Dr. Steffen Hohl studied medicine and dentistry at the Goethe University Frankfurt in Germany. He began his clinical training at Harvard Medical School in Boston, MA, where he trained in emergency medicine, plastic surgery and neurosurgery at Boston‘s Massachusetts General Hospital and the Brigham and Women‘s Hospital. He subsequently trained as a dentist for oral and maxillofacial surgery at the University of Cologne and the interdisciplinary trauma center in Dortmund, qualifying four years later as a consultant for oral and maxillofacial surgery and a dentist specializing in oral surgery.
In 2005, Dr. Hohl established die Zahnerei, his practice for oral and maxillofacial surgery and aesthetic dentistry in Buxtehude in northern Germany, where he is the clinical director. Die Zahnerei is also a training and professional development center for implantology and aesthetic dentistry. Steffen Hohl is the creator of the smile changer concept. He has also developed the world‘s first “soft sedation“ process, called Schlaf-schön-Sedierung, that he has been using regularly in his practice since 2014.
With more than twenty years of experience in dental implantology, soft tissue management, and implant restoration, he has brought together his own proprietary treatment concept known as the SOAP success concept. Dr. Hohl gives regular lectures both in Germany and internationally. His special interests are the smile changer concept, SOAP success concept, immediate implantation and immediate loading. Other practice areas include aesthetic soft tissue management and plastic periodontal surgery. Another focus is the 3D planning and 3D reconstruction of the peri-implant region.
AUDIO-DUwHF #1103 Steffen Hohl, MD, DMD
VIDEO-DUwHF #1103 Steffen Hohl, MD, DMD
Howard: It is just a huge honor for me today to be podcast interviewing a legend in cosmetic dentistry.
Steffen: It's my honor, thank you
Howard: A dentist a physician a plastic surgeon. So this mega gen conference is the the lineup whose figures everyone's world-class just just to even get to speak at this show is just a huge honor and this guy is probably the biggest name at the entire show, he's from Hamburg Germany which unfortunately whatever they taught you in school that's not where the hamburger was invented he just told me that it was not but doctor doctor that's how they do it in German Europe if you're an MD and a dentist they call you doctor doctor Dr. Steffen Hohl studied medicine and dentistry the Goethe University frankfurt in Germany. He began his clinical training at Harvard Medical School in Boston Massachusetts where he trained in emergency medicine, plastic surgery and neurosurgery at Boston Massachusetts General Hospital and Brigham and Women's Hospital. He subsequently trained as a dentist for oral maxillofacial surgery at the University of Cologne and the interdisciplinary trauma center in Dortmund, qualifying four years later as a consultant for oral and maxillofacial surgery and a dentist specializing oral surgery. In 2005 he established his practice for oral maxillofacial surgery in aesthetic dentistry in Buxton hood in northern Germany where he is clinical director DS honoree is also a training and professional development center for implantology and aesthetic dentistry. Dr. Hohl has over 20 years experience of implant training, in 2005 he became the author of the book Metamorphosis of Smile and a patient guide on implantology. Today he has posted over 50 articles and international scientific and medical journals both in Germany and international. He's the creator of the smile changer concept he also developed the world's first soft sedation process called Schlaf-schön-Sedierung that he's been using regularly in his practice since 2014. With more than 20 years experience in dental implantology, soft tissue management, implant restoration he has brought together its own proprietary treatment concept known as the SOAP success concept and what is SOAP stand for?
Steffen: Subjective objective assessment and planning which it's just a really common rule in the United States but I use it differently.
Howard: but what was the name of your lecture here?
Steffen: The Smile Changer.
Howard: Okay I thought when I saw that S I thought it was a smile change I didn't think it was the what we learned. His specific interests are the smile changer concept, SOAP success concept, immediate implantation and immediate loading, other practice areas include aesthetic soft issue management, plastic periodontal surgery, another focus is 3d planning and 3d reconstruction. What I'm gonna do now if you're listening this on iTunes you got to switch over to YouTube on YouTube we're youtube.com/dentaltownmagazine thank you to the 9,000 dentists who subscribe just on that but I want to show you these videos. The first video I mean because people do bleaching, bonding, veneers, they do braces but man you do the whole face as a plastic surgeon this lady basically you know you notice how when people are older they're like like me I'm 56 your big fat face hangs down so you don't see any upper teeth and then when they get older you start to see your lower teeth and by the time you start to see their lower gums they're always like seventy years old. The best giveaway that that guy said it sees me you don't see upper two you see lower teeth so you know I'm 56 but by time you start seeing just lower gums and what you're doing is you're doing surgery and lifting up the upper face but these videos are to die for let's play them now all four of those. Your work is revolutionary so talk us about what you're what first I'll explain that surgery on your website where the lady doesn't show teeth and you just lift up her.
Steffen: The smile changer concept is actually a three-phase surgical concept and it starts from facially driven dentistry originally because the problem is usually you have people and they lose their teeth probably they start being 50 or more years old and then they have other problems going on the same time for example they have to deal with skin aging which means that you have a prolonged upper lip that is completely in the way of seeing the teeth of the patient and dentists sometimes worldwide they think they can make bigger teeth, so the prolonged lip is not in the way anymore but for example in Germany we have special words for that for example a lady saw me last year she said I hate these horse teeth my former dentist gave me but I can actually understand why this was the case because the dentist thought I just have to overcome that big lip that is so long by giving her bigger teeth but that does not work out the lady would not look good and she felt like a horse as you said you would kill hundred horses. So something you don't make friends with your patients so you need to do something about the lip the problem is with skin ageing the lip especially the upper lip is not getting only longer but also thinner so you have to do something about the volume and you have to do something about the vertical dimension the length. So we make a beautiful small incision beneath the nose we put in fillers to create a beautiful three-dimensional volume again but the problem is and that goes back to neuroscience actually there was a French guy his name was Guillaume Duchenne he was a French neural scientists and he did studies I think for decades to find out how a real smile is defined and a real smile needs certain things it needs three steps you need to show beautiful teeth you need some muscles lifting up your oral angles and you need some wrinkling around your eyes.
Howard: You do need some wrinkling around your eyes?
Steffen: You do need some wrinkling, so a lot of people want to get rid of those wrinkles but you need some wrinkles and what you need is you need to get rid of the excessive skin around your eyes so actually somebody can see your eyes because the glance from your eyes is the fluid on your eyes that you only see when they are lighting in the room and there's the right emotion and there's like two different kinds of smiles we call it a social or fake smile or a Pan Am smile because all the flight attendants from the Pan Am was forced to show a social smile just like doing this show a bit of your teeth just lifting up your cheeks and that is now the neuroscience part to do so you only need your vertebral cortex so you do it willingly. You use the major circle magical muscle to show a fake smile okay but there's nothing going on around your eyes if you want to use your orbicularis oculi muscles you need your limbic system so that means to show a real smile you need to have emotions that is the big difference. For a social smile you can be tired exhausted without sleep everybody can do a social smile it just has to live up with cheeks but you show a real smile and that's the base of that three stage concept we give them back their teeth we do something they can actually lift up their lips and show their teeth and in the last step we do something about pulling back that glands in their eyes so and in that situation you will see I will show some results for example tomorrow or you can see that on my homepage and in the videos that these people who got treated with a smile change a concept they look natural but they look like minimum ten years younger they don't look like being operated or they don't have weird faces they just look natural but they were brought back ten years in time and that's the moment when I see the result of my smile changer concept giving somebody back the ability to show the real smile.
Howard: Now how would you say that's different than the average American facelift which does a lot of times looks unnatural?
Steffen: because it pulls the wrong strings in my eyes right because for some people it is really useful but I see an indication for a face combined neck lift when somebody has really excessive skin around his neck and excessive skin around his cheeks but you do not treat the right areas when you are really about a smile when you are interested about giving somebody back a unique and beautiful and young smile you need to treat those three stages. So it is not helpful to give somebody that that nice stretch look because it does not treat the right areas and sometimes you can see pictures on the internet I saw videos maybe from colleagues and the dentist were putting in some beautiful teeth really nice work brilliant colleagues and then an plastic surgeon would maybe do something like a fair like a lip lift and put in some volume and the lips to do to using fillers or something but then the people would still look tired exhausted because they still would have excessive skin around their eyes. Nobody did something for the whole thing like my concept is based on seeing the whole person the whole face doing something about the whole smile if you only treat a little part of that like only giving back the teeth only doing a lip lift only using fillers because the patient is scared of the surgical procedure then you will not reach the highest goal that is there because those people when you take photos before and after you can see there's something missing they are still looking sad maybe they appear tired or something. So you need to treat these three stages and you know what I have to admit I'm not that smart so I had to find out over a period of time what I have to do how much I have to do that it still looks natural but I can put patients back in time, I can give them 10 years or more and they look natural. I start very frequently that during the first appointment I talked to mostly ladies in their mid 50s and I asked them could you give me a picture and then they show me their mobile phone I said no no I need a picture of your face that is from the time before they had the mobile phones so bring me something printed when you were 20 or 17 and sometimes that procedure takes time let's say four weeks and then I have that picture and then I need to see the goal that I'm planning on doing in my mind I make the picture of where I want to go and then I talk the person through the whole process and actually the first question that I get is wow when I show them pictures from other people how many years will that take and I say yeah we are done in four weeks and they say yeah what do I have to lay in a hospital for four weeks and say no we have one surgical procedure where I can treat your teeth and you go home and you wake up with fixed teeth in your mouth and the second one will if you want that that way we can do the treatment of the lips but if you're lucky we can also do the treatment of your eyes the same day so it's your decision whatever you want. It's usually two to three hours procedures and then we actually done in two steps. The fastest thing I did this year was it took three three weeks and then we were actually done with everything it will be healed up after six weeks finally then we do the final photo session and we do a lot of videos and the most fun point is when I do videos before the woman that I treated looked sad she was crying the whole time she was covering her mouth with some tissue she was just looking down the floor and I took a video of that and then four weeks later I took another video once she was done she got dressed up she went to the hairdresser which she never went the last 20 years of her life and then I showed her that old video and we were really do recording that scene so you can imagine she was actually laughing at herself she was thinking wow how ugly would I run around so and look at me now I have the chance to start over again so that is actually very very emotional thing for me I love that I get chickenpox on my whole upper body when I think about these scenes because that is like really emotional for me, for me it's just little surgical procedures just following the whole plan and sometimes you have that spark flipping over but you really had the chance to change somebody's life.
Howard: and they take it all the way to the dark side I remember reading a study by soldiers who lost their lower jaw during wartime
Howard: Five years it was almost a hundred percent suicide yes so if you lost your mandible and they sewed it shut and you're going to go through life without a lower mandible it was it was too much for almost every single soldier.
Steffen: It's horrible most of the people because I I worked in trauma sent us like 1/3 of my surgery to Korea and I saw all these cases from young people to old people to cancer patients or whatever there's different reasons why somebody can lose his lower jaw for example and that is so dramatic that when you just try that situation to somebody on the street who is not even a dentist or has no clue about dentistry they cannot even imagine how much that ruins your life you cannot chew you look weird everybody will stare at you on the street you will never find somebody that you will actually trust to kiss so your emotional life is pretty much done in that life. So that is like really really traumatic and there is actually a good point that you just made there because that that was my starting point that was when I was thinking about somebody's smile is completely gone the ability to smile is completely gone there's no chance that this person can ever smile again and that made me thinking, so what do you need to do what can you do with people who have to do with skin aging or wounds or scars or even when you start with people who have no teeth at all they have a dauntless jaws and ugly dentures they are sometime also in the same situation like the guys with no jaw because the result is the same they cannot chew properly that TMJ is completely out of range they have pain the whole day they do not dare to open up their mouths when they are invited to a restaurant they look at the menu and they go do we have something soft maybe. So they cannot even eat properly then they get problems with their digestion and actually for me the worst part is when they enter the clinic and I see them the first time and that is something that human beings can tell right away that somebody is really ashamed of himself that is horrible to see because they stare at the floor they you see tears running down their faces they cover their mouth when you talk to them they still cover their mouth with something they they hold some some piece of paper or some tissue in front of their faces and you feel depressed while you are talking to them because you feel so sorry you think wow how horrible must that be to run around even for one day in your life and set in that situation. So in the earlier days let's say twenty years ago it would be like a big deal because nobody would know about techniques and implants were not usually used every day in every practice around the world like maybe today and there was no chance to restore a smile the way we are able to do it right now. We can do one day surgery we do immediate implantation cases I do that all the time we take out the teeth we augment the bone we put in the implants and then we have pre-planned and prefabricated bridges what we put on top right now and a lot of the patients let's say 50, 60 years old when I tell them what I'm able to do and what I'm planning to do for them they go like yeah and when do I get my teeth then I think yeah I just told you three times you get it right away and then the person goes back and says yeah what does right away means is right away two weeks or it's right away one month what is right away I said no right away the same day I put you asleep I take out the teeth to get the implants I put on the bridge everything is fine when you wake up you are reborn with new teeth and most of the people maybe 60 years old they cannot even understand that they have never heard about it they have never seen it on television and they cannot imagine how it would feel like or how it will look like so we use a lot of planning tools like smile designing software and especially from the Megagen guys they are like the biggest inventors I have ever seen in my whole life. These implant developers from Korea because they are able with there R2gate techniques right now there I use the oral designer from R2gate right now for example you have a little iPad and then the CBCT scanner digital data goes into that iPad you send it via email somebody is sitting there the whole day and night in Korea and planning it and then you go on TeamViewer or you can actually communicate with them every time you want and then they plan the implants for you and then you just push the button and say okay that's the way I want it I want six implants in the upper jaw six implants in the lower jaw for my patient I want PMMA or full ceramic bridge and they can produce it before you start the operation you place the implants through surgical guides to make sure that the implants are in the right spot actually maybe it sounds complicated but it isn't because I'm just on the end seeing the results I don't have so much work with what I'm just talking about. We have a lot of people in the R2gate centers in the dental lab in Germany who's taking a lot of work from us or doing a lot of work for us so I just see the result. On the day of surgery I have the surgical guide laying there why I put the implant through once this is done I screw on the little abutments and then I just reshape maybe the bridge a little bit i cement it or I screw it down and then I just have to check the occlusion.
Howard: So when you're talking there R2gate that's a Megagen product for the design what what CBCT do you use with that?
Steffen: I usually connect CBCT
Howard: So it was an R2gatre agnostic with a CBCT it'll work with various CBC all of them or
Steffen: Yes not a problem they use regular dye comdata regular just like JPEGs for pictures it's regular DICOM data where you just connect that to the software it can read it and then it can recreate these virtual pictures that you have three-dimensional pictures of the patient's jaw and actually we have a pretty big CBCT scanner so you can actually scan the whole head if you want that you have the lower jaw the upper jaw and pretty much of the cranium since we also operate like one or two centimeters area,
Howard: So would you say you extract the teeth and place implants and deliver the teeth right away is that is that all on four or
Steffen: We pretty much never do all on four because the whole on four needs a shorter row of the teeth so the row of the teeth usually ends at the second premolar we rather go for all on six that is like our minimum.
Howard: So all on six and with those be in the alveolar bone or where those go into the skeletal bone.
Steffen: No we we like to stay in the alveolar bone because we also care a lot about the appearance of the soft tissue because in my eyes that's the most difficult trick you can do for your patients to put in the implants and to make it look like a natural tooth and for that you really need to place them in the right situation that the soft tissue can really attach to every side of the implant.
Howard: and if you placed a hundred implants what percent would be what kinds of implants means are they all Megagen or what?
Steffen: Meanwhile they are on Megagen you know because I'm so stressed out and one out from using any other products because Megagen is like right now reaching a peak of modern technology and sometimes because we also have referring dentists from the outside they send patients and they ask us to put in another brands of implants and then a couple of years ago I did that while I was grinding down my teeth and getting stomach from stomach ache from it and then I just grabbed the phone and called back and say you know what I had I have a better solution because it is not only the surgical screw that is so brilliant about Megagen but it's more about the prosthetic parts because you don't want to limit yourself to the prosthetic solutions that you can find later on. So I want to feel completely free once I put in implants patient can change his mind maybe you see some difficulty trying to produce the restoration that you planned in the first place you can change that at any point of time and for example when we put in immediate loaded bridges we want to change that later to a final restoration we do full ceramic zirconia bridges and they have veneers on it with cut back technique. So the teeth actually appear completely naturally they they look translucent and from outside the oral cavity I think nobody would see that this is not his real teeth and for that reason you maybe have to switch the abutments. So I don't want to be limited that I have to go for titanium abutments if I don't want to then I would rather do hybrid abutments with glued on zirconium second iam caps on it or I want to screw down something because maybe it's difficult when you are in a in a situation where you have produced a pre milled PMMA bridge then maybe you want to glue that with flow plastic and screw it down. So I need a whole variety of abutments for me that is the big secret not so much the implant screw the ambulance crews really nice it's beautiful but for me like the biggest part right now 2018 when you use implants you need a whole bunch of different abutments that you that you are free in your decision you can do your kind of dentistry what your planned. So I use minimum three sets of abutments during one treatment so I'm completely free you can start with a screw down PMMA bridge the next thing can be something on titanium abutments and the thing after that maybe something is also problem about the pricing so the patient says you know what give me fixed teeth right now I come back next year I got promised some money whatever and then I want the full zirconium holy moly give me everything and then we go for the zirconium.
Howard: and by the way I just want to let you know that these aren't paid commercials Megagen didn't ask me to do these podcasts I had to beg them to come down here and podcast for speakers these it's not a commercial I'm too old and fat and tired to be bought and paid for this is all from the heart. I mean is this from the heart?
Steffen: You know what if you if you would know my story how I got to Megagen you would believe me that I'm not paid for saying this because when Germany or the German dentists they think they are the middle of the universe which unfortunately they are not.
Howard: The german dentists?
Steffen: They are not.
Howard: but you make the finest cars Mercedes, Volvo, Porches this is a country that makes the Chevy and the Chrysler.
Steffen: Unfortunately Mercedes is not doing dental implants the problem is with that product many years ago I was using let's say the regular implants for example a white Camlog whatsoever there's like we had...
Howard: Camlog who made that, was it Dentsply?
Steffen: No we also use Dentsply just to renounce everybody.
Howard: Who is Camlog?
Steffen: Camlog is from Switzerland yeah it's smaller company but they they do also produce brilliant implants but I had you know some problems here when I had to put in DENTSPLY implants day they had loose abutments sometimes or there were things that would break maybe once a while so that really annoyed me and then I started with using Facebook Twitter the internet so as you can see I'm not like seventeen year old guy just reborn with a mobile phone in his hand. So I actually know this times where nobody had a mobile phone so I started with Facebook and then I saw these implants once a while that a colleague from the other end of the world would use them and then I thought to myself or I also talked to my wife who was a specialized colleague also in our clinic and she said yeah...
Howard: So is she a dentist?
Steffen: Yeah she's actually not only there because she looks beautiful she can also work as a dentist.
Howard: So she's a dentist, beauty and brains.
Steffen: Thank you hundred points.
Howard: Good for you.
Steffen: and I actually I have to admit I told my wife and she said yeah go for it and I said yeah I don't know if their available in Germany I don't know if I want to stress myself so much because I have to buy them from another place in the world and then I try to figure out where I could get them there was like a really small company in Germany who would sell that and the company was provided by one person that is a lot of years ago and then I talked to that to that guy and he offered me to just use it to try it and I still had some stomach ache using it because I was thinking that is like a one-man company selling these implants from South Korea it did not feel well during that time the products were brilliant but you know that business connection was like you're buying it on the black market and hopefully you get a bill for it so you can give it to a tax officer what so that was like really some dark times and then Megagen started to grow bigger in between one or two years it made boom and there was the company the representative the CEO in germany coming to my office he was talking to me saying yeah I'm the representative of Megagen I said you would never believe how I bought these implants before you were there so I started like really basic using those and it came from my heart because I was so sick and tired I used all the implants on the market for the last 20 years and I found it to be really stressful sometimes because whether the implant screw was not really sharp-edged so you had problems with primary stability then you had problems with breaking or lose abutments and stuff like that that really made me sick and tired.
Howard: So what do you think I mean Dr. Park who's here today what do you think his advantage was why I mean most people after Dr. brandmark and Nobel biocare would be hesitated even though I compete with a company like that well. What do you think his secret sauce was and why do you think he was able to go against a company founded by Dr. Brandmark himself?
Steffen: You're asking about some magic stick also I don't know where his magic stick is the the thing is I think the these guys from South Korea they are in the first place they're really hard workers I have never seen something like that and actually as you taught as you told all the viewers that I studied in the United States and I was extremely I was thinking those are the hardest workers on the planet because I had to show up in the hospital at four o'clock doing pre rounds offering my knowledge to the next guy in line was the senior resident and he slapped my ass when I forgot some numbers or whatsoever so this thing was going on until late night or I slept in the hospital in front of some Apple computer and bounced my head against a screen and so I was thinking that the Americans are really hard working people but I think the Korean guys they they have seven day work week and I think they work yeah you can also call them on Sunday if you're bored the thing is but on top they are not so scared to try something new and that is something I feel in Germany a lot people are really scared they have so much things going on from the internet from the clinics from their responsibility so much things going on that they are actually satisfied with doing their little thing but to break out of that frame and start something new and trying something out here and trying something out here you risk every time that you fail that makes you scared it would make me scared because I also have to do that. So this year we invested some money in a new clinic other things in Germany so I know what I'm talking about that makes you scared because you have sums of money going out that it's not all yours and that makes you scared. So they started the same way they they had investors they had banks in their background but they would dare to try something new and actually do you risk that you fail.
Howard: You know I said a thousand if he ever want to know what made America great ever was that people voted with their feet and they emigrated here for five hundred years in every country on earth and when I look at a dentist coming out of dental school if they were not born in the United States and they open up man they hustle I mean they work 12 hours a day six days a week but if they were born and raised in the United States I mean right out of school they would have work Monday through Thursday 8:00 to 5:00 buy a nice German car and then when you lecture around the world I mean when I was and when I'm in China most of a China the norm is 12-hour days Monday through Saturday and then when you talk to me like how do you do that I go man Sunday is the hardest day because I have to do all my cleaning cooking and all that said I can't wait to get back to work on Monday and relax I mean I mean the work ethic the work ethic and other parts it's very different other words like work ethic and Greece and Spain and Portugal is very different that Denmark and Norway it just says I mean cultures but you're right there hard hard working but actually long hours.
Steffen: For me my experience at the Harvard med school thank you for that really turned my life around because I was very young ambitious and I thought I'm like a major hotshot which I have not been during that time but they showed me something and they taught me so much which I appreciate right now and I thought to myself you really have to have some balls in the United States to do that because you start with college then you go to university then you try to involve yourself in some Ivy League university you have like a major bank debt up to your head like your whole life will go down south if you cannot finish Medical School. So they have a lot of pressure and they work hard for example I would stay at a really cheap place in Boston it was cold and dark and much outside Boston and there were a lot of other students living in like a big house and when I talked to them I actually got more and more quiet because they impressed me with the effort to put in a lot of work for their goals so I have like the biggest respect for all the American dental and medical students because they have to put in so much work because in Germany it's like a most Cuse system you know once you're in dental school medical school the costs are overlooked able it's not so dramatic and I would say you can manage that pretty easy because I saw the difference in the United States I saw wow that is war you really have to stand up and do something it's not just sitting there and waiting the whole day it drops by and then you write a test and then you are done you have to do much more and I gained so much from that time I still profit from the time right now because they made me do things yes Steffen hey that's our friend from Germany you give a lecture next week and I was thinking they are talking about me what lecture I have no clue what do you want me to talk about. So I gave my first lectures actually at school when other people would sit in the background eating pizza and drinking coke and yeah so they would teach me a lot and they gave me the deep appreciation of what you can achieve when somebody just says you go you grab something grab your iPad prepare a lecture I don't care do something about the head impress us.
Howard: Ill teall ya lecturing around the world I've been the dental manufacturing companies all around the world Germany is absolutely a different breed of cat I mean you go into I've been into so many German manufacturer I would be cave or Dentsply or Ivoclar is Liechtenstein but that's kind of Germany is
Steffen: Let's pretend its Germany , its close
Howard: Yeah well it used to be Germany didn't it didn't sign used to be Germany then they carved it off for the king or something but I mean you go here's the one thing I notice about German plants when you go into German plants I mean eat off the floor completely organize the protocols I mean there's even protocols above the lights switch and when turn it on and off I remember I was in it was either cave Oh or Sirona or when I'm I said where's the bathroom she said follow the pink line and I looked on the floor and there's like six different colored lines and one went to the lobby one went to the bathroom and then I would go in there and I would say where's your marketing department it's a you know we we don't have one and then and then you go in there and they'd have like 60 PhDs then you go to American companies that might have do a hundred million in sales and you go I'd like to meet your PHD's we don't have one and then you go into a marketing department that'd be as big as this room you'd have 50 people dialing for dollars and a cheerleader and a thermometer and Americans are masters of selling stuff and they're all dialing and selling and they have daily production goals but the product you know there's nobody with the PhD and then you go to Germany and Switzerland and Austria and Liechtenstein and they have scores of PhDs and they don't do any marketing. Then you go to China and and and the model is just like we will just make it so cheap you'll just have to buy it and I always look at the three corners of the world are those three worlds and say okay the Americans should learn from the Germans and get more rd and make a higher quality product your you should try to get your Chrysler and Chevy more like a Volvo and a Mercedes and a Porsche and then I go to Germany I think you guys should do more advertising sales and then China I was going to China I go I go China I've been all around the world I ask anybody all around the world what is your favorite brand from China they can't name a brand from China they'll say they'll say LT's thats Korean they'll say hyundai i'll say thats Korean they'll say Toyota, Honda I'll say thats japanese. Name a brand from china you going to any Walmart they sell 60,000 SKUs and I'll ask anybody wall name one brand in this store that's made in that's in China they was in everything made in China I said I'm not talking about where was manufacture I'm talking about the brand and so I tell China what I would do is quit getting everything so damn cheap build a brand build I mean can you name a luxury brand from China. So that that's my point Americans only excel at one thing there are the masters of sales and marketing. I mean the advertising agencies in Manhattan are to die for and and and the other companies around the world are very smart when they want to sell their foreign car in the United States they don't use an advertising agency in Germany or Japan they get one from Saks Fifth Avenue and it's just quit trying to be the lowest cost and trying to develop a brand go for the go instead of just the value play do a premium play but I love German manufacturing I think it's the greatest and my favorite city in the world by the way is Cologne. So it's the largest dental meeting in the world the International IDS meeting it's in Cologne every other year they have minimum one hundred thousand and a show up every dentist you talk to you from different country this guy's from Tunisia Korea Brazil they're from every country on Earth.
Steffen: Yeah it's huge.
Howard: It's huge and they do it every two years because that's the product launch cycle for all these amazing companies they brought a say ok we're gonna spend two years developing this and then we'll launch it two years from now at the IDS meeting and my gosh and then the other thing I like about cologne it was it was the farthest out reach of the Roman Empire 2,000 years ago. So they still have the Roman Empire wall around it so it's the only place I've been in Germany where it's like we're Italian cuisine and beer and wine mate German beer cuisine and wine and it's just it's so fabulous it's so quaint and what I also love about it is of all the international cities I've been in that's that city is knows that you're lost and confused tourists and every citizen and that town will help you find your hotel you know you're trying to get on the train in many busy city I mean go try to get on a train in South Korea or Tokyo and you're all by yourself in Cologne Germany a little ten-year-old kiddo say do you need help and you're like yeah and they'll do the whole transaction for you and it's just it's just like...
Steffen: Cologne Germany is a really unique place in Germany it's really and you will find really cool people there.
Howard: It's the coolest city in Europe yeah and the beer the beer is to die for. So I'm gonna go back to you some questions for implants, obviously Americans would pay twice as much money for braces that they could be done in a day nobody wants out braces for two years and in implants a lot of these dentists are you know is the dog wagging the tail or is the patient the tail wagging the dog dentist they want their implants immediately loaded. If you placed a hundred implants how many of them would be immediately loaded and and what is your thing?
Steffen: I think right now but that is also depending on that I'm doing really special things because I would be so happy if you would come to my office and see me and I only had to put in one single implant, unfortunately in one way in the other way it I'm a really lucky guy I there's only complete catastrophic patients showing up in our clinic so they need 28 crowns they need minimum 12 implants all that teeth have to go because we have the image in our region and people sometimes travel from Hanover or Bremen we have patients from Frankfort or whatever so they've heard about us we even have patients from Russia and they expect us to do the job the same day and there's pretty much no patient are really rare customers they show up and they want two implants or four crowns or something it's more than big catastrophic cases the effort that we can help them and for us as you were talking about selling a product our biggest selling product is the soft sedation technique that we developed our what the soft sedation technique softly because most of our patients are scared they could also see a brilliant colleague in Munich they could see brilliant colleagues in Dortmund they could see brilliant colleagues and Hannover or whatever. So what they are looking for is that soft sedation technique which is not total anesthesia but it's just a mild sedation we can put people asleep for three to four hours they will be awake right after it and they will have no headache there will be no nauseousness is like it's IV sedation combination with inhalation techniques and some of our customers they come back just for that they say when I have to...
Howard: So it's inhalation and IV?
Howard: So what are they inhaling and what are you injecting?
Steffen: They are inhaling a special combination between laughing gas and oxygen and other things I cannot tell but it's not like severe medication but it's taking away their anxiousness so they are really relaxed their pulse is down to 60 while we are operating we also use certain local anesthesia solutions to numb up everything intraorally so they will not feel any pain when they wake up maybe there are some areas that are still numb in their faces but otherwise they have completely no pain and then they go on internet and Facebook and Twitter and Instagram and they post that for us they say I just had my surgery done and I that is great I will do that again. So sometimes we have patients maybe I take out the wisdom teeth and then they come back and say you know what when I have crowns I want the same sedation techniques and I want my crowns.
Howard: So why do you why do you call it soft sedation because it's not just putting them out with an IV?
Steffen: It's an IV technique but it's soft because it's like a special combination of a medication of different medications then they don't have so much side-effects and it's not strong if you want to use one of those things it would not really put you asleep it would not really take you out but the combination of these things what are not so which are not so harmful medications if you take only one of them but the combination is making the trick. So it's really soft because it does not take the patients out so much they are asleep they go on while they are laying there and you can operate really smoothly on them and when you let them wake up they are here right away it's no dizziness.
Howard: You know I think its funny, the endodontist want to change using the word root canal and call it endodontic therapy because root canal is a bad reputation and they're trying to get away from that and it just makes you laugh it's like almost every endodontist I know doesn't even have laughing gas. It's like instead of trying to change the word root canal or to endodontic therapy why don't you go get all the inner dollars just use simple laughing gas I mean what I can't tell you how many endodontist in America they if you said well can i have an anesthesiologist come in here and put me to sleep now oh you don't need it lean back no so so it's just a matter of hustling and listening and having empathy towards the patient and I don't care if you're an endodontist and you don't think the patient needs it the patient is scared and once laughing gas or wants to be put to sleep what why is it just a no and raising four boys I got four boys who now make turned into five grandchildren. You know I would see the emergency room so many times in Arizona I'll never get a look in there fell into a cactus they were pulling out so he's crying and screaming the whole innards and I said to him all the all these doctors and I said well why don't you have laughing gas they're like what I'm like you're an emergency room you just are always telling people to suck it up buttercup and you know there just is what it is like, when you study the market half the people are afraid of the dentist and half the people are afraid of the costs I'm which I want to ask you next for all these big cases how are people finding the money for this do you offer installment credit do you finance it or are these people coming in with catastrophic cases and a lot of cash and just writing you a check how does that work?
Steffen: Actually that is weird and it's a really brilliant question because sometimes I sit there with my wife and all the colleagues in the clinic and we are scratching our head and thinking to ourselves where's the money coming from because the person looks like living on the street and you tell them that she had to bring like a truckload of money and she goes like yeah okay no further question do you need some paper sometimes it's really weird and I think for us the secret is maybe pretty plain because we try to provide a really human and natural service for our customers so we really care once you entered our clinic everybody will ask you if you are okay if any one of our team will see that you are scared or you have trouble breathing you are nervous you play around with your iPhone somebody will show up and ask you can I do something for you are you stressed why are you stressed do you want to come with me to the next room and talk about it and then we start very very very slow making friends with the patients and sometimes we have situations that where I'm sitting with my wife in a treatment room and we talked to a person like for 30 minutes and then she goes out the room and says okay then I make an appointment and my wife and I we stare at each other and we go like she did not ask for the price so sometimes that is weird actually we we provide everything if you want to finance it we can provide you with that if you.
Howard: What percent financed?
Steffen: Actually for a couple of years we would not care so much because we have a provider who's completely hundred-percent service oriented and he provides everything we just exchange numbers with the patients and then they take care of everything that's like the whole concept of our clinic that once you come to us and you have problems with anything we take care of it 100% you don't have to move anywhere somebody will come to your place somebody will call you somebody will write you an email or you call there they call you back so and I think the last year we had three to four people financing anything and it was not even the big cases.
Howard: So just shows people people find the money for it they want and dentists are always telling me you know I'm I don't like the term United States of America because I would think of like Germany if you called the EU the United States of Europe well you can compare Germany to Spain or Greece to Denmark I mean they're totally unique countries and the United States there's really no United States it's really at least nine different countries flying under one flag you can compare San Francisco to Wichita, Kansas how do you compare a Manhattan to Miami. I mean there's
Steffen: To Las Vegas
Howard: Yeah Las Vegas which they call here Sin City I mean this is I mean this everything they're doing here gambling drinking all this like that I mean that's so taboo in the south you know so I'm even the Federal Reserve when they're trying to monitor the US economy they they look at it it's nine different countries. So a lot of times I'll be lecturing and what a lot of people think is a poor part of the country like an agricultural country like Kansas or Iowa Omaha Nebraska they'll say well these are just corn farmers and I'll say ok we're at a restaurant look in the parking lot what what are all the vehicles and they go and I'll look at it be like ten trucks and the f-150s for like fifty thousand apiece the f250s are ninety thousand a piece and the f-350 s are a hundred and ten thousand a piece I'm like okay so all these poor farmers I got fifty thousand dollars minimum for their tribe you could also makes me so so they can absolutely listen if you got fifty thousand dollars for a truck you have fifty thousand dollars for a smile makeover which totally could change mine. Last question and your lecture you also talked about you teach your colleagues to manage stress fear team-building and focusing on goals and when I want to finish last question on when I ask a hundred dentist what stresses them out the most they always say their staff they never say it's the filling the crown the root canal. When they get on dentaltown and they're really their stomachs just gurgling it's because they're having an issue with their with the staff so how do you what what advice would you give these kids on how to team build and manage their team and their staff better?
Steffen: I think the problem with team building is always that once you are the head of the team as being the owner of the clinic you should always talk last and you should just stick to questions because that gives you the opportunity to gain knowledge from all your team members and also to understand how they tick. Usually in the regular clinic I think it's done the opposite way around the head of the clinic the head of the team the boss of the clinic talks first does not accept anything and tells everybody what to do and then is the result not satisfying. For me a key point is when you understand how your people tick how they work how they go how their private life is going you can create a team by trying to understand everybody and give them a good view on what your goal is. So we sit down every week with all our team members and we tell them what our vision for the future looks like and then they are actually really proud to participate in that team all the assistants they are really proud for example we talked about service for me service means that when you have a person sitting there in your clinic the first time you do not know anything about that person service means you go there and ask that if you can help before they ask you. So you need to have a sense of what is needed is she scared is she just bored is she stressed because she needs to be someplace else, we actually we have a little fleet of company cars we have like these little smart cars three of them right now but we are actually planning on expanding it because for example the person is sitting there being stressed one of my assistants s will go there and invite you to take you home and then we call your we call you once your husband or your wife is done in our clinic we give you a call you can come back and pick him up. There's no need that you sit there and wait being majorly stressed because you want to be someplace else and for me or our team that that means service and actually I saw in all our employees and all the colleagues that work for us, you can see it lands in the eyes when they are successful with these techniques and that is how you build a team. You give them something where they can be successful with and that makes the team.
Howard: I would love to get your lecture on Dentaltown, I think you're amazing.
Steffen: Thank you very much
Howard: Would you be interested in an article and dentaltown magazine?
Steffen: Yeah sure
Howard: Oh I would love it, the Americans would love it. You got it on tape we got it on tape or when he says no we'll play him back this tape. Thank you so much for your so busy for your luxury to find the time to come by and talk to my homies for an hour that was fantastic.
Steffen: Thank you very much.
Howard: Thank you very much.