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AUDIO - Miguel Stanley - HSP #87
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VIDEO - Miguel Stanley - HSP #87
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Dr. Stanley explains why he started a makeover TV show, and how his experience has prepared him for what's ahead.
Dr. Stanley studied to become a DDS in Lisbon and has several post graduate degrees in the field of cosmetic dentistry and implant surgery.
He has built one of Portugal’s leading practices and is one of the most reputed dentists in the country.
He lectures regularly all over the world on his work, having spoken in over 27 countries.
In order to help pay for his degree, he was a model with Elite. His first TV commercial was at the age of 15 and he went on to do over 60 TV commercials. This close understanding of the TV industry helped him create over 6 TV shows as the creator, executive producer and host, all in the area of medical makeovers. Recently he starred in his own prime time TV show “Dr. White”, a Portuguese adaptation of "The Doctors" and regularly appears as a guest on CBS's hit show “The Doctors”.
He has also had a few cameo roles in feature films.
He is a published author with his book "Health on the Road to Happiness" - "Saúde no Caminho para a Felicidade".
www.white.pt
Tel: 21 396 2727
Howard: Live from New York, I'm with the most famous dentist from Lisbon, Portugal, maybe way beyond that. I'm with Miguel Stanley, Dr. Miguel Stanley, born in South Africa, and at the age of 10 sailed a yearlong sailing. Your dad is Portuguese.
Miguel: Yes.
Howard: Your mother is British.
Miguel: British, yes.
Howard: Anyway, long story short, not only is he a handsome devil, he actually started a cosmetic, what'd you call it?
Miguel: Makeover TV show.
Howard: A makeover TV show in 2004?
Miguel: Yeah, end of 2004, 2005, we did the first show, and then we filmed 7 seasons.
Howard: Yeah, so you are absolutely the most famous cosmetic dentist in your area, and you have a rock-star status practice. You do. You're a legend over there. Where did you get the idea of a, what did you call it?
Miguel: A TV makeover show.
Howard: A TV makeover. Where did you get that idea? How did you pull that off?
Miguel: Well, it's a great story.
Howard: Could you have done it if you had been born short, fat and bald like me? Did it really help to be rocking hot?
Miguel: With a character like yours, you can push through concrete, man. I think it's all about character. Of course, in life some people can rise to an occasion despite any odds, and others shy away. My motto in life is, "No obstacles, only objectives." If I can see it in my head, I can make it happen.
Howard: I can see myself as a Chippendale dancer.
Miguel: See?
Howard: I can see it, in a blind nursing home, a nursing home for only blind women. When did you start the show?
Miguel: The story started, I kind of fell into dentistry. I studied in Lisbon, and in my 4th or 5th year as a dental student, Ronald Goldstein came to town.
Howard: Ron Goldstein, from Atlanta?
Miguel: Ron Goldstein came to town, from Atlanta, and still today we exchange emails and he's probably the first person that inspired me to ever want to lecture, and even pursue a career in dentistry. I must have been 21, 22 years old.
Howard: You were already in dental school?
Miguel: Yes.
Howard: He came to town to lecture?
Miguel: Yes, he came to my university lecture, and I remember I was the only person that had the guts to go up and ask him a question. Of course, English is my main language. A lot of people say, “How come you speak English?" I say, "Well, how come you speak English?" Just because I was born somewhere doesn't mean I have to become, come from there, so I consider myself, English is my mother tongue, so I spoke to him, and had a chat, and he was super cool. I started saving up my pocket money and going to lectures abroad, so when other guys were like, where they were, thinking of where to go spend their summer holidays, or their Easter holidays, or their Spring Break, I was like, "Well, where's the next lecture?"
I started going to conferences even as a kid, even before I graduated, to that information in my head. Malcolm Gladwell, when he talks in Outliers about why some people stick out more, well, one of them is hard work, and being in the situation, so I put myself in the situation. Anyway, already graduated, 2004, I went to the Dental Extravaganza from Densply in Las Vegas. That was a big show. We had Dr. Phil on stage pumping everybody up, finishing with Born in the USA, and everybody was screaming. It was the first motivational speech I'd ever heard. It was Dr. Phil on stage in Las Vegas. This is 11, almost yeah, 11 years ago, and I was just, I'd never seen anything like that.
Coming from a more conservative European background in terms of dentistry, the dental conventions in Europe were very boring. Publicity in Portugal was forbidden. It still is today. Of course the laws at the time, still that prevail today, were written before the invention of social media, and of course, social media just changed everything, so the concept of promoting yourself was frowned upon back in 2004. I graduated and I went to go work 2 years in the south in Portugal and doing very terrible practices, very poor practices, but there was one good practice that I worked at with a South African dentist and a German dentist. They taught me a lot about just responsibility, responsible dentistry.
Again, I saved my money and in my weekends I went to Spain at [Siosta 00:04:37] Institute, where I studied with Mariano Sanz. He's one of the world's greatest perio guys, and [Burtsel Friegerb from the Brunnermag 00:04:43], I studied at the Brunnermag Institute. It took me about a year to get my degree as a, Postgraduate degree in [implantology 00:04:52]. At the time I was very focused on, I didn’t know what I wanted to do and I went to this dental extravaganza and I bumped into Bill Dorfman and I was, “Dude, what has this done to you?” He says, he was Bill Dorfman and he did a lot for dentistry I think in America. He made it mainstream and I know he gets a lot of, he gets a lot of shit for that but the truth is, is that he put dentistry in the mouths of literally, and the ears and the minds of millions of Americans and criticize and don’t criticize as a result of what he did on TV, people went to the dentist more and the industry grew more, it’s just that simple. Kudos to you Bill Dorfman wherever you are.
Anyway, I met the plastic surgeon as well and I was just, I’ve got to do this TV show. I said, I had a background in TV because, a lot of people don’t know this but I was a model, that’s how I paid my way through university. I was with Elite Models which was like a very famous agency and I did over 60-65 TV commercials through a 10 year span and I had a lot of experience acting and being in front of the TV, with makeup and sound and light and directing. I never thought that would amount to anything but I had that decade experience of television in the back of my head and plus I knew a lot of people in the industry, so it just doesn’t happen by chance. You don’t just wake up and say I’m going to do this. I have the experience.
Anyway, I find out that ABC was the network that had the rights to Extreme Makeover, it was a brand.
Howard: Is that what Bill Dorfman was in, the Extreme Makeover?
Miguel: Extreme makeover and now, and Extreme Makeover body edition, face, nose, plastic surgeon, morphed into Extreme Makeover home edition with Taylor, right? Most people don’t know that but thatw as a spinoff of the extreme make over body edition. Bill Dorfman and a team of plastic surgeons, they were the first people that pioneered the concept and then there were a lot of spinoffs with the Swan and so on and so forth. These programs, they focused a lot on beauty and, being American they were very US-centric. What I, my biggest thing here was, I wanted to have control because I knew we’d have to adapt it specifically to the European market and more specifically to the Portuguese market.
Got in touch with ABC and I said, who owns the rights in Europe and there’s a Dutch company called Endemol and they make a lot of TV shows like Big Brother. They did that. Do you get Big Brother in America?
Howard: I’m not sure.
Miguel: Anyway, so they make these huge TV shows and I realized that I was going into a difficult territory with a lot of people involve so I just said, to hell with it, and I wrote my own concept. I re-wrote the whole concept. I said, you know what, it can’t just be about the makeover. We need to engage with the doctors. It has to be a studio show so people are going to want to ask doctors the questions like “Why did you do that? How did you do that?” We were going to serve stuff that people hadn’t seen before. This is 11 years ago where the whole cosmetic world and cosmetic dentistry still wasn’t mainstream, and it still isn’t today and this is 11 years ago. I pitched it to a network and the guy said, “What do you want to make this happen?” He says, “I trust you. I know you can do this.” He was asking like how much did I want? And I said, “I don’t want any money.” He’s like, “What?” I said, “I don’t want any money. I just want absolute power, absolute control.
Nobody gets in my show, nobody gets out of my show, nobody, no publicity, no nothing that I don’t sanction.” Why? Because I wanted to make sure that it would be ethical and responsible and, few people know this but all of my TV shows I’ve been the absolute executive producer with absolute executive powers. That’s the reason why we’ve never been sued, we’ve never had any problems, we’ve never had any complaints, and because ethics had to be the foundation of this because these are human beings that we’re working on.
The 2nd thing that we did was we removed our egos from the equation so I invited my competition to be part of the first show. I got 6, 7 doctors that [have 00:09:06] never been done before, I knew that my license was probably on the line because I didn’t know how the bar of dentists, our ADA, let’s say, would deal with this. I was hoping they would see it as information and not publicity and I was very careful to hide the names of the clinics and stuff like that. We did the first show and it just exploded. It was just, the response was incredible because I wasn’t doing fillings. I was doing full on, smile, design orientated full mouth rehabilitation.
We did 23 cases a show, plastic surgeon [dentition 00:09:42] …
Howard: 23 cases a show or a season?
Miguel: Oh sorry, a season.
Howard: 23 cases …
Miguel: 2 cases a show, 13 episodes. We filmed it over 6 months to allow for the guided bone regeneration and all of that stuff. For the first time 11 years ago, I was showing, because I used the same techniques today as I did 12, 13, 14, 15 years ago. [I was just faster 00:10:02] at it and with responsible dentistry. Today I get a lot of stick from, still today from colleagues in Portugal because …
Howard: A lot of what?
Miguel: A lot of, I don’t know, a lot of stick, a lot of criticism.
Howard: Okay, stick means criticism?
Miguel: Well, yeah, I would say it was a difficult pill for a lot of my colleagues to swallow because it did give me a huge boost, I would even say an unfair boost, but I do know from the market, that it grew about 35% as a result of my TV show because …
Howard: The cosmetic industry or dentistry [crosstalk 00:10:41].
Miguel: The whole industry. People were doing more boob jobs and more liposuction, more everything as a result but in dentistry particular, the sales of implants went up 35%.
Howard: We knew it’s an err to think in fear and scarcity and high self-esteem people like you and me thinking hope, growth and abundancy and a rising tide leaves all ships so it’s sad when people don’t understand that people like you and Bill Dorfman are helping us all.
Miguel: I think in any war there always has to be a flag and something for people to follow. I know that for, I have a lot of people who support me in this and there’s something, there’s a German word called [German 00:11:29] which is to be happy for somebody else’s misery. Of course, in any field, people at the top, there’s always somebody trying to pull you down because they say, “Well, I could do that, I could do that,” but the truth is, you didn’t. There’s been a lot of trials of people trying to do this. I personally think that a decade later that the formula is kind of burnt out. I don’t think I’d do another show today, that’s, I’ve stopped doing them just because I think they’ve, people have understood already.
10 years ago it was innovative to show what medicine could do to help you with your life. My more recent show, Dr. White, which we filmed over 2 years in 2012, 2013, and I must say, I filmed this in a functioning practice where we were seeing over, I had about 12, 13 dentists on my team, I have a very large practice. Only at the time we had 8 units, 8, 9 dental units so not that many. We were seeing paying customers every day and filming a TV show simultaneously so the logistics behind that was quite [parton 00:12:41], let’s say, but we pulled it off. The last seasons of Dr. White were more about happiness and not about beauty because I thought that if you do a makeover show that focuses on beauty, you’re ostracizing about 95% of the population that don’t think of themselves as beautiful. If you focus on happiness, that includes everyone, and that’s what we focused on, how dentistry can help you be happier, and that is the title of my lecture which is no half-smiles and how dentistry can help you live a happier, more successful life.
Howard: Let’s go in there, how can dentistry make the patient live a happy, healthier life?
Miguel: Well, I will add to you that, how can ethical and morally responsible dentistry help people live a happier and healthier life? As I said in my lecture, I gave a brief lecture yesterday and I was saying that a dentist’s main role is in concern of his patient’s happiness. What I’m trying to say is that …
Howard: A dentist’s main role is what?
Miguel: A dentist’s main role isn’t doing fillings, or cavities, or, it’s to actually ensure his patient’s happiness and that means you need to treat your patient the same way you would yourself. I think it’s an aggressive market, it’s an aggressive industry. I’ve lectured in over 29 countries. I speak 4 languages so I really can get in there and understand.
Howard: What are your 4 languages? English, Spanish …
Miguel: French and Portuguese.
Howard: French and Portuguese, that’s 3 romance languages.
Miguel: That’s Brazil, Brazil has got 280 million people living in it.
Howard: If you speak Portuguese, French and Italian, is that what you’re saying?
Miguel: I don’t speak Italian no, it’s Spanish, Portuguese, English and French.
Howard: Spanish, Portuguese and French are 3 romance languages so that’d be very close to Italian and Romanian?
Miguel: Italian, I can understand Italian but I wouldn’t venture to speak in it.
Howard: Those 5 languages, and Romanian?
Miguel: Romanian no, Romanian is old Latin, it’s more associated to Latin but that’s completely different to French, Spanish and Portuguese. This is to say that I’ve lectured in these countries and I can see that around the world, there’s a lot of us that seem to look at dentistry as a business and it’s legitimate to look at it as a business but what’s not legitimate is to try and make money out of somebody’s ignorance and somebody’s misfortune and somebody that’s hostage to a pain or a certain dental condition and just because you have the tools to make money out of it, doesn’t mean you should.
I’m a bi of a Robin Hood of dentistry because I really do, people that can afford dentistry, I will give them, sell them a Bentley and charge for it and people that can’t, I’ll help them out, if they’re nice.
Howard: That’s well said, well said.
Miguel: We have, we’re doctors, there’s that thing in the Hangover where the guy says, “Oh, let me take a look at that x-ray, I’m actually a doctor.” He says, “No, you said that last night, in fact you’re just a dentist, just a dentist.” As you also saw in my lecture, we did a study proving that dentistry in fact has a much stronger impact in people’s lives in terms of, when I say, I’m not just talking about a filling, I’m talking about a brand new smile, correct [aprusion 00:16:07], proper function, healthy gums, and depending on your initial condition that could involve $50, 000, $60,000 of work, but if you have just the need for, I don’t know, for a root scale [inaudible 00:16:20], you can spend $100 and reach there. It always depends on where you’re coming from.
If a person recuperates their full smile, facially integrated, good looking set of teeth, innoclusion, healthy chewing function, good phonetics, it actually brings absolute joy to their lives.
Howard: Everybody that’s watching this right now, almost all of them have never gone to another country, let alone seen another dental [inaudible 00:16:46], another country. You’ve lectured in, what did you say …?
Miguel: 29.
Howard: 29 countries, so 29 countries, what is dentistry like and what …
Miguel: Including Iran.
Howard: What is the similar things in 29 countries and what are very different things?
Miguel: Well, it’s a great question. First of all, one of the cool things about dentistry is that we all speak the same language and people don’t think about that. I’m on the board of directors of an association called SENAME, South European North African Middle Eastern Modern Dentistry and Implant Society. It’s a mouthful but it’s every single country around the Mediterranean and we had an honorary American board member, Dr. Jack Crowser who’s also here today.
Howard: Yes, yes, from Tampa.
Miguel: From Tampa, well he’s originally form New York but he lives in Tampa, a great dentist and a good friend. We’re actually organizing an event in September, the 17th, 18th and 19th of September is Lisbon, Portugal. You can find out more information at www.lisbonsename2015.com, I’m sure you can help me out with that. The cool thing about this is that we actually have 17 board members. We have a Palestinian and an Israeli on the board of directors.
One of the reasons why I wanted to be part of this is because dentistry should never be political. Dentistry is about dentistry, and that’s the common denominator, it’s that it’s biological, it’s functional, it’s aesthetic and everybody can do the same thing. The tools to achieve your goals are the same things. A dentist in Lebanon and Beirut has exactly the same desires as a dentist in Michigan, as a dentist in Moscow, as a dentist in Australia, as a dentist in Sudan.
I just came from a conference form the IADS for all the dental students out there, it’s the International Association of Dental Students and there’s currently 200,000 dentists a year, new dentists a year joining the growing 2 million strong market. Big shout out to all the new dentists and don’t be scared because the future’s coming and I think you guys are the future, but I met a bunch of young female dentists from Sudan and the questions are the same, the hopes are the same, the dreams are the same. For me, one of the beauties why I like to travel around the world and teach is because it makes me understand that we’re all human and there’s no big boogeyman out there. I come to New York City and I go to Iran and I feel exactly the same comfort because the dental booth around the world is exactly the same.
Howard: That’s fantastic. In the United States, next month 5,000 kids are going to graduate from dental school. 5000.
Miguel: 5000.
Howard: What advice would you, how can they go from walking out of school to someday being a great dentist like you? What should their, how could you help them climb that stairway? What are some easy steps?
Miguel: I would say, I have a, I have a young assistant, her name is Philippe, Dr. Filipa Braga, she joined me when she was 23, fresh out of university and the first 6 months we didn’t pay her. We basically said, “Listen, you’ve got to own it.” No matter, if you graduate your first year of dentistry, don’t expect to make money for the first year. I see a lot of dental students coming out and they’re like, “Oh I want to be a prosthodontics, I want to be a peridontist, I want to be an orthodontist,” You don’t know what you want to be at 23 or 24 when you’re just out of dental school, you don’t know. Go on a journey and that journey is go visit practices, work for free, clean the floor, brush the toilet, do whatever you can. Find out somebody in your community that you respect and that runs ethical and morally responsible dentistry. Somebody that’s got a good heart and somebody that in the future could pay well.
I pushed my first mentor 2 years. I went every weekend with a bottle of wine, knocked on his door and I said, “I will clean the floor, I will wash your car, I will do whatever it takes but give me …” 2 years later I got the phone call and said, He said, “You’re the only guy that was that persistent,” and I got his clinic and that’s how I started. I think be persistent, be courageous and, yeah, just take time, just take time because you don’t even, at that age you don’t even know what you want to do. Look at your example Howard. I heard you’re a brilliant lecturer yesterday and I mean it’s, if you’ve never heard Howard [Farran 00:21:22] speak, I strongly urge you to find out where he’s speaking next because it truly is inspirational. It’s funny, it’s entertaining, it’s engaging but your own story tells that you never really know what’s coming around the bend.
You were smart enough to study demographics so if you really, if you need the money, go where the demographics suggest that you’re going to make more money. If you don’t and if you’re lucky enough to come from a family that can afford it, go find somebody near your house that’s just the best dentist in your community and, excuse my language, bust your ass for the, for 2 years for free. That would probably be my suggestion.
Howard: One of the differences between the United States and a lot of other countries is in the United States there’s 7, there’s 9 specialties and when you go to school, the specialties don’t like you really learning their specialty, so a lot of the general dentists …
Miguel: Territorial.
Howard: It’s very territorial because of money. A lot of these people who listen to you in America, 9/10 of these dentists listening to you, watching you right now, have never placed an implant in their life. When did you place your first implant and how can you go from talking to these people where 9/10 have never placed an implant to one day they’re going to place an implant?
Miguel: Well, I think I has to do with fear and a bit of ignorance because it is my understanding that a GP, a person with a basic DDS license is legally entitled to place a dental implant in the USA, is that correct?
Howard: Yes.
Miguel: All right, you don’t have to be a specialist in perio or surgery to place an implant. That means of 6 years of basic training, as a DDS, come out of school, how old you?
Howard: I was 24 when I got out.
Miguel: 24, well like I say, Dr. Filipa Braga she’s 24, she places implants and gets paid for it in my clinic, at 24. I taught her how to do it, I gave her the guidelines. Now with of course guided surgery, the risk factor goes down. I spent a year living in L.A. in 2013 and I lectured a bit in New Jersey sorry, and to a lot of general practitioners that wanted to cross over into placing dental implants because of course, as we saw in Dr. Roger [Levine’s 00:23:43] lecture, that’s where the gold is. I just think that it’s, the implant dentistry, that’s not a boogeyman. It’s sometimes easier than endodontics. Nobody comes out fearing endodontics.
I would just say embrace it. Don’t think of it as anything different and just go for it. The thing is that a dentist in Portugal or a dentist in Spain or a dentist in Italy, the second they come out of university, they’re free to operate anything. I can safely say 98% of the 10,000 dentists in Portugal place dental implants.
Howard: That is amazing. We just heard Dr. [Park Sangria 00:24:28] 15,000, 20,000 [inaudible 00:24:30] [crosstalk 00:24:31].
Miguel: Place implants and Korea is, I don’t know if people know this, it’s the country in the world that has the most, the highest percentage of dental implants per capita in the world. It’s followed by, I believe, Israel and then followed by Turkey.
Howard: Let’s get into specifics. First of all, these persons never place one implant. How much, first of all, what would be, would you say in Lisbon, is the same as America where in America, 95% of crowns are made one at a time, 95% of implants are placed one at a time. Is that true, Portugal too?
Miguel: I think that if you don’t base your practice around your patients you will fail. What I’m trying to say here is, if you do your treatment plans around your own limitations, you will fail. You have to be incredibly focused on customer care. Why would your patient, if he’s missing 7 teeth, want to come in 7 times? Do the quote in the beginning, say you need 7 implants, it’s going to cost this much. Do all 7 in one go and I’ll throw in one for free. The time it takes you, because that patient has one anaesthetic session, one antibiotic session, and one of my surgery professors said, “A little wound heals as fast a big wound,” so get them all done at the same time.
I just think that the big obstacle needs to be your … If you’re starting out, only accept cases that have a lot of bone in the thick biotype, meaning thick gum, lots of bone. Don’t take any risks. Never take risks with other people’s lives, that’s crazy, it’s irresponsible. The 2nd any of you dentists out there, choose to go over your moral compass and choose to make money as opposed to doing good dentistry, that’s the dy you’ve got to change your job. Go do what your hobby is.
If you’re beginning out, do easy cases. If you’ve got a case that for example has 3 easy implants and 2 difficult implants, do the 3 easy ones in one go and send the 2 difficult ones to somebody who’s more experienced.
Howard: Are doing, in my lifetime, when I got out of school, it was all 2D x-ray and now it’s all 3D x-ray, what 3D x-ray system are you using, do you …?
Miguel: We have the, I’m not paid to say this but we have the [Carestream 00:27:02] 9500D from Kodak, I think Kodak make it and I …
Howard: They sold it to Carestream?
Miguel: Yes, I bought it when it was still Kodak. I paid, at the time, $300,000 for it and it was a huge investment but at the time, as always, I prefer to have my Ferrari inside my clinic than in the garage.
Howard: That’s because the difference between men and boys are the price of their toys.
Miguel: I don’t have a Ferrari though.
Howard: If you placed, talk about surgical guides. Do you do a lot of surgical guides?
Miguel: This is exciting because I’m now working with Dr. Christian Coachman, have you heard of Dr. Christian Coachman? He’s responsible for creating digital smile design concept, and they do a really cool world tour. A lot of people think that the DSD system is just to design your smile and it’s a 2D concept. Now with the help of a laboratory in Madrid which is called 3D explora lab, and I could say it’s probably the only one in the world like it, it’s huge, they’re now converting the 2D into 3D.
A lot of other companies are doing this but in my understanding, it’s the only one that’s fully based on facially integrated digital smile designing, into the surgery. Basically there’s a lot of systems that are doing great work, but we are now working with Dr. Christian, his brother Francis, Dr. Filipa Braga from my team and …
Howard: Where are they out of?
Miguel: Well Christian and Francis are from Brazil, Francis now is living in Spain in Madrid, and Dr. Philippe is Portuguese and I’m Portuguese, well Portuguese based.
Howard: Are they in San Paulo or Rio or …?
Miguel: San Paulo, San Paulo, but he basically lectures 200 days a year. He feels a huge [inaudible 00:29:01] with this, he’s a brilliant guy and we’re very happy to be working on this concept with him. What I would just like to say is that, I’ve been doing free hand implant dentistry for 17 years now and a lot of people still today they, if I’m placing 8 implants, you’ll find it strange that I haven’t used the guide because they’re very parallel and I was just born with that 3rd eye in my head.
Some people just are born with a natural talent to do certain things. I have that 3rd eye I my head and I can just, I know how to do it but it’s not a skill, it’s something that I was born with. It’s …
Howard: There is some technical to it like a [4th finger rest 00:29:38]. What I’m asking, a lot, every lab tech will tell you if they get a [inaudible 00:29:43], every tooth is [prop 00:29:45], they can tell if the dentist was right handed, sitting on the right or [inaudible 00:29:48], is this patient of yours, when you’re doing a full arch, are you standing or sitting?
Miguel: I always sit down and I …
Howard: You always sit down?
Miguel: I always sit down and I move a lot. I have my patient’s head at 12:00 and I, well horizontal, and I just, they know, my team know they’ve got to get out of the way because I’m always running around, so I’m rolling around.
Howard: Yu surgically place implant setting?
Miguel: I surgically place implant setting.
Howard: Wow, I’ve never done that.
Miguel: My back is, I’m a tall guy, I’m 6”4’ so I’ve got to protect myself. It’s all about ergonomics and, when I place implants I have about 5 people in the team, in the room.
Howard: Do you wear loop finger placing implants …?
Miguel: Nope.
Howard: … because the, seeing too closely would hurt the parallel …
Miguel: No, what I do is we use of course CBCT, we know how much bone we have, we have a pretty good understanding of the bonedentity and, I always think of this as, in your brain, you have to have an abort button. Just because you’ve told your patient you’re going to place an implant, just because he’s paid for you for the implant and he’s sat down and he’s under and he’s numb and you cut him open and you open and oops, abort. If you don’t feel comfortable just shut him back, sow him up.
I do that sometimes, I think and I go in all confident that I, even with the CBCT that I can go in and do the surgery, don’t be scared of just hitting the abort button. Of course now you’ve got, to get back to your question on the …
Howard: A lot of women do that with me on a date, [inaudible 00:31:17] they just say, “Abort, abort,” and they turn and run.
Miguel: That’s funny. Now with the CBCT, it’s as, with the guided, look man, I think, I think that it is great. I think that a lot of the younger generation of dentists will never know how scary it is to go into a surgery blind as I did in the first 8 years of my career. In the first 8 years, 90% of my implants were placed just with an x-ray and a lot of guts and you know what that’s like, you know what that’s like, all right? Every single surgery you have that pang in your stomach and it was terrifying.
Howard: When I got my diplomat in international congress [inaudible 00:32:03] and my fellowship in this [inaudible 00:32:04], I had never even heard of CBCT. I didn’t know it was around the corner, I didn’t even know it was going to come [someday 00:32:10].
Miguel: I actually, the first time I heard CBCT I didn’t know what it meant, because we were sending our customers to the hospitals and we were having a decrease in acceptance rates because people thought, “Well if I have to go to a hospital, this is very serious. I don’t want to go to the hospital and get a CBCT, so they were dropping out of the treatment option. Buying the CBCT despite the investment, my acceptance rate went through the roof and this is interesting information for people to know. Dr. [Christiansons 00:32:40], Gordon Christiansons lecture, he actually mentioned that. It’s, the acceptance rate does go up when you have it on the premises.
I really think that guided surgery is the way of the future. I’m here [inaudible 00:32:53] event, they have a [R 2 Gate 00:32:54] system and it’s just, it’s genius what’s happening. I still …
Howard: What system?
Miguel: It’s called the R 2 Gate.
Howard: The R 2 Gate.
Miguel: R 2 Gate, it’s developed by Dr. [Jon Kim Cho 00:33:06] from Korea who works with Professor [Clan Bombark 00:33:09]. Basically they superimpose and intra-oral scan with your facial photography and your CBCT and create a virtual, a virtual arch, as if you would take an impression and send it to the lab and he’d put it up in the, and help me out here, it’s the articulator, so they call it Virtual Articulator. It’s fully, fully guided where the actual implant, the position of the implant, the abutment is [mold 00:33:44] in function to the soft tissue and the hard tissue and the bone density.
It selects the size of the implant for you, it pre-prepares the, a button for you. Basically, you send off the information and you get this box and it’s all there to such an extent your hairdresser will be able to do 8 implant, 8 customized abutments and fully loaded 2 arches in about 5 hours, in about 5 years’ time. It’s going to, and I’m going to predict this, I haven’t said this on TV yet but I think in the future, the whole risk will be removed from the dentists. I think my vision for the future, and I’m saying this first on Howard Farran’s pod-cast …
Howard: Fantastic, breaking news. Turn up the volume in the car right now.
Miguel: This is my vision for dentistry in the future. I think in the, and I’m just going to say it because I’m too lazy to create it myself and I want it, I think in the future it will be the patients who decide what they want. I think that the dentists, because there are more and more of them coming up, I think that the dentist will be removed from any choice. I think the patient will select their own treatment options because it will be made so user friendly that they’ll go to some center, take a CBCT, some photographs that will be uploaded to the cloud. Some huge team in China will have a huge site like Alibaba dental or Amazon dental, Jeff, what’s his name, [Bizos 00:35:16], Jeff Bizos, Amazon dental so if you want me to come and work for you, I’ll come and work for you.
The patient will have a screen and say, “Okay, well I’m missing 10 teeth, I’m [inaudible 00:35:26],” and we’ll say, “What kind of implant system do you want? How much have you got to spend, what’s your budget, what insurance companies do you have?” She’ll go, “Well, you know, okay well what’s the rating of this implant?” “Oh, this is the [Straman 00:35:37] implant that’s a very, very good implant. This is an imitation implant manufactured in wherever,” and the cost will change and so on and so forth and the patient will choose the treatment option, ABC, so just biology, biology function, biology function or aesthetics if they include the aesthetics in the function it becomes more expensive.
“For this you will need 5 fillings, 7 crowns, 4 restorations, 5 implants, 3 abutments,” and he buys the products online, swipes his card, he’s paying direct to the factory so there’s no middle man cost which is great for the public, great for the dentist, great for everybody. Then he’ll choose a dentist based on proximity, his Yelp and trust advisor and he’ll say, “Okay well that dentist looks good, he’s got a good success rate.” He’ll say, “I’ll go to that one.” That dentist will receive a message on his phone saying, “Beep, beep, you’ve just been booked, the surgical guide’s in the mail and so are the pieces and the components.”
A little drone drops it off at the door, patient walks up, dentist has no stock, no risk, puts it in the mouth, drills the holes, puts the teeth in, patient goes home, dentist receive a little bit less but has no stress. I think that’s the future of dentistry.
Howard: How long do you think something like that’ll take?
Miguel: I don’t know but I do know that it’s going to happen. I just have this, it’s inevitable. That’ my, I’ve never heard this in the world, it’s the first time on Howard Farran that’s Dr. Miguel Stanley’s prediction of the future of dentistry.
Howard: You heard it here first.
Miguel: Amazon dental.
Howard: What other …
Miguel: I really would like some money if that happens for having had the vision, you know.
Howard: One of my models is that we use the internet so that no dentist has [sparks all over 00:37:16] again, the dentist is out there looking. There’s implants that go from $500 [inaudible 00:37:22] there’s under $100, there’s probably what, 40, 50 systems out there?
Miguel: There’s actually over 2,000 different types of implants.
Howard: 2,000. My next question to you …
Miguel: There’s top 40 companies but there’s about 2,000 types of implants.
Howard: This dentist all by himself, is an implant, an implant, an implant, are they all the same? Do I need to pay $500 an implant to be a quality dentist, [crosstalk 00:37:50] a cheap dentist …?
Miguel: It’s a great question, it’s a great question. I was recently in Jordan giving a lecture and it depends on country to country. It depends on perceived value. A lot of dentists don’t have your communication skills, don’t have your powers of persuasion, don’t have, my capacities as well to communicate and they’re a bit lost in the science and they don’t know how to sell the treatment to the dentist so they hide behind the brand and they say, “Well this is the world’s best implant, it’s an amazing implant, it’s the best one in the world,” and they feel safe with the high end implant.
The truth is, is that a bad implant in the hands of a good surgeon, as long as it’s high grade titanium and has a good abutment selection is just as good as a brilliant implant in the hands of a bad surgeon. I’d say that probably the best formula is, doesn’t really exist but it also has to do with the volume. If you’re placing one implant a month, go for something good because if you’re only placing one implant a month, you’re probably not really good at it and that implant will be amazing, but if something goes wrong, at least you’re using a good brand.
I’m well known for only using the best materials and good companies and good products. I always do that because at the end of the day, you’re standing on the shoulders of giants. By saying that is if something goes wrong, at least it’s not by my materials. I’m not using replicas, I never use replicas, I never use imitations, I never use cheap materials. A) I don’t have a franchise or a network of clinics, B, if something goes wrong and my patient decides to sue me which thankfully has never happened, I at least can say I’m using nothing but the best. There’s independent studies that show if it’s not the best it’s in the top 3.
Howard: Name those brands, which brands do you …?
Miguel: They’re not paying me for that ...
Howard: I know.
Miguel: … so no, I’m not going to give anybody free publicity.
Howard: Okay.
Miguel: I think it’s just …
Howard: When you use the word publicity that’s, in America that’d be advertising?
Miguel: Advertising, yeah. I just said Kodak but there’s other great companies like [Thatech 00:40:05] or …?
Howard: I don’t know why you would fear being sued because you speak for a [crosstalk 00:40:08].
Miguel: No, no, no, not sued …
Howard: … you can just leave [crosstalk 00:40:10] BBrazil.
Miguel: I’m not saying sued, I just don’t want to promote companies for, a lot of people are watching this. I can tell you right now, for example, I’m a huge fan of [Voco 00:40:22]. It’s a family owned, German based company. It’s, they make some of the coolest products out there. It’s, I wouldn’t say small company but they make, for example, a product that I’ve been using for over 15 years which is a [bizicro 00:40:38], it’s called Structure, and I use it to make all my temporary crowns and I’m so loyal to this product that I will never change. They have great composites, they have great bonding agents. It’s V-o-c-o, Voco and it’s, just everybody that works in the company are great people. It’s not listed so it’s not, doesn’t have stock or it’s just privately owned and I like that.
I like that I can talk to somebody who owns the company. I also have huge respect for Megagen, it’s my implant system. I’s, the guy who created it, Professor [Kwan Boon 00:41:16] Park is just, he’s genius. The implant system is a paradigm shift and once again I don’t have stock on the company and I’m not, I don’t have a contract with them but it’s just an amazing company. I’m a big fan of Durr, D-u-r-r compressors. They don’t break down. It’s a German company. Do you know those, do you have that company here? Durr, very good. My chairs are from Anthos, I believe they’re Italian, A-n-t-h-o-s and WNH. I have a [pierza 00:41:52] surgery system from WNH and my, also my micromotors, my motor engines for implant placement, WNH, very good company.
Howard: Besides placing implants and doing smile makeovers, what else, do you do root canals, do you do porcelain veneers?
Miguel: I’ll explain how our clinic is run. WE have a small family that I started, well we started creating together. The first person I hired in 2001 was an oral hygienist, [Suzanna Bonnito 00:42:26]. She’s been with me for 14 years, 1 hour root scale [inaudible 00:42:34] with the EMS, ultrasonic and the [profijects 00:42:36] and the [hufruti 00:42:38]. She’s just brilliant and I love her to bits. She is, I say, the alpha and omega of all dentistry is dental hygiene. The 2nd person I hired was Dr. Alessandra Curto, she’s from [Badi 00:42:53] Italy, she’s an orthodontist. I love her to bits, Alessandra [grtsi portuti 00:42:58]. She’s been, I’d say 70% of her cases are adults. We’re one of the top [invisio-line 00:43:03] providers for over a decade now. She’s definitely the top Damon system provider in Portugal as well.
Howard: Damon system?
Miguel: Damon Orthodontics. It’s, they don’t use the Webber elastics [inaudible 00:43:19] …
Howard: Is it a type of removable like …
Miguel: No, no, it’s a bracket but it’s an American system called Damon and she’s just, it’s faster, less pain and it’s, just the results are incredible.
Howard: Where are they out of?
Miguel: USA.
Howard: You don’t know what [crosstalk 00:43:33]?
Miguel: I wouldn’t know.
Howard: Okay.
Miguel: D-a-m-o-n. Then ortho, endo, so I’ve had a specialist endodontist for 10 years, for a decade now. For the last 8 years I’ve had Dr. Carlos Morais and he’s just a brilliant endodontist. He worked with [Leica 00:43:50] microscopy, we have all the Japanese [Moritsa, Apico 00:43:55] locaters. His biggest tool besides his skillset and great materials is time. My endodontist does not work on the clock so whatever time it takes to get, “Oh I found another canal,” whatever time it takes just get it done well. It’s the secret to success in endodonty is time. A lot of dentists don’t factor that in so …
Howard: What’s that saying, the slower you go the faster you … what is it? The slower you go the better you go or?
Miguel: Then we have Dr. Ines Miguel, she …
Howard: The slower you go, the faster you go.
Miguel: The fast you get there.
Howard: The fast you, the slower you go the faster you get there.
Miguel: Then we have Dr. Ines Miguel who I recruited straight out of university and she’s my dentist. She’s an amazing dentist, she’s a cosmetic dentist, she, both Carlos and Ines were trained in Barcelona. They had a great university. Last but not least I have Dr. Suzanna [Gonsh 00:44:46] who helps me with all the implantology and restorative side, but more importantly, as I said, I’ve got this junior team, I’ve got Dr. [Beatrish, Motre Shoudvao 00:44:55] and Dr. Filipa Braga. They’re 23 and 24 respectively. If you just give them the right tools, love and respect, just are incredible.
We’re a very tight knit unit. It’s full time in the clinic so we’re always ready to go and …
Howard: You call them an operatory unit?
Miguel: Yes.
Howard: You have 8 operatory units?
Miguel: 7.
Howard: You have 7 units and …
Miguel: For 9 doctors I think.
Howard: 7 units, 9 doctors and what are the hours of operation?
Miguel: We open at 9 am, we close at 7pm and we don’t work Saturdays and Sundays.
Howard: 9am to 7pm, so 5, 10 hour days, 9 doctors can work in 7 [crosstalk 00:45:37].
Miguel: Yes because doctors work in pairs sometimes. For example, if I’m doing a full mouth rehabilitation, ‘m doing the implant placement and [inaudible 00:45:46] would be sitting next to me doing the cosmetic. She’ll be doing the smile design, the temporaries, so we work as a team.
Howard: How many auxiliary staff, how many non-dentist staff?
Miguel: Everybody [inaudible 00:45:58], I’d say about 30.
Howard: Including the doctors?
Miguel: Including the doctors.
Howard: [Crosstalk 00:46:05] 30 people who aren’t doctors.
Miguel: We’re into service.
Howard: Is that downtown Lisbon?
Miguel: No, because the cost, the end cost of the treatment is indexed to a rent and we have 1,200m2. It’s a big clinic so if I was in the center of town in a good area because you think that that brings you prestige, it’s wrong. Your CV and your ethics and your quality of dentistry brings you prestige. Rent, location doesn’t bring you prestige but it just adds to the cost of the treatment. We’re actually out of town. We’re about 20 minutes out of the center of town so we have a lower rent. I tell my patients, I say, “Listen man, my rent’s cheaper here but my materials are the best, we’re going to take as long as it takes to get you the good treatment and we’re still probably the most expensive practice in town.
If I was in the center, in the VIP whatever, I would have to be even more expensive. You have to think about the economy.
Howard: Are your prices in Euros?
Miguel: Yes sir.
Howard: Did you know Lisbon was the first town I’ve ever [crosstalk 00:47:06].
Miguel: Yeah, you went to Fatima as a …
Howard: I’ve got to share the story [crosstalk 00:47:09] because I, whenever [crosstalk 00:47:12].
Miguel: We had dinner last night, so I heard the story, it was brilliant.
Howard: [Crosstalk 00:47:14] Portugal it’s romantic. I grew up Catholic, my 2 oldest sisters, when they left high school they went straight into the Catholic [inaudible 00:47:20] and the Catholic church in Kansas had this recruited program where they rented a 747, they fill it up with like 454 seats [inaudible 00:47:29] Catholic boys and they would fly you to Fatima to spend 2 weeks.
Miguel: Fatima’s a very holy place where supposedly 3 shepherd children, 2 boys and a girl, when they were like 7, 8 saw the Virgin Mary appear in the middle of the field and till this day the Pope has agreed that this story is true. The last, the nun, she went into a monastery, she died only a few years ago. It’s considered one of the holiest places in the Catholic universe. It’s so incredible you went there.
Howard: The trip cost $600 just like back in 1970, 1978, it was $600 so I saved up for like year this and the reason the Catholic Church liked it is because of that 454, it was a recruitment to be, to go into the priesthood, at least a dozen guys would cancel their return and join the priesthood. That was the first time I ever saw New York City on the lay overs, first time I saw the ocean, I went to Europe, [crosstalk 00:48:36].
Miguel: How close were you to staying Howard?
Howard: Well that [crosstalk 00:48:39].
Miguel: You would have made a great priest.
Howard: Do you remember brother [Jino 00:48:42]?
Miguel: No.
Howard: Anyway, he was at [St. Barta 00:48:44], he was there too.
Miguel: Oh my god.
Howard: Yeah, it was very, very fun. I had the most romantic notions of what that was …
Miguel: You’ve got to come back to Portugal because you do have a fan base there.
Howard: I want to see your other meetings some year.
Miguel: Yeah, we have the SENAME meeting coming up in 17, 18, 19 of September this year in Europe. It’d be great to have you there man.
Howard: I would love to. Any chance I could speak there even just a little bit or are you full?
Miguel: We have to approve it by the boards but I’m sure that won’t be a problem Howard because you’ve got a huge fan base.
Howard: I want to switch to a huge, a totally different subject because I can totally sense in you, a lot of dentists couldn’t lead 5 ducks to water. They don’t, a lot of their stress, a ton of their stress …
Miguel: That’s because you’ve got to become the water.
Howard: … is not, a lot of their stress is not doing the dentistry. A lot of it’s because they can’t communicate and manage their hygienist, their assistant, their receptionist. Give them some skills on leadership. You just seem like a natural born leader, how can these dentists out there be better leaders for their staff, their team?
Miguel: 80% of my stress, actually let me correct that, 99% of my stress as a dentist is people. I have little or no stress with treatments because the trick is, is that we factor that out in the first appointment. If you know what you’re doing and you have a good team with you, dentistry shouldn’t be your main concern. Managing money, it’s stressful, patience not paying is stressful, we work with human beings and I might sound like I’m very caring and stuff but the truth is I’m tough as nails in the clinic.
We have incredibly high standards and I was, I consulted with a fe3w companies, like yourself, I just, for fun, and I [inaudible 00:50:44] Norway and Norway, everybody’s very nice and polite to each other and they have a lot of difficulty, how could I say this, the owner of a clinic speaking to an assistant, they have to be very diplomatic because you don’ want to offend their feelings. Take no prisoners, that’s my …
Howard: In America we call those Canadians.
Miguel: Basically, look, I have to tell my staff it’s not easy, you really have to be a dick sometimes. It’s just that simple. You can’t, you can’t be nice all the time. If you’re always so polite and always so nice, I’m talking with your team, and having a dental team, the doctors and the assistants, the nurses and the reception, you guys are a tight knit unit. Just like on a boat, and we started this conversation by saying there was only one captain. There’s only one captain and you can’t have different opinions and di9fferent people, it has to be, this is how it’s going to happen and that’s it and if you don’t like it, there’s the door. That’s one of the rules of success.
I’m fortunate I’ve never had partners, I have these colleagues and I value their opinion but at the end of the day it’s my way or the highway and that’s one of the reasons why I guess I’ve proven to be successful. It’s not easy and if you don’t have that capacity then hire somebody who does. If you want to be the good cop then hire a bad cop. If you’re a bad cop then hire a good cop.
Howard: That’s well put, and I also don’t understand the, I’ve never had a partner either. When you get married, you’re with a woman, you have great sex, you have children and that fails half the time. Now you’re going to marry another dentist that you don’t have sex with or children with, that’s crazy. Then I want to ask you another question, if you’re the leader and you’re the owner and these are your employees, can an employee be your friend? Or if you get too close, can you make a friend deliver all your expectations or do you keep a certain boundary between?
Miguel: That’s a great question, listen, I try to be as nice as I can, naturally polarized closer to some people. I have a huge level of respect for everybody that I’ve just mentioned but we don’t go around each other’s houses on Sundays. We see enough of each other during the week. I just think respect. There’s a lot of respect, there’s mutual respect. I don’t have a contract with these guys so they’re staying with me after all these years for something. Some have left, some haven’t dealt with the stress, some, it’s not always been a bed of roses but the truth is we have a massive responsibility with our patients and if you want to mess around on my turf in my clinic, it’s not going to work. It’s not going to work.
Howard: I’m just going to end on one deal, I’ve only got a few more minutes, what were you, of all the implant systems, you were at the [Megagen 00:53:37] symposium, what do you like about the Megagen?
Miguel: Well, several things. First I like the people that work at Megagen. I’d like to say a big thank you to Mr. [Carrey Alliance 00:53:47]. He’s from the integrated Dental Systems in America, represents Megagen and he’s the reason why I’m actually here in the US. [Inaudible 00:53:58] 2, because one of the main reasons I left my previous system was, I can’t say everybody but people for me are very important. I don’t know how they do it but everybody at the Megagen system, everybody, they’re just nice people. I don’t know if, I don’t know but it’s like they go to some training camp like some 4 seasons training camp in how to give better customer care.
2nd, in terms of the design of the implant, look, it’s got the widest selection of platforms of any other implant on the planet. It’s got, it goes from 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5 and 8 [all 00:54:40] where these last 4 have the same diameter body meaning it doesn’t eat away the bone, incredible primary stability. There’s a lot of gadgets around the implant like ISQ readers called the mega ISQ. It has [toique 00:54:53] measures, it’s the mega toique, and plus you’ve got the eureka R2 gate system which is the fully guided implant system. If you get to meet the actual Korean people behind the system, the designing it, these guys are geniuses.
I just wanted to say that I gave a lecture yesterday where one of the main things I said was change, you have to be open to change. Somewhere in the Middle [East 00:55:19], somebody said to me, “Yeah but how do I tell my patient that I’m placing a Korean implant in his mouth? He’s not going to accept that,” because the prestige, as we discussed earlier is in a Swedish implant or on a German implant or in a Swiss implant or an American implant. I said, “Well, you know what, don’t think, and with no disrespect to car manufacturers but don’t think Korean cars think Korean Samsung, some of the best technology in the world.”
Having said that, I just want to thank everybody at this event, once again for Sean Matthews, Dr. Kwan Boon Park and most of all [Carolines 00:55:53] for just being an incredible host, throwing what believe is going to be an incredible party tonight. Howard, I’ve been following your work, I’d also like to thank out good friend from Canada who runs Nexus, the Facebook page.
Howard: Ken Sarota.
Miguel: Ken Sarota, a big shout out to you Ken Sarota for giving me all this love for such a long time. I promise you I’ll give you some content very soon. Howie, thank you man, you’re an inspiration.
Howard: Thank you so much for an hour of your time.
Miguel: I hope to see you again soon and thank you everybody and don’t give up the dream of making the world a better place with a smile …