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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1187 Dr. Bobbi Stanley DDS, MAGD, DICOI, LVIF of Stanley Dentistry & The Stanley Institute for Comprehensive Dentistry : Dentistry Uncensored with Howard Farran

1187 Dr. Bobbi Stanley DDS, MAGD, DICOI, LVIF of Stanley Dentistry & The Stanley Institute for Comprehensive Dentistry : Dentistry Uncensored with Howard Farran

5/8/2019 3:31:34 PM   |   Comments: 0   |   Views: 70

Dr. Bobbi Stanley is a graduate of the University of North Carolina at Chapel Hill School of Dentistry but education has been a mainstay of her 25-year career.

VIDEO - DUwHF #1187 - Bobbi Stanley

AUDIO - DUwHF #1187 - Bobbi Stanley

As owner and principal dentist of one of the largest comprehensive dental practices in North Carolina, her goal has been excellence in patient care through continuing education, the latest dental equipment and technology and superior materials. Dr. Bobbi Stanley reinforces these guiding principals with her team members and offers a myriad of opportunities for dental continuing education for associate dentists, auxiliary clinical team members, and dental office team members.

Dr. Bobbi Stanley is a Master in the Academy of General Dentistry (MAGD), Diplomate in the International Congress of Oral Implantologists (DICOI), a Fellow with the International Association of Orthodontics (IAO) and a Fellow at the Las Vegas Institute for Advanced Dental Studies (LVI).

Dr. Bobbi Stanley is an Adjunct Professor in the Department of Prosthodontics at her alma mater, the University of North Carolina at Chapel Hill School of Dentistry. She is Co-Founder and Senior Instructor at Stanley Institute for Comprehensive Dentistry in Cary, NC, as well as a Senior Instructor at the International Association of Orthodontics in Milwaukee, Wisconsin and The Facial Beauty Institute in Memphis, Tennessee.

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Bobbi Stanley DDS MAGD DICOI LVIF, she's a graduate of the University of North Carolina at Chapel Hill School of Dentistry but education has been a mainstay of her 25-year career. As owner and principal dentist of one of the largest comprehensive dental practices in North Carolina her goal has been excellence in patient care through continued education the latest dental equipment and technology and superior materials. Dr. Bobbi Stanley reinforces these guiding principles with her team members and offers a myriad of opportunities for dental continued education for Associate dentist auxiliary clinical team members and dental office team members. She is a master in the Academy of General Dentistry diplomat and the International Congress oral implantology a fellow with the International Association of orthodontics and a fellow at the Las Vegas Institute for Advanced Dental Studies. She is an adjunct professor in the department of prosthodontics at her alma mater the University of North Carolina at Chapel Hill School of Dentistry she is co-founder and senior instructor at Stanley Institute for comprehensive dentistry in Cary, North Carolina as well as a senior instructor at the International Association of orthodontics in Milwaukee Wisconsin the facial Beauty Institute in Memphis Tennessee. She is married to Dr. Robert Stanley and together they have four children she is an instrument-rated pilot and has completed an Ironman triathlon. I think the only thing you could do next is just be the President of the United States.

Bobbi: No thank you

Howard: I mean that I mean your resume I mean it almost sounds like science fiction how did you accomplish all of that while having four children I mean it I mean you just you must have not slept in the last 25 years?

Bobbi: Well you know life is life is gray and I believe in living to the fullest so I'm just I'm gonna accomplish all my dreams. I have a long bucket list and I just go through them slowly and check it all off.

Howard: Well this is demonstrating sensors I don't like to talk about anything that everybody agrees on but there's a lot of girls listen to you right now that just graduated Ahnold school and they're saying come on Bobbi you graduated you graduated in the golden years of dentistry and I'm coming out of school three hundred fifty thousand dollars in student loans and she's wondering if that was even a good idea what would you say to her questioning going a third of a million dollars in debt to become a doctor a dental surgery?

Bobbi: Well I'm gonna tell you I we mentor a lot of young people in dentistry and I encourage especially young females to go into dentistry because it's such a wonderful wonderful profession we have the opportunity to give back, we have the opportunity to change lives and in doing so we can still be a mom we can still raise our children we can still have a life it's the best of both worlds for me I love it.

Howard: So you so you still think it's a golden era of Dentistry?

Bobbi: Always I sure do I think there's lots of opportunity out there everybody has teeth everybody needs help it's great even with big corporate dentistry which is what everybody's afraid of corporate dentistry coming in and taking over dentistry there's an opportunity we're here to give back we're here to serve we're here to take care of our patients and I really believe I always have believed that you do the right thing you take care of your patients and everything else takes care of itself it's always gonna be the Golden Age of Dentistry, dentistry is a great profession.

Howard: and what I love most about you is a lot of people who are doing what you're doing there in Beverly Hills you're in downtown Manhattan there and Kebascane no offence but you're in the middle of North Carolina I mean you're close to Raleigh I mean you're not exactly in Beverly Hills 90210 but you're still doing Beverly Hills 90210 dentistry.

Bobbi: People still want it and it's amazing people literally will fly here I have patients in London who fly to me for cosmetic dentistry it's just everybody wants it and when they when they find somebody who has a talent and somebody who has a heart for it you don't have to worry about patients they will do the right thing because they want to have a beautiful smile they want to be healthy so it's available anywhere.

Howard: The only people the only people that fly to see me is their dentist our family members out of state wanting free dentistry and I have to buy the plane ticket so uh kudos to you. Well you know one of the things that's on your you're at such a different level and when they come out of school and they just do one two dentistry I mean someone comes in it's usually if you look at the insurance data the four six year molars are the ones most likely to get any form of treatment and they're doing one two dentistry but you're doing comprehensive dentistry and I don't even know when they get out of school if they're even ready for comprehensive dentistry I mean you gotta get it I mean if you're gonna play football you need to learn a tackle a block a pass a reception when you come into school you need to learn how to do a filling a crown. When along their journey are they even ready to go from one to ten it's tree to quadrant dentistry to full mount dentistry when would the Stanley Institute even come up for someone who just got out of dental kindergarten school?

Bobbi: So I'll tell you right away when they get out of school their first thought is I got to get my speed up and I got to make money to pay down my debt and what I would encourage them to do is to broaden their horizons they really need to think about investing in themselves and learning and what I find is that when young people get out of school they don't want to invest any more money in themselves because they are in debt and I get that but if you don't continue to learn and grow and invest in yourself you're not gonna grow. When I got out of dental school first thing I do was sign up for the Pankey curriculum I just thought I've got to learn I got the basis in dental school now it's time to take that to the next level. So I would not tell them to hesitate to start learning even more because you've got very minimal in dental school and you're right Howard you need to learn how to do a basic crown and a basic filling and get your speed up for that but the only way you're going to be able to do demonstrating to take care of your patients is if you understand the broad scope of things so I wouldn't encourage you to jump in too fast but pick one subject and really hold down in it and get really good at that and then pick another and whatever your passion is that's where I would start. I find a lot of young people want to start with where the money is and the money is going to be anywhere where your passion is so just figure out what you love about dentistry and just get really really really great at servicing your patients with that and that's a great place to start.

Howard: You know I've always had two types of dentists there's the blood and guts dentist who wants to extractions place implants root canals and then there's the ones that they really want to be electrical engineers they want to do bleaching bonding veneers Invisalign your I could call you the queen of blood and guts dentistry I mean you like the implants the surgery what would you say to someone who's you know she's young she just got out of school and she's saying I don't I don't know if I like blood and guts I think I just want to do pretty soft stuff bleaching bonding veneers how did you get into blood and guts?

Bobbi: Sure so one reason I went into general dentistry was because I wanted to do it all I love it all I want every part of it and so what I did was I became really really educated at every aspect of it because here's the thing whether I'm gonna do it or not I need to know it I need to understand it and I need to learn it so I can communicate with my patients. So at Stanley Institute we teach dental implants and we often have students who come and take a course and they don't want to place implants in their office but they want to understand implants enough that they can educate their patients and send them to the appropriate surgeon who's going to place the implants for them and I believe that every dentist needs to be highly educated even in the surgical part whether they're going to be the surgeon or not because as the general dentist needs to drive the treatment you need to drive the treatment with your specialists and take care of your patients so you have to educate yourself from every aspect whether you plan to do it or not it's not okay to say I'm not gonna do the surgical part so I don't need to learn about that because you do need to learn about that.

Howard: Yeah so talk about your journey I mean how did you uh how did the Stanley Institute evolve where did that come from?

Bobbi: So I became a dentist way back in the early days where you way back in the early days and when I met my husband my husband aunt said gosh my grandfather was a dentist I always thought I would be a dentist but I went down the route of engineering and he went on got his PhD an engineer and he kept saying I really want to be a dentist and so one day he came home from work and said I really want to go to dental school so we talked about it and we you know consulted about it with a lot of people because we did have our small children and we decided that was the best thing for him to do was to quit his wonderful awesome high paying job and go back to dental school and so we made the sacrifice for him to do that and then he joined me at Stanley dentistry and when he came in to join me at Stanley dentistry our dental office became this really great comprehensive office because we had two doctors and we really loved for providing service to the highest quality and our colleagues actually would often ask us questions how do you do this what do I do in this situation and we would advise them a lot and finally somebody said why don't you guys teach so we started a study club and we started a study club where we were the primary teachers and we were present on different cases and we started doing it so much we'd loved it so much we decided let's put a curriculum together and so the curriculum was developed out of out of need and not of want from her colleagues they would say he does teach a course about this and we would say oh yes we can and so what has happen is because implants has become the focus with Stanley Institute we did we put together curriculum because patients wanted not only to learn about placing implants they wanted to be able to place implants here in the United States and then they wanted to be able to restore those implants so we have a whole curriculum that teaches how to place implants why to place implants where to place implants and then we give the doctors the opportunity to place the implants on live patients and then they also have the opportunity to restore those implants so it's a start to finish because one of my big things that I'm always saying is anybody can put a nail in a wall but when you hang that picture on that nail in the wall that's going to tell the true story of whether that nails in the right place and that's how we feel about dental implants we want the implant in the correct place not just a bone but in the correct place to put a tooth on that implant because your patient wants a tooth they don't just want an implant so you have to be able to start with a processes in mind and back up to the surgical and that's what we teach at Stanley Institute.

Howard: Well I want to I want to back up even further there because she's coming out of school and you know when they got in school they have been placed one implant they haven't done one Invisalign case they haven't done one sleep dentist I mean that I talked to people I talked to I went to bar the other day and she came at school she had one molar root canal one that was out I mean I did 15 canals and then so so basically that was my question is before you start telling me what we're doing in Cary North Carolina, she's coming to school saying well should I learn more on implants Invisalign sedation dentistry sleep apnea TMJ she can't take everything at once so where are you going so give her that stair step I mean why should she implants instead of an Invisalign let's start there cuz you're you're an orthodontic guru too.

Bobbi: Sure yeah but poor before she even starts to think about that I would think about where her passion is what she enjoys doing and then start focusing from there. So if she enjoys crowded bridge great and let's start focusing on cosmetics and veneers and making beautiful smiles if she enjoys orthodontics then I would start with Invisalign because it's a small stepping stone to get you to full orthodontics if she enjoys surgery by all means let's start with some simple extractions and some simple implants but it's got to be good you have to start with your passion and what I would encourage students and young doctors to do is find a mentor find somebody you can ask questions somebody that's been through the CE who can guide you to get great CE and and somebody who's always there for you if you have a question about any of your procedures that you're doing along the way but Howard it starts with your passion you have to start with what you enjoy the most and then you go from there.

Howard: So you the ceilings is you basically have E1 E2 E3 E4 its ones plan two's prepare threes place four is prost by the way on the placing if someone's licensed and Arizona can they place an implant in North Carolina or is that illegal?

Bobbi: Yeah no North Carolina Dental Board allows doctors to come in under my license because I'm an AGD accredited educator so they will allow them to come in under my license for education purposes only. So they can practice dentistry in the state only during the class.

Howard: That's amazing some states make it just most states make it to where you have to go to the Dominican Republic to learn how to place an implant I'm down here in Arizona if you cross the border of Yuma there's all kinds of implant institutes and and what's sad is they're placing him on poor people in those countries when Phoenix has got enough poor people to do it all day long regulators regulation is I've never been a big fan of regulation. Talk us through it's a big commitment to say I'm in Sliney Kansas I'm gonna drive two hours to Kansas City fly to Raleigh go to this course so that's a big so break it down why talk about what is e1 e2 e3 and e4 try to bridge the ground between I'm just hearing about it versus I'm buying a plane ticket.

Bobbi: Sure so e1 is basically getting ready to prepare for implants so there's a lot of goods in the implant dentistry like the materials the design of the implant and you need to understand on that so you can choose the right implant for your patient because let's face it all implants are not made the same so it's important that you guys understand that you understand the placement what kind of patient you're looking for the treatment planning is speaking with the patient so that's what the prepare part is for at the same time we also will educate your team members so team members will come to that and they will have breakout sessions with a financial administrator with the hygiene or with the implant coordinator so your team can get trained also because it really has a team effort with anything that you do in dentistry what we find is when doctors get educated if the team members are not on board then the doctors go back and not a lot happens so that's what happens in the one is some full comprehensive for doctor and team members that be on board to understand dental implants e2 is planning...

Howard: Wait I want interrupt the first one I get this valid complaint all the time that they feel like before they can go take a course they have to pick an implant because a lot of the implant instruction is driven by the company so you have a diplomat in the International Congress for oral implantology you're a heavyweight in this what implant what you said all implants are the same so what system are you recommending?

Bobbi: All implant systems are not the same we use exclusively Bio Horizons in our office so we teach Bio Horizons but we teach it from a direction that you can use any implant system because what we teach really is guided but we used to BioHorizons system the reason we used BioHorizons exclusively is that we love their material we love their design and as I said earlier my husband has a PhD in engineering so he has broken down the systems in detail and he teaches in e1 why he why an implant is a superior implant what you look for he never says you need to use Bio Horizons he just says make sure you look for these things and there are other systems out there that are great systems we just happen exclusively used BioHorizons and so that's what works for us.

Howard: It's an amazing place and a lot of people have never been to Alabama but Birmingham II that's where they're making the space shuttle Columbia solid rocket boosters and fuels it really is like a Silicon Valley in the middle of Alabama it's an amazing company I've been trying to get Steve bogan to come onto this show he's the president CEO Bio Horizons but he's he's too shy and humbled to come on Dentistry Uncensored so smack him upside the head the next time you see him, tell him to put his big-boy pants on and come on the show because I'm a big I'm a big fan of theirs and the reason you things you gotta remember in my 31 year 32 years of being at us and you know you know how many implants were placed 20-30 years ago and the company is no longer even existing or right and you know how many malpractice cases people go before the jury and they ask for research about this implant you're using and there's no research to support it I mean it's the major leagues I think we're we're probably down to only about a half dozen major-league implant companies but at the at the IDF meeting in Cologne last month over 400 companies were selling implants and a 350 of them don't have much time okay I got asked another question though to start so she's thinking about getting into implants and but she's thinking well I need to buy a hundred thousand dollars CBCT. Does she need to buy a CBCT before she gets to the Stanley Institute?

Bobbi: She does not but she does need access to a CBCT or being able to send her patients somewhere because one of the things we do teach the standard of care and we believe that CBCT is becoming the standard of care for dental implants. So there are a lot of x-ray or radiology centers that can get her an x-ray right there are a lot of doctors now who have the technology in their office that will allow patients to go and get that x-ray we actually have doctors who come in who send their patients over to our office for CBCT and we just send that back over the internet back to the doctor and the doctor takes care of it. So you don't have to invest in that at all there are centers and other offices they can do that for you but it is important to have a CBCT to be able to plan appropriately.

Howard: and what CBCT did you get that and the reason man says they I get a lot of feedback at and most people are complaining about my hairdo or whatever but then they would specifically say they don't like generalizations she said I don't think come on you've been doing this 25 years I'm at school what that's why I asked you what implant you place and then she's gonna watch CBCT did you pick?

Bobbi: I don't mind sharing at all we pick ICAD and the reason we picked ICAD is because they have very clear resolution and we like that a lot and it has a lot of diagnostic ability so it works really well for us.

Howard: Why do you think it is that whenever you meet someone who's really placing a lot of implants periodontist oral surgeons or whatever it seems like they got this specialty market it seems like it seems like there's not really a debate among specialists of what was CBCT they always seem to get the ICAD, why do you think that is?

Bobbi: Well I'll tell you for the last 7 to 10 years we had a different system in our office and it was a little bit harder to diagnose from that and it didn't seem to be developing or being on the cutting edge there wasn't a lot of software upgrades to it and you know we got the ICAD and it's just really changed the way we've been able to diagnose not just for implants but for airway for ortho for many other things endo it's just a clearer resolution and the whole purpose of this is diagnostic ability I guess always there for you that I mean they have their reps are available there they're there to help you in any way possible so they seem to be the cutting edge staying on top of what we need is a dentist.

Howard: and they're right up the they're not actually there in Pennsylvania that's a fairly fairly close to you right?

Bobbi: It is but I have no idea where they are is that where they are?

Howard: Yeah there and I'm there in Hatfield Pennsylvania.

Bobbi: Okay

Howard: You know I was lucky one night when we were little and by the way you need you and I each have four kids i I had five sisters and a brother and our vacations were only two things either when to go to Six Flags or something like that Disneyland or whatever or go to a factory and see something made and it's so funny because my four boys they've they've taken a tour of probably fifty dental manufacturing things and it's so informative it's like man if you really want to know an entire product from head to toe just go there and so we were talking about your continuums and E1 was planning and we talked about the implant BioHorizons a CBCT and then I interrupt rudely as you were getting ready to talk about E2.

Bobbi: So E2 is where you really start getting hands-on but the doctors feel like that they have a hard time planning they don't understand the planning process and they seem to think it's this big mist mysterious thing to plan from the post prospective for an implant so we really honed down on that and e to we help the doctors plan we give them a little bit of hands-on on how to plan we talk about bone grafting when you need it when you don't want you use that sort of thing and then from there we plan all the patients that are going to have be surgically placed at E3 so each patient gets planned for their implant so we go through about 15 20 patients start planning implants on those patients.

Howard: Another confusing thing when you're coming out of dental kindergartener is they think it is tricky because they go back and a lot of them get a job with their parents I mean I'd say a quarter of the class of any dental school I've been in has a family member a mom and dad and uncle someone in dentistry and it's tough because they're going in there and and dad's been doing it this way for 30 years and mom's been doing it this way for 30 years and she talks about that she wants to start a grafting after an extraction and and her mom or dad just looks at her like a deer in a headlight what do you think about let's say I came into your office and I had to have a first molar extracted would you graph that and yes or no or why?

Bobbi: So I'll tell you we're really big on a media's anytime we can place an immediate we will even in the molar position and my husband has actually developed a technique called the five thread rule where he can actually look and tell the probability of an implant being successfully placed in a molar position based on the number of threats that we can get in bone. So if we can get an implant in there we will always get an implant and then we follow some of research about grafting and breath in the gap and that sort of thing but if we take a tooth out an implant does not go in we will graph it.

Howard: Okay and now immediately placing the implant is also different than immediately loading would you immediately place a load or place.

Bobbi: We do not we only place well place and what will place a healing cap or what place an anatomical healing cap and just let it let it just sit there for a little while until it's integrated. So the only time I will place a temporary on immediately placed implant is in the anterior area and I always tell people that's just a smiling tooth I don't want you putting anything on that tooth but a big old smile.

Howard: Another again this dentist rien says I always try to find where they argue and I've especially on dentaltown I mean there seems like all the people do all the posting or you know they're either one way or the other but it seems like the reality of these dental graduates when they come out of school everybody they know that's placed 10,000 implants or more they don't use surgical guides and then everybody talks about surgical guides and they're always taught by someone whose place maybe a thousand implants or I mean most of these older periodontist are in California and Arizona tell you dude they didn't you know they didn't even have a CBCT they use Panos and they and so this is what they this is exactly what they say to the young kid they say you know if either become a surgeon and place damn implant are you know if you need training wheels throw the bike away they call guided implant surgery training wheels, now granted there's sixty seventy years old but what would you say to a sixty seventy year old man who says I never used training wheels for 30 years and she wants to make a surgical guide, what do you say to that?

Bobbi: Well I'm glad you asked me that question I've lived in both those worlds so back when I started placing dental implants I placed them when a pano and I placed them without a guide because that was just what we did back then we just didn't use a hole like I did and then my PhD engineering husband came into my office and he said well what if you're off a millimeter and I said okay so we're off a millimeter yeah but what if you're off the millimeter so then you know he we started doing some research and just looking into it here's what I would say I don't care how great you are I don't care what kind of hands you have I don't care what a great surgeon you are when you hit that cortical plate you will get kicked off every single time every single time because you're not that good with a guide what will happen is that it gets really tight as the implant goes in but it's not gonna get kicked off that cortical plate and that's the whole reason we use a guide it's not because we don't have hands it's not because we don't know where the implant goes it's just that you cannot fight a hard bone so if I want to put an implant in the correct position and I want to make sure it's in the correct position I'm gonna use a guide and how often is that that's every time because I want every time for that implant to go exactly where I want it because I've already planned the case I've already planned the tooth I already know where I want things I know how I want their smile to look and I can't afford for that to be off any. It's funny you should ask Howard we were just in a study group and my husband actually said to a periodontist how often do you see an anterior tooth where the implant restoration is up a little bit higher than the CEJ that you plan and he said all the time that happens all the time and so you know we said wait you know where that happens right and he said yeah the the burr kicked off the cortical plate it just came a little bit too facial more than I wanted but that's okay and that's not okay I don't care if the patient has a low smile line that's not okay because the patient doesn't want that and I've had patients who have come in with those restorations and they hold up their lip and they say can you fix this nobody knows it's there but me and the patient but they don't like it, it's not okay so why do we not use a guy what hinders us from using a guy cost well its minimal cost now time well know we can get it in our office the same day we want. So there's no there's no barrier to entry for guided anymore there used to be but there's just not anymore so if you're not doing it honestly in my opinion is pure laziness because you owe it to your patient to have a perfect placement.

Howard: I want to ask you something if you agree or disagree on this statement, some of the oldest periodontist I know say that whenever you talk about peri-implantitis which is all over the literature I mean a lot of people are saying that it five to nine years 30 to 40% of the implants have some form of peri-implantitis that's a lot 30 to 40 percent in five to nine years and a lot of the older guys say you know what when I place them and I had attached gingiva all the way around it wasn't an issue there's a lot of older periodontist in this state of Arizona telling young dentists that peri-implantitis was from poor implant placement didn't get enough attached gingiva around they're just that blanket statement you agree with that is that our disagree is it an oversimplification what do you think about peri-implantitis since you're such a major issue in implant dentistry?

Bobbi: I think my answer is yes and no so obviously there are other things that can cause period implant itis a lot of some of it depends on the patient and our home care and that sort of thing but yes I do believe that placement has a lot to do with it. We place a lot of implants a little bit off kilter so that the restoration has a cantilever you know what happens with cantilever says you beat that up over time and the restorations been beat up and beat up and beat up I mean over time you're gonna lose bone over time they're going to be issues and what happens is years down the road the patient comes in and there's they start to have issues with these implants and all of a sudden the dentist doesn't think is their fault because they've had it for seven to ten years and they're like well Mrs. Jones what what have you been doing different this implants got problems and you've had it for ten years just fine so we know that an implant that's not placed appropriately will have problems I most likely will have problems down the road if it has problems it will be way down the road so yeah I do agree with that.

Howard: You just open up a whole nother can of worms I'm gonna have to follow up with that you you're talking about inclusion and one of the most specific questions asked on dentaltown and email to me email me your questions is they say I you know there's pareo there's caries there's occlusion I want to learn more about occlusion but it looks like I have to pick a fork in the road right out of the gate there's either neuromuscular or CR Pankey what have you and that specific question if she wants to learn more occlusion you are a fellow at the Las Vegas Institute for Advanced Studies and Bill Dickierson is a big neuromuscular occlusion guy you mentioned early to show you enjoy it we went to Pankey Dawson that's a CR deal should she go neuromuscular or CR?

Bobbi: Well I think you have to decide that for yourself if you're gonna ask me what I believe I love neuromuscular and that's what I practice in my pic in my practice because for me allowing the muscles to dictate allowing the patient to dictate without me having to do any manipulation is it works great for me but I will tell you just a couple of weeks ago I was at spear in your part of the woods you know I mean you really need to look at it from every angle and every aspect to see how you can help your patients with what needs to be helped and then make an educated decision for yourself what works for you and for your patients and I have to tell you I feel like that we all start at different places but in the end we end in the right place because most of them will put patients in temps or will put patients in orthotic and then we'll adjust it until the patients have a good place and that's where we'll restore and that happens the same in one way or another in the end so I'm not sure that one's greater than the other but if you ask me what I'm doing in my practice I practice neuromuscular dentistry because that's what I know that's what I understand and honestly that's what gets my patients out of pain so I choose that.

 well if you call if you said neuromuscular what would you call the other would you just call it CR or what would you call it?

Bobbi: I would yeah we just call it CR.

Howard: Yeah and my answer to the question I think we both agree is you have your MAGD I have my MAGD I would say that you just take them all I mean I went to LV I went to Pankey Kois Spear all of those guys and my gosh. In fact, I don't want to talk about that you have your masters and the AG d your Masters in the academy general dentistry in my observation in the last 32 years no matter what you did in dentistry it seemed like the people that took a hundred hours of CE a year for 30 years they always were successful and by success I mean they were happy their patients were happy they paid off their bills or student loans they had a nice lifestyle and what would how important was getting your MAGD in your career?

Bobbi: Oh my god so important so for any student getting out of dental school if you feel you don't have the money to invest in your education I would tell you pick a few good meetings and go to the meetings and just start learning you know go to AGD you go to him and go to Chicago midwinter and just take as many courses as you can take but just learn but you have to be educated you have to grow because if you think what you got in dental school makes you a dentist you are so wrong there's so much more out there and you just need to get a little bit deeper into dentistry and the only way to do that is to learn so it's so important.

Howard: Yeah and the other part of that I look back at when I went to these Institute's part of it is what I learned but the other half was the dentists I met who's now been my buddy for 30 years and I mean it's all about your a summary of the five people you spend the most time in and a lot of these guys they come out of school and they're hanging with their five dentists friends from dental school and some of them hate dentistry they're working at some mill they're in some clinic they hate and they're here and all this negativity and then I go to a course maybe on implants but some guy is telling me all about some other discipline or sleep or TMJ or so I think the main thing is just surrounding yourself with people who just love to eat live breed die sleep dentistry.

Bobbi: So important so I'm a member of two mastermind groups in one study club group and you know we hand pick who joins these groups and it's got to be somebody who can just take us up to the next level and who enjoys dentistry the way we enjoy dentistry and that's so important so pick a mentor pick some people that you enjoy being around and schedule some of meetings and just go away and have fun with them and talk about dentistry so so important .

Howard: So do you have to take E1 before E2 before E3 before should you take them in an order?

Bobbi: Well we advise that but you do have to take E2 to take E3 and E4 because three and four are hands on with patients and if you don't take two you don't understand why you're doing what you're doing so we do require to take three and four and but one is optional.

Howard: and how long are each one of these E, are they all two day?

Bobbi: There are all two days with the exception of the E3 which is like hands on with patients that is a three-day event.

Howard: and what would you say is the dental kindergarten ideal placement I mean would you pick up a first molar would it be a maxillary second bicuspid what would type of patient are you looking for like when you talk about that anterior tooth the only thing I can tell you is don't touch the anterior unless it's a short fat bald guy with the liver spot if they got a liver spot on their bald head you can place number eight or nine and you don't have to take a shave guy.

Bobbi: but stay away from the laterals until you really feel comfortable but a premolar especially a lower premolar even an upper premolar it's fine, it's a real easy area then a lower molar would be great because you have lots of bone back there a lot of a lot of place space to design you know your guide so that would be fine but a premolar areas ideal.

Howard: and if she's gonna come to E3 and place an implant does she need to bring a patient or her mom or sister to place an implant do you provide the patients how does that work?

Bobbi: Both so we give them the opportunity to bring a patient if they want and some daughters do want to bring their own patients but we have patients available for them so either way works for us.

Howard: Well don't do what I did my first sinus live was on my mother-in-law and I you I don't know if I if I was just dumb or had nerves still think god it worked but yeah you might not bring your mother-in-law for your first implant but...

Bobbi: My father so I feel your pain.

Howard: You did what?

Bobbi: My first implant was on my father so I feel your pain it was kind of funny because I was using this implant wrench on my father and I'm thinking wow my father taught me how to use a wrench how cool is this.

Howard: So did you or when you grow up were you more tomboy or girly?

Bobbi: Oh no I was outside all the time I was tinkering on cars and climbing trees so I was very tomboy.

Howard: Very very tomboy and then yeah and then your four children were they all boys too?

Bobbi: No three boys and a girl yeah three boys well I can't seem to get anybody to go into dentistry just yet.

Howard: Yeah yeah I know it's up but you know what I that I was the biggest disappointment of my dad had nine sonic drive-ins and he begged me to when I told my was gonna go to college for eight years to be a dentist he said it was the dumbest thing he ever heard of his life he said he'll by the time you get out of school you already have three four restaurants to be a millionaire and I would go to work with my dad and he made a hamburgers and onion rings then I go to work with my next-door neighbor Kenny Anderson who's still a dentist after 50 years and he was taking x-rays and doing root canals and I told Dad I said I just don't want to make french fries for 50 years I want to be this dentist so that's what I told my boys I said you don't ever have to be a dentist because my dad in fact he thought it was a personal competitive thing so he fix me up with Dan Carney the founder of Pizza Hut to get a Pizza Hut franchise and I said no then he drove me to Dallas and talked one McDonald's people and he said we'll get a McDonald's franchise and say Dad I want to be a dentist and that's why my favorite character is hermie when he tells our what do you tell Santa Claus I think I think I want to be a dentist and it was the same reaction my dad gave me like are you out of your mind so then what is E4 is it's prost it's that restoring the implant that you placed?

Bobbi: It's restoring the implant but it's also where we go in great great detail about occlusion not necessarily neuromuscular nor CR but we talk about occlusion on the implant how it should be loaded and and that sort of thing so yeah they get to deliver the prost on their patient and and and we look at the occlusion then we talk about everything that goes into prost delivery.

Howard: You know it's kind of bizarre like you go to all the big meetings and it's always some guy talking about all on four and when you look at clear choice which the clear choices to get and all on four instead of having a full denture you know they're all they're only doing about eighteen thousand arches a year and our country has three hundred and twenty five million people so they're eighteen thousand arches a year isn't even in the plus or minus exactness of the American population but I see that you know I'm out here maybe it's because I'm in Arizona a lot of retirees but ten percent of Americans at age sixty four are totally edentulous and it's seventy four it's twenty percent and it seems like you know you're talking to all these all on fours but you know just one implant in the middle to implant an over denture could satisfy a hundred Americans for every all one for what do you think about the over denture?

Bobbi: and change their life ya know we do over ditches all the time it's really amazing the difference it can make for a patient now listen given the choice a patient will always want fixed and we understand that but there are cases where patients just cannot do a fix for one reason or another usually financial and that's okay if we can just at least give them two to hold their lower down it changes their world I mean it gives them so much more confidence they're able to go out and eat and smile and just feel more comfortable about who they are and a lot of patients don't even realize that's an option still how can you not know in today's society that that's even an option we still see patients who come in with their dentures loose and they want to know what they can do and we say well let's place a couple of in place and they say am ia candidate can I do that do I have enough bone yes yes and yes and it's really simple and it's not too expensive.

Howard: and it's so bizarre because not only do they just love it to death but they always tell me first well my upper denture is fine it's just lower denture so then you place your plan an over denture on the bottom and now that's so awesome now their upper denture isn't any good anymore because everything is relative the of the upper denture is only perfect because the lower denture is so horrible and I wish I wish our profession would talk more about over dentures than all on four because I'm pretty darn sure there's more poor people than rich people and unless I'm reading a different newspaper than everyone else. I want to go to when you're talking about precise I'm gonna go to when you restore it taking an impression are you a digital scanner or you a vinyl polysiloxane what how are you taking impressions?

Bobbi: Yes and yes so we scan but we we do take PBS impressions also if we need to or should we need to so we teach both we have three different scanners available for the Institute and we allow them to do whatever they do in their office if they want to experiment with scanning they've never done it will allow them to do that if they're comfortable doing the analog version would allow them to do that we want them to have whatever it needs for them to be successful in their office and take them to that next level so that's what we allow and we find that I'm doctors want to do the scan and whether they're digital or not because they really want to fill it and experiment with it and just see how simple it is.

Howard: Well it's it's tough because if you're gonna go into Invisalign Invisalign is owned by align technology which owns iTero so then they want to right arrow if you just are doing crown and bridge a lot of people say the 3Shape is that Denmark is the best 3M has a true def scanner what three scanners did you get and if she was only going to buy one what would you recommend?

Bobbi: So we have the CERAC and the CERAC is a viable option for implants for crowns and for Invisalign so that's a great option and I truly believe CERAC it's a great asset in your office to do single crowns or to do inlays and onlays so if you're going to start with something that's a great place to start we also have trios 3Shape but you know they don't play well with Invisalign so you have to be care use them from this line they just they don't play and then there's iTero which you can use for Invisalign and you can use up for your crown and bridge and your implants. Trios has worked really well for us we use their their 3Shape planning we also use some plant planning and we use Galileo's planning we use everything and we teach at all we want to teach every system because we don't want you to be limited to one thing or another that's why we kind of have an open forum as far as implants scanners planning software we want you to look at everything and aside what works best for you.

Howard: Well I notice you say you did not mention 3M's true def is that because is that because you have to use a powder to scan or why did you not mention 3M?

Bobbi: Yes well I honestly it's not something that we use on a daily basis here and yeah it's a little bit more cumbersome to use that powder so it's not something that I find a lot of people want to know a lot about usually it's 3Shape iTero or CERAC that they're interested in and so those are the three that we focus on.

Howard: So are you are you a CERAC owner I mean are like do you like CERAC cad/cam technology?

Bobbi: Oh my god we've been CERAC owners since the CERAC three came out do you remember when that was Howard you know way back in the day?

Howard: Unfortunately I bought the CERAC one I think in 87 or 88 and then I was so excited to get to CERAC two so what do I know so yeah so I remember when it was still a project funded by the government of France and did you know it was the French government's the one who did all the heavy lifting and then after ten years they gave up on it and then it came to America and so on so and you know what the problem was your the problem was with CERAC one two and three it was Intel they had they they had to write limited co-member the y2k these Millennials don't remember the y2k but in order to save space they just put two numbers for the year and then when it turned 2000 the computers all thought it was gonna be 1900 again and so they basically could not do what they did today until Intel's Microprocessors you know got out you know that they were basically Moore's law every two years they were doubling the number of chips on the on the transistors on the wafer. So yeah so but it but now it's 2019 so at 2019 is a Dentsply Serona CAD CAM a buy?

Bobbi: Oh yes I think most definitely you know when I bought my CERAC three and I wanted the two I wanted the two really bad my my engineering husband said just hold on it's gonna be better greater so I held out and when I bought my three I didn't literally count track of how many patients I did crowns on and what it would have cost me had it gone to the lab what it cost me for my blocks and and I just kept the try and within six months I have paid for the machine I mean it paid for itself not only that but it was a marketing tool patients were in ah especially back then oh my god I ain't get my crown in one day and it cuts down on the number the amount of chair time so I'm saving there so I don't see how you could go wrong with any type of in office mill system but CERAC been around for so long it's just so easy and you know now they have their their new prime scan the prime seems out so that's even faster better you know do it do it now.

Howard: Who has the prime scan? Dentsply Sirona?

Bobbi: Yeah

Howard: You also but you also are with the International Association for orthodontics out of Wisconsin so I assume are you doing more clear aligners are you doing more fixed braces?

Bobbi: I do both if I  had the opportunity to use clear aligners I like that because I can keep the teeth clean and you know healthy gums and that sort of thing but there are times when I need to use wires and I just feel like wires work better in my hand so I use wires and then come on kids they want wires they want the cool colors they want to be part of their crowd so they want braces. You know I'll have to tell you since you brought this up orthodontics is a great place to get started if you're a new dentist because it's one of those areas where everybody wants it and when a mom comes in the office and I say okay it's time for your child to have orthodontist they say okay how much when do we get started let's go because they understand that value already it's been created from years and years and years of the procedure being out there so it's a great place for a young doctor to get started if they enjoy orthodontics and in dental school they make it so complicated and it's really not complicated at all it's it's rather simple once you understand the process and you understand how teeth work and wires work and torque and that sort of thing.

Howard: Well we'll talk about let's switch gears ortho for a minute before you go back but you have your fellow with the International Association of orthodontics and talk about why did you do that?

Bobbi: For all you know I love accreditation in any organization I always strive if I'm a member of an organization to be accredited in the organization because it only makes me a better dentist because what they required you to gain fellowship and mastership and diplomat it pushes you to be a better dentist and to strive harder and to take it to another level so I always push for that and I would encourage anybody to push for that and that's why I did it with the orthodontic Association because I I felt like I needed to dig a little bit harder and understand things a little bit better and when you have to present a case to an examiner and have an examiner look at your work let me tell you you work a little bit harder to make sure your case is finished really the right way and so you know that's that's the kind of thing that you have to do when you get accredited and I would encourage anybody if they're a member of an organization take it to the next level don't just be a member become an accredited member become a better dentist.

Howard: Yeah I I agree the CE is everything they just kind of keep learning learning but you know another thing young kids when we got out of school cosmetic dentistry was so much worse because the dentists weren't using ortho and so in order to do veneer cases they often had to do root canals on the peg laterals and all the spiraling down teeth and now so back when I got out of school all the cosmetic dentists did didn't use any ortho and that was a lot of lot it was not very minimally invasive and it was not conservative all and now what I love about cosmetic dentistry is you can unravel all that stuff with ortho and clear aligners and also I want you to check this because where I call Bologna is when a dentist treats his spouse and kids differently his patients like the dad would say I don't know you're not getting veneers you're gonna have braces and bleaching but then he can do braces so then you go to office and all those cases were filed down to crown and veneers whatever so would you agree or disagree a statement that you cannot consider yourself a cosmetic dentist if you can't do orthodontics?

Bobbi: 100% agree 100% minimal invasive dentistry is is what we do in today's society we do not want to do anymore in the mouth and we have to do in the mouth and so if we can align the teeth and put them in the correct position it changes everything and I'll tell you Howard it's changed the way I treat TMJ I mean for my tmd patients we used to do full mouth restoration on those patients and getting them to a solid area and not anymore now we put them in braces we move some things around we support the joint the muscles and it looks a lot happier and a lot less invasive and a lot less expensive for those patients and patients don't mind.

Howard: and who's the director or who's the head cheese at the International Association of orthodontics?

Bobbi: You know what they just had a director change though I can't answer that question for you.

Howard: Okay but do you recommend that group?

Bobbi: Oh 100% absolutely so they're a group of general dentists who place who place braces who do clear aligners and and their education is beyond all else I mean it's just incredible the support that you get from that group it's great.

Howard: Is it Jacob Clonner DDS you don't know?

Bobbi: Yeah I can't tell you that.

Howard: Okay and then then I gotta ask you for one other one just because I don't want to leave it out my good buddy Bill Dickerson you got your fellow at the Las Vegas Institute for Advanced Study um he's uh came on this show what do you think LVI with that?

Bobbi: So I'll tell you Elvie I really changed the way I practice dentistry so I had taken a ton of CE prior to going to LVI and I actually didn't want to go to LVI you know over time people poopin want one direction or another especially with occlusion and so I haven't made up my mind that I didn't need to be educated by LVI because I have been told that you know I wasn't again a whole lot more and and my husband actually challenged me he said Bobbi when do you not go and see for yourself and I thought you know what you're right I need to go take a class and at least see for myself because people will say yeah you don't this people are crazy you don't need to do what they're doing but you really need to go and explore for yourself and when I went to the first class at all LVI thought gosh this concept of how to treat my patient and how to take it to the next level was really what I have been looking for and it changed the way I practice dentistry it helped me become a better cosmetic dentist it helped me be able to treat my patients with TMD and we do a tremendous amount of TMD in our office it's the first implant course I took was that LVI the first or that course I took was at LVI because there's so much support there and and they're still taking it to another level they just introduced myofunctional therapy we're huge myofunctional there are people in our office. I mean it just all goes together airway breathing functioning so you know LVI has a lot of that training and they have good support and the fellowship is great so I would encourage anybody to go.

Howard: and then I have to ask you about your last one which is a what do they call that master's AGD diplomat international college that fellow with international sources fellow was face of suit it was the other one it was the facial no the facial Beauty Institute.

Bobbi: So facial Beauty Institute was started by Dennis named Dr. Steve Colella out of Memphis Tennessee brilliant brilliant mastermind guy just amazing but his philosophy is let's develop let's teeth to support the face so you know all the times a child will go to the orthodontist and they'll say oh yeah let's straighten your teeth I wore interested and supporting your profile I don't want to extract teeth and lose that upper lip support on a female because God knows as we get older we lose that anyway so Facial Beauty Institute helps to take you through a controlled arch orthodontic system to support the face and facial growth so I love that Institute it really changed the way I practice dentistry as far as orthodontics and it helped me to look at people and their facial structures to see what they needed before I look at their teeth which I think is so important.

Howard: Yeah and again when I was little you know but in World War two you know they were averaging over five and a half kids for a family so only the worst case of the child got ortho and none of the other family members did I mean basically you sent the only kid who could never get married with those teeth and you fix that one up and if you're just mildly crowded you weren't even a candidate but it seemed like back when I was a kid so many of the cases almost a half were four bicuspid extraction cases and now in 2019 it's about 25% what would you what do you think of that what do you think of that 25% for bicuspid extraction and do you agree that it used to be 50%?

Bobbi: Well yes I do I would say it probably used to be even higher than 50% but I'll tell you I see in a lot of cases that I can finish very quickly if I take teeth out or I can take my time and I can develop the arch and I can give them a beautiful smile with a beautiful profile and I'd rather take my time and develop the arch. So I think often times we jump to taking teeth out a lot quicker just to get the patient through ortho thinking that's what the patient wants and certainly that's what the dentist wants and that's not necessarily what's best for the patient in the long run. So anytime I can finish ortho or get a patient through ortho without extracting teeth I will and I can tell you less than 10 cases probably even less than five have I ever extracted teeth ironically not twice on family members but you know it's just rare when I feel like I have to extract teeth because we can develop the arch especially if we get them early enough so yeah I think it's becoming less and less and I think that's a good thing and you know we also have to think about airway because when we extract teeth and pull things back and we start encroaching on tongue space and now the tongues down in the floor of the mouth and now we have smaller airway you know we're developing sleep apnea patients so we have to be really careful but we're just learning so much more about this airway thing I mean there's so much more coming to the horizon that it's changing the way we practice it as dentists.

Howard: Well I can't believe we went over an hour but I still gotta ask can I actually the one just one over time subject question?

Bobbi: Absolutely

Howard: You're on faculty at the University of Carolina dental school you're Dean Scott Esteroce is one of them the only Dean's I know that has an MBA we've talked about you about so much about clinical dentistry and we haven't we went over an hour and we never mentioned I'm an MBA a business of dentistry how important right how would you compare the importance of your clinical skills to business skills and what do you think of the fact that a Dean has an at DMD and an MBA?

Bobbi: I think he's one of the most great people I've ever met I love him I love its personality but I think that's so important and I think that we don't put nearly enough emphasis on the business side of Dentistry whether you're an associate or you're a business owner you're still in the business of Dentistry.

Howard: and you agree that dentistry is a team sport and you got to get everyone on the team involved and educated?

Bobbi: 100% is funny it takes us a little while to recognize that because I was the same way you were you know I woke up one day and I had this aha moment where I was like wait a minute I need to develop my team to not just myself so you're so busy working on your own clinical skills that you forget that you have all these other people that need to develop with you so if you take them along the way man it changes the world it really does it just changes life.

Howard: Two more really short questions how do you how does Robert Stanley and Bobbie Stanley Bobbi what was your was your name really Bobbi and his was really Robert and can he have to go by Robert because he can't go by Bob if you're Bobbi?

Bobbi: Yeah so when I met him he had been going by Bob and literally had just started going by Robert I I guess God said you're gonna meet this Bobbi so you need to change your name so yeah when I met him he was Robert and thank goodness he wasn't Bob anymore so it's work but weird enough we named her first son Robbie you know he's Robert a third we named him Robbie that really complicates things but people think it's a joke sometimes when we introduce ourselves.

Howard: Okay so last question I I hate to ask this because I I'm a man you're a woman but a lot of women seriously struggle with the issue that they're you know I got to dental schools in my backyard ones in Mesa AT Still the other ones in Glendale, Midwestern and they seriously have emotional pain and suffering wondering they their biology tells them and the world tells them when I tell them the most important thing I ever did was I made four children I mean Eric, Greg, Ryan, Zach everything I did professionally isn't even a footnote to that but they would it be a supermom and the truth of the matter is that if you're a woman dentist and your husband is a plumber guess who still is gonna have to do the majority of the cooking and the cleaning and the homework and all that kind of thing so we do live behind the times and equality and she's coming out of school her exact questions I want to be the best mother but I also want to be a dentist so would I be better off just getting a job at Aspen and so I don't do the business dentistry and then after five o'clock I can go be the best mom or should I open up my own practice? So if your kids came first would you rather be working Aspen or owning your own place?

Bobbi: I would do it exactly the way I did it I open my own practice so as I was planning my practice I have my first child when my doors open I had an infant with a baby in my belly I mean literally I did not stop life because I knew I wanted to be a dentist and I knew I wanted to be a mom and I just I'm gonna be the best both of them and you can there are people to tell you you can't but you can. I've closed my office early to coach cross-country at my kids school I couldn't do that if I was an Aspen employee and and it works I arranged my hours around my kids school hours that's because I own my own practice I can open when I want I can close when I want. I can't do that as an employee my kids always came first family first I tell my employees that for their families family comes first but I love what I do and I'm always gonna be the best at what I do and I'm always gonna give dentistry 100% but not at the expense of my children. I don't think as an employee I can give my kids as much as I can as a business owner I just don't feel like I could.

Howard: So I ask you if this is a fair critique or not some people say you know when I was in dental school you know the senior class had one woman mine had you know a dozen not now they're half women a lot of people are making macroeconomic bets now one of the reasons DSOs will continue to thrive is because the women aren't gonna want to own their own business they want to be an employee but I look back at my class of 87 all the women not only did they open up their own practice they on average their offices were at least 56 percent bigger than a man I mean I mean just so many of those women just crushed I mean Stephanie Carrmata, Lisa Gonzales just super unbelievable does but do you think yeah do you think the graduating class going from all-male to half women will that feed DSOs or do you not buy that?

Bobbi: I don't buy that at all I don't think that has anything to do with it I think they're always gonna be dentist male or female who don't want to own their own practice who want to be an employee and great that they can go to a DSO and it works great for them but I don't think I has anything to do with gender at all I don't the female dentist that I see coming out of dental school now they're on fire they want to own their own practice they want to be their own person and I love that I think that's part of the reason they went to dental school because they really want to stand on their own two feet and be there on their own person which means being a business owner so I don't think it has anything to do with gender at all no.

Howard: and here's the last word the last fact I mean come on guys I've been doing this 32 years you when I meet a dental student who's been an associate five years out of school they've had five different jobs they have running it's like if this was a successful strategy and you're gonna graduate in 2019 next month then just go four years back get all the names of the graduates that graduated in 2015 call them up and they should all say oh yes I've been an associate at this clinic for four years and I love it and then when you find out that nobody said that you can quit chasing your unicorn. I mean the bottom line is dentists physicians and lawyers they make horrible employees they're too smart they want to do everything their own way and I can assure you that the happiest you're ever gonna be is when you don't answer to anyone but yourself and so that the type of person that became a doctor isn't the type of person to become an employee. So I just want to throw my homies under a bridge that you guys make the worst employees that I've ever seen and I feel sorry for anybody that has to have a hundred of you working for them because nobody can make you happy. My last question is I hope someday you grace dentaltown with an online CE course or more and it would really add to the prestige of dental town to have courses by you I'm your biggest fan it was just an honor to podcast interview you today thank you so much for coming on the show today.

Bobbi: Thank You Howard I really appreciate I enjoyed it thank you.

Howard: All right have a great day. 


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