- 1, 2, 3, 4.
- On today's episode of this podcast,
we've got a very exciting guest with Dr. Daniel Galindo,
chief Clinical Officer at Integrity Dental Services.
For those of you that don't know, my name is Rob Dinker,
I'm the founder and CEO of Integrity Dental Services.
Before we get started in talking about some
of these full arch topics and,
and what's going on in, in, in the landscape
and space of the full arch world, uh, Dr.
Glendo, do you mind giving us
a little background about yourself?
- Absolutely. Thanks Rob for the invitation.
Love being here with you and,
and, uh, sharing some of my experiences.
I'm a second generation dentist,
originally from Bogota, Columbia.
I trained and did dental school in Bogota at Uni Ana,
and in 1996 moved to the US
to pursue my protic training at the University
of Rochester in Rochester, New York.
After completing my residency,
I took a teaching position at the University of Connecticut
and was there for three years
learning about the academic environment in the US
and then coming from the tropics, I had to move out
of snow country and relocated to Scottsdale, Arizona in 2002
where I've been in private practice since.
- So let's talk about sort of the full arch landscape
and uh, I know you, along with a few others are sort
of known as the, the early trailblazers
or pioneers of the full arch space.
And, and I know it looked a lot different,
let's say back in the early days to where to
where we are now with the makeup
of intraoral scanning, photogrammetry.
A lot of those fun things we'll get
to later on in in today's episode.
But why don't you sort of talk for a minute,
briefly about the day in the life of your role
as a prosthodontist and the, the original days of,
of all on four when you first started at Clear Choice.
- Yeah, so I joined Clear Choice in 2008.
We were the seventh center that they opened at the time,
and we were basically adopting a treatment modality
that was brand new to the United States.
There weren't many people doing all on
four treatment back then.
So we had to one, learn the protocols
that were initially established by Pablo Malo in Portugal
and one of the trailblazers
of the All On four in the US Mark Adams,
and be able to adopt those systems into
a brand new operation
and transforming patients on a daily basis,
but at the same time learning how
to complete those transformations.
So it, it was a lot of hard work,
it was really rewarding work,
but we put a lot of hours in the office and,
and learn how to make it better.
We're talking about a scale of, of not doing one
of these once a month or once a week,
but actually doing three or four of these per day.
So it, it helped us develop the skillset that clearly
was above the line of what was being presented out there at,
at the time and, and became the reference place for how
to do these procedures.
- How bet that made for some pretty long days
in the, in the beginning,
- Oh my goodness.
There, there was days in which we were walking out
of the office at eight o'clock, nine o'clock and
and again, this is not to talk about the skill set
'cause the skill was there, was just being able
to develop the methods of how to get this done
and get it done right the first time.
If there's something that I've learned is I just want
to get things done the right way from the beginning.
- Yeah, I think that's a good point in a,
in a good transition or segue into to one of our next topics
and talking about fast forward now into 2024,
we're seeing a lot more of, of GPS wanting
to get into the full arch space,
and let's talk about, I know a lot
of people have had success with it in the,
in the practice you came from when you were practicing, uh,
prior to your new role.
I know you, you had a oral surgeon in the office with you
for, for every case than you would take over
as a prosthodontist
and that was sort of the model that you all adapted
and scaled, which has been very successful.
What, let's talk about this, the new space
and maybe some, some insight for gps that are listening
that could be some possible challenges
or hurdles from them that you guys learned in the early days
and stuff maybe they could be aware of when wanting
to get into the full arch space.
- Initially, when we started doing this,
it was two specialists that were using their skills
to be able to get a patient completed.
And the most important thing that I learned is
I couldn't just be a prosthetist.
I also had to know oral surgery
and on the same end, the oral surgeon needed
to understand some prosthodontic principles
because at the end of the day, we wanted to make sure
that the patient would go home with,
with a satisfactory outcome based on the planning
and the execution that we had done.
So I had to revisit anatomy, complete anatomy
of, of, of the maxella, the mandible facial anatomy, and,
and the surgeon had to kind of relearn principles
of biomechanics and occlusion and whatnot.
So fast forward to 2024,
when you have a single practitioner delivering these
procedures, you, your knowledge has to be very broad based
and you have to understand both phases of treatment,
the surgical and the restorative phase so
that you can have a really successful outcome.
And that's the goal for every single patient
that accepts this as a treatment modality
to address their problems. Yeah,
- It makes a lot of sense and
and that's some of the things we see in the lab on a daily
basis and where people are wanting to change
and adapt new workflows.
For example, if, uh, some,
some offices out there now are are marketing, you know,
going to the final restoration
to a final zirconia within 24 hours, I guess
to be more appealing
or marketing to the patient, like, hey, you don't have to go
through so many steps or so many interims until the final.
Also, it's a cost savings from the,
the doctor's standpoint on office visits.
But let's stop for a second
and say, what are we giving up, you know, if, if for so long
and so many years the benchmark
or the standard has been, you know, the protocol
of understanding when the, the soft tissue in the mouth,
everything becomes stabilized,
the osteointegration of the implants.
I mean, in some of these gps that are wanting
to do the surgery, utilize photogrammetry
and go to final zirconia that day
or the next day, what, what are some concerns
or areas that, that would concern you
as a pro orthodontist in doing that?
- Well, let's talk about another one of our passions.
We like fast cars, correct?
We, we love fast cars,
but you need to know when you're gonna drive a fast car fast
and when you're gonna drive it cautiously.
You can't just take a turn at one 20 miles per hour
because you're gonna be slamming into a wall.
So the variable
that is not being considered right now
is the patient's biology.
And no matter how fast I want to go with the treatment,
I've gotta respect biology tissues swell up
during the course of surgery.
There's a healing phase that will happen
that includes inflammation
and if you don't account for that,
the end result is not going
to accommodate the healed tissue.
So it's very important to keep that variable in mind.
There's, there's treatment alternatives that will allow
for the correction of any variance that occurs from,
let's call it day one
after surgery to day 120 after surgery.
But there's some others that are static
and there's no way of modifying it without
compromising the final outcome.
We were talking about this the other day,
you can't reline zirconia in a way in which you're gonna be
happy for it for the long term.
So again, you need to know when you step on the gas,
but you also need to know when you step on the brake pedal
and slow down the procedure
and respect all phases of, of
what biology involved in a human. Yeah,
- And I think that that sort of plays into
what we're seeing on a daily basis
and talking with some of our clients who have,
I'm not gonna say jumped in with both feet, like some
of these other implant groups out there, you know,
maybe there's an elderly patient that they're,
they're only doing an arch on the lower
and they feel like doing a high water design.
It, it could work. And others, you know, it's like,
well when we get to the point, if the tissues change
that much, then I'm gonna make them another zirconia at the
4, 5, 6 month phase.
But then it's like, then what was, in my opinion,
what was the, the speed, the urgency, the rush to go ahead
and get them in a zirconia within 24 hours
if the possible treatment protocol was talking with one
of our docs in Chicago.
And I asked him the question, not
to challenge, but I want to learn.
I'm like, I want to understand
because the nature of this landscape of
what we're doing is changing
and I wanna make sure that integrity's always up to speed
and understanding the expectations of our clients.
Uh, and he told me, he said, Rob, you know, I'm really,
I'm sort of taking it as I go and,
and this is unchartered waters.
I'm, I'm wanting to learn what's acceptable,
what's clinically acceptable,
but chances are, like you said, I'm not gonna be happy
with relining, the zirconia
to really give the patient the best treatment out there.
Probably gonna make them another zirconia
several months down the road.
So, you know, we're all cause
conscious, you know, in the lab.
Sure. I would love to make multiple zirconia for,
for the doctor, but let's talk
about what's best for the patient.
And I think that will be a great transition
or segment into our next piece when we talk about education.
One thing I'm super excited about and
and with you coming on
as Chief Clinical Officer at Integrity is the education
facility that we've built and the infrastructure at the
Scottsdale location for integrity of what's coming.
Uh, for those of you that want to check out our website
to learn more on future dates for events,
but we're gonna take a few minutes to talk now about
what we're wanting to offer as a service because education
and anything we do, dental non-dental is very key
that we're educated by those of our peers
that have been there and experienced.
And I'm very excited, you know, we're, we don't just have a
a lecture hall set up to play PowerPoints.
We actually have a fully operational operatory so
that we can bring in a live patient.
So everything that you're sitting there talking about
that could be on a PowerPoint slide,
we can show them real, you know, real time.
So I want to take a second and let you talk about the
education piece and, and what we're hoping
and what we will be offering at the
Scottsdale integrity location.
- That's one of the things that excites me the most.
So, you know, in my previous career
I completed about 6,000 arches
of full mouth reconstructions using the all
on four treatment concept.
And that has allowed me to learn what works
and what doesn't work and what you can implement
and you can't implement and what's the next step.
Well, being able to share that with people
that are motivated by the same passion
that I have in helping restore somebody's dental condition
to a state of the art type of situation.
So we are going to break down each step of
the procedure into sessions that clinicians come,
can come over, see how they're performed,
see them in in a real life situation, see photographs
and sequences of what we've done with patients
and understand how they can deliver a result
that's more predictable, more successful, more long-lasting.
Ultimately, I think that's the goal of any clinician
that is helping somebody as a patient address a particular
situation that they have in their mouth evangelism
or broken teeth or extensive decay or trauma
or whatever it is.
The ultimate goal is to be able to let
that patient move forward
and carry on with a normal life, unimpeded life.
- Yeah. To play into that, one thing I've learned over time,
good friend of mine and, and a doctor
that used to work with uh, Dr.
Mark Andras, he really sort of educated
and brought light to me about, it's not just the education
for the day of the surgery
and what you guys do with the oral surgeon,
the prosthodontist, but also
after surgery when it comes to hygiene.
Then my brain started thinking about it
and I had to start asking different clients We have,
what is your hygiene protocol for for your patient?
Some of them could answer the question, some couldn't.
And obviously speaking with you, I know that you, you hold
that to a very high standard regard
and that's one thing for any patients out there listening.
If you're thinking of getting this treatment, not here
to sell you on where to go,
but ask the questions of what happens
after surgery once I've had this all on on all on four,
all on X procedure done, what is the standard of care
and what is, what's gonna happen for hygiene?
I want to talk about that for a minute.
'cause I think that's something in this industry we're
so eager to get the treatment done, let's close the patient,
let's get 'em better treatment.
'cause we are giving the patient, you know, a,
a better quality of life and a path for hope.
And it's like, what, what is the standard for for hygiene?
I think a lot of patients haven't even thought about that.
You know, you, for some of these patients,
there's a reason you're having this surgery done is
because of how you took care of the, the oral environment.
Some of them other things have happened they can't control.
But let's talk about it for what you think, you know,
the standard of hygiene should be for one of these patients.
- Yeah. And and I think that what you were mentioning
before is, is very important.
The conversation with the patient has
to be a comprehensive conversation.
Not only what's going to happen the day of surgery and
and what to expect with swelling and bruising
and, and discomfort.
Not only what's gonna happen when you make the definitive
bridge, but there's a life
after you put the definitive bridge
and the care that a patient gives themselves
and the the care that they seek afterwards, whether
with a dentist or a dental hygienist for the maintenance
of their bridge is incredibly important
for the long lasting result of this treatment.
You cannot just assume that
because I'm getting some titanium implants in my mouth
and a zirconia bridge, it's the end of the road.
Correct. It's, it's just really not that you need
to be meticulous as a patient, as a clinician, how
to teach the patient on the regular home care that they need
to follow the brushing, the flossing, the use
of the water pick, and then a regular program
where you see the patient in the office every six months,
every four months, every three months.
It all depends on,
on the individual situation of the patient.
But you want to be able to see this patient
and if there's a habit that you discover in one
of these post-op visits, you wanna break
that habit if it's one that's creating harm
or that could potentially create harm for the patient.
The goal is that these are the teeth that are going to last
for a very, very long time.
I hear it often where
patients are told these are gonna last a last a lifetime,
but okay, what are you doing in, in the process of
that lifetime to take care of it?
You can't expect just to not need to do anything for it.
So that that care aftercare is incredibly important
key to success and again, will allow the dentist
to discover a problem early on
and make the fixing of
that problem a lot simpler than if you wait five
years to see a patient.
- Absolutely. And that sort
of made me think last night when you
and I were talking at dinner, um,
we were talking about some meetings
and the AO meeting that you were just at
and sort of, uh, education that's out there now is sort
of a, an unknown, but there's definitely a fear amongst you
and and and your colleagues of periimplantitis
and without having these type of hygiene visits and,
and bringing the patient in to see, you know, this is,
you know, this is I guess over my level of education,
but is this when you would be noticing these trends
that the patient's developing perim, implantitis, you know,
if that's the case, what's gonna
become the standard protocol?
We don't know. You know, there's a lot of unknown out there,
but back to the point, if you're not coming in for a regular
visit for hygiene, if you're not going back
and developing a protocol for your patient so
that you can monitor and track the, the success of
that restoration in their mouth, I tell people,
tell me it's like having an air conditioning unit.
The filter's very important.
If you don't ever change the filter,
you're never going there to check,
but then all of a sudden your unit's freezing up.
That could have been preventative.
So like as you said, as is important, it is, we want to get
to that definitive restoration.
Whether the patient's getting into zirconia,
zirconia over a ty bar, whatever the,
the restoration may be, that's great.
But we have to talk about life
after that final restoration seating and,
and what is the protocol.
And I can tell you with the large number of doctors we work
with and the thousands of prosthetics that we've made
for patients, not that many, I can tell you only a handful
that really are disgusting
or talking about the hygiene with their patient.
I mean, I'm not saying that more aren't doing it,
but I just feel like the patients we talk
to when they call us and they say, Hey, you know,
I know you're in this industry.
My grandmother's thinking of this restoration, my sister,
whoever, who do you recommend?
This person has this price.
And they said, I can get to the final this fast.
Well, you know, let's sit back for a second
and think, like you said,
we're hoping these teeth last a long a lifetime.
Why are we rushing or why does a few extra weeks make
that big of a deal if we're able to know that we're able
to eliminate something that could arise
or become a compromise just because the competition
or someone's marketing on, on, on Snapchat or tip TikTok or,
or Facebook that hey, I can do an arch at X amount .
It's guys, we're we're not going out buying a new jacket.
We're not going out buying some commodity.
I mean, we're talking about something that's going
to become part of your body and it's gotta adapt and,
and the biology of it and the quality of the restoration
and there's so many out there that do it so well,
but my fear and we're seeing there's so many
that are wanting to enter this space
and their motive behind it is just cost
that patient care is being jeopardized.
And that really worries me. Yeah.
- And, and it, it has to worry.
All of us in the industry, we go back
to setting expectations.
If you set the expectation of how long a treatment is going
to take and how long it's gonna take to get it done right
and properly, I think most everybody will agree.
There might be situations where you need to compromise
because there's an urgent trip or an event that's coming up
and, and you do want to accelerate,
but I mean, you have to know how to do it.
We go back to when you can step on the gas
and when you shouldn't.
What we were talking about the meeting of the Academy
of Os Osteointegration, you know,
the topic being periimplantitis, it, it's kind
of a depressing topic,
but we've come full circle with the practice
of implant dentistry.
You know, in, in the, in the nineties we were learning about
cosmetics and what we could do
to achieve a great result in the two thousands we were
learning how to restore full larges with dental implants.
And, and now in the 2010s we were learning
that we don't have to work only with hybrids.
We can use zirconia
and ceramics to obtain some results
that are, that are amazing.
Now we're learning that there's something
that can affect the, all that beautiful work
that we've done in the past
and we need to learn how to break that cycle.
And I attended several of the lectures and,
and it's interesting that there's still a lot
of puzzle pieces that we haven't found out how
to put them together to understand what triggers
somebody all of a sudden losing some bone around an implant,
losing bone around all of their implants.
We don't know if it was a previous condition
that the patient had that's leading to the compromise of one
of the sites or if it's generated by medications
that the patients are taking or whatnot.
So it, it really opens our eyes to the fact that
a conversation with the patient before,
before you grab a scalpel
or a handpiece needs to be had with the patient
to set the expectation
and to get them investment invested in their treatment,
not only from a financial perspective,
which I know drives a lot of what, what what we do,
but also from a commitment perspective so that that result
will be a long lasting one.
- Absolutely. Well, Dr. Glendo, thank you
so much for your time today.
It's been a, a, a great topic.
I know we could sit here and talk for hours,
but I, you know, we wanted to just sort
of hit some high level points.
Definitely look forward to having you back.
Like I said, we'll, we'll be continuing
to check back on a lot of these things we're talking about.
I'm looking forward to some technology that's out there
that I've been privileged to for Periimplantitis
that could possibly be a solution for that.
Um, as well as some other things.
There's some exciting materials, there's some great,
right now it's such an exciting time in full arch dentistry,
but at the same time, we have to make sure
that we don't get in front of our skis.
We make sure that the materials
that are being developed are tested and,
and the benchmark test is not only out
of the oral environment, but also in the oral environment
to make sure that we're giving the patient
the best quality of care.
Um, and it's the same thing from the lab side where I'm at.
We're wanting to make sure that just
because we could possibly get faster,
are we still, are we jeopardize?
What are we jeopardizing? I mean that's been something
to talk about with a lot of these iOS scanners
as they get faster, what are we giving up?
So thank you again, look forward to, to working
with you in the future and like I said, looking forward
to possibly six months to a year coming back and, and,
and circling back on some of
these topics we discussed today. This
- Is so exciting.
Thanks for the invitation
and can hardly wait for the next time.