Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1128 Dr. Anthony Bordas DDS of Doctor Direct Smiles, A.B. Dental Devices, & Dental Implant Courses : Dentistry Uncensored with Howard Farran

1128 Dr. Anthony Bordas DDS of Doctor Direct Smiles, A.B. Dental Devices, & Dental Implant Courses : Dentistry Uncensored with Howard Farran

1/21/2019 6:41:10 PM   |   Comments: 0   |   Views: 173

Dr. Anthony Bordas, DDS is a dentistry practitioner in Downey, CA and has been practicing for 33 years. He graduated from Usc Dental School in 1986 and practices dentistry, periodontics, and more.

VIDEO - DUwHF #1128 - Anthony Bordas



AUDIO - DUwHF #1128 - Anthony Bordas


Accomplished and highly motivated Dentist with a strong background educating and training peers on innovative products, treatments and techniques through group lectures, seminars and individual instruction. Proven ability to master and implement new procedures, incorporating surgical and prosthetic principles into the general practice environment. Offer expertise in full mouth rehabilitation using implants and advanced bone grafting. Twenty five years’ experience in clinical dentistry and private practice. Excellent presentation, communication, analytical, leadership and marketing skills. Fluent in Spanish. 

Howard: It is just a huge honor for me today to be podcast interviewing Anthony Bordas, DDS. He brings more than 20 years of clinical experience in the surgical placement and prosthetic restorations of dental implants. He has lectured extensively in the past ten years on incorporating surgical and prosthetic principles into the general practice environment. He is a fellow and diplomat of the International Congress oral implantology and an active member and associate fellow of the American Academy of implant dentistry. He is a graduate and a fellow of the miss International Implant Institute at the University of Pittsburgh, an active member of the AGD and the ADA. He graduated from the University of Southern California dental school and was on faculty on the dental school. His practice has evolved into a general practice with an emphasis on bone regeneration and implant dentistry and he's talking to us from Downey, California where we've had Michael Detola on the show several times from Downey California and that was what, the first or second McDonald's ever. Wasn't the first one was in San Bernardino and you say the second one was in Downey?

Anthony: Downey, California, its still standing and running it looks like the old McDonald's with the big yellow arches. It's incredible, they're still serving the old McDonald's and the old you know cups, it's a morale it's an incredible place.

Howard: Well Ray Kroc was a big influence on me and I got to see him lecture when I was about ten because my dad had nine sonic drive-ins. So when you went to a restaurant convention he was a keynote speaker. I remember we got in, we drove down Interstate 35 I think it was to Dallas as a six hour drive. We sat in the front row and I remember one thing being ten years old and all I remember him is I'm talking about the bathroom. She was just saying when those families start driving down the interstate they're gonna have to go to the bathroom, now dad he'll go anywhere he'll pee on his own truck but mom's a squatter. She's got a sit and McDonald's gonna clean their woman's bathroom every hour on the hour. We're gonna have the cleanest bathroom when she pulls up off that interstate she's gonna see a filling station and she's gonna know it looks like a camel just used it and and then she's gonna see that McDonald and she says that's where I want to go squat in, a clean bathroom and while she's in the bathroom the daddy bear is gonna be over there getting salty french fries and delicious coca-cola and I just thought I just always thought of him as you know he's the operation logistics genius but he really was a psychologist. I mean he really knew how a human think cleanliness I mean available he's an amazing man and I thought the movie they did on him was really well done.

Anthony: Oh great movie definitely it's a big star

Howard: Whos the star in that movie?

Anthony: No, Michael, Michael.

Howard: Yeah, yeah man just unbelievable nailed it. So my gosh so podcasters I am they're not old like us I mean they're not they're not in their fifties they're still in dental school they're all under 30 I always tell people drop me a comment at YouTube how old you are what country you're from or email me but they're all coming out of school Anthony and they're saying the same thing, they said you know like Arizona has to private schools one in Mesa, AT still and one in Glendale, Midwestern. They're charging them a hundred thousand dollars a year and they say dude I got out of school I didn't place one implant and you're like the legendary guru of implantology and I can't believe you came on the show thank you so much but what would you advise some 25 year old girl that walked out with 400,000 and debt and she wants to learn implants?

Anthony: Well the way I started Howard is you know I opened up my practice out right out of dental school I opened up a one operatory practice 8 under script for me no assistance portable phone next to me I used a rubber damn on every patient's, I had no assistant. So I worked one day a week and then I worked for three or four different offices and my dad had a gas station in Downey that was his thing. So he would hand out cards to everybody that came through and I worked there as a kid changing oil you know full service back then.  I'm cleaning windshields everybody knew I was going to dental school. When I graduated you know I had a big push from that gas station down the street that was sending me patients left and right. So I went from one day the few days to three days luckily there was a periodontist upstairs for me Dr. Ronald Barbanell, now unfortunately he passed away. He was slamming implants left and right before anybody in the area old school, incredible. So I would go upstairs you know pop in on him and he used to always tell me, this is a future Anthony. This is a you've got to learn this. You know there were no programs back then. You know if you were a GP back then even specialist you couldn't do a specialty in implantology. So I did some research I either had to go to Sweden to train with Branemark and if your GP there's no way. So I found Carl Mesh like you think a lot of us did back then and I hopped on the bandwagon. Every third weekend and I had kids private practice, I'd fly to Pittsburgh it was the University of Pittsburgh back then. I flied to Pittsburgh I did this for a year then I did his his continuing programs and I learned a hell out of a lot of implants and we were doing implants before CT scans, never had a problem but I always knew the patient. I did what was people and profitable and that's the key to my practice. You know keep it simple keep it profitable do things that work. You know not throwing it all on fours, it's like some of these kids go out and they want to do all on fours on sixes and they put these big titanium frameworks and people are smiling with all this crazy heavy, I mean have you ever held one of those upper four devices. Well you know I don't know what's gonna happen with those things 10-15 years from now, it might be a nightmare. So my thing is if you're out of school with a ton of money don't spend a lot of money. You know get your feet wet, start doing oral surgery, find a mentor. You've got to find a mentor in the area which is it's hard to do now because I don't know about Arizona but nobody talks to anybody around here anymore. You know in the old days you can get together with your buddies have a few beers, you talk about dentistry. You can go down the street and hop in you know drop in your oral surgeons office, he'd help you out you know you've got to have a few drinks with them afterwards, for some reason that's not existent anymore. So but it's important to find some mentors. You know, take it one step at a time learn to do good oral surgery, learn to do good endo and and then start placing simple implants until you need, you know nowadays you can't take a weekend course and go in and do implants. If you if you do one implant a month you're gonna lose money you're gonna have complications. If you're gonna do implants for profit, we need to be doing at least I say ten a month to be profitable and to be good at it. Their's no way you're gonna be good at it and spend you know 50,60 grand get a CBCT can't get in debt and drop one implant a month. Give me a break just hire periodontist or an oral surgeon to come to your office and take care of those you. I think you can kind of get your feet wet, work hard.I used to work six days a week Howard at dental school. Work really hard, get your debts off, live out of your car if you have to, get rid of your debts and then one year moving nice and easy you've got some cash coming in go take a maxi course. Loma Linda he has one of the best maxi courses and implantology. It's sponsored by the A.I.D., you get your fellowship out of there and then you'll come out with a really good knowledge place and implants diagnosed. You'll be profitable, you can't just you know come out of school and start investing money and doing this the way some of these kids are doing it there's no way yeah pay your dues Howard.

Howard: Man we have such similar deals. I did the same thing I had four boys and was flying out to Pittsburgh once a month with Carl mesh and got my fellowship in the mission student diplomat all we had very similar journeys. So why did you and I walk out of dental school and open up a practice right out the gate when the people in dental school right now I tell them, go to the admin office get all the names of the of all the dentists at graduated five years ago and ask them if they're all working as an associate living happily ever after and they're all miserable and they all change jobs every year and does it do they just need like five years of sticking their tongue in a light socket before they eventually just go work for themselves why did we do it and they wait so long.

Anthony: I you know it's a good question because you know I was really driven back then you know. I you know I came out with you know at my time in 86 I had $70,000 of school loans which to me was a hell a lot of money back then but Howard I paid those things off in five years and less I worked my ass off. I think the mentality is different with these young kids they come out of school you know they think I'm gonna come out make 150, 200 thousand dollars a year, I'm just gonna work for corporate they're gonna pay me and then they end up in corporate like is they're miserable okay you know. They're put on a production basis, they hate going work and then they're completely miserable and they get depressed and God knows what happens after that. I mean you've got to come out you know you don't spend four years in dental school to go out and work for a corporation you really don't. This is one of the only profession I think the way you can go out there and open up a little shack. I mean you can find opportunities to this day even in California. I mean my daughter lives up in Northern California there's little towns in Northern California that still need good dental care but you've got to live outside the city. If you're gonna practice in San Francisco or downtown LA I don't know if you've been to downtown LA of Beverly Hills lately, you go into one of those towers in downtown LA and you go up at the elevator and you look at the directory one of those buildings you know a 20-story building has over 50,60 dentists in the building. I mean that's crazy. You go out to Norcal, Northern California, outside little competition you're gonna get paid less, little competition but you're gonna be busy. So you just gotta push yourself, you've got to get out there. You gotta do some research, you just can't sit there and you know have it happen for you. I mean it's not, it's a I don't think it's a different world honestly. I don't think there's any more competition now than when I came out of dental school I just think the mentality is totally different.

Howard: You said when you opened up your office what were your hours? Because the point I'm making is when you opened you had one operatory opened 168 hours a week because that's how many hours are in a week, would be the same as five operatories open thirty-two hours a week. I mean it's like yeah these dentists are only open 19% of the week I mean they'll go to the town. When I came to Phoenix I mean there are a bunch of dentists on the corner but they only work Monday through Thursday 8:00 to 5:00. So I was open until 7pm I was open all day Friday and Saturday  and it was great it was a lot of competition Monday to Thursday 8:00 to 5:00 but evenings were awesome, Saturday was awesome and you just hustled. I mean same thing we graduated with the same student loan that I had 87 thousand dollars and again we paid it off quickly, I would have paid off faster buys buying a bunch of panel equipment and you know expanding the operations.

Anthony: You know I still work late evenings, twice a week I'm here till 7:00. I used to work every Saturday, we can be open now in my practice if I have to right and you know I'm talking about associates. If I had the right associates here I can literally be open every Saturday and be busy, Now we're you know it's that busy here but when I started I would literally work six days a week, honestly people don't believe that and they thought I was playing my wife. I thought, you know remember the days where I'd be taking the kids to soccer practice you'd be working you know, that's you know if you go down the street to a corporate office they're open, some of these are open seven days a week now it's unreal you know. So you've got to be you know you've got a you don't have to be your corporation but you have to think like one, you have to train your staff like a corporation, just be your own mini corporation and your own little ecosystem here and you compete in with environment but you have to work, you have got to work hard, I'm still working super hard and I don't have to but I actually enjoy it.

Howard:  So many things, so you talked about this AAID maxi course that's the American Academy of implant dentistry. So you think if someone wants to be an implantologist they should take a maxi course?

Anthony: The only way nowadays, there's no option...

Howard: It's the only way right now, no way, wow that's a strong endorsement. I'm trying to see they at home they're their course they're their sight is

Anthony: They have maxi courses all over the United States, the one in California is top-notch it's the one out of Loma Linda.

Howard: Wow

Anthony: and the reason why yeah you can't learn it, you know I had a good mentor. I mean I was lucky I had a periodontist who mentored me and I was you know I had Carl Mesh. I became really good friends of Carl and and he, these guys were great mentors but unless you can find a mentor that's gonna guide you that's the only way you've got to take a maxi course.

Howard: So what did what did Carl mean to you? That was I was my favorite podcast of all time because they you know he was terminally ill and the format's an hour cuz the commutes an hour but I wasn't gonna interrupt him and say we're over, I mean he went for two and a half hours. Did you get a chance to see that with that one?

Anthony: Oh that was the best podcast ever

Howard: No this one is...

Anthony: That one with Carl mesh it was incredible, I mean brought tears in my eyes. You know I went, they had a big celebration for him when he was sick and he was you know, he was going through chemo and all that stuff and I mean I saw him there I meant this guy is a genius and now this he was stricken so bad by this disease but I don't know if you ever heard his his brothers Pete Craig.

Howard: Craig, absolutely, my god yeah I love Craig.

Anthony: He's just as phenomenal, board certified prosthodontist, oral surgeon, M.D., unreal.

Howard: Yeah that was, that was episode 282 man my gosh was hell of an episode. So that my homies like I know how they think, so you're putting in order for them you're saying okay join the AAID, take a maxi course. This is Dentistry Uncensored so let's talk crude and rude,  a lot of the education is tied to a manufacturer, so the people put it on a course or selling the implant. So a lot of my homies out there listening think, do I have to pick an implant system then go learn the training or can I learn to because I look at it as like when we took driver's ed and we were 14 in Kansas I mean they didn't care what car you were in and they said you got a driver's license drive a car but is it that way implantology or is it almost like drivers ed has to be in a Chevy or a Ford

Anthony: No, I mean like most of these maxi courses are university based but they are sponsored by some implant system. You know the does the implant really matter nowadays I mean to a point it does. I mean you do need to think about design, their research is so it doesn't I've used probably every product in the market honestly you know I lectured for a you know AB Dental, MIS, BIohorizons. I mean you name it I've used it. I have probably 10 surgical kits in the office. You know this is Dentistry Uncensored so I'll tell you,  I'm a big Straumann fan and now I get a volume discount through Straumann because I buy a lot of implants. The thread design, the texture, I mean that implant I've never seen anything like it. Their are a lot of good implants out there I mean the top tier five inputs are all good, Straumann, Bio Horizon, Nobel you know you can throw the you know the dense plies in there and you know that the Zimmer Biomed. You're never going to lose with those implants now when you get to the level of placing implants you have relationships with these manufacturers in volume discounts, so am I paying as much as you know somebody that's buying you know five implants a month, no I'm paying a lot less out and I have a good oral surgeon friend that places a shit load of Straumann's and this guy is getting a bigger discount that's the way these companies work they're you know they're pricing with you. I mean if you're just starting now placing one or two implants you know a month, you're not gonna get that discount so Straumann might not be the implant for you because you're gonna pay a premium for it but they are there are different plans I'd say stick to the top tier five companies because you're never gonna have a problem with getting parts for them. If you want to call the rep you know they're always available to help you out. When you go to these companies that you know are you know brand new on the market, you've gotta be a little careful you really do. So that's key and I I've been involved with a lot of different companies and their development pieces but they you know and they're all really good I mean they all integrate their FDA approved, if they're approved by the European medical approval process that they're used in Europe the USA you're not gonna have a problem if you want to use a lower priced implant but I feel like that's...

Howard: What's the approval rating from the Europeans the EU?, what's their committee called?

Anthony: What the heck is it, it's what's that called it's a "C" something rather

Howard: Yeah I gotta tell you I know that when you're an American you have to think so this the greatest country in the world but how many countries have you been to?

Anthony: I mean you know you know what the Europeans have incredible products.

Howard: There's a lot of countries that do things so much better than the U.S. like all of Scandinavia and Australia I mean if those aren't some of the greatest civilizations ever but, I think that it was the EU who brought down Microsoft's abuses and it'll be the EU that brings down Facebook and Google and Apple though because the United States government it's just you want to get a bill passed you gotta get out a bunch of bills and start paying but I one thing I've noticed about a you mentioned Straumann and we do the Townie choice a year award every year where all the Townies vote on their products and it's so amazing because you went through dental school four years undergrad, four years in dental school. No one in your class was stupid they all got A's in calculus and geometry and trig and creb and but you know all this stuff like that and so market share is a huge deal and Gordon Christian and I several times I look down at the at the Townie choice of winners and he goes, man everybody voting has eight years of college it's not like who's voting on the best movie in Hollywood you know what I mean and Straumann sells the most units of implants and I want to tie that around to something else you said earlier. Not only does Straumann sell the most implants in the world and they bought Neodent in Brazil and MIS, Make It Simple in Israel and all that kind of stuff but that guy came on my show I always noticed the most successful people make a religion out of availability. I guess that the CEO Bio Horizons, Nobel Biocare, Astra, Zimmer. You don't even get a reply to your request I mean they can't even hit reply and say no it's just and so you talked earlier about you met a periodontist who would show you the ropes and yeah the majority of humans are tribal and they think in fear and scarcity and the oral surgeon if you say will you teach me how to place implants she says no refer them to me, but I'm guaranteeing you in every county in America there's someone who thinks like me and you that's thinking a friend, hope, growth, abundancy, this is cool. I mean and and like saying 30 years 31 years ago half the dentists in Ahwatukee didn't want to have anything do with me the other half wanted to drink beers and watch the NFL and talk dentistry and shop and 30 years later I can assure you which group made twice the net income is the other group. So going around I mean it's a growing work like orthodontists are afraid of Invisalign and Smiles Direct Club. I mean my god last year in the United States only I mean only 5% of Americans get ortho, it has 95% of. What percent of 50 year-old women in California would like have their teeth a little straighter than a little wider...

Anthony: Hey I'm up for doing yourself orthodontics with Smile Direct, I mean I don't see a problem with it at all. I mean they were going to a market that needs to have straighter teeth mild crowding, you know who's gonna pay five six grand nowadays to see an orthodontist when they can go to you know CVS pharmacy now has small express shops. I mean we're doing that in our office now because I mean there's a huge market out there. I don't know why everybody's trying to sue these this company though you know the American societal orthodontist, Wisconsin Dental Society trying to sue them to put them out of business. Hey you know what these guys went after the market, they're innovative. I mean just create a product to compete with them but hey they're bringing awareness the market. I mean it's an incredible marketing you know platform.

Howard: Oh my god, they're up to four thousand employees they're about to do an IPO if that was your son if you're an orthodontist that was your son you'd be cheerleading and saying my look at my son he's the poster boy, I have American competition ingenuity all these things but then when it's a competitor then they're like they want to run to the government. Who for the last 5,000 years always helps the rich form a cartel against price-fixing, against you know creating the poor. The poor are designed by the government's working closely with large companies forming a cartel and I think America has always been number one because we've had the least amount of that compared to a lot of these crony capital bills but yeah but go back and watch episode 839 Implants around the world Marco Gadola CEO of Straumann because he really talks about that as stuff. I'm gonna go through a couple other things I'm with you because III think I wrote it I think you're a genius, I so many of your business moves are so obvious like you on your dental website is and I noticed that you have an anesthesiologist, I mean it seems like I'm in out here in Arizona and twice in the last five years some pediatric dentist has lost a patient down in Yuma and they don't recover, we saw the case in Hawaii they always go viral on social media but do you do IV sedation and would you recommend a young 25 year old girl a 400 grand learning IV sedation or would you say you know what you're not a board certified dental anesthesiologist just have them come in and what, so what percent of the IV do you do and what percent does your board certified dental anesthesiologist Mark Torbiner do?

 Anthony: I do zero percent of IV, if I need somebody sedated Mark is the guy. I mean and this is not for implants I've done cases where I'm doing immediate dentures I mean some patients I've had patients that need quads of SRP's and some restorative work. He'll come in and knock them out for three four hours for me this guy is topnotch. You should get him, you know if you want him on your show.

Howard: Absolutely

Anthony: This guy's incredible, I'll hook you up with him he's a great guy and he'll talk about all problems about sedation. Their  you know I don't understand why these kids will go out and get with all the you know legality with sedation nowadays and how many patients really need sedation- come on. Get some nitrous oxide for the mild cases and get a board-certified anesthesiologist do the work for you. This guy has never had a problem, he comes in with a ton of equipment, he's got these patients hooked up, any little thing that goes wrong when these alarms go off you know he tells you to "slow down Anthony I'll take care of it" it's unbelievable and he has treated patients that are medically compromised for me sedate them, high blood pressure, brings their blood pressure down for me. Their's no way you should be you know there's no way at all you should be doing IV sedation unless you're a board-certified medical or dental anesthesiologist don't waste your money on it hire one of these guys.

Howard: and so you gotta look around the world I mean there's 20 really developed rich countries that do a lot of things right, you know all their street lights work, they have 9-1-1 they have internet connection your cell phone coverage and none of those countries let you do the anesthesia and the procedure and in US hospitals a cardiovascular surgeon can't do the bypass and the anesthesia. The only place you're still seeing it is in dentistry, oral surgeons, periodontist and my oral surgeon up the street from us who we've had on the show he brought in anesthesiology not just because I mean he's a DDS, MD., he could do it but he says just for the practice management he just he can do so many more cases by having someone else do the anesthesia so yeah it's safer cuz you have one guy just totally looking at the at the anesthesia and all the vitals and all the monitors and he can just go in there and pull wisdom teeth and place implants so there's just I I don't know why dentist want to take this on.

Anthony: Could you imagine a plastic surgeon doing a Stevie on I'm doing a boob job that'd be crazy

Howard: Well who was that famous blonde comedian that just went in to have a bump removed... Joan Rivers.

Anthony: Joan Rivers, imagine that

Howard: Yeah and she's on top of her game what if she gets a leringer spasm, she's gone, what a great loss. I mean...

Anthony: Did you guys just lose some child in Arizona?

Howard: Oh yeah we have, I mean I've been here 31 years I'd say it's about every three years.

Anthony: How comes this happens a lot in Arizona?

Howard: I don't know, well with one guy was a terrible mistake, what would the hygienist numbed up the kid and then he didn't know it, then he came and renumber up the kid but even  talking about that, what percent of dentists weigh their patients before they give them aesthetic... I mean it's just you know they don't even weigh then I have a measurement. When you go into your physician the first thing they do is they weigh you and and they take you know your vitals and monitors I mean dentist's just they don't do that they and it was funny there's only three publicly-traded DSOs in the world two of them are on australia 1 300 smiles ones pacific smiles and there's H and H and Q out of Singapore and in order for them to go public they could not, the Wall Street boys looked at that and said you can't provide anesthesia IV station for anyone over 16 or under 16 or over 60 because that's where all the trouble is. So just for them not to have an accident they can only do it if you're a board-certified anesthesiologist and between the ages of 16 and 60 but when you start putting down a two year old or a 70 year old or some you know it's it's just crazy. So I'm gonna hold your feet to the fire, she only wants to buy one implant kit does that mean you just recommend Straumann or what would you recommend one to do it the 80/20 rule, she could do 80% of her cases if she had this one kit...

Anthony:  I would probably go because it was built for the GP, I would go with the Biohorizons

Howard: Out of Alabama,

Anthony: Yeah and you know if you're on with Steve Boggan the CEO of BioHorizons, he was with Carl in the early days you should get him on too.

Howard: I've asked them to ask them three times

Anthony: Have you really?

Howard: Yeah, yeah but that's public in all fairness public speaking is one of the biggest fears I mean I have really close friends that are really smart and all that stuff and they can give a lecture because they know they did the PowerPoint they're gonna go up there and read from the podium and read through the slides but just free-flowing live like you and I are sitting here at a McDonald's in Downey having a cheeseburger that just scares the holy living bejesus out of 90% of all my homies. So you recommended BioHorizons, so you're saying that Alabama they can't win a bowl game but they can make an implant is that what you're saying?

Anthony: I'm saying you know the kit was built you know Carl ,Carl you know he was part of the innovator of the BioHorizon system. He built the kit for the GP so it has drill stops on it, it has a very good flow pattern for the for the GP. The implants are what they call a three-in-one implants with the abutment and the carry on them and the carrier contains, you're not paying for a lot of parts and pieces. It's very streamlined super easy to use, all color-coded, so you can just follow the steps you know step one two three four and you're done. So I would go with biohorizons they're really creative on the way they develop that kit.

Howard: Yeah I remember back in the MIS, Pittsburgh days the biggest member I have of that whole event was, seven three-day weekends and on the fourth three-day weekend it was the same class, you already been with these guys for three weekends and KISS had a concert and I was like and I said to these guys I said come on let's let's all go to the KISS concert like we don't have tickets and I said come on we're dentists. So we just walked down there and we we got some tickets it was so it was so fun but yeah BioHorizons and so you recommend them. That's amazing tell that guy he needs to come on the show.

Anthony: I will email him

Howard: Who's the president of that company?

Anthony: Steve Boggan, he was with Carl in the old days, he's a good guy and you know they just got fully bought out by Henry Schein. So they were only partially owned but now Henry Schein bought the rest of their company out, so they're a Henry Schein company.

Howard: When did Schein buy them out?

Anthony: They did a complete buyout they actually closed it in January, in fact Steve had called me and told me about it that you know the company's been growing and Henry Schein just decided to buy the rest of the company out, he felt like he says he still has control of the company but he didn't know where Schein was gonna take him next because it's now they're under the complete umbrella of Schein.

Howard: I know Stan Bergman very well, for 30 years and he's been on the show he reminds me of the Cisco, a lot of companies have R&D but they don't realize their R&D never is successful as some young entrepreneur in his garage. So Cisco Tom Chambers set out a long time ago he said we're not gonna have an R&D; department we're just gonna see who pops up in the best and buy them and I think Stan Bergman has bought 50 companies and when you've bought 50 companies you wouldn't sell to Schein if you could go back and call those 50 companies, they said those guys came in here and ruined it for you. I mean so he gets a complete autonomy and he's a Wall Street boy so what's his main objective is you got to deliver earnings to the bottom line and the reason they can buy so many companies it's really simple I mean it's just basic finance 101. If my stock is trading at a multiple of ten and I can buy your company on a multiple of five years EBITDA(Earnings before interest, tax, depreciation and amortization),  well the minute I buy your company for $1 I just double the profit on my earnings because my umbrella company is trading at a EBITDA of ten and a lot of times these mergers acquisitions the these stocks are publicly traded at thirty times earnings and you can only sell your company of five to seven times earnings and so I if I can buy your company of five times earnings and my stocks trading at thirty times earnings I'm making money by just doing paperwork.

Anthony: Yes there's no doubt, I mean the only thing that worries me about Schein, when they buy out these companies that are really innovative, when they're you know when they're on their own, the only thing I see is they tend to lose the innovation once they're under the Schien umbrella.

Howard: Well they do, they want to just they buy your beautiful cow and then they just want to milk it to death they have no incentive to build another cow or R&D; another cow so yeah I mean look at when they bought Dentrixs in Provo Utah. I mean look at all the companies that popped up around Provo just from ex-Dentrix employees adding features that they couldn't get the dendrix to do now. You know went from it went from an innovation company to we just want to sell a bunch of software and make a bunch of money and a bunch of earnings and then a bunch of employees like well if you're not gonna do that I'm just gonna quit and go. I mean how they call you know there's Silicon Valley they call it the, what do they call it in Utah the mountain valley or whatever but I mean, I mean we've got a whole issue on Dental Town of it and I think six months ago of just startup companies in Utah and most of them are all tried back to. So they're gonna buy a successful milk cow and then milk it and make a bunch of money. I want to talk about something else I would like to switch gears we talked about implants, you gave me some good advice during the AAID, take a maxi course, start with BioHorizons but you're also you're also doing orthodontics, straighten your teeth; Doctor Direct Smile, straighten your teeth and six months or less now is Dr. Direct smiles is that you?

Anthony: That's me so let me tell you the story so you know I'm always the kind of guy that when innovation comes around I jump on it so when Invisalign came out back in 1997 I think you know I started jumping on in the Invisalign bandwagon. I mean I love technology because  it's in my opinion it's simple it simplifies your life it's more predictable and once you get that down it's very profitable. so I used I was a big Invisalign fan for years. I mean in fact back in the early days of the design I had this rep, I forget his name this big guy he was an ex, he played an NFL got dropped out for some reason and we would do these Invisalign days in my office and again you know going back to my whole you know nature doing things I was the only guy doing invisalign you know back when it first came out in my area. so we would do these Invisalign days and one Saturday and this guy would go to those go to the mall down the street called Stonewood shopping mall. He would set up a booth and you see you know Invisalign day with my office, you know he's getting a commission on this you gotta realize this so, one Saturday we popped 20 cases in one Saturday we closed on him he was running all over the office giving the girls you know gifts and all this stuff and I was doing you know this is a real thing you know you can actually straighten teeth of this these clear liners. I kept using them and using them and then I got bummed out last year when I realized that Invisalign you know Invisalign,the reason Invisalign got involved with Smile Direct clubs because Invisalign sued Smiled Direct Club before the patent expired, so then they ended up just buying a percentage of them. So I actually have patients coming in here and saying hey I can, why should I pay you so much if I can go and get my aligners done with this mill order kit for less than $2,000. I'm thinking shits this for reals you know, so I'm going; you know this gotta be a way around this because I'm losing you know I'm losing now to these this new I mean I think it's very innovative I'm not gonna talk back about bad about Smile Direct Club I think it's a great product. So I had to think of a way to compete against this in my area and then when they opened up a smile shop in CVS Pharmacy two miles from my office, I go you know what the heck is going on and I looked online they're opening up smile shops all over the country. I'm thinking man they're gonna be in Walmart, Costco, you know everywhere. They're called smile shops Express, they have a scanner in their, patient pops in and they get scanned and in 72 hours they tell them that they're a candidate or not for their you know, they only do mild cases 24 hour aligners or less. Now what ticked me off the most is I found out that if they're not a candidate for their you know Smile Direct Club product the complex cases, they actually outsource them to their Invisalign Elite providers. So they go, the patient or the clients see's the Instagram ad, goes in there, they get scanned. If they're a candidate they get their aligners sent to their house and they're not they get outsourced to Invisalign elite doctors you know and I'm going you know what they are gonna kill me and I spoke to the orthodontist and they're starting to feel the pinch. The ones that are not elite providers. I go you know I'm creating my own product. So I went out did some research I spoke to a couple companies that you outsource lab you know, your lab work too. So their's about three companies that found that our lab the lab outsources where they will print your models and make your clear aligners for 50% for what your going to pay Invisalign you know so I'm getting my aligners printed for about ten dollars and fifty cents a pop. So you know I'm gonna brand my own product for my patients and we're gonna market it internally and then we're gonna go externally to compete against you know the Smile Direct Club, and the small express shop. So we launched this in my practice in September and we've been batting a hundred percent on doing this. Now that the key difference is with me is the patient has to get their exam and x-rays, they need to be clear of dental work, they need to be healthy and I differentiate it through a mild case from moderate case if anything I'm on her case it's going out to the orthodontist, but imagine now we're doing cases now competing head-to-head with what smiles direct on pricing right now with my patient. So my goal here is you know if I'm getting a hundred percent conversion rate with my patients, you know I'm going to build a website and then I'm gonna start marking it locally first on Google, maybe some print marketing and do some data to see how this works. This is how this whole thing involves it so it's really my own branded product right now that this doctor directs smiles is about.

Howard: So on doctor directs smiles do you, is that just for your own office period it's not for anybody else?

Anthony: Right now it's just for my own office. My whole thought process is because  you know this is not a unique model honestly, this is not new this is what Invisalign did 20 years ago. They found offices you know they marketed the product, patients came in and they saw you okay so I'm not doing a the new or revolutionary. I didn't create the aligners or anything, all I'm doing is creating a marketing campaign to bring patients in my office. Now I'm gonna do this for four to five months and get as much data as possible and then if other doctors want to join in on this I'm gonna try to figure out a business model to go, you know obviously if I market this product in the entire LA County area I'm not gonna be able to handle the volume, there's no way. So I need other doctors on board. I'm trying to figure out a business model where it's not gonna cost a doctor a dime to be part of this. I just want to train them and show them how to brand it and use a branded product to be able to do this in their office.

Howard: Well how are you doing it in your office? I mean what is the, you going to need a CVCT and some software and a printer?

Anthony: No, you need an intraoral scanner, I mean the key to making this profitable quick and easy you need that, you know what we call the digital workflow and it's the key in dentistry and implantology. You need a really good digital workflow, so you need a good intraoral scanner and there's a lot of scanners out there. Now I just picked one up recently that's new on the market because their's no monthly fee, it's open source you can send your STL file anywhere. It comes from a very reputable company. I'll tell you the name I know you know a lot of doctors don't like throwing names, it's a Korean company it's called a Medit I 500. The company met at MEDIT has been out since the year 2000 they do they were making a lot of industrial lab scanners and they're being very successful the dental laboratory industry and they just launched a scanner. Now I did my research on this scanner, the top guy and I don't know if you've ever had them on your show, it's Michael Scherer. He's a prosthodontist out of Northern California I know you've ever had him on there he used a digital guy let me tell you

Howard: Yeah I love that guy Mike. How do you spell his last name?

Anthony: It is Scherer, out of Sonora, California. He lectures a lot.

Howard: Michael D Scherer, that's a tough name Michael David Scherer and yeah he was episode 166 on the podcast. So he recommended, Michael recommended this Korean company?

Anthony: So I called him up and I go you know what you know you're the guy to talk to, you I want to buy a scanner and he told me this is the one to buy. So if he you know and I went in I demoed the scanner and it's been incredible.

Howard: What are the cost?

Anthony: It's under 20 grand, it's the only intraoral scanner that's open source with no monthly fee that's under 20 grand. So you need the scanner to do the aligners because the patients come in you know, you've taken a full mouth set of x-rays you scan them and it immediately flows through the you know the the orthodontic lab to print your aligners. Their's no you know areas where you have to stop pour a model, take an impression and send the impression out ship it. Their's none of that's involved, it's clean, it's a perfect digital workflow. so that's the thing that we need to train the doctors on how to do this that's why I like mean I need to do before I can launch this to other doctors.

Howard: So you're saying, so the biggies are what's the one out of that in Copenhagen, Denmark, Three Shape. So that's close to yours?

Anthony: No Three Shape's not but they have a monthly it's like a $200 a month right you know subscription fee, I don't get it. You paid them like 40 grand for their scanner it's not a cheap scanner and then you have to pay them two hundred hours a month to bloody use the thing.

Howard: That's what Wall Street wants. Why do you think they put Netflix at the same value as Disney, because Disney would put a hundred million dollars into a movie then try to have a blockbuster. Netflix just has that steady income so if you don't have a recurring revenue business model then Wall Street's gonna hammer you. That's the number one thing they look for is a recurring revenue model. That's what Apple used to have because everybody would upgrade their cell phones so regular but the times are turning on now that's not so much, it's getting more price sensitive. So talk about your digital workflow, you're giving great advice. I mean you're telling them here's a twenty thousand dollar scanner, by the way the open source is everything. I use soft end which used to be owned by Kodak and was the big boy thirty years ago and we spent all last year and converted to open dental just for that reason because every time I do a podcast with anybody high-tech they say we can seamlessly program this into open dental because it's open software and people just they don't realize but you're a big fan open software. What practice management software do you use?

Anthony: I use it's called its ACE out of Atlanta. Have you ever heard of them?

Howard: No ACE dental software

Anthony: It's the best, I dumped all those other guys this is an incredible easy to use software. I've been with them for over four years now and they keep improving the product small company I think they're out of Atlanta aren't they. I think they're out of Atlanta

Howard: Yeah they are East Dental Software,

Anthony: Yeah John Hastings is the guy to talk to

Howard: John is he a dentist?

Anthony: No he's the guy that I think he's the programmer they created it. John Hastings and I've talked to him several times, so great product I've recommended like ten of my friends on that platform out here in California.

Howard: Wow that is amazing, so you like the open software and you are using ACE Dental software out of Atlanta. Whose website is www.ace-dental .com So you like the open software of ACE and you like to open software of MEDIT and then are you printing these in your office?

Anthony: Not yet, well I you know the problem with printing is I would have to hire because of the volume of aligners were doing now would have to hire somebody to you know dump the file into the printer and then do the suck down on the aligners. You know that's labor-intensive. So I can get the aligners, I can get the models printed and then the aligners fabricated for $10.50 a liner right now.

Howard: for how much an aligner, how much?

Anthony: $10.50

Howard: and then how many aligners does your average patient need 18 to 24, how many?

Anthony: So what I'm doing is for the mild cases that we're competing with smile direct Club with just 24 aligners, that's their model. 24 liners which is about three to four months of wear. It's cost me $252 for the aligners okay then I pay outsource my design to a company they're actually out of Glendale Arizona it's called Full Contour Design. Have they been on the show?

Howard: No, I don't know I've done a so many, I think we've talked about it.

Anthony: Yes, so what I do is when we scan the patient with our scanner it goes directly to Full Contour Design, they actually do the whole design of the movement of the teeth. So  they have a program that designs a case for me in 72 hours. The case is done, it goes directly to the lab to print the aligners. So full contour design for $99 assigns me aligners then it gets printed so my total fee for the training of the aligners and design is about three $300 on the average and I'm charging $1950 the for the 24 liners. So my net profits is $1599 per case, my gross profit after the lab fees.

Howard: Wow

Anthony: So imagine I don't do any work, you see my goal you know as I get older in my practice, you know in order to generate more revenue because I can't do any more restorative or implant, I just don't have the time to do it. My goal is to get the staff to perform as much as possible for me in profitable situations. So what happens is they scan the patient,they submit the file to Full Contour Design, it goes to my printing lab, we get it; the patient has the option to come in on their first visit or like Smile Direct Club we send a kit to them. We have our own boxes with our own logo on them that's all pre-made that we had manufactured. So I don't, I'm not involved in the whole patient flow at all unless they need some restorative work. So my goal is and the way we're going is to just generate as many aligner cases per month as possible. Right now we're averaging just about 15 to 20 cases a month with a gross profit of $1,599 per case. Which is really I mean in my opinion I mean for me not having a drill, cut, use a scalpel. I mean it's great profit and that's why I've gotten involved with this whole process and turned into our own brand and aligners.

Howard: Yeah that MEDIT is not Korean it's actually I Winnipeg, Canada.

Anthony: Oh really yeah okay I thought they were Korean.

Howard: Yeah they're actually in Winnipeg, Canada. Interesting man.  You have so much phenomenal advice. I just want to tell the young kids who were not, you and I are old enough to remember orthodontic Centers of America so we've seen all these DSOs go through and the genius of what that move was and why it made Wall Street is because what people don't realize that orthodontist sell Invisalign for 6,500 bucks and then they put a huge economic barrier to entry they say well we need 1500 down and that's why only 5% of Americans have more so they can't survive the $1500 downpayment how most cars are bought without a 1,500 down payment and then they finance the 24 months with interest and it's like come on dude it's a service it's not a car. When GM sells a car they got to buy 30,000 parts and they got to buy those parts and then assemble them and then sell a car. So they need their money back because they need to pay their there to their suppliers. Well I mean imagine you went to get your haircut or your nails done and the lady said oh I'm gonna do your nails once a month for two years and it's $100 every treatment. So for two years its 2400, so for me to do your nails today I need $600 down and then I'm gonna finance the remaining $1400 at 10% interest of you and it's like well none of this makes sense and Gas Lazarus is the first one that saw that and Smiles Direct Club sees it too. I mean the actual Smiles Direct treatment cost is averaging according to Google $1850 with a payment plan available at $250 up front. Which is $99 per month for 15 months and so Americans don't have a, I mean most orthodontists want that whole $1850 as the down payment and then they would have financed something for the next two years where they're not gonna incur any cost of rent, mortgage, equipment, build-out, computer, insurance, update, professional fees. Why are you financing bills that you haven't even paid yet. I mean the actual braces and brackets and the film on the seff, I mean you don't even have $100 in this case. So what Smile Direct Club, that's why these guys can say; Oh zero percent down 0% financing we can we can finance this $99 a month they can finance that nine nine dollars a month because we're not financing anything.

Anthony: It's no risk for them and imagine they're doing if they're doing you know hundreds of thousands of cases a month and let's say a small percentage of these patients aren't happy, they'll just write em a check and give their money back. That's what their doing.

Howard: Right exactly and it's gonna stir up a lot of you know there's a lot of orthodontists that are posting all these case videos don't do it yourself and do here, but you know what. Some people that entry level of straightening is gonna get them interested in their teeth. They're probably gonna do some Crest strips, they're gonna start straightening and then as they fall in love with their teeth they value more then they'll go to orthodontist. I want more than he might say well for more this case needs this and that; so it might be an entry-level starting point for a lot of Americans who then migrate up the food chain up and orthodontist offices. I think it would be a much better country if twenty five percent of the people who wanted ortho could get it as opposed to fight percent today. I mean when you got five percent in the system and ninety five percent. I mean America was not built on making a few rich things for some rich kings and queens, it was about Henry Ford making a car for the masses and I don't think anybody can say I've been in dentistry thirty-one years and I don't think anybody could say that orthodontics is being delivered to the masses. It's being it's being delivered to the rich and the Suburbans and in competition is good for any industry. Just look at what you've done, it's forced you to figure out open systems versus closed, different software, a digital workflow. So is this digital workflow, I want to go back to where we started to implantology or this digital workflow. A lot of these young kids think well maybe I don't have to be a surgeon to place implants, so I get a really good digital workflow and make some really good surgical guide stunts I mean if you had an exact CBCT, guided implants. Couldn't Stevie Wonder just go in there and place the implant; so what how does your digital workflow affect implantology? Do you use guided implants?

Anthony: So let me talk about guided surgery, so you know I'm an editor on for the AID monthly journal. So I get to review a lot of articles, so recently in the past couple years or so some articles some researchers came up on the accuracy of surgical guides. They're not 100% accurate and in fact I was just at Columbia. Columbia has a great one day implant symposium the second weekend in December every year. It's great you go to New York and you listen to the you know the top guys internationally, they just bring in the top few guys that are talking about problems and implant dentistry and it was brought up about you know surgical and guided surgery. Their's more cases with nerve day just worldwide now, problems associated with you know misplaced implants because of guides. Guided surgery is great, it's great technology, it's part of the digital workflow but you can't trust it 100%. You can't put your drill with a stop above you know the inferior alveolar canal, one millimeter above and think that the guides going to be you're heaven, your Savior and everything's gonna go perfect. You know one thing that I always say is you know use technology, you know but if you're gonna use it you've got to always confirm that things are accurate.A lot of things can go wrong with a guide from the placement of the guide in the mouth, the teeth can migrate a little bit, the way the guy gets printed because a lot of inaccuracies that can cause us minor deviation in the placement on the drill. So I only use guides in my practice if I'm doing an anterior case. You know everything else that I do is pretty much you know on top with Carl Misch, I'm flapping, I'm evaluating, obviously when my CBCT scan we have one in the office and I couldn't work without one. I'm evaluating everything very carefully, one thing that I do but every scan that I take in my office again with a part of my digital workflow is that file is uploaded to, UCLA has a great maxillofacial radiology department they review every CT scan that I take and they provide measurements for me and usually I request a three millimeter safety zone above the inferior alveolar canal. So the radiologist reviews every scan I mean every CBCT scan, they provide me a report. If I'm gonna use a guide I use my digital workflow in the office from my internal scan my CBCT, then I use Blue Sky Bio to merge them together and with Blue Sky Bio I can again outsource that file because it's again it's an open file system. I can have my lab printed guide, but do I use it in every case; I only use it in aesthetically critical cases. I use drill stops not on my posterior cases I have a drill stop kit that if I'm putting a 10 millimeter implant my drill has a stop at 10 millimeters but again I think the key is is to use technology because it's great but always verify it. If you're gonna use a guide take your guide, put it in the mouth, verify, drill halfway down if you're gonna put a 10 millimeter implant about the inferior alveolar zone. Drill ten millimeters if you did until ten millimeter drill halfway down, verify your guide the accuracy of your guide before you go and start drilling holes above the nerve and in causes  irreversible damage. So trust if I verify your guides trust and verify that's a key.You know and that would really alleviate a lot of problems these you know problematic implant cases.

Howard: So you're very digital, were you always like that or I mean you just love technology?

Anthony: You know I'm always on technology, I don't jump on it right away but I wait you know. I've waited to get my CBCT scan you know I probably. I outsourced my scan for probably about five years. I've been doing a company here in California it's a mobile now my mobile CB CT scan approach where they send out a van of your office and your patient get scanned on it so I waited until the price the CBCT scans came down below eighty grand and I never you know...

Howard: which one did you get

Anthony: J. Morita

Howard: J. Morita, Japanese

Anthony: Yeah the Japanese. They have a good scanner it's about $80,000, really good

Howard: Whats the name of it

Anthony: It's a J. Morita Verascope, yeah so they have a sub 80000 scan, CB CT scan option, you know if you'd only going to be placing one or two implants a month don't go buy a CB CT scan. I mean that's they outsource it. Buy a scanner but you're at least doing a volume of 10 of 15 implants a month minimum and even at that you can still outsource your CB CT scan but take a scan every case for god sakes, you after nowadays.

Howard: This is so amazing, I mean you could do an online C course for dental town on how to do the the ortho the surgical guides. If you ever want to do some of the best marketing in the world just put a course up on dental town and then they'll get turned on to you and as soon as they hear you and see you and all that then they'll be going to your websites and courses and because you're someone that every damn homie listening to this show needs to know more of and listen to more of.

Anthony: Thanks alot Howard.

Howard: You are, you you've been amazing for three decades what year do you get our dental school?

Anthony: 1986 it's hard to believe, What year did you get out?

Howard: One year behind you 87 you just look so much younger at all that get hair but yeah these homies that they love this stuff they're commuting to work you give them so much rock-solid advice. So many things they can do this is this is, come on guys you live in the richest country in the world you live in the strongest economy in the world and nobody wants to lose their teeth. I mean go up to any woman in America who's complaining that she doesn't have any money and say well I'll give you a thousand dollars if you let me pull your front tooth. She'll run, there's women who would not get take a million dollars for their front tooth. I mean I I've played this game on airplanes for thirty years how much money would I have to give you to pull your front tooth and they just scream and they and they love whiter, brighter, sexier teeth. There's so much technology from implants, ortho, bleaching. I mean there's just so much it's really our game to lose and man I am so honored that you came on the show today. Is there anything that I didn't ask about that you wish we would have talked about?

Anthony: No you're good I didn't you know my big advice is you know it's you've got to learn, learn, learn and then practice within your scope. You can have like five different profit centers in your practice you get really good at them it doesn't mean you're gonna be doing all on fours. You know these crazy surgeries but develop a technique that very profitable and simple you know develop an endodontic technique, an implant technique, cleaner liners. You know you get three four profit margins in your practice you'll be really successful  and but for God's sakes train your staff and pay them well because if not it's nothing's gonna work.

Howard: and to tell you how how completely backward dentistry, is you go to all these conventions they're all gonna bring in these people that talk about these all on fours and they're like the sacred golden cow and America does a hundred all on none for every all-on-four and would you rather own the whole all on none denture market or own the whole all on four I mean the whole all on for me what is it clear choice I mean what do they do about sixteen seventeen thousand units a year in a country that has three hundred twenty four billion people and I know dentists, I know so many dentist back in the MIS days. You know who made the most money in my in my class I went through the missions too we got our fellowship you know who was?

Anthony: No

Howard: It was about three different guys who went back to their hometown where they had this nice practice in the suburb and realized that over in the poor trailer park area there was this old denture world that had been in business for thirty forty years and he went in there and they were doing about three hundred thousand a year and the guy said I'm gonna buy this and I'm gonna keep you on as a employee and then I'm gonna, we have the denture and they come in and you're advertising it two fifty and an arch or four ninety nine full mouth but then you could upgrade it to two dentures lower snap-on and then you get up were eight to four and you're gonna and and the upgrades. So everybody would always go to denture world and then he started upgrading a hundred implants a month for three decades. I mean I've seen this in Bakersville, I've seen this in my own backyard, I've seen this a couple places in Florida, one in South Carolina and they just said you know so they went after the the mass McDonald's market where everybody's going to denture world and then they started upgrading them into these findings and sure enough you have a hundred people that come wanting a new denture one or two of them's gonna get all in four.

Anthony: I've been doing implants for over 20 years, I rarely have a patient that's gonna give me $25,000 for an arch honesty. So yeah I just, I personally stopped doing those cases because if I'm only doing one a year I'm gonna lose money on it. You know I'd rather keep it simple stupid man, just work hard and keep it simple, you'll be very profitable. If you start going to these courses where you're doing all these all on fours you have one failure it's gonna cost you a frickin fortune.

Howard: and if it goes to court it's gonna be the next five cases you did are gonna just pay for your legal fees but hey think you'll ever make us online CD course would you ever be up for that?

Anthony: I'll definitely put it on

Howard: ah thanks man, that'd be so exciting for those kids to see, see that course that would be amazing but hey again thank you for all that you do for dentistry! You ever want to come back on the show or you want to send someone else on the show, you talked about your anesthesiologist or whoever. Thanks for all you do for dentistry and thank you so much for coming on the show today

 Anthony: All right thanks our pleasure, keep it rocking.

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