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Howard:
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It is a huge, huge, unbelievable honor today to be podcasting Dr. Behnam Shakibaie. Did I say that right?
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Dr. Behnam :
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Behnam Shakibaie, exactly.
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Howard:
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Behnam Shakibaie, and you're an oral surgeon master in implantology, master in periodontology. You're a specialist in microdentistry. I'm your hugest fan. I just love what you're doing. It's truly amazing and over my head. I want to read up your bio. From 1993 to 1998, studied in dentistry at Berlin University. '96 to 2001, a doctorate at Berlin University in clinical guided bone regeneration. Specialization oral surgery in Berlin. Mastership implantology and periodontology, specialist in oral microsurgery and micro dentistry at Carl Zeiss Academy, specialist of oral surgery, oral maxillofacial surgery in Iran. Owned clinic in microsurgical implantology and periodontology in Germany. Invention development and international publication on microsurgical techniques and instruments in oral implantology. 2008, scientific consultant, German Association of Implantology. Instructor of implant microsurgery at Zeiss Dental Academy. In 2009, was the ambassador of Quintessence Publishing Group. That is so amazing. 2012, founder of First Specialized Microsurgical Implantology Clinic in the middle east in Tehran, Iran.
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Dr. Behnam :
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Exactly.
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Howard:
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2014, founder of International Group of Implant Microsurgery. Internationally granted awards, best practitioner, 2007, of German Society of Periodontology, first scientific prize, 2010, of German Society of Periodontology, innovation award in medical science, 2011, of Tehran University in Iran, best education lecturer, 2012, of Zeiss Dental Academy in Austria. Congress best presentation, 2014, of [Amad 00:02:12] in USA. European business management award in Croatia. I mean, man you are a legend and you're just a baby. I'm a decade older than you and you have more credentials than I'll ever have. Thank you so much for joining me today.
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Dr. Behnam :
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Thank you for publishing my CV. It's a great honor to be with you today. Our first connection was through Ken Serota two years ago, if you remember.
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Howard:
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I do.
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Dr. Behnam :
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We had a chat one and a half years ago on Skype, but unfortunately, because of the shifting of our clinic to the new rooms here in Tehran, I was so busy with this issue. We had a delay to find each other. I am very happy to be your guest today.
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Howard:
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Where were you born? I don't know where you were born, but you've gone to school in Germany, Berlin, you've lectured all over the world. You could lecture anywhere. I consider you more of an earthly citizen. You could practice anywhere. Where were you born? Were you born in Tehran and you went back home?
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Dr. Behnam :
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Yes, I am born in south of Iran, just to be exact. I am born in south of Iran. The city is named Ahvaz. This is just in the neighborhood to Iraqi border. Therefore because of this location, we lost everything through the time of Iran Iraq war. That was back in the '80s. That was also the reason for my parents to send me to Germany to continue my education at the school. After outbreak of Iran Iraq war, it was very hard for us to continue the school. I had to change the school within three years five or six times and that was very hard. I left Iran in that time and went to Germany to the family of my uncle in Berlin. At that time, I was 12. It was 1986.
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I went to school. I started the school in Germany with the school level eight. It was a tough time because you might imagine German language is totally different than the international language around the world, which is English. I could speak broken English at the time. German language was totally new for me. I had to learn it from A point, from the start up. It was a tough time because the German immigration government didn't want to have me there. The only condition which made me able to stay in Germany was to go to a camp of [maladdition 00:05:53] children. It was very hard time, but I continued the school.
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I made my degree or I finished the school in Berlin and started dentistry back in 1993. Started dentistry study at Berlin University and continued as you described before on my CV.
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Howard:
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That is so amazing. Probably 80% of my podcast listeners are Americans and the other 20% are about 135 countries. It's so good for them to hear this because so many times, I'll meet a dentist like yourself who came through a war or something so hard, moving different countries. It makes everyone listening who's whining about their schedule or their overhead, they think they have all these stresses and then you meet a poor young dentist like yourself who had to live through the Iran Iraq war and go to a different country. I couldn't even imagine.
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I podcast interviewed another woman who survived the Vietnam war and came here. It just puts everything in perspective. It's why I like to do charity dentistry, because you go to a different country where they're all poor and they're all so grateful. You're working on kids in a orphanage and it makes all your problems seem like they're really not problems. I just can't imagine living through that. I'm glad you made it. I'm glad you're safe because dentistry needs more people like you. Your work, you look like Beethoven playing the piano.
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I want you to start with, why did you pick oral surgery? Do you just like blood and guts or is it an adrenaline rush for you, as opposed to doing a filling or a crown?
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Dr. Behnam :
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There were different reasons why I have chosen oral surgery for a specialization or to specialize in. The first one was the fact that I am coming from a family in which my grandpa was a doctor, my uncles are doctors. My father was a famous gynecologist in south of Iran and he was a university lecturer also in Ahvaz, in the city where we used to live. That was the first reason, like a dynasty, you know? We are a medical dynasty in Iran. Behnam, my person was forced somehow to continue this way.
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Sometimes I felt really big pressure on my shoulders to be in such a dynasty family because somehow I didn't had the aim to get, to become a specialist in oral surgery. After a while, during the dentistry time, during the study time, I developed a passion for this subject. After a while, after few years in dentistry, with the passion I had developed, that was the right subject for me. I wanted to continue the specialist way and to go forward as far as I could. That was really the first reason.
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The second reason, normally or usually, all Iranian doctors, they love to go to invasive specializations of medicine. All of the general practitioners, no matter if they are in general medicine or in dentistry, they want to cut and they love the blood and they want to suture. This is also in my stomach or in my heart. That was the second reason I have chosen oral surgery.
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From the first day of my oral surgery specialization, it was clear for me that I didn't just want to end up with the oral surgery specialization. It was clear for me that I want to proceed in implantology from that that time. That was back in 2003, 2004 as I finished a degree of oral surgery at Berlin University.
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Howard:
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I must be Persian because I love blood and guts. I think a composite filling, I do them all the time, but they're so boring compared to pulling out an impacted wisdom ... How could you compare placing an implant or pulling out an impacted wisdom tooth to an MOD composite? One is like, you could almost fall asleep while you're doing it and the other one is just like total intensity. I get the blood and guts.
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It seems like so many of your cases, you're using magnification, microscope. What are you thoughts on, endodontists are starting, all endodontists will say that sometimes, they'll buy a microscope and they'll say, at least 10% of the cases when they just get magnification, they do higher quality. How often are you using a microscope?
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Dr. Behnam :
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If you allow me, I want to describe how I got in touch with microscope dentistry. That was back in 2004, as I finished the oral surgery specialization in Berlin, I decided to leave Germany for minimum one year to just have experience outside of this country in another English speaking country. I applied in several clinics in UK, in London, and surrounding area of London. I was accepted in end of 2004 in a multidisciplinary clinic in Gatwick, London Gatwick. I shifted from Berlin where I was living at that time, I shifted, I moved to London Gatwick. I started the job in this multidisciplinary clinic.
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They used to have a specialist in endodontics who was using a very old pico microscope of Carl Zeiss in this clinic. This time, I had the idea to check my surgeries, my implant surgeries, what I was responsible for in this clinic, I was in charge for, under the microscope he was using. He was just coming through the clinic for a few days, for three days per week, and the other time, this microscope was free. I ask him and he agreed, and I started to check my implant surgeries under this microscope. I was just shocked to see what I was doing to my patients. All my colleagues in that time, they used to say that Behnam is a very precise surgeon, but I was a precise conventional oral surgeon. Under the microscope, I saw really a new world. Everything was different and everything was so big. I could see all my failures I was doing during the surgeries. I started to think about getting new instruments for the surgeries because the conventional instruments for implant surgery are much too big to use them under the microscope.
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I went through the literature at that time for Dennis Shanelec, for example. You certainly know the name Dennis Shanelec from Santa Barbara, and [Tibitz 00:15:28], and Audrianna [MacGreggor 00:15:29], those people. I went through their publications, but those people were dealing with periodontology or microscopic periodontology, not exclusively with microscopic implantology. I got some ideas from them and also from Marco [Slotsva 00:15:53] and [inaudible 00:15:57] from Munich and [inaudible 00:15:59]. Those are the people I have learned a lot from them and I have taken over ideas form them, but I needed new instruments.
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I started to negotiate with the industry, for example, with [Ufridi 00:16:18], with I don't know, can I say the names here?
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Howard:
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Absolutely. This is dentistry uncensored. You can tell us anything you want. In fact, I want to know about which city was more fun to party in, London or Berlin?
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Dr. Behnam :
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Berlin, at that time, was a little bit boring. It was 2004. London was much better and I was much younger. You can imagine it was a tough time, but right now, I like Berlin more than London because Berlin developed amazingly during last 10 years.
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Just to come back to the session I was talking about-
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Howard:
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Yeah, please name the companies.
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Dr. Behnam :
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Yeah. You have mics on and everything?
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Howard:
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Yeah, you're doing great.
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Dr. Behnam :
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Okay, okay. I started negotiations with Ufridi, with Aesculap, and Helmut Zepf Medical Technics. Unfortunately, I couldn't come to a result with Aesculap and Ufridi, but Helmut Zepf, this is a very small and traditional company in Tuttlingen. I have been working and developing with them since [inaudible 00:17:48] and they are also my fixed sponsors for all my educational.
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Howard:
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What is the WWW for their website, to go to their website?
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Dr. Behnam :
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Zepf-
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Howard:
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How do you spell that?
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Dr. Behnam :
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Yeah. Z-E-P-F-
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Howard:
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Z-E-P-F.
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Dr. Behnam :
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Z-E-P-F.
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Howard:
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Is the first letter you're saying, Z?
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Dr. Behnam :
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Yeah, Z, zed, Z. Z-E-P-F.
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Howard:
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Okay, medical instruments.
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Dr. Behnam :
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Medical instruments.
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Howard:
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Yeah, I notice the Germans pronounce Z differently than I. You say Z, what, zept?
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Dr. Behnam :
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Zepf.
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Howard:
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Is for the letter Z?
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Dr. Behnam :
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Founder of the company, Helmut, and the surname is Zepf. I think the address, the web address, is zepfdental.com. Zepfdental.com.
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Howard:
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Okay.
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Dr. Behnam :
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We started developing new instruments for some new ideas I had in that time. We could surpass all the government necessary authorization for developing new instruments and we could end up to bring out, up to now, more than 20 instruments for microsurgical implant surgery, especially for two techniques which I have published worldwide. The first one is microscopically guided external sinus floor elevation.
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Howard:
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Wow.
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Dr. Behnam :
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Where we developed 18, no, no, 17 instruments, new instruments for. The second technique is the socket and ridge preservation technique of Skakibaie. Especially for these two techniques, we have developed six new instruments. They started promoting those instruments and taking them to international, into the international catalog of Zepf in 2010. From that time, they have been selling the instruments regularly and we are using them for my international courses and congress events also worldwide.
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Howard:
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What do these instruments do for you that you were not able to find beforehand?
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Dr. Behnam :
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There are special factors or special points which make them different in comparison to the normal external sinus lift instruments, for example. First of all, we have smallized the size of the instruments. Those instruments are 1/4 or 1/5 of the normal size instruments for sinus lift, first of all.
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Secondly, we have changed the tip angles of the instruments because once you are using the microscope, you are not able to move your body like a normal surgeon without optical magnification. You are usually fixed in your position like this and this is the reason why working under the microscope is much more ergonomical than without microscope, because you are fixed in your position and you don't move like this. It's ergonomical. Therefore, the instruments have to change the angle because surgeon is fixed normally in one or two different positions [inaudible 00:22:32] under the microscope. We changed the angles and adapted them to the view direction of the surgeon.
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The third point, we have changed the surface of the instruments. Normally, the surfaces are highly polished of the normal instruments. This is very annoying for the surgeon to work with them under the microscope because they reflect the light into the eyes of the surgeon. That was the reason why we sandblasted the surfaces of all our microscopic instruments.
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The last point and the fourth was to sharpen the ends of the tips. Normally, in a normal sinus lift instruments, they have rounded tips because the surgeon doesn't want to injure the Schneiderian membrane during the elevation. Once you are able to look into the sinus bottom with the microscope and with the optical magnification, you are able to check your movements and to control your movements visually. You see what you are doing and how you are elevating the membrane. We sharpen the ends of the instruments to put less pressure on the membrane, on the bone in the sinus bottom without any contact with the membrane.
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Describing the theory of this technique is one part and experiencing the technique practically is another part. The people have to, the people who are interested in those techniques, they have to come to our courses and to see what we are doing and which benefits they can get out, they can bring out of these techniques for their daily work and implant therapy.
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Howard:
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Where would they find a list of where your hands-on surgical courses are? Would it be to go to drshakibaie.com, D-R-S-H-A-K-I-B-A-I-E dot com? Is that where they would find a list of where your courses are?
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Dr. Behnam :
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Yes. We have a special part in our website for education and congresses, which is regularly updated by my admin. The next opportunity to come to one of my practical courses is in Dubai, April 10th, less than two months, on the microvision world congress. May I show you the prospect? I have the prospect here.
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Howard:
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Absolutely.
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Dr. Behnam :
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This is the prospect and the name of the congress-
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Howard:
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Microvision congress, April 7 to April 10, 2016.
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Dr. Behnam :
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Exactly. This will be my next event, but you can see there are world famous speakers in microdentistry in all the branches or all the subjects. There will be a part for esthetic dentistry under the microscope, for endodontics under microscope, perio and implantology. I take over the miscroscopic implant part. We'll lecture and also with a practical course on microscopic external sinus lifting. After my experience on [Amed 00:26:53] in 2014, at Maryland University, November 2014 at Maryland University, that was my first speakers activity in the US market. It was very interesting.
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The people in the congress, they were amazed on my work. They came to me and asked me, "Behnam, what the hell are you doing in Tehran with your concept? How do you find the right patients for your concept? Does the people understand in this market what you are doing with the microscope? This is a unique concept. Only few people are working exclusively in implantology under the microscope. One of them is practicing right now in Tehran." This is very unusual. After my experience on [Amed 00:27:53] congress where my presentation was voted as the congress best presentation afterwards, I became interested to have some activities in North America. We started to talk about this with Ken Serota also, and also with Jack Dillenberg. I have to, you know Jack Dillenberg from Arizona University?
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Howard:
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Oh, he's been my friend for 30 years.
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Dr. Behnam :
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Yes, he told me that. I have to send you best regards from him. I just met him last week in Dubai.
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Howard:
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In Dubai?
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Dr. Behnam :
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Yes, in Dubai on [edic 00:28:38]. We had a long meeting together with this whole delegation. He was there with his delegation from Arizona University. We are about to start cooperation with Arizona University. I am interested to increase my activity in North America market.
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Howard:
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Dental Town could put on that course. Jack can do it at his school, he's right up the street from me. He's like one of my best friends ever. Dental Town could also put it on because we put on courses at a casino right next to our office on, what's the name of that? Talking Sticks Casino, and we have a clinic. There's a homeless shelter clinic that has got permission from the Arizona State Board of Dental Examiners that if someone like you, a licensed dentist comes in, can do these procedures and other dentists can come in. They're allowed to do surgical hands-on procedures at the Cass, it's the Cass Institute or Cass.org. It's with Dr. Chris [Volchack 00:29:51], which is another good friend of Jack Dillenberg.
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Another thing I was thinking about, what would really do to, there's 210,000 dentists on Dental Town. We put up 350 courses. They've been viewed over half a million times. Now they have the app on the smartphone. On the smartphone, it has the online e-courses. 40,000 dentists downloaded the Dental Town app from every single country measured by iTunes. If you put up a course on your microscope sinus lifts or whatever, all the Americans would see that, then they would want to come see hands-on.
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Dr. Behnam :
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Ah, this is a very nice way to promote the course.
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Howard:
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Oh, absolutely.
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Dr. Behnam :
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I agree totally with you.
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Howard:
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I love it because last night, a friend of mine, Neil in Kathmandu was saying that he projects these online e-courses on the screen for his study club in Kathmandu, Nepal. They're having a study club and you can't have a speaker in Kathmandu come in from Tehran, without spending a lot of money. They're sitting there and so that would build up, you would be educating dentists in dental schools all over. I've been in so many dental schools in Shenzhen, in India where the online CE on Dental Town is a huge part of their curriculum. You would be educating dentists in every single country. Then the ones who want to, have the money and the passion to come see you hands-on. I recommend emailing, I am Howard@dentaltown.com. The person that puts up all our courses is Howard Goldstein, so since there's two Howards, he goes by Hogo@dentaltown.com.
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Email Hogo@dentaltown.com and put up any and all courses you want to. I've seen so much of your work. Ken Serota thinks you walk on water. Ken Serota and I are both just amazed at what you're doing.
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Dr. Behnam :
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Yeah, thank you very much.
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Howard:
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[crosstalk 00:32:11] No, go ahead.
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Dr. Behnam :
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Sorry for interrupting you. We will have our first Canadian course, I don't know if you are informed so far. Ken Serota and Dan Hagi, they are preparing my first Canadian course. This is a whole symposium, because I will have one day to lecture theoretically on my inventions of microscope guided sinus lift and socket and ridge preservation techniques the first day. The second day is purely practical. That will take place in Toronto at Toronto University on 15, from 15 to 16 of May this year. I am really very excited to go to Canada for the first time with this concept and to be supported by these guys. They have already confirmed the support of the industry. They are willing to come to this event. All my sponsors, international sponsors, are already willing to come to the event. We could do that like this also in the US. That will certainly succeed because it's a unique concept. The implant therapy must become more precise and more minimally invasive as all the disciplines in dentistry do. [crosstalk 00:34:14]
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This will be the future in implant surgery. All the people are doing implant, one day they will realize the techniques are a little bit old and little bit tough for the patient. Even if they are not willing to learn the new minimally invasive technologies, the patients will come to them and force them to integrate those new microscopic techniques in their concepts.
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Howard:
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Are you doing all your implant surgeries under a Zeiss microscope?
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Dr. Behnam :
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Yes. We have just recently opened our new clinic in Tehran, which is the first exclusively limited clinic to implant microsurgery in whole Asia. We have some clinics on this topic or with this activity field in Japan, but they are covering the whole dentistry. They are making periodontology. They're making esthetic dentistry, crowns, bridges, and everything. We are absolutely limited to my inventions and to implant microsurgery, which starts from removing of the tooth. This is very important to see that implantology starts from the minimally invasive removing of the tooth. This is a much more important part than the implant surgery itself.
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Because I am able, with new techniques of vertical tooth extraction, to preserve the whole structure of the socket. In the same time, I can provide the patients with new materials to fill the socket and to avoid resorption process, resorption process of the alveolus and of the alveolar ridge. This way I can simplify the implant surgery afterwards on the one hand. On the other hand, I can increase the quality of the implant surgery and keep it minimally invasive because I have a great ridge, great three-dimensionally preserved ridge and I can place the implant in the right position in the right prosthetically important angle with the right diameters, diameter and length. This is very important.
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We are running a minimally invasive implantology concept. Implant microsurgery is only one anchor of this concept. We have few anchors, which one of them is minimally invasive tooth extraction. Second one are prevention techniques for the ridge after tooth extraction. Third one are 3D analysis programs for radiology, you know them, we all know them. The fourth one is using microsurgery for the implant surgery itself and all the adjacent augmentation procedures for bone grafting and for soft tissue grafting and like that. I call it minimally invasive implantology, not only implant microsurgery.
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We just opened our clinic recently here in Tehran. We have installed the first Carl Zeiss [pro ergo 00:38:18]. You might know the name. This is the motorized system of Carl Zeiss. The motorized microscope of Carl Zeiss and in my eyes, the complicated and the best system in the world right now for dentistry. We are about to upgrade the system with all the audio visual HD filming and photographing systems. I have already ordered the cameras and the adjacent technology for it. We will upgrade the system in two months. We will be able to film all the procedures we are doing here in Tehran and to broadcast them worldwide to international events or to other courses on microdentistry.
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Howard:
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That is so amazing. That is so cool. I hope you make us a course for Dental Town.
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Dr. Behnam :
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I will certainly do that. Let us work out the details from this. I am very interested to have some forwarded information about your clinic because if you want to go in this branch of education forward, then we have to attract ... Dentists are coming to my courses, for example, at Carl Zeiss Academy in Switzerland and Germany. By the way, I'm the head of the implant section of Carl Zeiss Academy in Switzerland and Germany. I have been the head for more than five years and my contract will end in 2017. I will remain in this position for next two years.
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The courses are full, you know? The dentists who are coming to my courses are the leading dentists of their countries. Those are people who have already experienced implantology for many years. They have been working on microscope and with optical magnification for many years. They want to make the next step and they want to rise up the quality of their implant treatments higher to the next level. We should have the right promotion concept to interest those and to attract and interest those dentists from USA to come to our course in, I don't know, where is your clinic located?
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Howard:
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Phoenix, Arizona.
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Dr. Behnam :
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Okay. Do you have microscopes there and surgical motors? I don't know all the equipment.
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Howard:
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When you use your Carl Zeiss microscope motorized, is it mounted on the ceiling or do you use a ground microscope that you can move around in your clinic?
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Dr. Behnam :
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Yeah, you can do both. My microscope is mounted on the ceiling. This microscope is provided in three versions, mounted on the wall, mounted on the ceiling, and on a base, on a rolled base which you can move from room to room. [crosstalk 00:42:10] Yes. You have-
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Howard:
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Go ahead. Go ahead. I'm sure we could get one for the course at the Cass. The thing about the United States is that it's one country, but your dental license is individual for each state. If a dentist goes to a course that's not in their state, their license doesn't work. Phoenix, a center has to get permission from a board to accept licensed dentists. The only place I know of that east of the, or west of the Mississippi River is in Phoenix at the Cass Institute for Homeless Veterans. I'm sure if you have a course there, Zeiss would show up with a microscope that you could use during the course.
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Dr. Behnam :
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Yeah. I can send you some pictures from my courses in Switzerland. Normally, as the lecturer, has a special table, you know? I am sitting in the front to be able to project the whole procedures to the audience. The audience is sitting in front of me. Normally we have 10 to 16 participants in each course and all of them, they have a pico microscope installed on their working place. They have a surgical motor. They have a straight hand piece. They certainly must have a basic microsurgery implant set of Shakibaie and a second set which is especially for microscope guided sinus lift. Also, meaning they need two surgical sets from Helmut Zepf. I think they have a distribution in USA and we could contact them. They would certainly consider to support us. Zeiss would certainly also support my courses because I am one of the international instructors of Zeiss worldwide.
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Just the same way Ken Serota and Dan Hagi are doing right now in Canada. They could provide you with latest information, how they organized the course, and regarding the promotion, you are the big boss to promote the course for USA in the best way.
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Howard:
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Yes. I think you doing a podcast and doing a online CE. We can put that email in front of 300,000 dentists. It would be very fun. Let's start with the extraction. Instead of just using an elevator and rocking the tooth all around, you're basically saying that's a little bit too much trauma. You're trying to remove the tooth without a bunch of trauma. How do you remove a tooth with the microscope? How are you removing it with less trauma?
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Dr. Behnam :
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When we are going to this subject, we have to talk about vertical extraction. Normally, when we take the forceps and you take the tools to remove it, we move the tooth in different directions and also in horizontal direction. Every movement in a horizontal direction of the tooth to get it loose and to be able to get it out of the socket is like, I call it poison for the ridge. It means with every horizontal movement of the root, we take the risk to break the ridge structure or even to remove some parts of the ridge structure of the ridge bone together with the root.
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The first point is to think about the movement direction of the root when we start the extraction. There are different techniques which enable the surgeon to work just in vertical direction. First of all, there is a system called Benex system. You might know it. The Benex system is also produced or manufactured by Zepf Dental and it is like-
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Howard:
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Did you say in Benex, B-E-N-E-X?
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Dr. Behnam :
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Yeah, Benex. Ben-
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Howard:
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And then second word.
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Dr. Behnam :
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Ex.
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Howard:
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Just the letter X, Ben X?
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Dr. Behnam :
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B-E-N-E-X.
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Howard:
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One word or two?
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Dr. Behnam :
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This is one word.
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Howard:
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Okay, Benex extractor. Right, okay.
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Dr. Behnam :
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Yes, Benex extractor. This is a very useful and very great device we can use for vertical extraction. Technically, we have to have adjacent teeth as anchors, as hypomochlion. This is the first technique we can use to act minimally invasive on tooth extraction. The second part, in cases where we unfortunately do not have adjacent teeth, we can make a decapitation. It means we remove the crown firstly and then we have the pure root in the socket. We go into the root with very thin bores, very thin [lindamen 00:48:34] bores, I mean the thinnest, and separate the root in different sections or in different compartments. This stage of extraction can be checked and can be overviewed or supervised by the microscope.
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Howard:
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What city are they in, Benex?
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Dr. Behnam :
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Benex?
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Howard:
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Yes.
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Dr. Behnam :
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I didn't get that.
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Howard:
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What country are they from?
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Dr. Behnam :
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Benex is, you mean the development?
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Howard:
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The company.
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Dr. Behnam :
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The company is Zepf company.
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Howard:
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Is that in Germany?
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Dr. Behnam :
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Yes, that's in Germany. That's in Tuttlingen.
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Howard:
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Okay. I think it's-
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Dr. Behnam :
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The headquarters of Zepf and the production site is in Tuttlingen.
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Howard:
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Okay, that's a hard one.
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Dr. Behnam :
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Two months ago, I visited them. I paid them a visit in the headquarters and visited also the production site. This is a traditional small company, but they are producing very high quality dentistry instruments. The big point on this manufacturer or company is that the point that they are flexible and they can integrate new developments into their regular program very fast. This is the big difference between this company and the huge companies like Aesculap or [Ufridi 00:50:21]. They are very slow in integrating of new developments. That was the reason why they didn't cooperate with me 10 years ago.
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Howard:
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In the New York stock exchange, the 500 largest companies in 1950, by 2015, only 12% of them were still in business for that very reason. It's creative destruction. You would think in 1950, if I said, "Here's the 500 largest companies," you would say, "These will be the greatest companies forever." Yet, they have a 88% mortality rate in just 65 years because of that very reason. They get so big that they just crumble and the always get ran over from behind. My favorite business book was Only the Paranoid Survive by Andy Grove. He says, "Everybody's looking out their windshield, but it's their review mirror." He says, "You're going to get crushed from behind." 88% of the time, you're going to die because someone's going to come up behind your business and pass you because you don't get it.
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Dr. Behnam :
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Exactly.
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Howard:
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When you're working under those microscopes, what magnification are you working under? 8, 10, 15?
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Dr. Behnam :
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Yes, this is a very good question. I am frequently asked all around the world, but this is the question on magnification power we are using every day. In the first phases of my, in the starting phases of my activity with microscope, I started with a normal loop which had only magnification factor of two. I used it more than three or four months. That was back in 2004 in London, I mentioned before. Then I increased the magnification factor to a stronger loop, to five times. Those were from Carl Zeiss, they are named the imac. They have a small loop and a bigger loop which provides a magnification factor up to five times.
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After getting used to work with loops, I shifted to microscope after almost eight months. In the beginning, I was afraid to increase the magnification factor over 10 times because I was still not adept with my fingers, with my manual work to greater magnification factors than 10. It takes time. It takes time and for me, it took more than one year to increase the power over 10 times. Right now, for example, for minimally invasive tooth extraction, we use normally between 8 and 12 or 14. This is the interval we are using for minimally invasive tooth extraction. For sinus lift procedures, we are using 10 up to 18, sometimes 20. Sometimes 20, and those are the intervals we are using in our clinic.
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It is important to say that we don't use the microscope permanently throughout every surgery, just for decisive parts of the surgery. We bring the microscope into the work because it's beside my head, the microscope on the right side, and the surgical light is on the left side. Normally, I use the loops and sometimes I bring the microscope into the surgical field and I use it for, normally, 15 minutes, 20 minutes. I shift to the loop afterwards. It's not a permanent working on the microscope what we are doing here in the clinic.
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We have to show the procedures to the users. They will understand it better when they see one or two surgical procedures in a workshop, for example, or in our clinic.
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Howard:
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What type of sinus lift do you like to do? There's very different kinds of sinus lift surgeries. Do you like any one more than the others?
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Dr. Behnam :
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Yeah, we have, when you're talking about sinus lift, are mainly two procedures. The first one is the open procedure, the classic technique of Tatum, you may know. The second one is the closed procedure, the inter-crestal procedure from Summers. You may know Summers. But we have different conditions. We have to have different clinical conditions, or different clinical conditions are required to be able to do those surgeries. For example, for the Summers technique, we need to have minimum five millimeters of ridge height to provide the patient internal sinus lift. Otherwise, when we do the internal sinus lift by a ridge which is smaller or smaller in size, in height, than five millimeters, the risk for membrane perforation will be too much or too high during the internal sinus lift procedures. Minimum five millimeters in ridge height.
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When we have less than five millimeters in ridge height, we have to change to the open technique, which means we have to prepare a window for the sinus lift in crystal zygomatico alveolaris to work indirectly and to elevate the membrane indirectly through the window, and set the implants intercrestally from the down site. The clinical conditions are the crucial points to decide the technique.
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Howard:
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Now, Tatum, right now he's in France, isn't he? Didn't he move from Clearwater, Florida to France?
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Dr. Behnam :
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Yes, originally he is France.
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Howard:
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Where is Summers right now?
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Dr. Behnam :
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Summers? I don't know. He is practicing in USA, but I don't know the faculty is. I think is retired right now, doesn't work any more, I think.
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Howard:
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If he's retired, I'll still drag him up for a podcast. I told [Hilt 00:58:35], if he didn't do a podcast, I'll fly all the way to France to get it. Are you, help the listeners out. When they go to the [cologne 00:58:44] meeting, the what is that? The IDF meeting, international-
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Dr. Behnam :
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IDS.
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Howard:
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IDS, international dental, what's the S stand for, IDS?
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Dr. Behnam :
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IDS is International Dental Show.
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Howard:
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Okay, show. The last IDS show, which I think is the greatest meeting in the world because so many companies release all their new products. They time it every two years for the show. It's just the newest everything. How does a dentist navigate? Last year, they had 175 different kinds of dental implants. You're talking to thousands and thousands of individual dentists who are overwhelmed with all of these choices. Are you, is titanium, titanium, titanium or do you like some systems more than others? Because you're looking at it under a microscope, and you seem to be so precise, and so accurate, what are you seeing under a microscope? Are they all the same or do you have favorites?
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Dr. Behnam :
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To answer this question, I might be not the right person because I have been using one system during the last 10 years. My favorite system is Camlog, the name is Camlog. The company is Altatec and is distributed in the US market through Henry Schein. Henry Schein has taken over this company, I think, six or seven years ago. This is Germany. Germany is number one. Few people know that, that the first one in Germany, the most sold implant system in Germany is Camlog system. It is not so well-known in the US market as it is in Germany.
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I have grown with this system during last 10 years and I made all my research and all my publication also with this system. They are my main sponsor for worldwide education also. I recently, just few years ago, after shifting to Tehran, I shifted to Tehran in 2011 after receiving official invitation of Irani president. I didn't mention that. That was the reason why I decided to start a clinic in Tehran, but I am just seven months of the year staying here in the clinic in Tehran. The rest of the time, I am cruising around the globe from congress to congress, from university to university to teach those new techniques.
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In Iran, I was forced to change the implant system because Camlog is still not present in the market here. I have chosen another big German name and this is Friadent Xive 01:02:02]. You might know Friadent Xive is spelling is X-I-V-E.
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Howard:
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X-I-V-E?
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Dr. Behnam :
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X-I-V-E.
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Howard:
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Let me see if I can get close enough to it on Google.
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Dr. Behnam :
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Yeah, Xive.
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Howard:
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X-I-V-E implant.
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Dr. Behnam :
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This is the name of the system, but the manufacturer is Friadent.
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Howard:
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Interesting. That's a German company?
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Dr. Behnam :
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Yes, this is a German, this is a old and traditional German company in Mannheim.
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Howard:
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What is their website? What is their WWW?
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Dr. Behnam :
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Yeah, I will tell you, they have also been taken over by a big USA company, by-
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Howard:
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By Dentsply.
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Dr. Behnam :
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Dentsply, exactly. They name it, right now, Dentsply Implant Systems because Dentsply has integrated different systems into the company. The first one are Friadent, which are Xive and Ankylos. They have also taken over, I think, Astratec from Sweden.
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Howard:
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I'm going to ask you one last question because we're over time. Our show's an hour and it's already a hour and three minutes. I always hear that in Germany, three out of four dentists place implants, and in Korea, South Korea, three out of four dentists place implants. How many dentists are in Iran and what percent of them place implants?
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Dr. Behnam :
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I don't know the exact statistics about implantology, about placed implants in the year in the Iranian market. Implantology is getting very, very popular in Iran, especially in the last five years.
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Howard:
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How many dentists do you think are in Iran?
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Dr. Behnam :
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The great part of the market is dominated by Korean companies, because of weakening of Iranian currency for three years. Almost all the people shifted to Korean companies because they are cheaper than leading European and US companies. We have the big hope for the future after lifting the sanctions against Iran by five plus one, you may know, that the leading companies will get into the market again and take part in the implantology market in Iran. I think two out of five dentists are practicing implantology in their practices in Iran right now.
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Howard:
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How many dentists are there?
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Dr. Behnam :
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Right now, Iran has more than 25,000 dentists working in the market. The number of the dentists are increasing very fast because Iran has more than 30 dental faculties. Iran is a big island, big dentistry island in middle east. You can't compare this market to other countries in this area because there's a huge number of dentists. Most of them are under 40, the majority of them are very young, and they are hungry for new technology and new science and knowledge. That will be also a great market for Dental Town to get in.
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Howard:
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I would love that. In fact, my goal is to, before I die to lecture in every country on earth and I've never lectured in Tehran. I've never been there and I cannot wait to lecture there some day, see you, see your clinic, everything.
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Dr. Behnam :
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We will make it happen in future, surely.
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Howard:
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Okay, and I hope you put a online e-course on Dental Town. I think that would be amazing.
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Dr. Behnam :
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I will try my best. We have to prepare that. I will check the opportunity to come to Arizona, I mean to come to Phoenix, especially to meet the team of Jack Dillenberg at the university. I will visit you and your team, surely, in the same time.
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Howard:
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Okay, we'll all go to dinner together, you, me, and Jack. That will be fun.
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Dr. Behnam :
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Yeah.
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Howard:
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Okay, well, Dr. Behnam Shakibaie, thank you so much for spending an hour with me today all the way from Tehran.
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Dr. Behnam :
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Welcome, thank you very much. It was my honor to be with you today.
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