you think about that, the only drawback, the weakest point in the workflow would be capturing a post-op intraoral scan. And after that, everything else is cookie-cutter. I mean, very predictable, no issues. But even with the trios five, which is arguably the best intraoral scanner out there for large spans of soft tissue, now we're releasing a tissue mapping function for the post-op scan, where you can use the micromapper to actually probe the tissue, and within seconds the AI will fill in the tissue. I can send you some video if you want to attach that to your show notes, just to show everybody. It's super exciting. So you still need the trios for the pre-op, capture the bite, but postoperatively you would do a photogrammetry, leave the scan bodies on, and just take this probe probe in approximately between each scan body and it'll prefill the gingiva. Yeah, and then you export a file directly into Exocad, adapt it to the wax up, and you're done. And you just 3D print it.

Dr. Noel Liu:
I am digital, Patrick. It's just that, you know, I was never sold on photogrammetry, man, you know. Yeah. I got the printers, I got the IOS, I got everything, I'm doing all the stuff. You know, I use scan bodies, you know, Jonathan's. people love him. People hate him. You know, so.

Patrick Dewey:
You know what? I think a while back, I listened to him. I think you did a podcast with him, right?

Dr. Noel Liu:
Yeah.

Patrick Dewey:
Jonathan is like, he's one of those personalities, that, right, yeah, people either love him or they hate him. But I think he loses a lot of viewers because maybe some people say they hate him and they're everybody else should hate him or whatever, but he actually brings up some good points. He's got some real big pearls that a lot of people, though, because of whatever the stigma is about his name, they automatically like write it off. And I say this because Dr. Abenaim, he's not a huge proponent of photogrammetry. He's not. But he still has some really good points. It's funny. Now, I remember because I actually listened to your podcast. I listened to that one. And Jonathan, I forget what it was, but he brought up some really good points. I think it was about soft tissue. I think that's what it was. He brought up some really good points about everybody's looking at surgeries and doing the remote anchorage or stuff along that nature, but the one thing that his myopic focus is, is that how much importance and stress he puts on closure, proper closure, making sure that tissue doesn't run away.

Dr. Noel Liu:
The basics. Yeah.

Patrick Dewey:
The basics. Yeah. And doing it extremely well. And how valuable that is for the life of the implant. So anyway, I respect everybody. Jonathan, I know he's a contentious figure out there, but I think he's got a lot of value to add as well. And hey, it's okay not to see. Like I don't see eye-to-eye with him on photogrammetry. I believe in photogrammetry. I've seen it. I mean, we have an office that does almost 200 arches a month, one single office. They've got eight micro mappers. So I mean, it's.

Dr. Noel Liu:
Something that, you know what, Patrick? I'm going to take you up on photogrammetry. I'll give it a shot.

Patrick Dewey:
Yeah, yeah.

Dr. Noel Liu:
I'll give it a shot, man. I'll give it a shot.

Patrick Dewey:
I'll make it easy for you just so you can see the light. But my point is, Dr. Abenaim's got some really good pearls. And I hope, I would challenge your listeners to. If they do think one way or the other, just to hear him out and listen to those things. Because there are some good pearls there.

Dr. Noel Liu:
100%. Hey, Patrick. Thanks so much, man.

Patrick Dewey:
It's been a pleasure. Thank you for having me on. I appreciate the time. Yeah, hopefully we can do this soon after you implement photogrammetry.

Dr. Noel Liu:
We will get back again, for sure.

Patrick Dewey:
Okay. Perfect.

Dr. Noel Liu:
I'm definitely going to take you up on that one. Awesome try. All right, Patrick. So yeah. Hey, we're going to land this plane now. Ladies and gentlemen, thanks for watching and hearing and listening. Patrick was a great, great resource and lots of nuggets today. So just make sure to like and subscribe, and we will see you on the next episode.

Dr. Noel Liu:
Thanks for tuning in to the Secure Dental Podcast. We hope you found today's podcast inspiring and useful to your practice and financial growth. For show notes, resources, and ways to stay engaged with us, visit us at NoelLiuDDS.com. That's N O E L L I U D D S.com.

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