Episode 809: Mastering Large Composite Restorations

Like to me, if they don't need a crown before they go into endo,
they don't need a crown after, right? So I'm going to say to the endodontist in my referral, and
I'll say, listen, if you see something in there with your microscope, if you see that this tooth
needs a crown, I'm doing a crown post-endo. All the other times, my go-to post-endo is a
composite restoration.
Welcome to Austin, Texas, and welcome to the Dr. Phil Klein Dental Podcast. In many of our practices,
when a patient presents with the loss of multiple cusps or develops a crack or needs restoration
after root canal therapy, the treatment plan often points toward a crown. But what if a beautifully
executed direct composite restoration could save that tooth, preserve valuable tooth structure,
function predictably, look fantastic, and provide years of service? That's exactly the conversation
we're having today. Our guest is Dr. John Gammicia, a general dentist with more than 30 years in
private practice, who has built his career around mastering what many call bread-and-butter
dentistry. He believes restoring a single tooth with composite is one of the most rewarding and
most underestimated procedures in dentistry. Whether it's a tooth with two or three broken cusps,
a cracked tooth, or a post-endodontic restoration, Dr. Gammicia isn't afraid to ask the question,
why not composite? In this episode, our guest pulls back the curtain on how he restores these
large, complex composite cases. He'll share the materials he loves and clinical techniques he
employs that have made these restorations predictable in his hands, along with the practical tips
and tricks he's developed over three decades of practice. You'll also hear why he believes this
approach not only helps patients by preserving more of their natural tooth structure and providing
an affordable alternative to crowns, but can also be an enjoyable and financially rewarding part of
a general practice. Fair warning, you may completely disagree with our guest, or this conversation
may challenge some of your most deeply held restorative beliefs. Either way, it's going to make you
think. And if you're open to the possibilities, by the end of the episode, you'll be looking at
composite in a whole new light. 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. Gammicia, welcome to the show. Thank you, Phil, for having me. Gosh,
I love it every time I'm here. It's kind of an honor to be with you. Yeah, you've been doing real
well as far as the listenership, if that's the right word. And I've gotten feedback on the reviews
of your podcast episodes is that you're very down to earth. You know, you got your finger on the
pulse and you're very practical when it comes to what a patient. needs what they can afford and
what your capabilities are using materials that actually don't cost the patient that much and
that's really what this episode is about and some of the materials that you use around doing some
of these procedures so let me begin with this question you often ask a question that suggests a
restorative solution that makes a lot of dentists a little uncomfortable and that question is why
not composite now you're suggesting this When a patient presents with fractures of multiple cusps,
they may have a visible crack on the tooth, a tooth that needs post-endodontic restoration,
which is typically a full crown. At least in my day, it was. Almost every root canal patient had a
full crown. So why do you believe today, and you've been practicing this in your office for years,
that composite deserves to be in the conversation far more often than it actually is?
You know, I have 31 years of experience and I feel like I work in the real world just like kind of
everybody else does. And, you know, the impetus of how I started was I would go to all the classes
and I'd read all the magazines and I was I was all ready to do kind of. maybe more aggressive
dentistry. And when someone walked in with a, had an occlusal amalgam and they broke the lingual
cusps off and I said, gosh, this is, this would be a perfect time to do a buildup in an onlay or a
buildup in a crown. And I would present that to the patient in my, you know, small town,
blue collar area. And they would say, okay, let's do a buildup in a crown. Well, first,
how much is a buildup in a crown? And then I would tell them the price and they would say, well,
You know, how much is it to extract this too thin? Because there's no way that I could, I can
afford what quote unquote ideal dentistry. So. Then at the beginning of my practice,
I would say, well, I'll try a composite filling and we'll just see how long it lasts. And in fact,
I can't even guarantee this thing. But what I found is I did that large composite restoration as
best I could back in 1996. And I saw them on recall in a year later,
and that filling was actually looking quite good. And then I saw him on recall year two.
And again, it was looking really good. So then I started doing it again. And I would still probably
say to the patient, you know, I don't know. I'm pushing the limits of this material. I just don't
know. And then here I am. 31 years later, and I don't even present the buildup in onlay anymore.
I just do a composite restoration, knowing that it's probably going to last for decades.
Now, are you hand sculpting this freehand when you do? Oh my gosh, it is one of my favorite things
to do. And people say, what if you sculpt the whole thing, and then you check the occlusion,
then you wipe it out, right? And I'm like, well, great, you get to do it again. Right.
So you do it with hand instruments before the curing. Sometimes you wipe it out with,
you know, occlusal adjustments and then you get to do it again with the burr. It's like painting.
It's like doing art twice on a tooth. So I love it. So you are one of those people, obviously,
one of those. I'm weird. I know. I know you're weird, but you were one of those people in dental
school. And I talked to someone recently on a podcast that they could carve up a beautiful tooth
out of a block of wax. You know, they could just take a we had these big green. blocks of of wax
and you know they gave you a hand instrument and you had to make a tooth out of it that was kind of
challenging for me um and i certainly wouldn't want to hold my wax up uh compared to some of the
real artists in our class were you one of those super artistic people with your hands okay i'm
gonna come clean i'm gonna come clean so we did have like a sponsored event in dental school that
says like let's do a carving contest and in dental school it was amalgam for us and i thought i was
you know i thought i was it so i went to this thing and i probably got like 13th place right like I
got smoked. I was not very good in dental school. Well, 13th place out of, we had 100.
Maybe 14. I don't know. We had 180 people in our matriculating class. We only ended up with 120.
I think 60 didn't make it. I don't know where they went. No, I wasn't great in dental school, but
it's a skill that I've honed. So with these cases, Dr. Gammicia, when you have a really broken down
tooth, what do you rely on to hold that composite in? Are you relying strictly on adhesive
dentistry? I assume you don't use a post too often. And again, you'd have to have endodontic
treatment first. But for those vital teeth, are you strictly relying on adhesive dentistry for your
retention? Yes. Yes. I haven't done a post in a molar in 30 years.
The only time I ever use a post is like an anterior broken down the gum line. you know crown breaks
off i'll use a post i the adhesives that we use are so superior and they're so good and they last
so long that i i trust i trust in my adhesive system for sure.
So you're, it's not taking, okay. So brass tacks, right? So if, if other dentists,
I understand the obstacles that other dentists can say, look, you can't take the crown away from
me. Right. If you're telling me this tooth needs a crown and you're doing a filling, why would I do
a filling? I'm really good at crowns. I make really good money doing crowns. Well, here's the
thing. You know, if you're efficient at doing fillings, it is so profitable. And what dentists do
is they fall in love with the top line. Right. If it takes you 60 minutes to do a crown. 30 minutes
to, you know, seat the crown, you know, you've got a lab bill, you know, down to brass tax per
hour, you're looking at six or $700 per hour, right? If you do a filling, let's say you charge $330
for a DO filling, and your overhead might be six bucks, right?
Let's say you do two MOs in an hour, so then you're almost at $700 an hour doing two fillings,
right? So there's no question monetarily, if you're good at it and efficient,
you're going to come out ahead on the money. But what about the actual argument that the dentist
will say that tooth doesn't have enough strength and needs full coverage? Are you saying that the
adhesive systems today could hold that tooth together for a long period of time?
where the patient will not come back requesting an emergency visit. Absolutely. So what do you
attribute your success to, Dr. Gammicia? Is it the materials? Is it your technique? Is it your case
selection? Or all of the above? Molars aren't breaking off at the gum line, and I'm building this
thing back up. Okay, so I do that on occasion. But what we're talking about is maybe the lingual
cusp breaks off. Or the, you know, the... mesial cuffs break off.
I don't have any problems doing doing fillings like that. And I know and even in my practice,
I would say if something doesn't last five years, it doesn't matter if they come in on recall,
if they smoke, if they if they never brush your teeth, if my stuff doesn't last for five years,
I'm doing it again for free. That's how much I trust my materials. Now, what about shrinkage? We
know that every composite has some level. of shrinkage and polymerization stress are you seeing
some staining at the margins for instance i find not not really and so i know i have nothing i have
no axe to grind i would tell you if i feel like something is not working well and where my where my
failures are coming i don't really feel like i see stains on my margin and here again is It's the
materials I use. You know, I tell you, a big thing that people overlook is the light.
The light is so important when you're doing dentistry the way I do dentistry. So your light has to
be superior. So I really feel like the adhesives, the composite materials, and I would,
you know, the flowables are great. I warm my composite, my packable composite, great light.
So everything that I use is, you know, the best. When you say light, you're talking about the
curing light. Curing light, yeah, sorry. And you test it regularly? All the time.
And about half my restorations I'm doing with the Monet laser light.
Do you know this thing? Second cure. It's a Monet laser light that really,
I've done over a thousand fillings with this light with a one second cure. Yeah, no, I'm familiar
with the Monet light. It's a very interesting new approach to light curing. It uses a laser instead
of using the conventional LED. And it's very focused, very,
very collimated, highly collimated, I should say. But it relies on the camphor quinone photo
initiator in the composite. So make sure that that standard camphor quinone initiator is in your
material. And so there's a lot less scatter. So the energy is very focused.
And it's great for like deep boxes and predictable curing. And it's more expensive than a regular.
curing light, but a lot of GPs swear by it. They say that it cures faster and it's more efficient.
It's incredible. So Dr. Gammicia, doing these regularly over the last 30 years,
these large composite restorations, what are you getting out of them in years on average? Because
the insurance companies cover five to seven years, they allow you to do them again. So they're
assuming that they may not surpass seven years. What are you typically getting in longevity with
yours? Well, I, you know, it's, it's really hard to say because I don't see a ton of failure.
So then I can't say that they don't fail. They must be just, the patient must be going somewhere
else, you know, geographic success. And, but the ones that I see every day, I'm taking photos of,
I'm like this, this, this M O D F restoration is 14 years old.
It looks like the day I put it in, let's get a photo of this. Right. So my feeling there's.
thousands of them out there in my practice. And I get to see them every six months in my recall,
right? Yeah. And you would hear from patients. If they started failing, they'd be calling your
office. So you often emphasize that success starts with a composite restoration long before the
composite is actually placed. Now, how much of the outcome comes down to preparation, design,
burr selection? And what are some mistakes you see dentists making before they ever touch the
composite? So I use superior products, even from the adhesive all the way to the curing light,
right? So everything that I do is very, very important to me. All the steps are important.
So my adhesive is SE Protect from Curare. Do you typically employ the selective edge technique?
I do a Selective Etch, yes, with the Bisco Etch because it's nice and thick. It's antimicrobial.
Yeah, so everything I do has a thought behind it. So we might as well finish out your whole
armamentarium. You're using the Monet Laser Light, which is a laser curing light.
You're using Bisco Etch. You're using Clear Fill SE Protect as a primer. You're also using the
Clear Fill SE Protect Bond. Do you have any particular preference on burrs?
The burrs that I use, I love to use microcopy burs. They're a single use,
but you get efficiency, consistency, and every time I'm cutting into a tooth,
I know what I'm getting with these burrs, right? So what I'm hearing from other KOLs, Dr.
Gammicia, is much the same as what you're saying, is that it's much more efficient. They also don't
have to worry about sterilizing it, which takes time. and restocking it. So they know when they
open it up, they have a brand new burr. I do want to ask you a question about the patient who
presents with a full coverage crown. So they come in with a crown, the crown is leaking,
it has recurrent decay, it probably didn't fit the day it was put in, or maybe it's cracked.
Do you still give that patient the option of restoring it with direct composite after they've
already had a crown, or typically you're going to just replace that crown in most cases?
I'm not I'm crazy, but I'm not that crazy. Right. So if if a crown has failed and I have to cut it
off, you know, I'm always cutting it off with my neo diamonds from microcopy. Right. Like butter.
It goes right through zirconia like butter. But yeah, if I'm cutting a crown off, that's really the
only time that I'm going to do a full crown on somebody is when I'm taking another crown off.
And so I'm crazy, but not that crazy. But yeah, so I don't do a ton of crowns.
Like in 2018, I asked my, I know that was a bit ago, but I asked my ceramics,
how many crowns did I do in 2018? I did 53. You know,
I'm 25 years into my... I'd be 20, almost 20, over 20 years into my career,
25 years into my career. I did 58 crowns that year. That's one crown a week. And,
you know, so I still feel like I'm fairly successful in my practice. I just, I am doing a lot of
stuff with composite. Let's talk, let's talk about post-endo. Let's talk about cracks, right? I'm
doing everything I can. Tooth structure is so valuable to me. It's still sacred to me.
Right. So I want to avoid crowns as much as I can. Sure, I'll do an onlay. I want to avoid all that
indirect stuff. Right. And so I start using a lot more Ribbond. Right. And so I think,
you know what ribond is? Yes, it's a splinting material. It's a fiberglass mesh, right?
It used to be it is made for splinting lower interiors and things like that. But I'll take that and
I'll cut a little piece and I'll put a piece of rib on perpendicular to a fracture line that I see.
And then I'll do a composite restoration over the top of like a like a rib on filling.
And so reinforce it reinforces the composite. Correct. Yep. And then as far as post endo,
I would say.
75% of the post endo restorations I do is our composite filling and you're not seeing any
fractures. Like a few years later, because I have a relationship with my endodontist and I say,
look, you know, what kind of dentist I am. I don't like to do crowns. Right. So if you see, you
know, like to me, if they don't need, they, if they don't need a crown before they go into endo,
they don't need a crown after. Right. So I'm going to say to the endodontist that my referral, and
I'll say, listen, if you see something in there with your microscope, if you see some, if you see
that this tooth needs a crown, I'm doing a crown post endo all the other times. My go-to post
-endo is a composite restoration. So what about veneers? You have a patient 50 to 75 years old.
They're coming in discolored, social six, wear facets. Teeth are a little bit broken down,
but they're aligned. They're pretty much aligned. How do you propose to the patient to fix those
teeth, to make those teeth more aesthetic?
It's going to be the same thing. Somebody wants something, right? They're going to say, I hate the
way my teeth look. And I say, you know what? I think veneers, you know, you've seen ads on TV.
You've seen everything like, you know, veneers. I said, I would love to do six to 10 veneers on
you. Veneers are $1,600 a piece. And some people would have no idea.
And they're like, wow, that's crazy. I can't afford 16. And I said,
well, there's another way. Right. This is when I do composite veneers. And then people will say,
I really don't. So there's is the money factor. And some people want to change the way their teeth
look without porcelain. So there is a cheaper, less expensive alternative. And I tell them
everything. I tell them, look, you don't have to cut as much tooth, but I don't know how long it's
going to last. You're going to get, you know, they're going to dull a lot faster, but they're about
a third the price. Do you use a clear matrix for that? So I do a lot of my veneers by hand.
But yes, of course, I do a lot of clear matrixes. How do you fabricate the clear matrix? Yeah,
so I'm still, I mean, I'm still a little old school when I just use the Mylar strip. I have
experimented with the Premier. I've experimented with the BioClear.
It's all really good stuff. I have not done injection molding, but I've used some of the matrices
that they have. So you're talking about the prefabricated ones. What they'll have is almost like a
sectional matrix for the anterior. And those are the kind of matrices that I was looking for that
help you with the contact. Now, as a credit to you, you're starting to teach a bit more.
You've been asked to teach in front of some decent-sized audiences at some of the conventions and
so forth, study clubs. And you openly and unapologetically say, that you genuinely love single
tooth dentistry. And yet that philosophy has been viewed by some as almost taboo over the years.
Let's talk about why that is and whether that perception is justified. You know,
I don't, I love all on fours. I love doing full mouth reconstructions. I did all the Pankey
continuums. I'm in the speed on my Spear study club once a month. I love that stuff,
but I don't do it every day. Right. What do I do every single day? And that is bread and butter,
single tooth dentistry. So I'm sorry. I freaking love it. I'm sorry. I freaking love it.
Yeah, I don't think. But that's the thing. You usually say you're. unapologetic. Now you're saying
you're sorry, but I think that your approach is quite impressive because what you're doing is
you're saying, because I go to a lecture, a SPEAR lecture, or I take this continuum with COIS or
whatever, a Panky Institute, it doesn't mean I have to look at every patient like we're going to be
doing a full mouth rehab on this patient, getting their occlusion to a point where it's perfect and
it's textbook. If a patient's 60 years old and they've been living with a bite their entire life
and they're comfortable, Generally speaking, with their occlusion and they're chewing their food
and they have two or three teeth that need to be restored. What's wrong with doing tooth dentistry?
With excellence. With excellence, right? And I'm not saying that this person might not need a full
mouth. What I'm saying is what I'm doing every day is bread and butter dentistry. And for some
people, that's not sexy enough, right? I'm bringing sexy back to the bread and butter dentistry,
right? And I want to do everything with excellence. I want to have a Ritz-Carlton experience for
people. All from what I learned from the Panky Institute is I want to know my patients. I want them
to... in what I do. I want to do everything, but I'm just not doing all those big cases every day.
So I want to bring all that that I learned and bring it to single tooth dentistry. Now, let me ask
you something. When a patient you know has a lot of resources, do you still suggest the composite
direct restorative? solution and say we could do this for a third of the price it will still look
beautiful and work very well for you for many years do you sometimes talk them out of it even
though you know they have the resources to do something more sophisticated that's a great question
um I think that a porcelain veneer is superior than a composite veneer,
right? I have dentists referring me composite work because they would tell the patient,
listen, if you don't want a porcelain veneer from me, I think Gammicia is the guy to do your
composite veneer. And so, you know, we have a good relationship. I do some composite veneers for
somebody. But yes, I really believe a porcelain veneer is superior on a person of a certain.
age you know what i'm saying i don't love to do veneers on a 22 year old person i just don't so i
would love to do a composite veneer two times when they're 20 when they're 20 and then maybe 30 and
then talk about porcelain later on right or you know repairing something but in the posterior gosh
that's a great question i the majority of the work i do in the posterior is composite yes even if
they have means Right, because you feel comfortable with it. You also, we talked offline about
this, that you get a lot of career satisfaction out of doing direct composites and intellectual
satisfaction because you're still challenged every day and still excited every day when you do a
direct composite build up and make a crown, make a tooth into a beautiful restoration out of
composite resin. You still get excited about it? It can't be just me. that every day someone comes
in with a giant hole in their tooth. And let's say that person is 11 years old,
right? Now, without someone like us and our mentality, this person is in for it.
So for me, if the tooth is vital, I'm doing a very large composite restoration on.
a first molar on an 11 year old kid. And I do it with all the superior products.
I do it with excellence. And I know this kid has now, I've changed this kid's life.
I've changed this tooth's life till about 30 years old, right? How awesome is that?
Totally agree. If some dentist that wasn't like us and saw that and like, this kid needs a root
canal, you know, yeah, sure. It's huge. But you know, if you don't know how to deal with a deep,
large restoration, you're kind of like, I don't know what to do here. Right. When a kid walks into
my office, I mean, we we do it every single day. And I'm finding in my practice, I'm finding a lot
of it can't be just me, but a lot of large holes in teeth. I saw a kid,
a kid today that came home from college with nine holes in her teeth because she just she went wild
in college. So now I have to help. And, you know, I'm going to help her. I'm going to turn her life
around. And it's not going to be with root canal posts and cores and crowns. Yeah, no, it's a
conservative way. And I think that your approach to understanding the value of tooth structure and
cherishing it is very, very important. And that's all part of direct restorative dentistry. You
can't do a crown as conservative as you can do a direct restorative composite, right?
I mean, it's very hard to do that. Yep. Can I say something? Yeah. I did some stats in my office
last year. I did 253 crowns last year. How many crowns do you think I did on somebody under 50
years old last year in my practice? So you did 250 last year.
But in 2018, you only did 53. Yeah. So you're doing a lot more crowns.
My patient population is a lot older, right? So what I'm doing is I'm taking a lot of old crowns
off and remaking them. So I do a lot of decay under crowns and things like that. So getting back to
your question, under 50 years old. maybe 10% of your total crowns? 12,
exactly. I did 12 crowns on people under 50 years old. So that's less than 10%.
10% would be, you said 250, so that's 25 crowns. 5%.
Correct. Of people under 50 years old. So think about that. If you're under 50, you're not getting
a crown in my office. Yeah. Yeah. I mean, I would love to see a longitudinal study that follows
these patients for 10, 15 years, because I'm not so sure, you know,
it depends on the operator, depends on the dentist, but I'm not so sure a crown versus a composite
is a slam dunk winner. Because if a composite is done by a dentist who is very careful and
meticulous with adhesive dentistry, isolation, and goes through all the proper techniques that
you're talking about with curing and everything else and occlusion versus another dentist who puts
a crown on and maybe uses a lab that may not be the best lab in the world, who knows where he or
she sends it to, your longevity may be far superior in what you're doing in your office than a full
crown. Is that... you agree that that could be very much the case? Yeah. I mean, so crowns are
dentist specific as well, you know? So, I mean, I believe in crowns. Don't get me wrong. I believe
in them. I just don't do them as much. I just not as aggressive in my treatment planning or
actually I would say I'm more conservative. By the end of this conversation, I'd love for our
listeners to have one of these, holy cow, I didn't know you can do this with composite. I mean,
that was your title of one of your webinars you did for Viva Learning. What's one technique, what's
one mindset shift or clinical pearl that you think will completely change the way general dentists
think about direct composite restorations with these larger decayed teeth?
Wow, that's a great question. There's just so... you know when we talk about deep restorations
there's there's a technique when we talk about deep there's there's there's also a technique when
you talk about big right big is kind of big scares people away and so the contact is really the
hardest part about doing a large restoration there are so many products out there that help me with
my contacts so and you know the The military guys used to use the Toffermeyer,
right? Just the regular Toffermeyer. Now, if you lay a Toffermeyer on a table, it's completely
flat. Now they make Toffermeyers that are convex, occlusal gingivally and convex buccal lingually.
So you have a Toffermeyer. So you have a large restoration that a sectional matrix won't fit.
Right. So you have alternatives to that. There are just products that make these things easier.
So you're saying instead of using a sexual matrix system, you sometimes you have to use a
Toffermeyer. There's just nothing else. But now you can use a Toffermeyer that kind of that kind of
fits the kind of thing you're doing is going to help you get a better contact. OK, that's a
clinical what we call a clinical pearl for sure. There's a product that Garrison Dental makes called
Perform, and it's also basically a contact helper. So there are many products out there that we can
just go over and over. I think you just have, it's not something that this is going to happen
overnight. If you start doing large restorations, you're going to, it can, it can be a struggle. I
would love to talk to your listeners about it, but the contact is super important because you
can't, and the sensitivity is important because if you get a lot of patients that are sensitive
after big restorations or the contacts are bad after restoration, this is going to keep coming back
on them and they're going to get really frustrated. What do you use as a base or liner? Do you have
anything in particular?
You remember Dr. Bertilotti back in, I saw him for the first time in 1996, and they basically call him
the godfather of composite. He was the first Bondodontist, right? He would say,
if you seal it, it will heal. My go-to liner has always been Vitrobond. It's a glass ionomer.
And maybe a little bit lately, I've been using a Bisco product called Theracal.
When going on something really deep, I employ the technique of incomplete caries removal sometimes.
So I don't necessarily have to take all the decay out. So if I'm getting really deep in there,
I leave the decay. Yeah, well, that's an amazingly beneficial thing you're doing for the patient.
The leathery dentin that we're typically told to peel off. that could completely remineralize,
especially with silver diamine fluoride. You put a little silver diamine fluoride there and it
arrests the carries and completely remineralizes that leather redenton. So there's so many
techniques. But not doing a root canal, and I know you're an endodontist, so don't get me wrong.
I love endo, but I want to kind of stay away from root canals as much as I can. So I'm going to
kind of, that's kind of a sacred area as well, right? Now, I know we've, absolutely. Now, I know we
talked a lot about composite, but with these larger fillings on a younger patient, you also could
consider... said, leaving the affected dent in there, the leathery dentin,
putting the silver diamine fluoride on there and go straight with a glass ionomer on top. And when
that sets up, you know, now you've got protection for years and then you could always remove that
glass ionomer if you want to down the road and replace it with a composite. But meanwhile... Or put
a packable on top of the glass ionomer like an old sandwich. Yes, that's right. That's right. You
can do that. Yeah, I mean, I think we covered a lot here. I think the bottom line...
correct me if I'm wrong, is that the notion that a dentist can't make a living by turning patients
away from full coverage and doing direct restoratives on a regular basis, even though they can get
great results with what you're doing, if they keep doing it, they're going to learn the same tricks
of the trade that you've been learning for decades. They're in the mindset where they need to do
the bigger cases. They need to do the prosthetics. They need to be more on the prosthodontic side.
But you're saying financially that is not the case. I know you touched on it, but the bottom line
is the practice could be fine. financially very, very viable using direct composites,
or even more viable in many ways. Remember when we talked about 2018, I did 53 crowns.
One of the reasons why I asked my ceramist about how many crowns I did, the ADA did a study that
said the production of dentists, they do like a survey every other year,
and the 75th percentile dentist did X amount of production. And in that case,
in that year, in 2018, I did 29% higher production than the 75th percentile dentist in that
survey. Right. So I did 30% higher in production than the 75th percentile dentist.
And I only did 58 crowns. Right. Right. So I find myself.
Look, I'm successful because I love what I do and I have value and I love people.
I feel blessed all the time, right? Because of that, treating people well, I just have,
I think I have a successful practice and people come back and that's kind of what it's all about.
And because of that, I feel like financially, I have a very profitable practice, right?
And I don't have to be aggressive in my treatment plan. All I can say, Dr. Michi, is God bless you.
Thank you for being a genuine guy and your patients certainly appreciate it. And it's great that
you shared what you do every day with our audience. You certainly have found your North Star and
you're sticking with it because your career satisfaction and internal happiness shines through
brilliantly when you talk about the dentistry that you're doing and the people that you're helping.
Any closing thoughts before we wrap it up? I was giving a lecture just the other day and someone
came up to me and said, thank you for validating my 43 year career. Wow.
So how awesome is that? There are people out there, right? And they just haven't heard it before.
And so I feel like I'm kind of waking up. I'm speaking to people. There's a lot of people out there
like me, right? And they just, we just need. we just don't hear about it because it's not sex well
that's why i love that's why i love having you on the show it's not in the magazines it's just like
how to do a great feeling you don't see that article it's boring right like right but i love it and
you want me to write that article i'll do it you know so you know there are tons of people out
there that are doing it that are sitting in blue-collar communities like me that love on their
patients right and i'm not saying people that do crowns don't love on their patients because they
do right but i just that it's so satisfying to hear about people like yeah I'm sorry to hear that
Dennis needed to hear you to validate 41 years of their career. But listen, we love having you on
the show. We reach a lot of people, thousands of listeners every week. So whatever you're saying,
the word will get out there. It's my face. It's my face. Yeah, it's your face. It's an audio.
That's right. You got a face for radio. I appreciate your time. And we're going to get you on again
and keep doing the thing because you're helping a lot of people. And that's what it's all about.
You too. Have a great evening. I appreciate you so much. I had a great time.