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AUDIO - HSP #187 - Justin Moody
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VIDEO - HSP #187 - Justin Moody
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Justin Moody, DDS shares how easy, predictable, and successful implants can be for general dentists.
I was the 5th generation to be raised on the Moody Ranch in Northwest Nebraska. Attended the University of Nebraska for undergraduate and the University of Oklahoma for my Doctor of Dental Surgery. Returned home to my hometown of Crawford Nebraska upon graduation and began my lifelong quest for continuing education. Have received my Diplomate in the American Board of Oral Implantology, Diplomate/Masters/Fellow in the International Congress of Oral Implantologists, Fellow and Associate Fellow in the American Academy of Implant Dentistry, Masters and Fellow at the Misch International Implant Institute, Adjunct Professor at the University of Nebraska Medical Center and am a Mentor at the Kois Center in Seattle Washington. I currently manage a small group of general dentistry practices in Western Nebraska and currently live and practice in Rapid City South Dakota where my practice is limited to Dental Implants.
Justin D. Moody DDS
705 Columbus Street
Rapid City, SD 57701
(605) 716-5622 - Office
(308) 430-2179 - Cell
justin@justinmoodydds.com
www.justinmoodydds.com
Howard Farran: It is a huge, huge honor for me to be interviewing my buddy Justin Moody. You came by the office, what last week I saw you?
Justin Moody: Yes sir.
Howard Farran: Yeah and you were out for teaching implants and I wanted to get you on so bad because you're a real world guy placing lots of implants and you're not doing it in Beverly Hills or [inaudible 00:00:31] Florida or Manhattan. You're out there doing it in South Dakota and always hear whining, everybody's got an excuse. They don't have the right attitude they always have excuses. They're like " Well you don't understand I'm in Salina Kansas." I'm like dude I know Justin Moody. How many implants have you placed in South Dakota?
Justin Moody: Quite a few, quite a few.
Howard Farran: Do you have any ball park number? It's more than a hundred.
Justin Moody: Yes sir it's a few more than a hundred. A couple of zeros probably.
Howard Farran: Ten thousand?
Justin Moody: Maybe in my career I'm getting pretty close. Somewhere in there.
Howard Farran: I want to start. There's so many things we could talk about. In fact we should probably just talk all day. So many people go into dental school and then when they come out they decide that they don't like blood and they don't like surgery. If you didn't like blood and surgery wouldn't you'd been an engineer or a scientist or a physics major? I believe they really liked blood and guts and the human body and they wanted to fix the human body but now that they're scared they just say "Well I don't like surgery, I don't like blood and guts." How come guys like me and you just can't lay a flap big enough and other people just don't want blood? Do you think it's just fear?
Justin Moody: Yeah, some of it might be fear. Some of it might be just ... I think some of it comes down to the fear of hurting our patients or our patients having pain afterwards. For me I hear you on your podcast talk all the time about a root canal doesn't hurt in matter a fact a root canal is what makes your tooth feel better. The implant itself, proper treatment planning and pharmaceutical protocols most people say that it's one of the easiest things that they'd ever had done. I think the real misconception comes in the dental schools because we're really taught that the only people qualified to this are specialist. Those that have a few more years of education than we do. I think that fear ends up translating outside of the real world.
Howard Farran: Yeah, I always want to ask every orthodontist did you ever do your first case or did already have a hundred finished cases at birth? Everybody has to start somewhere. My big beef with the education, that line of thinking is where you and I are from. I'm from Kansas, you're from South Dakota and that is half of Americans live in 117 big cities metros. The other half live in 19,022 small rural towns. These dental schools don't recognize that these small town Americans they don't have the 9 specialties recognized by the American Dental association. Yet their tax dollars are paying for these universities. When these kids walk out of school and say well I'm 250,000 dollars of students loans, I don't care. The people of your state picked up three quarters of the cost of your education. When tell someone at the University of Missouri, Kansas City, well if you want to be an ortho be an Orthodontist. Then you send them back to a town of 3000 that doesn't have an orthodontist, this doesn't add up.
Justin Moody: It doesn't Howard, having gone to University of Nebraska for undergraduate and then Oklahoma for dental school. Those land colleges I think their purpose is to send people back into the communities that are paying the bill to help those communities. I have 3 general dentistry offices down in western Nebraska and the closest one of them to an oral surgeon is 120 miles. Endodontist same way a 120 miles, periodontist a 120 miles, one way. When you make a referral to one of these specialist and if they only want to do a consultation. This poor patient has taken an entire day off of work to go have a consultation. Then an entire day off of work to have the procedure done. My biggest thing with the young doctors that I have working in my system is the one thing that's missing in dental schools and in dentistry all together is mentorship. Trying to get that confidence level back up because our patients want us to do it.
Howard Farran: Absolutely, Justin what percent of the general dentist, there's a 120,000 general dentist in the United States, 30,000 specialist. Of those 120,000 general dentist how many of them do you think are [inaudible 00:05:13] have never placed a single implant surgically?
Justin Moody: I don't think more than about 5 percent are placing so I suppose 95 percent of them don't have any surgical experience in placing an implant.
Howard Farran: I just like to get things done. I like to get them implemented, I like to look for the tricks between guys like you and me who did well versus the ones that I watched for 20 years that didn't do well. This podcast is a big part of that because in my walnut brain what I saw is all the guys who signed up for the AGD and got their FAGD exam which was 5 years of dentistry 500 hours of continue ed. They just leaped ahead. I saw that the dentist who took a hundred plus hours of CE a year they just skyrocketed to the top. They just got their head filled with a lot of good information. That's why I'm doing these podcast because what I'm doing is I'm tricking these kids. They say they don't have the time or the money for CE but they'll download it for free on I tunes and play it in their car to work. What I'm doing is I'm getting legends like you and this young girl's driving to work and she doesn't even want to go to the monthly study club once a month. We got to go from the first step to the second stairway. We've got to walk up ten stairs.
You're talking to about 7,000 dentist right now. I bet 6,500 have never placed implants. What would be step one Justin? I've never placed an implant and some day with in a year I'm going to place an implant. What would you tell her to do first?
Justin Moody: Everybody wants to talk about taking a course. There's a big difference between taking what we used to call them, weekend warrior courses. They were put on by an implant manufacturer. Their job was to get you excited and get you rah rah and get you to go out and place an implant and buy their kit. Buy their motor, buy their starter kit, go out and start placing some implants. When you want some more education we'll send you some place. There's a ton of these courses out there and truthfully there's a few of them that are taught by some really good guys but at the end of the day implant success and really implementing them into your practice.
It's so much more than a weekend warrior course. It's so much more than a Thursday, Friday, Saturday, even if you got three days. I went through [inaudible 00:07:52] I went through the AEID Maxi course, I've gone through Pecos and Russo and all those people and my skill level and my teaching philosophy, I didn't make this stuff up. Mine's a culmination of all the things that I've learned of what works well in my hands, one guy to the other but what I do know is that the success I've had in training doctors and doing it the right way with getting them on board with implant rational, risk factors. I'm a [inaudible 00:08:26] center mentor, I'm big into accessing the risk and trying to ... I want docs to finish strong. Have a high success rate for those first hundred they place. That comes with having a good solid foundation.
Howard Farran: Now John [inaudible 00:08:44] is 100% Greek. On Christmas do you send him a bottle of Windex? Does he spray the implant with Windex before he cements the final restoration.
Justin Moody: That's possible.
Howard Farran: That's a joke to the movie My Big Fat Greek Wedding. When a guy like you is so obsessed with implants, do you do anything else other than implants? Do you still do a molar root canal? Do you do fillings, crowns? What do you actually do?
Justin Moody: I try not to.
Howard Farran: You got 3 offices right now.
Justin Moody: I have 3 general dentistry offices that have associates in them. Then I practice at an implant only facility in Rapid City, South Dakota. I have a very unique niche here in South Dakota. I see work from about 72 different dentist in four states.
Howard Farran: That refer to you?
Justin Moody: Yes sir, so even though I'm a general dentist. I have every credential on the planet and at the end of the day that doesn't make me any better than the next guy. All it does is gives me the knowledge base. What I try to do is I try to make implants easy and predictable and successful for these docs. Most of them want crown and bridge. They don't want to mess with torque wrenches and access holes and excess cement and complications. Over the last 9 years being in Rapid City, South Dakota I've carved out a referral based niche of giving my referring doctors exactly what they want.
Howard Farran: Give my listening dentist, give my hommies exact verbiage. I'm a patient and I just say to you "Dr. Moody what last longer the 3 in a bridge or the implant and crown because it looks like they're about the same price?"
Justin Moody: They are about the same price however the bridge is going to force me to grind down your adjacent tooth and irreparably harm them. Causing them to be more susceptible to carries, more susceptible to future endodontic treatment. The literature is very specific on that or we can just replace the missing tooth with a dental implant. The dental implant is nothing more than a man made root designed to replace the root of the missing tooth or the tooth that needs to come out. Then after a short healing period you will have what you actually want and that is the crown, the piece that makes it look like a tooth. It's about the same price as a bridge, it will pro long the life of the adjacent teeth and you'll be able to floss around it and clean it.
Howard Farran: "I drove over a hundred miles to get here. Can you pull the tooth and put in the new man made root at the same time? Or do I have to come back?"
Justin Moody: Do you have enough time to get numb?
Howard Farran: "yep."
Justin Moody: Then we're ready to go.
Howard Farran: "you'll pull the tooth and put in the replace the man made root at the same time?"
Justin Moody: Immediate implants are 42 and a half percent of my business. I do have some criteria. The success rate that's kind of a myth that people think that immediate implants are less successful. If you operate in a risk factor controlled zone they're just as successful as healed sights. What I don't do is I don't place implants into what I call a hostile sight, somethings got perilous to it. Some sort of large soft tissue defect we need to do augmentation procedures first. The majority of the teeth that I see Howard are broken endodontic teeth. Endodontically teeth that need to be retreated. Coming out of the oil fields in North Dakota I see a tremendous amount of drug induced carries, meth mouths.
Howard Farran: Meth grinding, meth mouth for carries but I see fractured by [inaudible 00:12:53] just by grinding their teeth on meth.
Justin Moody: Absolutely because they're ...
Howard Farran: Is that still booming there? This is October of 2015, is fracking still booming or is that busting?
Justin Moody: They would certainly like the price of oil to be a little bit higher than it is today.
Howard Farran: Are they laying off people or is it flat?
Justin Moody: Yeah, there's layoffs out in the Bakken oil field for sure.
Howard Farran: I don't know how old you are, I assume we're the same age. I'm 53, how old are you?
Justin Moody: I'm 44.
Howard Farran: Oh my God you're decade younger. I think you're my age just because of all your experience. You've come a long way to be 44, unbelievable. I want you to sell these young kids on a mindset. Half of America's rural and I really believe those dentist are sold all day long by their patients that they're poor. I've lived in the big city Phoenix, I've lived in small town Kansas and if you see someone driving a Lexus in Scottsdale it's leased. If you see anybody with a BMW it's leased. You find someone driving a truck in Kansas they probably paid cash for it. The dentist always believe that these rural people don't have any money and I think it's exactly the opposite. They don't have all these shops and eating out and all these things like that. They just don't spend their money. How are you selling big cases in South Dakota and Nebraska? Do they have money, are you financing it? Do you think you're a better salesman or do you just refuse to be sold when grandmas says "I don't have any money I'm on a fixed income." You know in your head "Yeah and you haven't spent a dime in ten years, you have more money in your savings account than probably anybody who just graduated law school five years ago."
Justin Moody: There's multiple questions in there and I'm going to address the first one. I think if you were to ask anyone of my associates if they would give up practicing where they're at and go back to Lincoln or Omaha or even down to the front range in Fort Collins, Denver. My answer would be no. My associates have been with me, we have 3 young doctors. Two Nebraska grads and one UNLV grad. Moving out to western Nebraska has been the best thing that they ever did and they'll tell you. For a number of reasons. We spend zero amount of money every year on advertising. Our demographics in western Nebraska but it doesn't matter if it's western Nebraska, western Kansas, western South Dakota, the demographics work because people are used to driving.
There's not that many dentist out here so our numbers are really, really good. What you may make up in lower wages we don't have to charge a tremendous amount of money for our dentistry. Truthfully our overheads are low because the buildings are cheaper, the cost of living is cheaper and our dentistry is cheaper but you know what cheap doesn't mean that ... The perception is that you've got to go into the city to get the kind of high end care that you would need, other than what you could get in western Nebraska.
My little town of 1100 people, Crawford, Nebraska where I grew up. I was a fifth generation to grow up on the ranch out there. Nobody's ever owned that property. It went from the Louisiana Purchase to the Moody family in 1883.
Howard Farran: Are you serious?
Justin Moody: Yeah.
Howard Farran: Oh my God that is hilarious.
Justin Moody: My dad and my brother still work. It's a working cattle and wheat ranch and it has been for five generations.
Howard Farran: They bought that from France, Louisiana Purchase from France?
Justin Moody: Yep.
Howard Farran: What do you think was the worst real estate deal? Russia selling us Alaska for 11 cents a square acre or France selling us the Louisiana Purchase?
Justin Moody: It's kind of a tossed up because you've got one where you got all the natural resources in it and the other one you've got the bread basket of the world. I don't know.
Howard Farran: When anybody says you can't make any money in real estate, I'm like how can you say that and live in America?
Justin Moody: 100%, you know Crawford, Nebraska had 1100 people. I was a fourth generation to graduate in that high school and I built a 10,000 square foot, 10 operatory office that's been on the front of the Sidekick magazine. We have the first cone beam CT machine in the state of Nebraska in 2006.
Howard Farran: That was an Icat right?
Justin Moody: When I put that in I guarantee you the other 850 dentist in the state of Nebraska thought that there was one bat crazy dude out in western Nebraska. Now we have them in every office. We have cat cam, we have inter oral cameras, digital x ray. That technology, there's nothing in the city that we don't have but yet we get to offer it and we get to offer it to our patients. The answer to your last question, how do we do that kind of dentistry? Our patients are exactly what you said. That rancher that drives up in his truck, somebody may talk about buying a 50,000 dollar Lexus but that rancher may be driving a 70,000 dollar diesel pick up that he uses to haul his horse trailer. He didn't buy that thing until he could pay for that. If you pre judge and I think that's the worst thing we do as dentist in the entire planet is we pre judge every patient that walks in our door. By the way they look or by the way they dress or by the car they drove but the fact is out in western Nebraska, when they walk in if you don't have something that they find a worth in. If you can't show them the value in what you're selling them then it doesn't matter.
It's not about the price it's about is it valuable enough to them to make that purchase. I think when you have good solid implant education and you can talk to them about the real benefits of bone maintenance and longevity and maintaining your facial features and being able to eat. When you tell somebody that I'll take your teeth out and put a set of dentures in but you eating that steak you worked so hard to raise for all these years is a thing of the past unless you like the blender. You just turned the corner on that person. To the young dentist out there I'll tell you what if you pass up looking at some of these rural opportunities I think you're crazy.
Howard Farran: Some of these famous Hollywood movie stars in real life are painfully shy introverts. Do you think a lot of these dentist listen to you that they're just shy? They're mathematicians and engineers at heart and to try to sale you that you need a big implant case is just frighting. Do you think they can learn that in your program? Is yours more a technical program? Do you help them with the skills of being an actor? Just say come on you're on stage you're an actor now, show some enthusiasm and convince grandma that there's no way to spend a life with this slipping, sliding, miserable denture. If she can snap that thing down and eat corn on the cob.
Justin Moody: I think that's one of the things that I do differently than what's out there today and that is every implant course has it's didactics. Whether you're sitting there looking at slides and reading through the manual and finding the numbers and things like that. What I incorporate into that is a practical side of how do you talk to the patient. I tell you what Howard, I'm going to write a book about the associates that I've had over the years. Even at 44 I've had a number of associates. I'm fairly motivated to try to bring dentistry out to these smaller communities. My office is set in towns of 910 people, 1110 people and just shy of 10,000 people and I guarantee if you asked one they're making twice as much as any associate that went to work in the cities. It's really about getting them to talk to the patient. I don't know how many times I've walked by a room and the associate's in there and they still got their loops on with their four inch thousand times magnifiers in and their mask is on and they're sitting next to the patient and they're talking in their ear hole.
The patient can't understand what they're saying and they're talking to the patient about irreversible pulpitisis. Which I don't even know what the hell that is. What I try to teach them is hey listen our patients are human and you need to be too. Get that stuff off your face, get your loops off, get your mask off. Wheel your chair down to the foot of their chair and look them in the damn eye. Say "You know Mrs. Jones this implants expensive. I don't care if you're a dentist, a school teacher or a housewife, it's expensive. However, to maintain the bone and be able to eat and chew and look the way you need to look, not now but in 20 years. What I'm talking about is important to you." I just tell them is this something that you want to do? Almost all of them say yes. Then it's your teams responsibility to figure out how we're going to get it paid for and how we're going to schedule it. For me that's part of ... It's a full two day course. The full days of the course is to how to talk to people about these cases. How to get them energized and it's also about building their team too.
Howard Farran: They don't even let them talk, they get in trouble when they talk. The hygienist tell me they get scolded that they were diagnosing and breaking the law and you're not a doctor and the assistants. It's crazy and if I walked into a hundred offices one percent has that feeling like when you walk in your office or mine where it's just approachable and fun and everybody's talking. It's a human fun place we all play in the sandbox. At least 80% you just think you walked into sister Mary Allowishes library.
Justin Moody: I agree. My advice to these young doctors if they want to get into implants and the only way to get really good at implants is to do a bunch of them. If you want to do a bunch of them you've got to be able to sell it. It's not just about you, you can go to every course and you can travel from corner to corner and listen to every dog and pony show and get all this knowledge that you can. When you come back and you sit in the back and nobody ever comes through. Then you don't realize that you've got somebody at the front desk who may mean well but somebody calls and says "Hey I just moved to the area and I was told I need an implant. Does Dr. Farran do implants?" Then the lady says "Oh yeah, he makes cut in your gums and uses a drill and puts this screw in your jaw bone." I'd be like yeah that doesn't sound real great. It's the little things about having every person in your team with the same message. The same man made root. The same gently placing it. The same giving you back your smile and your function and stopping the bone loss.
If everybody talks about that, my hygienist are all bonused on implants that come out of hygiene. Think about it, what part of your office is with the patient the most? The hygienist. Who has the most opportunity to a either drop a patient education video in front of them while they're getting their teeth cleaned or to talk to them about this ill fitting denture, this ill fitting partial or this identulous spot. That's the best place in the world to come up with work.
Howard Farran: I've always said that I think 4 or 5 dentist could double their income if they don't a weekend job as a bartender or a waiter just to learn how to talk to people.
Justin Moody: Absolutely.
Howard Farran: If they just walk up to a table and just feel at ease. Some have done it through [inaudible 00:26:11] if they could just learn how to talk to people and just feel comfortable. I've always thought that these patients are going to spend all their money anyway. They're going to spend it all. In fact America spends about a hundred and one percent of it's income every year, they just go deeper in debt. They buy everything, they buy their cars, their clothes, vacations or cruises and when a patient walks in and they're pointing to one molar.
Then you sit there and you start thinking well they don't have any money and they're just pointing to this one. I'm just going to fix this tooth versus the upper 10% of the dentist like you and me. That can sit there and slow down take full x rays, a full exam, a full treatment plan and motivate them. Wouldn't it just be nice to get this all fixed up. You don't buy a car in parts and pieces and assemble it after 5 or 10 years. It's not like a third world country where their house, first they lay the floor and you come back 5 years later and there's two walls. Takes 5 years to get a roof on it, it's never finished. I want to talk specifics about your course. How does one of my listeners learn from the man?
Justin Moody: Just go to Justinmoodydds.com you'll see a list of courses underneath there.
Howard Farran: What is the curriculum? Is it intro level 1,2,3,4? Do you take them in order? How much do they cost? Where are they given at? Is it in Rapid City?
Justin Moody: Yep, we have 6 courses I believe. They range from implant 101 which is the edentulous mandible rational for implants. Basically 101 is designed for the doc that hadn't taken a course yet. They're going to get some risk assessment, they're going to get some pharmacology updates. They're going to find out how to place an implant in an abundant piece of bone and in the edentulous mandible. All cases that every practices has an abundance of. Go back Monday morning and do your first 50 cases on healthy individuals with abundant bone.
Howard Farran: Your saying dentures?
Justin Moody: In lower edentulous mandibles in between the frame and a couple of locators and a denture.
Howard Farran: That's interesting Justin, you think the entry level, grade school, first implant cases should really just be in mandibular lower removal. Not a single tooth replacement for the most commonly missing tooth which is the lower molar.
Justin Moody: It could be either one of them.
Howard Farran: Is this a two day course or a three day?
Justin Moody: It's a two day course. 18 hours worth.
Howard Farran: Friday, Saturday? Saturday, Sunday? What days?
Justin Moody: Friday, Saturday.
Howard Farran: In Rapid City?
Justin Moody: They're held in Rapid City. Once a year we usually generally do it somewhere across the country. We don't have that schedule out for 2016 yet.
Howard Farran: You should start doing that in Phoenix and I'll be your marketing arm. There are 3800 dentist just in the phoenix metro. Can you believe that?
Justin Moody: That would be an awful good place for a South Dakota Nebraska guy to go in February.
Howard Farran: I know. You know what's funny? When this town literally prays that Nebraska make the Fiesta Bowl out here. When ever the teams are from the south like Florida Seminoles or something from Dallas or California, the attendance is not great. My God when Nebraska makes the bowl this entire city turns red for 10 days. They come 3 or 4 days before the games, stay 3 or 4 days. You can't get into a restaurant or a shop for a week if Nebraska plays down here. Rapid City, do you fly straight into Rapid City or do you fly into ...
Justin Moody: Yep.
Howard Farran: Really?
Justin Moody: We have directed flight from Mesa on Allegiant. We're served by Delta from Salt Lake and Salt Lake, Minneapolis, and Atlanta we're serviced from United Direct from Denver, Houston and Chicago and to Dallas on American. Rapid City is for some people it's a direct flight but for everyone else in the country really it's two flight stop.
Howard Farran: That's a Friday, Saturday course and how much is it?
Justin Moody: 2250.
Howard Farran: Their first case would be double that revenue.
Justin Moody: Absolutely.
Howard Farran: That's like when people don't want to take an invisalign course or an orthodontics program. It's like dude if you go through these ortho courses and do one case you get your money back. How can you not do one ortho case in exchange for the knowledge of how to do ortho? Which will help you understand your TMJ and inclusion and everything else. So 2250, every time I see an implant course they're 5 to 10 thousand bucks.
Justin Moody: I've taken those courses and truthfully it needs to be inexpensive. The only way I can get out there and teach people to do what I do because I do love it. I'm a Monday morning guy, don't get me wrong I love the weekends but come Monday morning I'm ready to get back after it. I like my job. The only way for these docs to be able to, especially my younger docs ... Everybody targets you and me because they feel like we've been in practice long enough and we've go all this disposable income. Maybe our kids are grown enough where we can fly and stuff. We did the 201 course two weekends ago here in Rapid City and we have 12 docs in there, 4 of them were brand new grads.
Howard Farran: Nice, now that wasn't your 101 course that was your 201 course?
Justin Moody: Yeah, that's because these 4 guys that took 201, they also took 101 and they also did it ... Two of them did it before they even graduated.
Howard Farran: Wow, I love that.
Justin Moody: I give them a break, I give new students a break it's like 1800 dollars if they want to come. I want them to get excited about it. I want them to use me as a resource. The mentorship, that's where I really have fun. Sometimes people go on and they'll call me and they say "Hey I want you to come and see how my office operates." I do on sight mentorship all the time for people. That is probably my favorite thing to do.
Howard Farran: 101 is just entry level, in two days we're going to teach you how to place simple implants in overly abundant bone, probably lower mandibles to help snap on a denture. Would that be two implants with ball and locators or would that be two or three implants with [inaudible 00:33:17] bar [inaudible 00:33:18] bar?
Justin Moody: It's just easier to make it easy. Two implants locator abundance on top. Convert their existing denture to get these people into some teeth or if you're already in the process of making them a new one then do that. You can get as elaborate as you want but the fact is Mrs. Smith's been in a denture for 30 years and now she can't even hardly eat and she doesn't even want to go to church anymore because her teeth flop around. It's simple as two implants and a couple of locators and Mrs. Jones is bringing you ham at Thanksgiving and dropping you off cookies at Christmas. You're making a difference in somebody's life.
Howard Farran: Here's how you and I are a like. Dentist take 8 years of college and physics and trig and they can't even tell me what price elasticity means. It means that price has a very elastic effect on demand. If you price it at a Mercedes Benz, 100,000 you're going to sell a hell of a lot less than the number one selling car in the world. Which would be a ford Taurus or a lower priced 10,000 dollars a car. Obviously the plan is going to buy 25 10,000 dollar cars for a 30,000 car and when you send your patient Mrs. Jones the older lady, had a denture for thirty years, to an oral surgeon.
They only have one treatment plan, six implants on lower, six implants on the upper, two [inaudible 00:34:49]. No matter what they say it always comes to 50,000 dollars. Then you say to oral surgeons "Okay, America's got 330 million people, why is everyone of your treatment plans a Mercedes Benz?" The periodontist do it, the orthodontist do it. The orthodontist never going to say well Justin we have two things. We have a low cost 6 months braces we're just going to level and align everything for 6 months. We've got a high cost two year 24, 30 ... It's always one high price.
This is why I like general dentist like you and me getting into this. You're taking her existing denture, you're just putting in two, you're just down dirty. You're the Henry Ford, make it for the masses, you'll make so much money you'll be rich and eat with the classes. When you only eat with the classes you'll be broke and you'll be living with the masses. Why do we see price elasticity? Why do we see that in cars as a Chevy and a Pontiac and an old and a Buick and a Cadillac. Where as the oral surgeons and the periodontist only see the Cadillac?
Justin Moody: I don't know, I think this is where I enjoy your friendship too because like yourself it doesn't bother me to upset somebody. Or to make somebody think about what they're doing themselves. Up here when I first moved to Rapid City I was looked down upon as far as in the specialty world and those that were already placing implants because they were too darn high. There was no reason to be. I came to town with a 1600 dollar fixture and if you come in and you have an edentulous mandible you can spend two hours talking to that patient about a thousand different treatment plans. You can do what Zig Ziglers always said and that is if you show them more than 3 options they're going to chose none of them. For me, my lower treatment if it's a peril or what ever but it's how I treatment plan everybody with an edentulous mandible is your options are having two implants on the floor. It's like a two legged chair. If you've been standing in line for a concert ticket I'd take a two legged chair over a four. It's sitting on your gums and it's going to rock a little bit but you can get rid of the fixedent and you can have some confidence back.
We can go to four implants in still a locator denture. It'll snap in and on but now we're starting to get that four legged chair that's still sitting on the gums but it's starting to get more implant born instead of tissue born. If you have the bone for post terrier implants we can gravitate towards something that's fixed. For me it's 6,000 for two implants and a lower denture, 10,000 dollars for two implants and four implants and a lower denture. It's 19,500 for full fixed.
Howard Farran: Full fixed one arch or full fixed upper lower?
Justin Moody: One arch.
Howard Farran: Say those prices again. Two implants [crosstalk 00:37:53].
Justin Moody: Two implants locator and a denture is 6 grand.
Howard Farran: Six grand and what was the next four implants?
Justin Moody: Four is 10.
Howard Farran: Four is 10.
Justin Moody: Then 4 to 6 implants and full fixed is 19,500 and I don't care ...
Howard Farran: That's going to be 6 implants or you don't even care?
Justin Moody: I don't care, 4 or 6 depending upon how many. If they've got the bone for me to put 6 in why would I charge them another 3,000 dollars for two implants that cost me 170 dollars a piece. It took me no more time to place and I can over engineer this thing so that I can have it last a long time. That's where I just find people that gauge them to death.
Howard Farran: So when they come back, you said you had 6 courses. Are the 101, 201, 301, 401?
Justin Moody: Yep.
Howard Farran: What was 201 covering?
Justin Moody: That's the edentulous Maxilla because the maxilla's treated completely different than the mandible.
Howard Farran: In my [inaudible 00:38:57] years, tell me if you agree to this or am I wrong. It seems like when they come in the problem is always the lower it's never the upper.
Justin Moody: Never.
Howard Farran: Then you fix the lower, soon as you fix the lower now the upper's the problem.
Justin Moody: 100%.
Howard Farran: Do you see that true?
Justin Moody: Everyday.
Howard Farran: Why is that? Explain to these young kids why that is?
Justin Moody: The upper denture is only moderately better than the lower denture because of the suction factor like water between two dinner plates. When the bottom one the tongues throwing it around and the skinny ridge and it won't stay put. All they're concerned about is getting that lower fixed but when you solidify that bottom they don't realize that they were having the same problem with the upper it was just tolerable.
Howard Farran: Is there also the other factor that they used to be chewing against that upper with a floppy lower and now they're chewing against that lower with a firm fixed far more pound per square inch bite? [crosstalk 00:39:55]
Justin Moody: The only thing it's doing is now it's heightened their awareness of how crappy their upper denture was.
Howard Farran: Just to be clear when you do two implants versus four. Those four implants are all still in front of the metal framing correct?
Justin Moody: Yeah, if I could put them behind the frame that's better. Increase your AP spread hold the bone but the reality is when a edentulous maxilla walks in your door you can almost assume it doesn't have any bone behind the frame. That's just the way it is.
Howard Farran: Okay, so what's 301?
Justin Moody: Let's see 301 is, I got to look real quick I just want to make sure that we talk about the same things. 301 is hard and soft tissue regeneration. We talk about grafting. We talk about sinuses. We talk about ridge augmentations. We talk about using alloderm. We talk about using free [inaudible 00:40:58]. Things of that nature trying to rebuild sights that were not necessarily good to begin with.
Howard Farran: Justin can you be placing ... We both agree probably 9 out of 10 dentist listening to this podcast have never placed an implant. What would you consider the number of implants being placed a month for someone who's doing enough of them to start getting traction and getting good? I don't believe you can get good at endo doing one root canal a month.
Justin Moody: No, you need to be doing a couple a week. I think if you're not placing in that 70 to 90 implant range you're not getting enough experience in there to see enough different circumstances to make you good at that.
Howard Farran: 70 to 90 a year you mean?
Justin Moody: Yeah.
Howard Farran: 75 to a hundred a year?
Justin Moody: Yeah, that's higher than the average for sure.
Howard Farran: Another thing that I love about implants is the fact that if I build this bottle of water and I sale it for a dollar and all I make profit is the cap. 10 cents on the dollar. Then I refuse to spend 5% on marketing and advertising but they send me a ppo plan that lowers all my fees 30% now I'm doing this for almost at a loss. What I like about implants also is there's no fee schedule with delta, blue cross and blue shield, Aetna and so when you price an implant it's a lot more profit dollars. When I look at implant guides and when I look at the total profit from the practice. Implants might only be 10 or 15% of their revenue but it's usually half their net income profit. Do you agree or disagree with that?
Justin Moody: I agree with that whole heartedly and even in a world where you're not in the insurance. It's the revenue per hour. We're in the business of selling time. We've only got so many minutes in the day to do dentistry so how do you become more profitable? You need to become more efficient. How do you become more efficient? You do something more. That goes back to how I'm successful up here. Everyone else is that 2,000, 2500 dollar range for placing their implants and I do them at 1600 dollars. They're just like that guys just a loss later and this and that. It's not because they don't understand that I've done so many of them that what they block half and hour to an hour for is a 10 to 15 minute block in my schedule.
My technology has made me so efficient and my volume has taken my unit cost down that chances are that my 1600 dollar implant I'm crazy more profitable than that person with the 2,000 dollar implant. When you look at implants and you place an implant in that hour time frame for me you're looking at a 1600 dollars of production, how many fillings can an average young doc do in that one hour? A couple, they were used to doing two in an entire day in dental school. That difference in money per time is off the chart. It's absolutely off the chart.
Howard Farran: What are you going to teach them in 401?
Justin Moody: We're going to teach them about complications and this is my favorite lecture. Nobody likes to talk about it. Nobody from the podium likes to show their stuff.
Howard Farran: You know my first idol implantology was exactly that. Do you remember and I'm so sick I forgot his name. Brain fart, 53. He was a prosthodontist he ended up working for Green laboratory before he died. He was a prosthodontist guest lecture but everybody would do implant lectures and they just show all their best cases. He had so much self esteem and he'd go out there and he'd only lecture on everything that he ever did that failed. What was his name? His last job was the dental director at Green Laboratory in Arkansas.
Justin Moody: I don't know that part of the history.
Howard Farran: Anyway, just legendary and that just speaks volumes. You learn more in what goes wrong. If you do some dentistry like you always do and it always works you don't learn anything. It's when it fails you start scratching you head saying that's the way I always do it.
Justin Moody: I learn more ... I take a post operative ct almost every patient because it's my instant gratification on what I just did or what can I do to get better because I want to see how it went. My complications, we did a lecture in Dallas this summer there were 79 docs at the course and it's my funnest one because for two straight days I show them failures. I show them there pre surgical failures where I pick the wrong kind of unhealthy person. There's surgical failures where I didn't even get to place the implant. There's non integration, there's prosthetic failures, there's home care failures, there's peri-implantitis failures, all those. Every slide I show is something of my own after 10,000 implants I've got a pile of them out there. If you talk to somebody and he tells you he doesn't really see that many failures or complications I'm telling you that you're talking to somebody that a has an ego that he can't tell you how many failures he has or he doesn't place enough of them.
Howard Farran: Okay, finish with 501 and 601.
Justin Moody: 501 is a full arch immediately loaded course. You can call it all on four. You can call it teeth express what ever you want to call it but we talk ... For those who want to get into this all on four I teach them how to treatment plan the case digitally. I teach them how to place implants, placed angled implants, use multi units, convert dentures and then finally chose the right final prosthetic for this solution. It's a great course for those that want to get into that rem.
Howard Farran: How long do you think it would take for someone to go through all of your courses?
Justin Moody: Well, it'll take a while because if you're just taking 101 this year you're probably not ready for a full arch course for a few years. Now 601 is the guided implant surgery course. I love guided implants and that's been a real topic for you lately. People are pretty sold on either guided or non guided across the board and I'll throw my two cents out. I like to do everything guided in the aesthetics zone. I don't like to take that to chance I want to put it exactly where the bone is. Right where I treatment plan it prosthetically . The down side to guides is you can't do it every time because as you get into the posterior places a lot of times you can't get all your instruments and such back there. Like I said I do 42 and a half percent of my cases immediately, break a tooth fix a tooth.
A couple of years ago I had an intern, you'll like these numbers. I had an intern come in and this high school girl wanted to do something for the summer time so I had them go back through all my CT's and my spreadsheets I keep for all my implants. I wanted them to go through it and I said "Hey, I want you to go into dentrics and I want you to find out how important it is to strike when the iron's hot. As far as getting people to commit to treatment."
If we were able to go from the time we saw the patient to doing the surgery same day or less than 10 days out, we only had a cancellation or postponement percentage of 2%. When we went from 10 days to 20 days that raised to 11%. From 20 day s to 30 days it raised to 19% and if I put the patient out more than a month it was 29%. Would either cancel or postpone their treatment. I'm here to tell you that you've already said it before, people find something else to do with their money. If you've sold them on the value of what you want to do right now ... I try to tell my students that ... I get this a lot and it's not necessarily from the young docs, from the older one. They're like "Dr. Moody I don't know about your practice but mines so busy I'm booked up 4 or 5 weeks."
Howard Farran: Right.
Justin Moody: I can't possibly do an implant in 2 or 3 days or the same day like you're talking about my schedule doesn't ... I said "You know doc I understand busy and I appreciate how busy you are, sounds like you may need an associate but if that's not what you want to do." I said " Is there any time in the next 10 days that you're going to do some fillings on someone?" He's like "I do fillings everyday." Then I said "Then you know what I would suggest you do? I would suggest you either take that patient that you got 200 dollars worth of fillings on and move them to your lunch hour, move them to the next day and free up that spot for a 1600 dollar case." Nobody's that busy and I'm sure I angered a bunch of people driving to work today saying "I am that busy, I can't do that." If you want to you can do that. I'm here to tell you.
Howard Farran: When they're booked up 4 weeks in advance. They're busy and they're bat shit crazy because they can not tell you their activity based costing. When they walk out of a room and they spent one hour doing two MID composites and I go in there and say "How much did these cost?" They're not sure because they apply to 10 different insurance plans. They'll say "Oh they're about 250 a piece." I'm like really "Well, this was United Concordian, you signed this ppo and no they're not 250 a piece they were 180 a piece and you just did this much revenue. What is your cost in this place per hour?" "I don't know." "How do you even know you made money on that?" "I don't know." So you're booked up a month in advance, when I'm the customer and I say "Gosh can I get in I broke my tooth I want you to help me." You're so busy doing dentistry with Stevie Wonder Ray Charles accounting where you don't even know if you're making money, losing money, whatever. Not having the practice manager software hooked up to Quicken or Quick books pro. Nobody knows their activity based costing and what I see is the guys like you and me who know we've got procedure with out doing the math we know you're heavily in the profit zone.
Look at the endodontist they average a 40% overhead across the country, oral surgeons are 40 to 50. When you're doing a molar endo you don't have to know your fee you know you're in the profit zone. When you're doing extractions and implants you're making a ton of money but I would challenge almost all dentist who tell me they make money off cleaning, exams, x rays and fillings. Show me the math, show me the math. You're telling me something because you got a gut feeling and your guts are filled with shit. You don't even know the answer, you have a shitty opinion you're making money.
Then when you accountant calls you up in April and say "Oh Justin I'm going to need you to write a check to the IRS for 40,000." You're like "40,000 I don't even have 40 dollars, I don't have any money. I've been busy all year and I don't have money to pay my taxes." That's the same person who doesn't want to learn how to place implants, do molar endo, do invisalign, do anything where you're sure you're in the profit zone and they just want to do fillings all day long.
Justin Moody: I asked the class two weeks ago, how many people in here know what their net margin is on an hourly bases. They just looked at me. I said "It's two things, what do you want to make per hour but what are you actually netting per hour?" That's a real number that every practice should know but nobody does it. I would challenge you this, you want to make a difference in my world, you need call dentrics up and tell them how to link that into my Quick books Enterprise so that I can actually have a real time accounting of what the hell's going on. Instead of having to look at a full monitor deal.
Howard Farran: I love Stan Burkman the CEO of [crosstalk 00:54:12]. He's a great guy and he put this MBA on it from Shine and they surveyed a bunch of dentist. They asked them do you want that? They actually said no they wanted voice activate peril or be able to change the font of the chart or turn the text from black to fuchsia or yellow or green. That goes back to Henry Ford and Steve Jobs. Both of them said your customers don't know what they want so you build it for them and show them how to use it.
Henry Ford when he started everybody loved their horse, if he would've said hey you want a horseless carriage. Hey Justin you can shoot your horse, stop feeding it hay and buy my horseless carriage. Everybody's in love with their horse, he knew a horseless carriage was better than a horse and buggy. He wasn't going to touch the horse, he just going to build it faster, easier, lower cost and put it out in front of you and say yeah but can your horse go 60 miles in a day. Pretty sure your horse can only go 20. This baby can go a hundred in a day.
Same thing with Steve Jobs, every product that he came out with was innovation. These dentist have got to innovate and they've got to innovate, they've got to help patients and they've got to stay in the profit zone. I like to make decisions. I think a lot of dentist get frozen Justin because they don't know what to do and they have two choices just like a patient. Offer them three choices they'll pick none. Tell them what to do they'll probably do it and I'm telling you if you listen to this guy, I know Justin. He's a good homie doing it in real world. Go to justinmoodydds.com and he's going to teach you how to do implants. Number two Justin, there's 275 implant companies. These guys go from agnostic to actually buying a kit. If they were going to buy an [inaudible 00:56:01] or pick a brand with 275 brands out there, what should they get and why?
Justin Moody: Listen, it's not secret ...
Howard Farran: How many kits have you worked with? In your life?
Justin Moody: Half a dozen, Zimmer, Sterngold, Corvan. I even started back with Corvan was still around. [crosstalk 00:56:20] yep, Nobel [crosstalk 00:56:25] and since 2006 I've been with Bio-horizons and they all work don't get me wrong they all work. If they all work how do you choose one? I like to choose one that has good customer support. I choose Bio-horizons for a number of reasons, not necessarily price, they're not the high, they're not the low but they were put together by a bunch of good ole engineers in Birmingham, Alabama. This stuff is American made by American Auburn and Alabama graduates. If you ever get a chance to go to their corporate these guys are the real deal and I couldn't imagine going anywhere else.
Howard Farran: They were linked initially with Carl [Mish 00:57:31] weren't they?
Justin Moody: Carl helped them with some implant design initially the square threads and some things with some people like Martha Diaz and some others. Today Bio-horizons is run by it's CEO Steve [Bogan 00:57:31] who's just one of the best CEO's on the planet. I'll tell you what else they have is they have the only surface treating that the FDA allows them to say that they have soft tissue attachment to the implant. It has this surface treatment called laser lock.
Howard Farran: I want to ask you ... Go ahead finish your deal on laser.
Justin Moody: You talk about bone loss and so forth and everybody talks about the bone to implant junction and how we can minimize bone loss. Think about taking a platform shifted implant putting this laser lock on it so if there's any portion of this implant that is exposed, soft tissue will grow to it. Even putting this laser lock technology on the underside of your [inaudible 00:58:13] which is actually giving you a seal from the micro gap itself. When I went from Zimmer to Bio I saw less bone loss but when I went from their tapered to their platform shifted implant I just bone loss is a thing of the past. Why I chose Bio-horizons is the science on top of the titanium.
Howard Farran: How would you've answered this question? I got this asked during the Cardinal's game last week. One woman down at the bar, young girl, I think I had asked [inaudible 00:58:45]. She goes "Well it doesn't make sense." She lost this tooth from gum disease so now you're telling me to put an implant in her mouth that she lost from gum disease. The bugs are still there she's just going to get peri-implantitis and it's not going to work anyway. What would you say to her? How would you have answered that? If you lose the teeth from carries, she gets it. You're not going to get a cavity on a titanium implant but when you're losing your teeth from p gingivitis from gum disease and then you're putting implants in there, is this a set up for peri-implantitis?
Justin Moody: It certainly doesn't help. As I've gone through over the years one of my risk factors that I identify in my patients is uncontrolled periodontal disease. That's a hostile environment in itself. When that periodontal disease is hostile and it's there you're going to open up yourself to more peri-implantitis. Those are the patients if it's system wide, those are patients that you should really think about getting rid of the disease. Get rid of the disease first, come back when the bug is out. Once you remove those teeth the bug is gone. The periodontal disease is gone. Come back, remove the teeth, do some graphing, put them in a set of immediates. I like immediates because it lets them appreciate what you're going to do, what you're going to spend on the implants. That's the only down side to the immediately loaded case is that the patient never has to experience what the rest edentulist world and that is ill fitting dentures.
Howard Farran: When someone's got a full mouth of gum disease and you pull all their teeth and you put them in immediates. I agree because when you pull all their teeth it's like a baby. A mother can't transmit gingivitis to it's baby when it's edentulous because it has no anaerobic place to grow. It's only when the tooth pops through is that little tissue over there where an [inaudible 01:00:43]. When you pull all those teeth there's no place for the anaerobic bacteria to live now in the mouth and then you put them in immediate. How long do you think they got to be in immediate before you go back in there and start putting implants in and you think they're less susceptible to peri-implantitis?
Justin Moody: My personal experience is 4 to 6 months, I don't have a literature article to sight on that but out of the hundreds of arches I do all year the best long term full arch success I have is when I get rid of the periodontal disease teeth. Come back 4 to 6 months later into some nice bony spots, put my implants where they need to go instead of where I was trying to pick and choose between extraction sights and such. They just do so much better.
Howard Farran: Justin we are out of time, it's been an hour. You're my idol, you're my rock star, everybody I know that knows you seriously worships you. You're just a good old boy, I'm going to say this because I've begging you for a long time. You've got 6 classes which nobody listening to this is going to go take that class and then send me an email that says that wasn't worth my money. This guy knows more than you'll know in a decade if you just did it full time. Number two I want you to put a teaser hour of each one, you've got these two day courses and instead of just a flyer with some print. I wish you would do an hour course on each one of these six deals so they could get to know you, so it makes it physiologically easier for them to say I like this guy he is smart, I do learn a lot. You can't learn how to place implants at your dinning room table you actually need to go see some and any chance we can get those?
Justin Moody: We're working on it sir.
Howard Farran: Maybe this podcast will hold you few and far but thanks for training so many dentist. You were in town last week, every dentist I know that's every heard you lecture just thinks you're down to earth, you're wickedly smart, you're very successful. Thank you so much Justin for spending an hour with me today.
Justin Moody: Appreciate your time, thanks Howard.
Howard Farran: All right have a great day.
Justin Moody: You too.