Episode 797: The 3D Printer That Could Replace Your Mill

When you do these printed veneers, onlays, crowns, and so forth, does the patient actually see the
Ceramix Nano? Because it is one cool looking thing. Oh yeah. I make sure that before I even put the
patient in the room, that printer is sitting on the desktop. And you say, okay, I'm going to make
your crown with this. And they're like, with this? I'm like, yeah, with this. And you leave it
there. You don't move it. You do the work in the room with them if you want to. They're watching
the print. They see the timer. And in their mind, they're like, holy crap, this guy is a whiz.
Like, I have never experienced a dentist like this.
Welcome to Austin, Texas, and welcome to the Dr. Phil Kliein Dental Podcast. Has chairside milling
finally met its match? For years, milling has been the gold standard for same-day dentistry. But
advances in 3D printing and artificial intelligence are challenging everything we thought we knew
about single-visit restorations. And I'm talking crowns, bridges, veneers, and even replacing
stainless steel crowns with aesthetic white printed crowns for kids.
soon become the most valuable piece of technology in your practice. In this episode, we're joined
by Dr. Michael Erdos, a general dentist from Brooklyn, New York, to take a close look at the new
Ceramix Nano from Shining 3D. We'll explore what makes this printer different, how AI is
simplifying restorative workflows, what the ROI is, and whether chair-side 3D printing is ready to
replace or at least rival traditional milling. So if you've been wondering whether now is the time
to rethink your digital workflow, this episode may change the way you're thinking about practicing
restorative dentistry, especially when it comes to a 3D printer. Before we get started, I'd like to
thank all of you for tuning in. If you're enjoying the show, please follow us on Apple Podcasts and
Spotify, and even better, leave a review. By doing so, you're not only showing support for what we
do here, but your reviews are instrumental in getting more dental professionals to listen and
benefit from our content. We really do appreciate it. Dr. Erdos, welcome to the show. Bill,
glad to be here. Yeah, I really want to comment on an excellent webinar that you presented on Viva
Learning back in October, not October, July 7th. And it's called Small Footprint,
Big Impact, Same Day Restorations with Nano-Sized Chairside 3D Printing.
Really good job. It was very well done. And it was very logically presented. If anybody wants to
get a really good idea of the newest concepts in 3D printing, I certainly recommend that podcast.
Now, that webinar. Before we get into the discussion, Dr. Erdos, I want to give the listeners a
brief... overview or slash background of where we are with 3D printing in dentistry and how we got
here. Without a doubt, I think the evolution of 3D printing in dentistry has been nothing short of
remarkable. Actually, it's really something to see. how it's changed the way we practice.
Now, although the technology itself dates back to the late 1980s, as you pointed out in your
webinar, it took decades before it began transforming everyday dental practice. And up until around
2010, digital dentistry was totally dominated by chairside milling systems,
with CEREC being the de facto leader in that space. We're talking about same-day dentistry. Then
3D printing arrived, and that completely changed the conversation. Around 2010, dentists began
using printers in their office to make things like models. That was the main thing they were
working on as far as printers. Then they got into surgical guides, night guards, and then some
dentists were getting really bold and printing dentures. with pretty incredible efficiency.
Now, unlike milling, which is a subtractive process that removes material,
as we know, 3D printing is additive, meaning it builds things layer by layer. And that allows for
remarkable precision, which is ideal for dentistry. It also results in less material waste and
significantly lower equipment costs. However, the early printable materials weren't designed for
permanent restorations, thus limiting the technology's clinical applications. Now, today, it's a
different story. We're witnessing right now, arguably, the next major leap forward in 3D printing
and dentistry. Now, a new generation of printers, a compact, specifically the one you're going to
be talking about, a compact countertop printer. which really could be more accessible than ever
before because it puts such a small footprint out that it could be used in multiple operatories.
You can move it around or you can have one for each operatory, which is really a fascinating thing.
Now, on top of the technology of this printer, which we're going to be asking about shortly, is the
fact that the materials have changed. It's now FDA approved, actually, where we can print permanent
restorations. So that's been a big... major innovation in the whole 3D printing area.
So we have these unbelievable new 3D printers, and now we have materials that can actually pass the
litmus test of being more than a temporary material. So having said that,
let me ask you this, Dr. Erdos. For years, same-day dentistry has been almost synonymous with
chairside milling. But with the rapid advances in 3D printing, as I just talked about, is it time?
for dentists to take a fresh look at chair-side printing as a viable alternative to milling for
fabricating permanent restorations in a single visit? I would say yes. So in general,
what I like to say is it doesn't replace milling just yet, 3D printing, but it is starting to catch
up to milling. And milling proved the concepts. Patients love same-day dentistry,
and it works clinically. the problem is with milling in the past at least you needed a serious
capital investment you needed the space for it and you needed the training to learn how to use the
machines and how to design crowns using those machines or any restorations that you were making but
what's happening now with printing and i'm assuming it's going to come to milling as well is that
the price went down tremendously so the the printer that we're going to mostly be talking about
today the Shining 3D Ceramics Nano comes in at about $6,000, which for a dentist is not a lot of
money in terms of investment in hardware for the practice. When our audience is hearing that we're
going to be talking about a printer, they're thinking in the back of their mind, this clunky, large
piece of equipment that takes up a whole area back in the lab or some counter where it fills the
whole counter up. And then there's a curing box that's involved. Now, I saw this webinar.
that you gave and i was amazed at the size of this thing and how that the curing capability is
built into the actual printer itself so before we get into the details talk about the size of this
and how convenient it is to have even in a very small office that's a great point i took that for
granted that everybody would visualize the printer that i had in my mind but the first thing you
notice when this when you see this printer is how small it is we like to call it like the espresso
printer It looks like an espresso machine, the smallest one that you would see in any hotel room in
Europe. And it weighs less than five pounds, and it's smaller than literally a shoebox.
And the good thing is, like you pointed out, it's not just a printer. It has a built-in curing
unit right under it or as part of it. So it's an all-encompassing, all-in-one,
under-five-pound, tiny little printer that you can bring with you from operatory to operatory,
from office to office, really wherever you want to. So that, in terms of not needing a dedicated
lab space, not having a secondary curing unit, not needing any plumbing, water lines.
air and nothing, it can pretty much stand alone. And all it takes is one plug that goes right into
the wall. Yeah. I mean, you showed us the workflow and I was really amazed to see how simple it is,
especially using AI design software, which I think you prefer. Talk about with us for a minute,
the flow of the digital dentistry process. So the patient comes in with a broken crown and you
know, you have to remove it. And you suggested even in the webinar to the patient, how would you
like me to make you a new crown? It's 9.20 in the morning. By 10.30, you'll have a new crown or
something like that. Talk about how a general dentist could do that, where this machine takes up
almost no space and it requires very little time to actually come out of there with a crown in your
hand. What are we looking at as far as time and workflow? Okay, so time and workflow, once you get
this down, you could probably get a turnaround time of about 30 minutes,
start to finish, to crown delivered. And most of that time,
or I would say about half of that time at the least, can be done by an assistant who is very
basically trained. You don't need to have the best assistant in the world. But it all starts with a
digital scanner. intraoral digital scanner that's the first thing that every office should get when
you're trying to get into this tech and you uh whatever you're trying to do you take a scan of it
that's step number one now if you're using shining system shining calls it the shining flow which
is their architecture that connects all of their shining devices to make things seamless efficient
and to make it easy for you to adopt. So you scan whatever you're scanning with the scanner,
you upload it directly to the cloud, and now you can access that file or that scan from anywhere,
from any computer in the office, your iPad, wherever you need. Well, let's say we're doing tooth
number 12. That's the one with a broken crown. When they come in, you scan what is existing.
right? And then you also scan the prep that you did after you took off the fractured crown,
and then you take a bite and scan that. What else do you scan? That's pretty much it. I'll scan
the, just like you said, I'll numb the patient up, or if you don't need to numb them, then you can
skip that step. And then right away, I'm scanning the entire patient's, the entire mouth, upper
arch, lower arch, and the bite. That's before I touch the patient. I have a record of what things
look like. If I'm trying to model my crown and make it look like that crown, now I have a reference
point. But usually the patient, I'm waiting for them to get numb anyway. So it's the perfect,
let's say two, three minutes of stall. At that point, I'm going to do my prep or whatever I'm doing
in the mouth. And then I'll scan the prep or any part that I changed. After I finish,
which takes maybe 30 seconds once I finish my drilling portion. After you scan, it goes directly to
the cloud, what, automatically? There's a button that says, do you want to send it to the cloud?
And you press yes. And then within five seconds, the file is uploaded to the cloud. Okay, so now
you're looking at this digitally. What's the next step? So when you look at it digitally, usually
that's the time where you're going to decide what kind of restoration you want to make. Usually,
you know, before you start, before you touch the tooth, but now you have a visual of it and you
say, okay, I want to design something. You can design, I'm going to use a crown for an example, but
it can be an inlay, an onlay, a veneer, whatever it may be. And you tell yourself, I'm going to
design a crown. I can do it with AI if I want to. AI means the computer is going to generate a
crown shape or design for you, usually in one to two minutes, or you can have a human do it.
If a human is going to do it, it's going to take a little bit longer.
The most it would take is 24 hours. But if you chose rush, then you can get it sooner. Which is why
most of the time I'm using the AI design. When you say human, is that your lab you're talking about
or someone at Shining 3D? Shining, yeah. Shining 3D has a lab. And they have,
I guess, on their end, a team of designers that are designing things. And I use them all the time.
But when it comes to this same day, half hour, one hour turnaround, I need speed.
And I don't have an extra 20, 30, 40 minutes to wait for a designer to make my crown. Yeah.
How important? is the opportunity for that patient to get that crown so quickly regarding case
acceptance. Do you think it makes a difference if you said to the patient, you know, in two days,
come back, we're going to make a temporary for you. Two days, come back, we'll have the crown.
They're not going to say no to that because they need a crown. What's the advantage of doing it in
one visit besides not having to make a temporary? Not having to make a temporary is a big advantage
besides just not making a temporary. People don't like temporaries, but I find that the clinical
outcome is better when you don't have to make a temporary. I don't know if the patient understands
this. So from a patient's perspective, usually they are trying to push off anything that they can.
I'll come back another day. I got to run to work. Any excuse that they can come up with. And
usually they're valid excuses. They're not making them up. It's just if they don't have that excuse
to make. your case acceptance goes up tremendously. And then as a provider,
when I'm looking, because at the beginning of every day, you look through your schedule, you see
where it's a little bit lighter, you know where you can put in more work for yourself so that you
could increase your production and then you could have a better day. Now, if it's in the social
six, how do you get the shade match to be confirmed? by the patient where you don't run into any
surprises when you finish printing that crown? We haven't got to the point where you deliver the
crown. We're going to get there. But jumping ahead, how do you ensure that the patient's going to
be satisfied with the shade? That's tough. It's still pretty tough with the resins that we have.
Most of them are monochromatic or monolithic or whatever you want to call the word.
You can add stains, you could add glazes, and they can look pretty nice. For an interior crown,
it's still borderline. I would start with some easier cases, and you could even print multiple
shades if you want, and you could show that it's so cheap, so you can just show the patient, look
at this, here's an A2, here's an A1, do you like them? And maybe you can add some of your finishing
touches. So the worst scenario is if they don't like the shade, you can just change it and just
print another one, and in a very short period of time, you have another crown. Yes. Worst case
scenario for me is use the bad shade as a temporary. You're in a rush. You're getting out of here.
This is your temporary. I know it's not perfect. And then when they come back, everything looks so
much better. You can always use the printed crown as a provisional. So what is the material that is
now accepted as a permanent restoration from a 3D printer? Whereas before,
you know, the conversation among dentists was typically. The material itself is not going to last.
What we're printing now, these resin materials are not strong enough to compare to lithium
disilicate or zirconia for sure. What's different about these materials now that they are able to
be permanent? And again, there's nothing really permanent in dentistry, so to speak,
but I use that term to differentiate from a temporary. Yes. Well, now they're starting to put
ceramic filler content in these resins. So the resins are being infused with various ceramics,
whether it be lithium, diasilica, zirconia, anything that they can come up with to increase the
strength, make it easy working properties, to make it aesthetic. And that's the area that I think,
as you touched on, will be the biggest game changer moving forward over the next couple of years.
I think those are going to exponentially get better to the point where it becomes almost standard
to have same-day printed crayons. The way you showed it in the webinar, and again, I keep going
back to it, it's really amazing. It looks like a little espresso maker. I used to stop by some of
the booths at the shows and they would make me a little cup and it would be sitting there on the
counter. And it was a tiny little compact thing. That's what this printer looks like,
this Ceramix Nano. It's just an amazingly small device. And it does so much.
It just amazes me that I can actually create a crown in such a short time. So let's get back to the
cloud. It's in the cloud. You've designed it using AI. Do you have to approve it now? Yes.
So now you get a chance to check over everything, which is what you want to do as a dentist. AI is
a designer, and you are the dentist checking everything. in the old days let's say you had a
milling unit or maybe even an old style printer you had to do a lot more work in terms of design
but now the design that comes back really is 90 of the way there you want to make sure overall
number one the margins are good that they marked your margins correctly you want to make sure the
contacts are good you want to make sure maybe the emergence profile or the shape is good but the
less futzing around that you do the better it comes out usually okay so you're doing that all in
the design software interface you haven't printed anything yet so you go through that i haven't
printed right so you check everything that you just mentioned so now you're ready to print tell us
those steps so once you have that design as long as you have the shining products and you're within
the shining flow you can send it to nest in one click where you press one button it automatically
nests it puts the supports where it should be based on the type of restoration that it is,
and it gets automatically sent to the Nano in the air. Now you go to the Nano, you're starting your
printing process. Printing process usually is going to be about 10 minutes. And within that 10
minutes, you have a mixing phase where the resin capsule that you put in, like your Nespresso pod,
gets mixed automatically by the machine. And then at that point, the printing depends on what
you're printing. But it usually ranges between like 5 and 15 minutes, depending on the size of your
restoration. Now, those little capsules were very interesting. They go into the top of the printer,
the machine, because it's really a printer and a curing machine in one. And it mixes. Who makes
those materials that come in those small capsules? Shining is the one that makes it, the one that
I've used. So you don't buy the material from somewhere else. You're staying within the Shining
system. I'm staying within the Shining system. But I believe it is an open source and that you can
get materials from other places that are not shining. But they have to fit in that capsule,
though. But they have to fit in that capsule. So my guess is the more popular it gets, the more
companies will start to make third-party capsules. So is the capsule sealed when you added the
packaging? The capsule is sealed. Sealed completely. You don't make that capsule. You don't fill
those capsules up. They're just sealed and they're one use. Can you get more than one crown out of
them? You can get more than one crown out of them, but they're single use. So you would have to be
printing it at the same time. I see. So back to the previous portion where I was talking about
nesting, when you're nesting what's going to be inside of this capsule, or when you're laying out
the restorations that are going to be printed from this capsule, you can put multiple patients'
crowns in the same capsule, assuming that the shade is the same, but you just have to set it up. so
that it prints in one time usually what we're doing is we're doing one patient's restorations and
if it's two crowns i'll probably print that together i'll print four or five veneers together maybe
even six if they could fit if they're small teeth but you could print whatever it can fit
essentially inside that capsule and you have a choice of the kind of material it is or is it all
one kind of material you just have a choice of the shade at this moment one material They're
lumicera material, and you can pick between, I think it's five or six shades.
Right, so there's a ceramic component in there that creates the strength and the aesthetics.
Correct, over 50%. Right, so now you've printed it. Tell us what happens when the printing phase is
done and you haven't cured it yet. Once anything comes out of a printer, any resin printer,
it's going to be sticky. It's going to be covered in liquid resin. And cleaning that off is very
important. Number one, because it's hard to work with. But number two, so it doesn't cure extra
material around the restoration that you work so hard and that these companies work so hard to get
precise accuracy. So cleaning it off. usually means running water on it wiping it with a paper
towel or a napkin and some version of isopropyl alcohol certain materials could be soaked in
isopropyl alcohol some you only want to touch them briefly for a second or two with the alcohol so
you don't denature or stain the material which like in this case i would say the lumicera is one of
those you don't want to soak it in alcohol but i have an alcohol spray bottle i'll spritz some
alcohol run it underwater probably about 30 seconds, a minute at most,
depending on how many restorations I have to clean them off to make them dry, essentially.
And at this point, I like to polish my restorations before I cure it.
Once you cure the material, it gets a lot harder. So it takes a lot longer.
to flatten out the supports or to smooth things out. So I like to do it beforehand. But you could
also do it after. What do you use to polish? A rubber wheel. I forgot the name of it exactly.
I learned it from Wally Rene on his Mod Institute website. He had a recommendation for a polisher
for the 3D printed resins. And I love it. I think it's from Brassler. It's a little soft pink.
So you do that prior to putting it into the curing drawer, which is underneath the print.
It's the bottom drawer level where you cure it. Correct. You could do it after too.
And sometimes with veneers, I'll do it afterwards because veneers, like every edge of that thing is
so important. And I want a harder material to polish so that I have...
It's more forgiving. What I want to also emphasize to the audience is that the accuracy of this
actually surpasses milling, right? You're getting a more accurate result than you would if you
actually used a burr and milled it. Is that correct? It's possible, yes. It depends on what you're
making.
can make things that are smaller and more accurate than a mill because when you have a mill like
you mentioned milling is a subtractive process you take a brick and you're drilling out the shape
from from a brick So the burr that you're using or that the machine is using to drill the shape out
of the brick limits how small you can make your corners or your curves.
Or just like if you're trying to make a tiny prep on a tooth, but you have a very fat burr, you
can't make a tiny prep on a tooth. Your prep is limited to how big your burr is. So it's the same
idea with milling machines. With the printers, it's additive. So you can make as small of a layer
as you want to and build upon that. are you finding that your veneers using the ceramics nano is
super accurate super accurate i'm yeah i'm blown away by the accuracy um for me it's the aesthetics
that take a little bit longer to hone in because you have to add a little bit of your touch either
via staining or via finishing once it's bonded onto the patient's mouth so there is a step that you
have to learn there but in terms of the fit yeah i'm blown away i don't even touch most of the
teeth And these things fit perfectly. They drop right in. Now, where does the nitrogen gas come in?
The pressurization or the gas creates stronger and more aesthetic restorations of any kind.
So after I cure my restoration, in your example of crown number 12, I finished polishing it.
I cleaned it off. I'll put it in the curing drawer for three minutes, and that makes sure all my
materials cure, it's hard, and it's ready to go in the mouth. But when I want to give it an extra
layer of glaze, of aesthetics, just to make it feel like a permanent restoration,
like a nice smooth restoration that a patient's tongue would appreciate, that's when I do the
nitrogen cure. And in my case, I do it 99% of the time I'm doing it on a restoration. Yeah,
and that's a separate little device. I just don't see a reason why not. Right, it's a separate
little device. It's very small. And what does that take, like 30 seconds? The cure is 30 seconds,
yes. You have to glaze the restoration, which takes probably 30 seconds. Fill up a little drawer
with the gas where the crown is in. That takes 15 seconds. And then the cure portion is about 30
seconds. They call it Ceramix Nano for a reason. To have that kind of technology packed into such a
small package with all the things that it does is just... really a testament to the kind of
innovation that's coming out in the 3D printing world. So let's talk about dollars and cents.
When dentists evaluate new technology, return on investment is always part of the conversation. A
lot of dentists are kind of gadget people. They tend to buy a lot of things and sometimes they
don't need it. Sometimes it's pretty expensive. They could invest a lot in a laser and then they
just don't use it. And it's just a huge waste of money just sitting there. When it comes to this,
beyond simply producing restorations faster with this device, which gives you the option of same
-day dentistry, where do you see the greatest financial and clinical return on investment with the
Ceramix Nano? So there's different ways you can see the return on investment.
The first is what people traditionally think, which is money. The printer costs about $6,000,
which is not a lot of money for a piece of hardware.
If you were even to just pick one lane or one niche that you want to use this printer for,
forget about everything that it can do. Pick one thing. I believe you can make your money back in a
week, a week, once you know how to use it. Let's say for me, veneers were the thing that drew me to
it the most. I want to be able to offer a lot of patients who I was traditionally doing bondings on
another avenue of indirect restorations. that was more affordable than a porcelain veneer.
The porcelain veneer still looks better than this 3D printed resin,
at least right now. But in terms of case acceptance, so many patients are accepting treatment with
the 3D printed resin veneers. And if they don't like it, you can always upgrade them. The best part
about it is most of the time I don't have to prep teeth. I don't have to cut away enamel. I can use
their teeth that they have, round off maybe some edges. And that's it. They don't get numb. It's a
fairly easy appointment. First appointment, round edges, scan their mouth with a scanner,
take some photos. Then they come back one time. As long as they like the final print that I made,
we glue them right in and that's it. Well, let me ask you, why is there less tooth preparation with
printed veneers versus laboratory fabricated? Just the thickness of the material?
Yeah, I would say thickness of the material. When they print, they have to be a certain thickness.
But once they're bonded into the mouth, you could thin them out really, really thin. And so far,
they've been holding nicely. Okay, so you're saying they're over-contoured when you put them in,
but then you take them down once they're cemented in? Often when you're doing a no-prep case,
yes, because you're not prepping the case, or at least not touching the enamel of the tooth. You're
not worried about fracture of the printed veneer when it gets that thin? Once it's bonded,
as long as it's not on the incisal edge, not really. It's resin bonded. There's nothing really to
fracture it. Worst case scenario, you just cut off the restoration. There's not much downside.
It's not like I just prep this person's tooth and down. kind of stuck right but back to your main
question the main question being how do you get your return on investment is this a good printer i
was saying pick a niche pick a lane in my case it was veneers but you could be a pediatric dentist
and say you know what i want to offer my community 3d printed resin crowns no more stainless steel
crowns we're doing white crowns for our kids printed the same day and that could be that could be
what you want to aim for You want to be the inlay only guy. You want to be the budget crown person,
the budget crown doctor. Whatever you want to pick, you can pick your lane and you could focus on
that. Now, this printer does all of that. You don't have to pick one lane to stay in. But from a
financial perspective, if you can make yourself or market yourself as this type of dentist,
that's something that can spread and build patients and build happy patients and a practice.
So that's the money perspective. And then you have the marketing perspective. Right. I was going to
ask you, do your patients see this device, whether it's during the printing phase or just sitting
there saying you're going to use this device to make their crown in one visit? Do they see it?
Because it really is a cool looking thing just to look. Oh, yeah. I make sure when I'm before I
even put the patient in the room, that printer is sitting on the desktop. Now, they don't know what
it is in the beginning. Even when you start scanning a patient, if a patient hasn't seen a digital
scan, they're blown away. They're like, whoa, this is the coolest thing. You can have a model of my
mouth on a computer that quickly. And then you bring out this printer and you say, OK, I'm going to
make your crown with this. And they're like, with this? I'm like, yeah, with this. And you leave it
there. You don't move it. You do the work in the room with them if you want to. They're watching
the print. They see the timer. And in their mind, they're like, holy crap, this guy. is a whiz.
Like I have never experienced a dentist like this. Is this the smallest printer that's out there
right now that with this kind of versatility? As far as my knowledge, yes. Yeah, that's why, you
know, we're doing this podcast program and I'm talking to the audience now and we're focusing on
this ceramics nano, but you really have to go online and look at this thing, watch a video on it,
look at it in an image, whatever, and look at how small this thing is and how it's so compact.
That's, in my opinion, Just a beautiful thing for a dental practice to have something this
versatile. And I do really think what you're saying about the ROI is very interesting because the
cost of this to you is relatively low once you buy the machine at $6,000,
but whatever cost versus going to a laboratory. So to fabricate these things yourself using AI
design and then going to the printer in your office, what does it cost you to make a crown? The
capsules right now, I believe, are about $22 each. So that would be the cost.
But if you made the patient a bridge... If you made the patient a bridge, it was still $22.
Because you can make it out of one cap. Right, because you can use... If you're doing veneers,
often four or six veneers for one capsule. Right. So what do you charge the patient for four
veneers? I started what I consider on the lower end, I'm charging $750 right now.
for the 3D printed resin veneers. And often patients are doing multiples. They're not as conscious
or cheap, whatever the word is, thrifty when it comes to this. Usually when you're talking indirect
porcelain veneers, the patients are like, ah, two veneers, try to do one, maybe two, maybe four.
With this, I find that they're accepting more because the price is lower. But for starters, they
always say we could four veneers, $3,000. Right, $3,000. Plus we charge about.
$3,000 for one regular porcelain veneer versus four 3D printed veneers for $3,000.
Right, so $3,000 for four printed veneers. You can do that in one visit, and it costs you $22.
Usually two visits is what I'll do. I don't like to rush the veneer process because the design
phase is very important. And also you have to put them in. Yeah, delivering them takes time. You
could do it all in one. visit. It's not impossible, but let's say two visits. All right, two
visits. It costs you $22. No numbing. Barely any prepping, and the patient's excited the whole
time. Right, and it's $22 for you. For me, it might cost $22. And you charge $3,000,
which is a very fair price. And I'll charge $3,000. Everybody wins. Right. The big question is
right now is the aesthetics. When people go for veneers, they're obviously very attentive to the
way they look. And even if it's half the price, if they're looking at their friend's veneers who
had it done to the dentist down the block and they had it done with a lithium disilicate and they
went with Emacs with all the bells and whistles of glazing and staining and everything else,
yours aren't going to look as good, right? Because they're printed. Correct. You can learn to stain
and glaze and make them look really nice, but it takes more time. Right. But you still charge the
same 750 anyway. I'll charge the same 750 anyway, yes. Right, because you can't tell the patient,
hey, listen, I can make these really look good, but they're 900. But if they look okay, I'll charge
you 750. Exactly. I don't really offer the staining and the glazing. Most patients are really
thrilled with them. And in the back of my head, I'm like, if they really want to upgrade down the
road, now they have like a baseline. They know it's something that they're comfortable with that
looks good on them. Now they just want something a little bit more artistic that had the hand of a
ceramist. I mean, the bottom line is, I think you're right. Choose your lane. There's a swath of
patients, huge swath of patients in everybody's dental practice that already exists. They're all
patients of record. That would be very happy to see the improvement from what they currently have.
They may be a patient that has wear facets, right? Their teeth are discolored.
Whatever you print using this machine is going to look a whole lot better than what they have.
And like you said, they can always go to lithium disilicate if they want to step up.
It's like, you know, I guess buying a Subaru as far as the way it looks and then moving up to a
Porsche. I actually like Subaru. I love my Subaru. So, you know, I hope nobody hears this at the
dealer where I go. Because I always tell them I love my Subaru. I have a Forester and I love it. I
don't want a Porsche. Although my friends tell me to get one, I don't want one. But do you know
what I'm saying there? Does that make sense? Yeah, it does. And what I would say is I'm not trying
to convert someone who wants to buy a Ferrari into someone who's buying, let's say, a Volvo,
like a porcelain veneer to a 3D printed veneer. I'm converting the guy on a Vespa with his
bondings, with his direct bondings into the Volvo, into the 3D printed veneer for not much of a
price difference. Right. So it's more of... the bondings and increasing them rather than taking the
porcelain veneer patients and decreasing them. Now, do you think the pediatric dental community is
going to start doing what you suggested and kind of precluding the use of stainless steel crowns,
which require, you know, fitting? They come out of a box. They need to be crimped.
I mean, I haven't done a stainless steel crown since dental school, which was quite a while ago.
But they're still doing it, right? You're still using it. And the parents don't love stainless
steel crowns because they don't want their kids walking around with these stainless steel teeth. So
to print one of these things, it seems like it's almost easier because you get a much closer fit.
I would think so. And if you have a decent patient or you have a patient that has other work to do,
you could, for example, get the tooth ready for the stainless steel crown, or in this case, it
would be a printed crown. You can do one or two restorations on the... pediatric patient that you
were going to do anyway. And by the time the appointment's done, your assistant hands you the crown
that's ready to just be looted in. So you could be doing work and that way the patient's not
sitting there because I mean, what kind of four year old or five year old or six year old is going
to be sitting around for even if it's only a half hour waiting for their crown. Right. And worst
case, you can do it in two visits if you really need to. But it provides an alternative at the very
least to help out really mothers and fathers, but the kids too,
who don't really want to walk around with. of her teeth so as we wrap up this podcast it's been
pretty interesting talking with you uh and i like your candor and you have a great practice in in
brooklyn i i know isaac pretty well isaac towel he's your part one of your partners right over
there yes yeah great guy him and his father yeah great great operation do you do as much implants
as he does no The reason I don't need to do as many implants because he does the implants,
but we collaborate on a ton of cases, and we tend to work together. He does what he likes,
implants. I do what I like, cosmetics, crown and bridge, prosthodontics, that kind of stuff.
But you both love the Knicks, though. You both love the Knicks, yeah. I stayed up for game four,
and I watched the whole game, and my wife, unfortunately, she didn't like the officiating at the
end of the first half, so she called it quits. That was an historic comeback, 29 points.
I've been suffering for a few years. You guys have been suffering for a long time. So yeah, I could
imagine how exciting it was to see them win. Yeah, it was pretty exciting. Okay, so looking ahead,
where do you see Chairside 3D printing and AI-driven restorative design, let's say five years from
now? And for dentists who are still relying primarily on analog workflows, you mentioned it,
but I'll ask you again, what's the first step you would recommend to begin making the transition to
digital? And I think you mentioned getting a scanner. Yeah, exactly. Before we talk about printers
or any of this, step one is buy the scanner. The intraoral scanner is good for everything.
Impressions, patient education, making you seem like a more tech-forward dentist.
But you really, you need it. It's a standard that you're going to need to collect data that can
then be used by AI to be worked on. The way I see it is AI will get better and better at doing more
and more, making the dentist do less and less. Originally... Like I was saying, the dentist,
when it came to milling 10, 15 years ago, had to do a lot. The learning curve was very steep to
design crowns, to use the technology. Some people did it, but it wasn't for most people.
Forget about the money, forget about the space. Now, the dentist really does not have to do much.
You have to know what you want out of your restorations. And that's where I think AI is going to
get better and better and better, where you do even less. And I think even AI... like we're seeing
with digital x-rays or AI doing things like that, they'll do the same with your scan.
You take a scan and then AI is going to spit out a list of things that it noticed. This cusp is
broken here. You should do an onlay. This tooth is grinding here and this is here. And as you start
scanning your patients for every hygiene appointment and you start building up a time lapse of how
their mouth is changing over time, AI will start telling you more and more based on what we're
seeing now and over time. This is what I recommend for the patient. And you're the dentist, so
ultimately it's in your hands. But I just see AI helping in this process to make it easier and
easier. And if you don't have that scanner or you don't have the digital data, you're not going to
be able to utilize the new technology that is coming. Again, I do recommend the webinar that Dr.
Erdos presented back in July 7th. Check it out on vivalearning.com. Small footprint,
big impact, same-day restorations with nano-sized chair-side 3D printing. And he highlights the
ceramics. Nano by Shining 3D, which is something I really think people should look at just to see
what it is. I'm not saying to go buy it. Just take a look at it and see what's happening in this
area. Dr. Erdos, thank you very much for your time. I appreciate it. And it was nice to hear that
you listened to our show. That's great. Yeah, thank you very much for having me. It was an honor. I
had a great time and hopefully we can do it again. Thank you very much.