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AUDIO - HSP #273 - Lou Azzara
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VIDEO - HSP #273 - Lou Azzara
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Lou Azzara
President at BEGO
Nick Azzara
Chief Sales & Marketing Officer at BEGO
Oliver Klein
Director of International Sales & Business at BEGO
BEGO traces its roots in the dental industry to 1890, when German Dr. h.c. Wilhelm Herbst developed an innovative procedure for using gold fillings for dental restoration. From that beginning, BEGO has built its business on a commitment to innovation and quality.
With operations in over 100 countries, and the same commitment to innovation and quality in every office, the phrase "Made by BEGO" has become synonymous with the best, safest, and most reliable dental materials and equipment.
BEGO USA was founded in 1991 and is headquartered in Lincoln, RI.
Along with innovation and quality, BEGO employees are committed to patients' health and well-being. Combining these values with the company's tradition and culture guide us in working together for success.
Howard Farran: I am at The Greater New York Dental Meeting in Downtown Manhattan and with 2 of my buddies for 25 years, 2 brothers, Lou Azzara and Nick Azzara. We've known each other for 25 years. Your biggest started out with Captek wasn't it?
Lou Azzara: Right. That's our first introduction, Dr. Farran, was Captek, and thanks to your guidance it became a household name.
Howard Farran: I didn't do it. You guys are legends. What I like about your guys, everybody knows you, everybody loves you, but man, you guys are operators, you guys work when everyone else is asleep, and I don't know even know when you guys sleep. Captek, do you think Captek really changed when the price of gold went really high? We've seen PFMs really plummet, and we've seen all porcelain, E-Max, Glidewell, BruxZir. Do you think a lot of BruxZir and E-Max success was because gold prices went as high as they did?
Lou Azzara: I think that was on of the influences, but there was ... It was very dynamic at the time. We have the price of gold, which was a visible catalyst, but I believe the premium of labor was increasing. People were looking at more ways to automate and that trend obviously continued on, but that began the sensitivity. People started measuring that and moving away from a labor-intensive restorations to less labor-intensive restoration, and simultaneously, I think you had the introduction of BruxZir and E-Max. They were alternative solutions that combined, because gold had been creeping up, maybe it didn't peak like it did in such a spectacular way and labor has always been an issue, but you had this convergence and simultaneously you had another solution. I think all those dynamics played a role.
Nick Azzara: Captek was evolutionary product. It was that transitional product from that PFM and giving doctors the ability to do what they did with their preparation style, with the way they manage their work but yet get some sort of better aesthetic and healthy outcome. As the material has evolved and the techniques to manufacturers evolved, that ... now those other materials have evolved into the solution that Captek was providing at that time. It was a great experience for us to be involved with the behaviors of why people choose materials and why they stay with them, whether it's easy or faster, cheaper, or better looking, better solutions, but we are always about better dentistry. That's what it was about for us, and that was that perfect product at that perfect time that helped the industry get to that next level.
Howard Farran: You should never ask a friend to predict the future because nobody can predict the future, but you're my friend and I want to ask you. Since we've been in dentistry, when we all started in dentistry there were 15,000 labs in America. Now, there's half that. Where do you think labs are today versus 25 years ago and where do you think they're ... Where will they be 10 years from now.
Nick Azzara: That's a great questions.
Lou Azzara: It gets to the heart of a lot of other things that are occurring at the same time when we see that decrease in actual laboratories, physical locations, but we're not seeing a decrease in what comes out in the output. I think what we're seeing is more ... The industry is getting more efficient. There's great decision-making being made. There's technology that enhances the productivity. I believe that at the essence of it, it may sound a little corny, but as you create a dental town as a community where people came together and best practices, laboratories are sort of the same thing. They moved outside their own realm and gained a broader perspective as the world got smaller and communities developed and it allowed them to ... technology develop, yes, but they could not leverage it the way they can without the community effort that goes forth. I think we're going to continue to see that but not in a negative way ... Our industry is going to be able to produce 2 or 3 times what it used to be able to produce with more sites and they're going to be able to produce it more consistently at a higher level than we've ever witnessed, and I believe dentists and patients will be the direct benefactor of that.
Howard Farran: I want to ask you a controversial question. It is dentistry uncensored. It's hard to get numbers from a lot of companies, but some people say that the Americans bought 13,000 CAD/CAM machines. Some say it's 8,000. Some people say they sold 13,000 but only 8,000 are being used. On Dentaltown all day long, it looks like there's 2 groups. It seems like sometimes a dentist will buy a laser and it just collects dust and other times a person will buy a laser and it's a game-changer and changes practices, but where do you think CAD/CAM is going? Do you think that it's more efficient to optically scan a tooth and email that to the lab and let them make it, or do you really think it's efficient use of a dental office's time for them to scan, design, mill, stain, glaze? In some respects, isn't a dentist paying $150,000 to be a lab tech? Where do you see the CAD/CAM now and going as far as efficiency? What's ...
Nick Azzara: It's another amazing question that we look at every day, and I think, for me, the real tipping point is when everything is connected. You have a device and you utilize that device and you get whatever you want out of it. It doesn't change the way you practice dentistry, it just enhances it? You look at where we are today. We happen to be at The Greater New York and we're in the Shine Connect pavilion, and that's connecting all of these companies. We happen to be representing a 3D printer company for labs and offices, but there's a CAD solution. There's mill solution. There's intra-oral scanning solution, actually 2. There's a practice management solution. If all these things continue to talk and these things are ... it's easier to get whatever you want, then I think it's going to only accelerate.
I think the factor that's kept them down, #1, the price but also that you get this device and that one company comes in and trains you on that device and then how do you connect it to everything else, and are the labs prepared, can the labs do what you want to do, or do you have to go to a different lab? These are all decisions that are downstream that I think become more important. Once these things are connected and they're really close. At least everyone is cognizant that this is the way it needs to go, that it's only going to accelerate.
Howard Farran: I would say one of the problems I see when I'm visiting dental offices is that when you start doing things ... All the wise men, of course, whether it was Buddha or whoever was always saying "Moderation. Moderation. Moderation." It seems like all the humans always seem to be extremists, black, white, yes, no, up, down when all the answers are 50 shades of gray. I'll see dental offices reschedule a patient because they don't have time to do the CAD/CAM. When I hear a dentist say that they bought a CEREC and all their restorations or CAD/CAM ... I know that's never a good idea, and in my office, its' all in moderation. Sometimes, we scan and mill it out right there and it's a great decision, and other times, it's a lot better decision to take an impression and send it the lab, like multiple restorations, and sometimes just due to workflow, it's just better to ... "Let's prep, temporize, and send it to a lab. I see too many dentists being extremists. It's like I bought a CAD/CAM, so I no longer use a lab, and now, I'm rescheduling patients to come back to fit my machine and my workflow. It's like, "No, the patient is first. What's the best for the this patient?"
I ask every one of my patients, I say ... because you guys you are busy guys, and if I say to you, "Okay, buddy. Here's what we can do. I can have you in here for about 45 minutes and fix your tooth and temporize you, leave, and you come back in 2 weeks for a half hour and I'll cement in a temporary, or you can say 2 hours right now and we'll do it all." It's Monday morning at 10:00. In your real world, on a Monday morning at 10:00, where would you most likely be headed?
Nick Azzara: A million different places, and I have a schedule that's really tight.
Howard Farran: In Phoenix, ...
Nick Azzara: ... and I'm already behind.
Howard Farran: In Phoenix, 4 out of 5 people say "Oh, my God, if you could let me out in an hour that'd be awesome." No one cares about it. The other thing I keep, that irritates me that I keep hearing about is same day crown, same day crown, same day crown. Are you deaf? When I listen to patients it's always, "How much is it? Will my insurance pay? Are you going to give me a shot? Is it going to hurt? What is it going to look like?" Same day crowns would be at the bottom of the list, but when you hear 10 dentists talking, it's all they hear about. I do believe the market is going all digital. I believe it's going to go all from analog to all digital. I believe everything is going to talk together in the future. I like my CAD/CAM but I think it's frightening if you buy a CAD/CAM and you're not really heavily using labs. I'm actually more excited about optically scanning and sending an impression because those labs are telling me that when they get an optical scan impression they're having about a 1% remake and when they're getting polyvinyl/polyether is about a 6% remake. Do you agree with those numbers?
Nick Azzara: You can't argue today that the accuracy coming out of a scanner, whether it's a lab scanner or an intra-oral scanner, is superior and more consistent. You can't argue with that. It's really that workflow right now.
Howard Farran: Do you like any scanners in particular?
Nick Azzara: We certainly see the results out of all of the scanners but I think they're all at a level that work.
Howard Farran: Name some. These guys are all listening alone in their car.
Nick Azzara: iTero has been a great [inaudible 00:10:17], and the output out of an iTero arguably. The models up to this point have been the best. People want to work on models because it's an actual milled model. Now, that's being challenged because we're actually printing the outputs right now, and the printing technology has evolved. That's why we happen to be here. We have a 3D printer now through ... designed by a dental company that actually makes models that don't ...
Howard Farran: What's the name of that company?
Nick Azzara: It's the BEGO Company. It's based out of Germany.
Howard Farran: I just ran into these guys. I've know you guys for 24 years. I think you guys are 2 of the ... You're definitely the 2 smartest brothers in dentistry. I don't know of any 2 brothers that are this smart.
Nick Azzara: I don't know about that. I can name a lot.
Howard Farran: I can't name any 2 brothers, but you guys are ... You're always where the ball is during the football game. You're always in the right space at the right time, and I'm embarrassed. When you told me you guys were now on the BEGO team, I had to say, "What's BEGO?" First off, I thought bagel. I thought this was a Manhattan bagel ...
Nick Azzara: That might stay with us.
Howard Farran: Tell me the BEGO story.
Lou Azzara: We've ... It's a family company with 125 years history and really focused on the laboratory community.
Howard Farran: It's a laboratory company.
Lou Azzara: Aside from him, we'll get it to you from Oliver too from his perspective from our headquarters in Bremen, Germany, but it's been very disciplined, 15% of the employees are actually educate ... dedicated to education, dental technology education and now implant education, 3D printing education. The company has always had a deep discipline on not just materials but how do you use the materials, and getting back tot he CAD/CAM and the current world context, is it's not just the device, you have to understand the context of where that device is being used. All of these technologies or a vast majority of them work, and all of the analog materials work but do they work in the current situation that someone is in and understanding a laboratory's DNA, how they operate, how they deliver their services, and come paramount to will this work in your situation and your lab. We have a long history of that, not only analyzing that and being a part of it but also being a part of how to help it evolve.
Nick Azzara: No, that's, like Lou said, the educational part in CAD/CAM world. There was a conflict right between a dentist getting an intra-oral scanner and now lab losing work. You hate your lab, you want to go get an intra-oral scanner. You get an intra-oral scanner because they work and they work in the workflow and the lab should be part of that support because 9 time out of 10 right now, whether the design is done by the dentist or the design is done by a lab or the device is manufactured at the lab or the device is manufactured in the dental office, should be whatever is best for the patient or whatever is best for that situation, and everybody has got to align to that. We understand. I think we support that type of philosophy, and we can help dentists and labs work together with our equipment, with our scanning technology whether it's implants or scanning technology or printing technology.
Howard Farran: What is your oral scanner then?
Lou Azzara: We're really not tied to any.
Howard Farran: You're agnostic.
Lou Azzara: We enjoy all of them. We work closely with 3Shape. We work closely with a lot of 3M, a lot of image [crosstalk 00:13:53].
Howard Farran: 3Shape, and then what else, iTero?
Lou Azzara: iTero, we have ...
Howard Farran: What's 3M's?
Lou Azzara: 3M is ...
Nick Azzara: True Def.
Howard Farran: True Def, and those are all good?
Lou Azzara: I think all of them ... Again, it goes back to context. We had a personal experience with a doctor that has ... He geared his practice ... He does 20 crowns a day and geared his practice where he has a team of assistants. You put an intra-oral device in that world, it's going to slow them down.
Howard Farran: You put a what device in it?
Lou Azzara: A capture device, an intra-oral camera, in that world without making adjustments to his team and his staff, you have 5 assistants not doing anything and he's doing half of that production, but it really comes down, Dr. Farran, it's understanding your own DNA, how do I operate every day, understanding the environment that you created for yourself and how does this technology fit in, and if you wanted to change that environment what's your path of doing it. It's not going to be because the device. That is part of enabling. It's going to be much more behavioral, much more earthy, getting down to how do we answer the phone, what do we say yes to, how are we trying to accommodate whatever goals and objectives, and getting back to your ... We walk in, you don't know what a patient is going to ask for, you don't know what is going ... they're going to consider valuable and not valuable. We can say that in general, but we never know in particular. Someone may have 4 hours. Someone may have 15 minutes.
You will know that at the point of that moment, and giving yourself the most versatility to say yes to the most opportunities is what technology should be able to provide for you, and how many times have you shared with us "I want to appeal to everyone that walks in. I don't want to say no to anything. I want to accommodate." If that is your goal, that you're not trying to fit someones into what you deliver, that you're trying to fit the practice of the lab into what the world is asking for, then technology has to be approached and the purchase of technology has to be approached in a way that accommodates that.
Nick Azzara: ... and in harmony with the lab, but what technology does your lab become ... have accept the scans from and what are they comfortable with and what's the best output that they can get from it? If they can work with all the systems, that's fantastic. You've got somebody who's very versatile who's evolved in digital technology, but if somebody is on that journey, then find somebody that has a similar path as that doctor.
Howard Farran: You're also an implant company, BEGO Implants. You're from BEGO. How long have you been with BEGO?
Oliver Klein: I'm with BEGO for 3 years.
Howard Farran: 3 years?
Oliver Klein: ... but I'm in the dental industry now since 14 years, almost all the 14 years in the implant industry.
Howard Farran: What company before BEGO and Implants?
Oliver Klein: I used to start with Nobel.
Howard Farran: The [iBrand mark 00:17:13].
Oliver Klein: Yeah. Afterwards, I stepped into the consumables. I was managing director for Kerr in Germany and Austria.
Howard Farran: What city are you in in Germany?
Oliver Klein: Bremen.
Howard Farran: Where is that?
Oliver Klein: That's in the northern part of Germany between Hamburg ... [inaudible 00:17:31] of Hamburg.
Howard Farran: I think Cologne ... I love the Cologne meeting. I go there every other year. If you never knew the Cologne meeting, it's about 100,000 dentist show up.
Nick Azzara: Oh my gosh, it's the largest meeting.
Howard Farran: It's the only dental meeting where if you're talking to 3 dentists, one is from Kuwait, one is from Japan, one is from Brazil. It's 100,000 dentists from all around the world, but what's really neat is the City of Cologne knows there's 100,000 people who don't know how to ride the subways and the trains and they're all prepared for a bunch of idiot dentists who don't speak German and the town is so helpful here. Everybody takes you under their wing and helps you on every subway and train and the restaurants, and a little history, it was the Roman Empire's furthest outreach. You still see the Roman wall around the city. It's the only place in Germany where you're really getting really great Italian food next to German food, and it's really the coolest city. [crosstalk 00:18:25]
I want to go back. You have an implant, and I am ... I believe that a human bone cell, an osteocyte, can't rub up to this titanium and say, "Oh, this is Nobel Biocare, and oh, this feels like Megagen and this feels like BEGO." An osteocyte doesn't know titanium brand name. Titanium is titanium, titanium, but the one thing I think the future is going to go is when it's all the technology is open format and we can go from a CBCT to a surgical guide to a placement faster, easier, higher on quality, lower on cost. What excited me about what you said, you said 15% of this company is involved in education. As the founder of Dentaltown, I'm still shocked that we started in 1998, this is 2015, 17 years later on the internet there's still no curriculum to place implants from A to Z. I don't think I could take my son, Ryan, and teach him how to place implants on a 1-hour online course. I think it's going to be a 25 to 50-hour curriculum, but I think if a company ...
If I was you guys, and you two are the 2 smartest guys I know in dentistry, I would get your greatest minds and say, "Okay, we're going to commit to a complete A to Z package. Here's the CBCT. Here's how you trace it. Here's how you get to a surgical guide. Here's how you pick the implant." If you would go online, and I think it would take 25 to 50 hours to where ... because we're at that Greater New York now and I've been lecturing since 1990 in this town. I lectured this town the first time August of 1990 and dentists had to close down their office. This is Monday. They don't want to close down their office for $5,000 and then come pay tuition here. It just gets too expensive.
We put up 350 one-hour courses on Dentaltown and they've been viewed over half a million times because the dentists are saying, "I want to watch this just in hour increments. I'm going to watch it in my Lazy Boy and I want to lay on my couch, my hammock, and then, halfway through it, if I've got to go to the bathroom or call my cousin Eddie, I just want to pause it. I don't want to take notes. I just want to go back and replay it." They don't have to take notes for online. It's right there forever. I think if you guys have got ... You said 15% are committed to continuing education?
Lou Azzara: Personnel. The larger percentage part is dollar invested.
Howard Farran: I think you guys ... Also, explain to the viewers, there's a difference between open and closed formatting. You think of Microsoft as open and Google open, but Apple is closed. We have that in dentistry. Talk about open systems, closed systems, and where do you thing the future of that is headed? What are the pros and cons of open versus closed?
Nick Azzara: Closed systems have some great advantages, because everything is talking to one another and you've got these. The scanner is talking to the mill and everything calibrated correctly but yet you've got ... You're limited in the development of utilizing technology as it comes along. You're along one path. I think eventually though we do believe in some sort of controlled, open platform. Dentists and technicians have the ability to add technologies. They have the abilities to make good market decisions, the best technology at that time they'll invest in instead of looking at only one path, "I can't do this. I can't do that," and be limited. Right now, open does make sense ... closed does make sense in some situations, but long term, ...
Howard Farran: Brand names, who's the most closed and who's the most open?
Nick Azzara: The best example is Sirona, what they've done with ...
Howard Farran: For a closed system?
Nick Azzara: ... for a closed system, and arguably, that's worked very, very well for them. They have a semi-closed system where they do bring on other manufacturers and we've been part of that over the years, but their files are different. Their files are unique, and then once you go out of that environment, now you run into possible issues and you're paying to get out of that environment. It makes sense because they need to capitalize on their investment and they've put a lot of energy into developing dentistry, but the long term is that ... Our iPhones, we love to download that app. We get access to other technologies, the long-term direction is open. We see even companies as powerful as that moving in that direction and not being afraid of a closed environment anymore. You look around the show and everybody is focused on open [crosstalk 00:23:07].
Howard Farran: BEGO sells an implant line, and titanium is titanium is titanium.
Nick Azzara: Mm-hmm (affirmative).
Howard Farran: What could you foresee .. What would be the CBCT? What would be the surgical guide? What would be the software? What did you ... Do you think they're ready for an easy system from A to Z, from scan, surgical guide, place implant, restore a crown whether it's lab made or CAD/CAM, or is this a year off, 5 years off, 10 years off?
Nick Azzara: I'll turn that over to Oliver. I certainly have my opinion, but then ...
Oliver Klein: This is a great question. I think we are that far almost. If we combine our strengths, which we have on the lab side, on the surgical guide side, on the 3D printing side, and on the implant side, and this is why prosthetic parts are really good solutions we have. Then, we are ... We are that far that we can provide this to our customers. I call it one-stop shop at the end, and this is what our customers like very, very much, or the dentists like very, very much and the lab to partner with each other in getting everything from one line and in one workflow. I think this is one of our strengths.
Howard Farran: What CBCT would you work with?
Oliver Klein: We are working with all the systems. We are based in the Exocad software. This is the most used, and we are open for any software.
Howard Farran: They're all owned. If they were going to buy a CBCT or they were calling a CBCT ... I think the future of CBCT is going ... for general dentists is going to be a radiology place. An oral surgeon or a periodontist might benefit from doing enough but the problem I see with CBCT is just like your iPhone, after 3 to 5 years, you want the newer greater model. I don't think anybody is going to want to buy a CBCT and want to own it for 25 years. I think if you were calling a lab ...
Speaker 5: Endocrinologist.
Howard Farran: If you were calling a lab, what CBCT do you work with?
Oliver Klein: Everyone.
Howard Farran: Name some.
Oliver Klein: Maybe, we have Planmeca. We have ...
Howard Farran: Planmeca.
Oliver Klein: There are a lot of we have from the Sirona. I don't know the name.
Howard Farran: GALILEOS.
Oliver Klein: GALILEOS is there from cable, the Regentex. We are ...
Howard Farran: Plethora.
Oliver Klein: Yeah.
Howard Farran: How would you ... What would you recommend for making the surgical guides.
Oliver Klein: Right now, I would recommend to do this with BEGO with the 3D printer in regards that we are very, very cost efficient.
Howard Farran: Explain that. Would the dentist get the lab or would you lab print it and send it to the dentist?
Oliver Klein: It depends on what the dentist wants. If the lab has the 3D printer, the lab can offer the service to the dentist to maybe upload the CBCT. The lab maybe do the planning, send back to the dentist, he agrees, and then they make the surgical template, or what we are offering and bring for European customers sending upload their CBCT, we are doing it in BEGO. We are printing the surgical guide and send it to the dentist or to the lab, whoever they wanted, and I think [crosstalk 00:26:37].
Howard Farran: Where is the juncture of CAD/CAM where you're starting the block and reducing versus printing where you're starting printing up? What was the advantage of just [inaudible 00:26:48] on surgical guide between reducing CAD/CAM or printing up?
NO one wants to touch the question. You know it's a good one, all 3 of them are passing. Ryan, they want you to answer this question.
Lou Azzara: Yeah, I think Ryan, you'd be better qualified, but just to take one step back, I think a company's own personal experiences are going to have a big influence on the way you position technology and how you implement technology. Selling a printer is one dynamic. Using a printer every day ... BEGO has 6 major production centers across the globe, so not only ...
Howard Farran: What cities are those in?
Lou Azzara: Bremen, Russia, France, Spain, China, US.
Howard Farran: Where is it in the US?
Lou Azzara: US is in Lincoln, Rhode Island, New England.
Howard Farran: Lincoln, Rhode Island.
Lou Azzara: Major and not only resin printers, which are very common on the market, but also large industrial metal printers, and have been doing printing and printing technology since 1999, well before it was commercially viable. The company is based on not only providing these technologies and powering doctors and laboratories to utilize them, but every single day across the globe there's crowns and bridges and surgical guides and implants and abutments, bars being produced inside that are being measured and adapted on a very tight time-frame and on a very demanding type of quality. Our experiences are not just developing products that are going to be shipped out the door and implemented. We're also living off of these every single day. You get a perspective and the products tend to evolve based on usage.
Howard Farran: Let me tell you a problem that my homies tell me. I get about 300 messages a day, whether it be private messages on Dentaltown, emails, texts on the phone, or whatever. This is what my homies are all telling me. They're saying, "I decided I wanted to place implants. I went and got a CBCT, $100,000. I went and signed up for a [Gargs 00:29:06] course and flew to the Dominican Republic, and I bought this implant system for $8,000, and I had to buy 50 implants. Bottom line, I spent $200,000 before I placed my first implant." When I saw you guys and you were telling me last night that you were with BEGO. What I was most excited about is you guys work the problem hard the old-fashioned way.
My old man told me that God gave you a brain and 2 eyes and you're supposed to keep one eye on the customer and one eye on cost, and you're supposed to use your God-given brain to drive down cost so that your customer has the freedom to afford what it is you're selling them, in this case afford to save your teeth, have some human dignity, keep your teeth. Do you think you could do an online program where this dentist wouldn't have to close down their office and this dentist could understand you provide a complete solution where they could learn how to CBCT, surgical guide, treatment plan, implant kit, and that they could go from "I ain't every placed an implant" to "placed my first one" but not have to spend $200,000?
Lou Azzara: Oliver, I'm anxious to respond to that, but I think you're ...
Howard Farran: Do you agree with that number, about $200,0009 before they even get their first one in?
Lou Azzara: Presumably, it's a lot.
Howard Farran: Crazy a lot.
Lou Azzara: We see the same thing, Dr. Farran, on buying technology. I think that issue ...
Howard Farran: Oh yeah, you need a mic.
Lou Azzara: That issue is an issue not just for implants but I'd love to address it specifically to that but also on the technology that you're buying. The lab turns around and they're $100,000, $150,000, $200,000 in with the same cost structure that they had before that investment was made and throughput that's no different, and to make that alive and active and get a return, that's the essence of where education and actually utilizing technology to produce comes together where you can partner or collaborate with the lab, but I'll allow Oliver to address your question specifically about implants.
Oliver Klein: I think we are able to do this. We already started a project for use doing webinars to specific topics, but I think if we, in the future, we will combine all these trainings and will make a road of it where we can really address from A to Z everything, every step to our customers, and even if they're not our customers even to somebody who would want to see it and run all of this workflow.
Howard Farran: These companies, it doesn't even make sense. Take BioHorizons, which Misch was involved with in the beginning. Misch is older. He's [sick 00:32:00]. He has 5,000 hours of his surgery video tapes sitting in his garage. I see these disconnects where ... I see the world's 2,000,000 dentists and Misch's 5,000 hours of surgery was digitized 2,000,000 dentists would get to see the Beethoven of implants. I remember the first time I got my fellowship in the missions too and I got my diplomat in the International College of [inaudible 00:32:29] and the first time I saw Misch, it was amazing. He had an anesthesiologist who had this person asleep and was in his office and he was just a friendliest guy. He's talking to me the whole time while he lays an incision from retromolar pad to retromolar pad and reflects back, sews a lingual this side to that side, this side.
Anyways, long story short, in 25 minutes he places 8 implants on the lower, 8 implants on the upper, but I swear to God, it seemed like the whole time he was like "Where are you from, Howard? What school do you go from?" I'm sitting there the whole time. It's kind of like when someone is talking to you while they're driving and you're like, "Dude, keep your eye on the road. Stare at the road. You're going to crash this car." I watched that guy, and after 3 days of watching him place that, it made me go back to my office, and then, when I was just placing my one little dinky implant on a first molar, I felt safe because I felt like I'd already gone to World War III watching him place 16 implants in 20 minutes. I'd never want to do that.
I just think that we have the opportunity with digital on their smartphone and their iPad that if we put up the whole solution where they're just laying there in their Lazy Boy, they're laying on their couch, it's evenings and weekends, they're not flying around the world, they're not staying at The Greater New York, and they just see enough of this stuff that eventually it's going to click, and they're like, "God, I can do that." I just think we could ... we have the technology, we could get these guys to understand it and do it in a tenth of the time that it took me 25 years ago.
Lou Azzara: I would ask you, Dr. Farran, why with all the great content that exists, all the great teachers that exist, and the experiences that people have why has that not happened?
Howard Farran: I think they think that they would rather monetize it by you paying $6,000 and come to their 3-day course in Mexico or Dominican Republic or Brazil. I think there's a lot of that going on. There's just a lot of money in education, and my idols have always been Sam Walton of Walmart, IKEA of furniture, Herb Kelleher of Southwest Airlines. I've never got really excited about making a Porsche for a few rich guys. I've always been a Henry Ford type of guy where I just want to take ... My whole deal with Dentaltown, actually my whole goal with Dentaltown in the beginning was I was lecturing ... I've lectured in 50 countries and I was seeing 20 countries practice like Unites States, Germany, Australia, Canada. In 200 countries it's a pretty margin back, even in our own country. You go down to where Ryan and I live in Phoenix, you just go 100 miles south and you're in Mexico. You get a root canal in Nogales, Arizona and it's good enough for all 4 of us. You cross an invisible line in the sand and a root canal turns into complete bat shit crazy voodoo. You're just like, "What the hell," and now, ...
When I saw the personal computer and now the smartphone, I see a convergence where I'm going to get the 2 ... There's 2,000,000 dentists. I'm going to get 180,000 dentists to merge towards the top 200,000 dentists [snap] like that, and I see it as a duty of rich countries and ... because Germany, sorry homies but Germans have the best dentistry and the best products, just look at a Porsche and Mercedes and Audi, then look at a Chevy and a Buick and a Pontiac, and if you have any more questions just go home. If you still have questions after looking at your cars, just go home. I've been in many German factories, and I've been in every American dental factory. Again, there's no comparison.
You know what the best way to explain it to an American is? I remember when I was a little kid, I saw the space shuttle Columbia come out, and there's this big sign that says "Fuel enter here" and there's an arrow to the gas tank, and I'm like "How dumb are them boys in NASA. There's no arrow by my car gas tank. Don't all these astronauts know where the fuel goes in?" What they don't get is that's the German mentality. When you walk into a German factory, you can eat off the floor. You don't ask someone where the bathroom is, you follow that blue line and that's to the front office, you follow the yellow line and that's to the bathroom. Above every button there's a deal with the instructions of when to turn on, when to turn off. The whole place is in instruction format, and German manufacturing is just perfect. I don't care if it's a Kavo Handpiece. I don't care if it's Porsche car. They just make stuff real ...
Then, you go into an American manufacturing deal and the R&D department they don't even have one but they have a telemarketing department with 60 people dialing for dollars and a big ole mercury thermometer. They're trying to hit the $10,000 a day sales goals, and then, you go into a German department. I own a media company. They don't even have an advertising department. They don't even have a telemarketing department, but they've got a R&D department of 6 guys in white lab coats. The Germans believe that if you make it the very best it will sell itself. The Chinese believe if you'll make it so damn cheap people just buy and throw it away, and the American's believe it's all marketing. If you can't sell ice cream to Eskimo you don't have a good marketing department. I always thought the 3 countries ... The Germans need to learn how to market and advertise more. The Chinese need to learn how to ... more quality like the Germans, and the Americans just need to hire their first PhD. There's very few dental companies in American that even have a research where they have PhD, like 3M does, but most ...
Lou Azzara: I think that brings up a great point and inherent with the company, and one of the things that was so attractive, they have more engineers, material PhDs, 38 I believe and growing, and we have sales people.
Howard Farran: That's German. They probably don't even have a sales team. I bet they don't have a telemarketing department.
Lou Azzara: They don't have as many as they have engineers. It's just as you said. It's precisely as you said. It's from the ground up, but I think the uniqueness though, it's also from experience from the ground up, that we're actually producing the same things our clients are producing. We're living every day and the improvement is not based on "Hey, we'd like to make this better or put a fancy bell on it for marketing." Improvements made ... How does it make our production line more stealth, more efficient, more accurate?
Howard Farran: Let's make your sales team more ... There's no leverage in a 1-day analog lecture to 300 monkeys sitting in a chair. What's leveraged is you digitize that one time so that ... When I go to dental schools, the thing that makes me, just refuels my [inaudible 00:39:29] ...
I've walked in dental schools in countries from Africa to Kathmandu where I walk in there and when the dean realized it was me the owner of Dentaltown, they busted our bawling, and they said that before Dentaltown they had 20-year-old books that were Mandarin Chinese and French and none of their students knew Chinese or knew Mandarin or knew French, and they looked at the pictures. Then, they discovered Dentaltown, and you open up something on Google Chrome and it'll translate it to anything. All those courses ... Anyways, long story short is Dentaltown in the curriculum for hundreds of private dental schools from Brazil to Venezuela to India, and private means they're not the government schools, they're just private, they're shorter programs, and they're not going away. Great companies like yours could literally digitize the instructions, the whole curriculum and it might be the only ...
Then, there's a kid in Tanzania or Ethiopia on a Samsung and he's listening to first world dentists from Germany on first world Star Wars technology and it's scalable. We just put that up there one time and it wouldn't cost anymore for the two-millionth dentist to here than it did the first dentist. That's where I think this needs to go, and when I saw you guys were involved in an implant company, because I've pitched this to Megagen. I've pitched this to Nobel Biocare. I can't even get a returned phone call from Nobel Biocare. That's just like ... I had to talk to Dr. Branemark's wife in Brazil at the time, and she was like, "I don't know." Straumann, none of these companies get it, but I know you two would get it, and ...
Nick Azzara: We're forced to listen to you. We have to listen to you, and based on our success, whatever success we're blessed to have, we had great mentors along the way and one of them being you. We remember when Dentaltown was a newsletter, that first newsletter that came out, and just looking at 3 things and keeping it very simple and just bought your latest book. Always a fan and always a student and we are very grateful to following that, but brutal honesty as well. I love when you say your credentials, and it's like "Oh, I'm a fellow in this and you're understated." I know you're a great dentist, unfortunately. I've seen you work and you're amazing, but you're having to look at the real humanistic approach to just price and delivery and access to care.
Howard Farran: I think it all started when I took one of my first courses at the [inaudible 00:42:00] and they were talking about how the right patient was the A patient and you didn't want the B patient ... C patient. When they got down to the D and F patients they described my entire family tree from Kansas, from my cousin Eddie to my cousin Jerry to the whole dysfunctional ... I never was interested in the lifestyles of the rich and dentistry. I was always most interested in middle-class dentistry for the masses, and I really think if anybody ... They don't need a CBCT, they need access to one. They need to get an implant system where they don't have to buy a $10,000 starter kit and by 100 implants. They need to teas into this, but I think if we made it to where they just had access to an open CBCT and if they use ... let the lab make a lot of this investments in printer and CAD/CAMs.
I just think if we could get this system to where the entry point was just spending a lot of time listening to the program Dentaltown or their Samsung or whatever, so they could get in to placing their first implant for ... cut that $200,000 bar in half, cut it in fourths. If we can get them to get their first one in the ground, in the bone, and under $10,000 or $20,000 we're really going to save a lot of teeth.
Nick Azzara: Hopefully, all these things are converging for us where we're that convergence point and we certainly have the technology to do it and the desire. I remember almost, maybe it was 10 years ago, I don't know if it was 12 years ago, sitting in one of your programs and you said, "If you really want to look at the effects of not getting good dentistry, walk through any nursing home in America today," and going through that with 4 grandparents and seeing the people we missed along the way that didn't have access to care and seeing where they are, that situation effected me, certainly. I think being involved, the cool place to be years ago was fixed dentistry. Now, the cool place is whatever dentistry that's necessary, whether it's fixed or removable and that technology allows us to get there and make a big impact for people.
Howard Farran: What I like about the implants also is for ... A fireman fights fire and a dentist fights 2 bugs. He fights streptococcus mutans that eats teeth and P gingivalis that eats gums, and for years, we kept making these beautiful wooden barns and then we get done making a wooden barn and we say "Now, you got to brush it and floss, and it's all up to you to keep that." Then, 6-1/2 to 7 years later, the barn comes back and termites have eaten the whole damn barn. Now, we're going into your cousin Eddie, who you know is not going to brush 2 minutes every morning and every night. You know he's going go have a can of chewing tobacco skoal in his deal and you know he's going to swish instead of Listerine use Budweiser.
That ain't going to change, but now, you just built an aluminum barn and say, "You know what, don't brush it. Don't floss it. Streptococcus mutans isn't going to eat it." I go into nursing homes and the only teeth they have left were my titanium implants that I put in there, and these old World War II guys are telling me, "Only the ones you did ever worked." It was like no only the ones I did, you didn't have to take care of. I like going from a profession of building wooden stuff when you know termites are in the mouth to now building titanium stuff where you know termites can't eat it.
I've got to tell you the weirdest story to end on, to throw that as ... There was some oil tanks, gas tanks leaking in Phoenix, and when they found out it was leaking the tank company sued the tank builder, and the tank builder says, "Wait a minutes. These things, we build them in the desert. There is no humidity. They can't rust." They went and cut out the deal and it was rusting, and they were like ... Everybody is suing everybody and nobody could get it. Finally, the head lawyer in Phoenix walked into ASU Department of Biology and says, "What do I do? The guy says that this metal can't rust and you guys have an engineering department, you have a biology department and blah blah blah. What do you guys think," and the ASU guy said, "Well, that ain't rust." They took it over to biology and they looked at it under a slide, and it was the first identified species who's evolved to eat an iron tank, and they were looking at a bacteria. I don't know if it was a fungus or a bacteria. I'm sorry. I think it was a bacteria eating an iron tank.
There will be a day when there will be a bug that can eat titanium, but it may be a million years off the evolutionary chain, because this one had iron in it and that's a very ... lots of bacteria are used to iron but medical-grade titanium, I think we're going to have a long time. That's a funny thing in the implant deal because the dentist have figured out that on the implant studies they're always taking a patient where they lost the teeth from streptococcus mutans and they replace the implants in the most dense bone and then they say our implants have a 99% success rate, and they never go in and take a person who lost all their teeth from periodontal disease, P gingivalis, and then placed the implants in upper maxillary bone. That might be a 20% swing the other way, but I am very excited about ...
I've very excited about titanium ... replacing edible stuff to streptococcus mutans with titanium stuff. That's going to be a huge deal, and I'm really excited that I think you guys ... If I knew any two guys in dentistry who could just get it done. If there's any two guys you can just hand the ball to and go away and you know is going to score a touchdown, it's you two guys for 25 years. I just want 7,000 dentists looking at you right now to sit there and say, "I got the time, I just don't have the money, and I don't want to fly all around the United States to sit in a classroom and listen to a lecture when they could listen to it on their iPhone. I don't think they need $100,000 CBCT that's going to be outdated in 5 years, they just need access to one.
I've told them 1,000 times I'd never met a periodontist or oral surgeon CBCT that you said can I send the patient over to get one because the oral surgeon and the periodontist they all want a friend, they all want a referral. They all want to meet you. They're like, "Hell yeah, what is your name and let's have lunch," because you might place the one single implant but you're going to have 25% of your cases are going to be over your head, and if I'm your friend and you're using my CBCT, you're going to be giving me all the big complicated cases. That's how endo works. I'll help you do a single canal because you're never going to be able to do a molar or a second molar. Oral surgeons, "Yeah, I'll help you pull these gum disease teeth and everything because you're not going to pull the wisdom teeth." Orthodontists are the least likely. Orthodontists should be helping you do your Invisalign because they know you can't do your Class II, Class III and nobody wants to do the ceph tracings to predict what a child at 10 is going to look like when she's 13 or 15.
That's how the specialties work. We'll help you with the easy stuff and then we'll make a lot of money off doing the hard complicated stuff. They don't need a CBCT that's going to expire in 5 years. They need an oral surgeon, periodontist, or a lab, and you, big companies, when you put together on webinars it should be a complete curriculum from A to Z so that you guys sit down and say you know what, if Amy just committed the 25 or 45 or 65 hours and just worked her way through this when she watched the last one she'd say "I can place an implant, and I'm going to use your brand because titanium is titanium. There's nothing fancy really about it.
Lou Azzara: That's been the message I believe resonated with Nick and I throughout the years. You democratize information. You brought people together and you made ... gave access. I think the one mindset, Dr. Farran, that you've always brought to us, and I think to so many, is that it's not a finite pie. If we make this pie and give access to more people of education and we're going to give access to great treatment, we're going to make the pie bigger, and that's how we're all going to benefit. I think you had mentioned to us just yesterday that you wanted to ... you had this vision of a step-by-step and by this morning we were ...
Howard Farran: I know. I know.
Lou Azzara: We see and follow that path, and I think we have a lot of offer. The entire industry has a lot to offer. You have a great delivery platform to offer it in. I think together these two combinations could literally change the world and make that pie bigger for all of us.
Howard Farran: It was amazing going in some of these African cities and seeing dentists who told me, "I graduated from the best dental school in Abu Dhabi or whatever in Ethiopia and they didn't know any of that stuff. Then, they discovered Dentaltown, and then, they spilled through all the classes, and we make them free for all the Africa. We only change money to 20 countries if they have money, but we don't charge if they don't have money. What's amazing is I was watching this kid and he was so motivated and I was in Tanzania, and I would have let him do a root canal on me. He was doing first world Phoenix, Arizona, Manhattan endo and he knew all the players, all the names, and he did all of that on his computer for free.
I think we always, at the end of the day, we forget there's 2,000,000 dentists out there, and I think that the smartphone alone is going to do more for dentistry than any other factor in all of the history of dentistry. I think that smartphone and that Samsung and that iPhone is going to get 1,800,000 dentists to jump up a couple of generations, literally, in the next 5 years, right before our eyes.
Nick Azzara: It's exciting times.
Howard Farran: Who would have thought the next G.V. Black would have been the iPhone, but that's what it is. I hope you guys ... I hope you guys help all of our dreams come true.
Oliver Klein: Yes, I'm sure. I think you have to believe in that and then work hard on that and then it will happen. I thank you very much. It was a great time being part of this discussion, and I'm really glad and learning a lot. I think we all may work together and make it happen.
Howard Farran: I want to say and I want to say it, and we're at the eve of a presidential election. I want to say that having lectured in 50 countries and being around the world, I do think Germany is probably ... I think the greatest societies ever are Australia, Germany, Denmark, Sweden, all the evil socialists countries. You guys seem to have the most educated people, the most healthiest people, the best products, the best work ethics, the nicest people. I really think Germany, Scandinavia, and Australia, New Zealand, Canada, that's probably the greatest civilizations on Earth. I can't think of any place I'd want my granddaughter Marie to live than those civilizations. Great products, great people, and if you haven't gone to the Cologne Meeting you've got to go because if you're walking ... Humans walk about 15 mile minutes, about 4 miles an hour. If you went to the Cologne meeting and just walked down the booths, could you see every booth there in the ... What is it a 5-day or 4-day?
Nick Azzara: It's a 5-day.
Howard Farran: I don't even think you could walk by all the booths, could you?
Nick Azzara: It blows your mind, the scope of how dentistry comes together, the world of dentistry comes together for 1 show. You think of The Greater New York or you think of the Midwinter Meeting or any of the largest meetings in the United States and you times that by 10.
Howard Farran: Yeah.
Nick Azzara: ... and that's what you got. It's hard to imagine.
Howard Farran: It is amazing. What is so cool is it doesn't matter if you're from Saudi Arabia or Iran or Japan. You got 5 dentists at a booth trying to figure out a product. It's just the coolest the experience because every dentist ... I love dentists. I really do love dentists mostly. I love my profession because I spent the night in a 100 dentists home and a 100 non-dentist homes, and dentists are all readers. You go to any country, they're in the top 1% of education from their country and they're usually in the top 5% income in their country, but if you go spend the night in someone's home and they're not a dentist or a physician, there's no non-fiction books there. It's like magazine, 50 Shades of Grey, a bunch of movies, Disney, but you stay in any dentist's home from Warsaw to Kathmandu, they have 100 to 1,000 non-fiction books that are all well read, they're real smart. I just love dentists, and it's so fun to go to Cologne and be sitting at a table drinking a beer with 5 dentists from 5 different countries, from 5 different continents all talking root canals. It's just so damn cool.
Thank you for spending time with me at The Greater New York.
Nick Azzara: Thanks for everything. Thank you.
Howard Farran: All right, buddy.