Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1205 Orthodontist Sam Daher DDS, MSc, FRCD(C) of the Daher Aligner Institute : Dentistry Uncensored with Howard Farran

1205 Orthodontist Sam Daher DDS, MSc, FRCD(C) of the Daher Aligner Institute : Dentistry Uncensored with Howard Farran

6/9/2019 9:21:19 AM   |   Comments: 0   |   Views: 106

A bilingual native of Montreal, Dr. Sam Daher received his Doctor of Dental Surgery degree from McGill University (Montreal) with distinction in 1994 then practiced general dentistry for a few years before returning to Université de Montréal to complete a Masters’ degree and specialty in orthodontics.

VIDEO - DUwHF #1205 - Sam Daher

AUDIO - DUwHF #1205 - Sam Daher

Currently living and practicing in Vancouver, Dr. Daher operates 5 very successful orthodontic practices across Canada: in Vancouver, Calgary and Montreal, where he treated over 6,000 Invisalign cases of varying complexities. He was the top Invisalign submitter globally 2009-2011 and remains one of the top 5 single-provider submitters in the world. He currently uses the ClearCorrect system from Straumann as his choice of Clear Aligners.

He is an active member of both American & Canadian Association of Orthodontists (AAO & CAO) and a Fellow of the World Federation of Orthodontists (WFO).

Howard:  it is just a huge honor for me today to be podcast interviewing Dr. Sam Daher DDS MSC FRC D he's an orthodontist he's the owner and founder of their ortho style in British Vancouver Columbia which is absolutely the hottest city in North America I mean it just is he's a bilingual native of Montreal he received his doctorate dental surgery degree from McGill University in Montreal with distinction in 94 then practiced general dentistry for a few years before returning to University of Montreal to complete a master's degree and specialty in orthodontics currently living and practicing in Vancouver he operates five very successful orthodontic practices across Canada in Vancouver Canada Calgary and Montreal where he's treated over 6,000 Invisalign cases he was a top Invisalign submitter globally 2009 to 2011 and it remains one of the top 5 single providers submitted in the world he currently uses the clear correct system from straumann and we had the CEO straumann on the show as his choice of clear aligners he's an active member of both American and Canadian Association orthodontics and a fellow of the world federation of orthodontics your bio it's another thousand words I mean I'd have to live to be about three hundred and twelve to do what you've done how are you doing today Sam

Dr. Sam Daher: I'm doing very well and I'm honored to be with you Howard and I'm telling you a story at some 25 26 years ago when I saw your lecture for the first time I was in awe I'm one of your biggest fans I just want you to know that and I want to touch up a little bit on that and it was everything that I've never learned in dental school as I sat in there and the way you delivered everything I was in awe back then so I'm a big fan as well I just want to let you know ah thanks no you're too kind um you know it's interesting there's a when I got our school to reside nine specialties and now there's ten they just added dental illness anesthesiology but man your specialty is probably undergoing more change than pediatric dentists and honest 

Howard:I mean I don't know what's keeping in the darkness awake at night but you guys got smiles direct Club yeah you got Invisalign you got all these things I mean it's like holding on to a rocket being an orthodontist isn't it 

Dr. Sam Daher: yes it is it's exciting and it's stressful at the same time stressful if you don't stay on top of things that become stressful and  within half a decade it becomes our cake whereas if you stay on top of it it is exciting but this is our time and you know every specialty will get its turn it seems that now is our turn and being able to go straight to the public and people appreciating a smile I think it is shining a light on this specialty today there are certain things that we need to work out that it's an amazing time these are exciting times to be in dentistry and to be in orthodontics as

Howard:  well let's get right to the chase how is technology change since you walked out of ortho school 

Dr. Sam Daher :well let me tell you when I graduated from dental school in 94 and somebody would have told me that when you walk into an office and the first thing you do is you'll turn the computer on out of laughter you it's it was ridiculous back there but nowadays I literally turn the computer on you turn the scanner on you turn all these electronics on so the practice is completely different the practice of orthodontics so we have plastic instead of stainless steel nowaday so we moved it with custom made appliances which is something that is unheard of so you have these three-dimensional technology and I think where the future is gonna come all together is just having that platform the three digital the 3d digital platform connect all these units together which is what's happening slowly but surely but it has certainly changed the quality has changed the quality the quality of the life the patient and the doctor has changed the quality of the dentistry and the orthodontics has changed and it has opened the door for general dentists as well to take a glimpse to sort of pick and choose and I say as exciting as it is for orthodontics for orthodontists nowadays general dentists get the benefit the most because they get to take a peek behind the curtain and pick and choose what they wanted what they want to treat so this acknowledge is there hopefully the education is gonna be there as well but man it's exciting time for the general then it's just as well because you pick you choose and if you find an easy case but a difficult patient you'll pass as an orthodontist I can't do that I can't say that's an easy case but a difficult patient that's where we're where the buck stops so we have to do it all but technology has made all of that possible not to mention communication between the specialists and and  we understand the GP so all of that has made has made it a lot more exciting a lot more challenging as well because you do have to stay on top of things but certainly I tell you those that haven't jumped on board yet telephone that they'll fall behind the eight-ball very soon unfortunately 

Howard: and you  were talking about how technologies so I mean when I get a dose go this how I got out in 87 we thought we were so lucky because as we were leaving they were installing computers in the dental school and we were high-fiving each other like I we got out of here before I had to deal with it at that stupid stop thing and that was back when they used to tell you that if you didn't understand Fortran or Cobalt by now you would just be some illiterate guy living in a box and but  you were talking about how technology really changed clinical work though but it's actually really changed the business of practice management of Orthodox I mean you are managing five practices in three different cities some hundred miles apart some thousands of miles apart how is technology change the business of running an orthodontic practice

Dr. Sam Daher: well perfect you took the words right out of my mouth so 10 50 20 years ago that would have been impossible because of the internet because the computers because of digital imaging I can actually help so I owned five practices in Montreal and Vancouver that's a 2,000 mile distance so I'm rarely in the city or when I go in there twice or three times a year to drop by but the rest of the time I stay active in the treatment planning these patients so I got my associates who are so each patient really gets two opinions at once cuz I got my associate working on it she'll give her opinion if she has any doubt or if she has any questions chilly that's why we have that iPhone with a big screen no matter where I am in the world she'll send me photos she'll send me x-rays and she'll chill couple it with a couple of questions and then I'll look at it I'll ask her a few questions back and I'll give my feedback so now the doctor has a second the patient has two opinion my associate has the confidence to know that a colleague of mine also agrees with us so I give my opinion so the business in this business model would not have existed without technology without the internet without everything else that we use so she can even scan she can take a free model a 3d scan and intraoral scan send it my way and I can manipulate it imagine the old days where we used to take these ortho plaster models put them on a table make sure they articulate a certain way and God forbid you drop one of them which did happen to me a couple of times early on and they shatter and back to square one so being able to communicate that's what the associate how about me how about the office managers as well because there are times where you know the office manager will send you a text or will call you say hey this patient is actually will be out of town for the next six months he or she is at this stage what do we do and go hey Helen send me a couple of photos or send me a scan she'll send it to me I'll review it send her back or reply and instantly before the patient leaves the practice they know what the next plan is hey take these aligners and we'll see you in six months or do this or do that so we have a plan for them so the business of orthodontics has changed quite a bit and none of this would have been possible before  the technology that we use today was available to us one of the things that I do is and I'm just gonna take an extra many here if you don't mind Howard what I do is because of what I do remotely I've got a lot of my colleagues I got I've given lectures all over the world and a half study Club and I get colleagues or patients GPS especially they come in and say hey whatever you do with your associate can redo the same thing with us so a few years ago I started the dire aligner Institute so what I do is the exact same thing now we send if a dentist wants to start an Invisalign case or a plea correct case or whatever the case may be and they're not sure and they have questions so they will send me the records that send me photos I scan if available and they'll ask me the questions within 24 hours to 48 hours I'll reply back answer the question it confirmed the treatment plan and off they go before the next visit that patient is ready to go so that consulting service has certainly improved the quality of life for the doctors and a patient it's amazing it's something that we would have never been able to do 20 years ago I tell you Howard

Howard:  okay well this is dentistry uncensored so I don't want to talk about all the pretty fluffy stuff yeah of all the specialties if I man ended honest and I start lecturing at the study club of two GPS how they can do better faster endo everybody's good same with the oral surgeon teaching CPR to pulling wisdom teeth but  of all the specialties when a specialist orthodontist goes out and starts helping general dentists do ortho they are not the most popular guy in town and what I've noticed is that those guys are never from the United States of America it's always someone from Canada like you or Australia or something like that so are you the so what are your orthodontist colleagues think of you helping general dentists lowlifes like me do clear aligners 

Dr. Sam Daher : yeah well an excellent question so when I first started I started speaking to my colleagues the orthodontist I've set up a reputation and my colleagues know this is not really about selling so it's gotten to a point where I've got a solid base I've got I've got I got my doctors that respect what I do and I appreciate that very well so when I started reaching out to the general dentists one of the first things that I did and I made clear is that I'm here to help you in other words if that case if in my opinion that case it's difficult I'm gonna tell you from the get-go this is a case for the specialist so the idea behind it is a word that we haven't used that you which is education the idea is to educate the general dentist so I believe a certain percentage of cases can be easily treated by the general dentist provided that when that deadness is educated and orthodontics they will refer the difficult cases out so at the end of the day the patient wins the general dentist win and the orthodontist wins as well so again education is going to be key and I never shy away from pointing out the curveballs to the doctor so the general that doesn't say hey before we start I reviewed this case this is a difficult case in my opinion this should go to a general dentist because a B and C because there's still education but the easy case is sort of the low hanging fruit whereby I know you're gonna enjoy it I know you're gonna provide a service to your patient and I know you're gonna make money out of it and you're not gonna be out of your depth and two or three-year treatment then you go ahead and do that so I think education is the key word here so educate inform and ultimately the orthodontist will actually benefit from having general dentists that are more educated more aware and can recognize malocclusion a lot better because they're paying closer attention so ultimately the orthodontist won't benefit 

Howard: so the website where you're helping general dentist is actually the day her the DAR Institute da h ER but it's pronounced DAR right correct so it's DAR but it's fel da h ER so if my so is who's going to dark Institute ah is that mostly general dentist or is it orthodontist

Dr. Sam Daher :okay so when I first started this this adventure I was under the impression that most of my corner court clients will be orthodontists but it ends up being the vast majority our general dentists if I were to give a ratio will be 75 25 actually and I understand and appreciate the general dentists are the ones that probably need more pointers and more help and advice so you can go in but either GP or also as a matter of fact I have one periodontist not in North America but we have a one periodontist that actually uses if there's a line and he use services so you go in you log in and you ask you a question you download the other photos and we'll ask the questions that you want or you can simply submit the case their vessel ID and allow us access and we'll modify but we'll educate at the same time again the idea behind it is you can't just go in and do it yourself you know they're all saying you teach someone to fish they'll eat you know you give them a fish to leave for the day you teach them how to fish they'll eat every day and that's the whole idea behind it is you want to educate them at the same time as you're telling the technician what to do and a lot of doctors find value in that and the one that I've been with me for a couple of years now actually end up submitting more cases but the difficult cases and they keep they won't need my help with the easy ones anymore which is good and I'm fine with that 

Howard: okay so they go to that darh Institute calm yes and tell him how it works are there online courses that teach you how to do Invisalign arts or clear aligners or tell us what they're gonna find they're driving to work right now when they get to work they go to your website what are they gonna find 

Dr. Sam Daher :so they're gonna fly right now the first stage is to they'll  see a bit of information explain to them how the treatment planning service works that's what we're working on right now but what we're doing behind the scenes is we're putting lectures together we're doing similar to do what you're doing right now podcast some lectures and I'm gonna do some short half an hour kids attention span as you know very short so I want to do some short sound bites on class new treatment cross bite so on and so forth now this is in still we're still working on that but right now what they find is they'll go ahead and they can log in they can have their own portal password you know user name and password and from there once they go in I'll ask him a few questions how many cases have you done what's your system what do you prefer click correct or Invisalign how many cases have you done are you GP or an ortho that's all I need from them so every time they said by the case I can review their profile I can tell okay well I'm dealing with a dentist that has done 200 cases or I'm dealing with someone that just started so my education my information will be based on that so I have four other orthodontist with me so one of us is always available to reply within before to 48 hours as a matter of fact 

Howard: wow that is amazing and this is perfect timing because they just graduated 6,000 dentist in the United States and Canada this this month and every one that I've been having dinner with or meeting with from my 80 still and Midwest they all said I'm almost $300,000 in debt we didn't do one Invisalign case and I didn't place one implant so I'm gonna hold your feet to the fire I just graduated last week and I how am I gonna learn to do my first clear liner case 

Dr. Sam Daher : what would you tell that okay kid well what they need to do I know Invisalign I don't align technology the makers of Invisalign they sort of ask you to take a half a day course to be certified and that course is not there's a little bit of clinical dentistry orthodontics design but it's mostly hi how many submit a case how do you log in how do you use our software the treatment planning software and so on so the first thing they need to do is to get a password is to take that Invisalign course they're not going to get a lot of clinical dentistry out of it but they will get the basics once they do that now they can easily identify what we call a Monday morning easy case they can pick that case and then what they'll do is they'll just submit it to the Darr Institute and the question could be hey is this a good Invisalign case is there a curveball that I don't see in here did he give me your advice and there's a small fee for that it's not a full fee for that we could say yes this is a perfect case for you go ahead and do it in other words we're putting the training wheels on and we're telling them what the limits of the sandbox are or it could be hey I know I can do this case but I need you to hold my hand along the way that would be sort of the second tier that we'll go in will modify the Clint check will explain well educate the technician and the doctor at the same time so they can see a pattern so now when they push accept and the aligners come to their office they know it's been reviewed by someone who's got thousands of cases of experience and they say well this is the best I can get out of this one patient treatment and they go through it and we'll give them advice along the way if there's any clinical questions they can always reach out to so that's what we're doing in so they can start in essence in a week or two submitting cases Timbers are like treating patients and there's no harm in saying not only are you getting my opinion I'm getting a world leader to review your case as well so you'll get two opinions in one by the time the general dentists sees their patient back in a week or two by then that would have gotten their feedback from us anyways so basically if you're just  starting and say I don't want to worry about the treatment plan I want to learn we'll do it from A to Z the only thing we will not do is push Excel or legal purposes we need the doctor themselves to review and push accept but we'll do everything along the way they'll read it they review the notes they'll get educated the submit the case the aligners will come to their office and off they go they'll just have to follow the instructions from  Invisalign which will be really dictated by us in the first place let's  roll over six months from now I've done cases now I'm comfortable with this well now more questions will come up and I like that now it says hey I submitted this case I noticed that when I do IPR early on for instance patients don't like that how can I deal with that and now we're getting into the sort of the juice of it now we can say hey don't start off I'd rather you do the  IPR Midway because a B and C and that's how they evolve that's how they grow that's how they get educated and that's what makes it exciting for me as well seeing quote-unquote my students progress there's a lot to be said about that

Howard: so do charles orthodonture 'ls j ruff yes he has he has 6,000 post on dental town he's a diplomat of the American Board of ortho I am he's legendary he is the reason I was calling you on dental town if you if you search for your own name Sam Darh first thing he says is check out Sam and he's got great ideas I mean he's so he's uh he's the biggest orthodontist on dental town and he's your biggest fan so my question is how much money did you pay him to post that a couple of years

Dr. Sam Daher: but he's a he's a wonderful man he invited me to speak at his university as well to to his colleagues and he's always when he's when he gets stuck on something and I love that that camaraderie he'll shoot me an email and it'll be straightforward hey stop I'm in the middle of this I'm how do you deal with this I mean my reply is usually two or three lines as well until we meet again and we hug each other but when he eats something he reaches out because he knows he can get a straight answer from me so I'm a bit of a fatty but he's a dear friend and he's someone I look up to and respect very much so

Howrad:  yeah I I mean it when your general dentist it's just such an honor that an orthodontist will you know will l talk to you like that I mean you know that'll be your buddy I mean most of the orthodontists you ask him any orthodontic question they say well you know if you want to learn more about that you should really go to ortho school like come on I mean there's I mean there's four there's uh I mean almost 19,000 towns in America and in the rural areas in any town under 3,000 people there's not any specialist so half of America lives in this rural same thing with your country Canada I mean yeah  you got Montreal Toronto embrace Vancouver but most Canadians live out in the middle of nowhere and these general dentists you have to learn something about it you have to learn a little bit about everything now your job is to learn everything about one thing but the general dentists got to learn a little bit about everything in fact that's why I wish you would you got all those online courses the best marketing you could do would be to do an online CE course for dental town and if you just gave a one hour lecture and said for more you know go to my dahr Institute so you so you have some other websites so dahr Institute is basically where you're teaching helping people with clear aligners correct no

Dr. Sam Daher: not fixed right not not fix I I do get I do get questions about things I mean I haven't forgotten how to do braces but if someone has questions about fixed raises the treatment plan is the treatment plan so it doesn't happen often very rarely but I will I won't turn down a collie if they have questions about fixed braces

Howard:  so then you have other websites so you have ortho style comm is that your patient website for British Vancouver and then your other website is there dar ortho style is that also a 

Dr. Sam Daher :patient website for Montreal correct so d'Arthur style is is that's  the the regular sort of generic website for my patients to sort of get acquainted with us nowadays I find websites are not really marketing as much as education on the more educational they're more their marketing value is which is ironic so what I want to do is I want my patients to know who I am before they come in to see me or who my associates are and what our practice philosophy is and give him an idea before and after and so on and so forth so that website the DAR or the style website is for the patient's the DAR Institute com is for the doctors that are seeking treatment plan service and hopefully within the next year or so we'll have continuing education and by the way you're on for a webinar for your for your dental time for an hour will be my pleasure and my honor to do that as well Howard so the dollar or the style is simply for our patients to get educated and that's how they reach us so I wanted the two to be separate because doctors have questions to ask that I wanted to be free to ask any questions they want which are completely different than the questions that we get from patients when they reach a saying most of our patients make their appointments online nowadays a phone call to make an appointment it is almost rare let me tell you

Howard:  so then I want to be clear about something else so I'm sure um you your dar Institute website you talk about Invisalign but then you said in your bio that you switch to strummin clear liners and win before you start answering that oh my god I mean Invisalign was it was the clear aligner and then the patents all expired about a year or two ago now everybody and their dog has a clear aligner I mean I  at my list of clear liners companies just passed 30 you got big dog Henry Schein doing them now I mean for Bergman's the biggest I mean he's the biggest 400-pound gorilla in dentistry so is daher Institute aligned with Invisalign clear liners or is a generic clear Alliance so

Dr. Sam Daher:  its generic it started off when the patent was still when a line was really or Invisalign was the only brand or the biggest brand nowadays like you said with the patent wearing we're finishing you've got all these aligners so clear correct in my opinion is a good company I met with the CEO I flew to Switzerland met with the CEO which I know you had on your show what a wonderful intelligent man and his goals for clear aligners and his vision is completely different no better no worse with people you know can interpret it whichever way they want but I was very much aligned with the CEOs thinking from straumann so what I'm doing is I'm working with them and I'm helping them develop what they want they have the idea I have the know-how and my own ideas on how to improve that product so I absolutely love it so I still use I obviously have thousands of patients in Invisalign that we're gonna continue we're gonna finish those treatments with them there's a line and I still am an Invisalign user but I'm focusing more on ClearCorrect nowadays and they see the writing on the wall within the next year or two you'll see what ClearCorrect is gonna turn to because of Strom and support obviously that there's exciting things happening

Howard:  that's funny because you're Canadian and when I did the podcast with Marco Dola the CEO straumann who let me remind you if I ask me does who sells the most implants in the world they always say no we'll biocare and I said Stroman sells twice as many as no one there's the number one dog a lot of its M&A; activity I mean they bought they bought neo debt in Brazil they bought em is in Israel but um it was I was giving a lecture in Toronto Canada and he and he's the busiest guy in the world jet-setting around the world he guess I can only do it this time and I wasn't gonna say no and it's the middle of lecture so I just filmed a Howard Dentistry uncensored in the middle of my seminar and he got to answer questions but that's why that guy is the biggest beasts in dental implants and that's why I'll also think he'll take the Invisalign deal because take the CEO of Invisalign Joe Hogan CEO of Invisalign you can't even get an email return from that guy I mean I probably have a better chance of having a breakfast with Trump tomorrow than Joe Hogan but that that mark oh good Ola you can just tell he's gonna just walk away this face why do you think he's gonna be dominant in clear liners as opposed in this liner and shine or all the others 30 companies 

Dr. Sam Daher : well when I spoke with Michael when you sit down and talk to him one-on-one you realize how how sharp and he is how smart he is so his idea was I mean it stems from the fact that he already services that I have a good connection with hundreds of thousands of doctors worldwide so he listened to what his doctors want he came to me and he goes here's what my doctors want do you think we can do this and I said absolutely we can so what I think is number one that he said he made time he made time for you it must have been it might have been limited but he's one of the busiest people and he makes time so he understand the value of providing a service to his doctors that nobody else does and he's not ashamed of saying hey I don't mind focusing on general dentists to begin with they he sort of doesn't mind it he says I'm not gonna ignore  the orthodontist but I don't mind providing my general dentist with what they need so let's combine is such that before we place an implant and I have a 5 millimeter space and I need to make it 8 how do I do that hey let's take these clear aligners let's upright these teeth let's create space let's make it a space for an implant and in so his way of thinking you sit down and you talk to him one-on-one and you see how his brain works oh he's open-minded which is a huge advantage to him and he to the growth of his company in his business so he wants to provide the doctors what they want but he already has a good rapport with hundreds of thousands of doctors that when he comes up with  any kind of appliance his doctors already trust the quality and Trust his vision they will jump right away and I think that's probably one of his biggest advantages

Howard:  yeah andthese young kids they come out of school that's a great point not he made time for me he made time I mean I know why he made time for you but he made time I mean you're a big orthodontist I'm but it's about networking and these kids come out of school they go back to their hometown they start practicing with their mom and dad who might be dentist and then I go meet up with them two years later and they're in this little small town of 5,000 I'll say how many physicians are in this town I don't know and then the iGoogle and I say okay there's 12 how many of them have you had dinner with this year none I mean I mean in in the last 12 months I've had 20 doctors Duane tanaan dentists you know md's chiropractors everything in my house me cooking them dinner I mean and then and then they think oh I don't do that I just want to make a post on Instagram and they're all gonna be building my way I mean you take those guys like Stan Bergman Henry Schein he probably plays a million miles a year 256 different countries but you're like that mean you've been an educator and a speaker your entire clinical career that's why you're so in touch because you're out there pressing the flesh and hearing what other people are doing it um do you ever think how can I stay in Vancouver and lecture to dentist in Europe Africa and Asia and South America 

Dr. Sam Daher :  yes I do I mean I do get demand so the demand on my time became so big at one point that you couldn't be cloning apparently is illegal as of now and you couldn't be everywhere all at once so because of technology what I want to do is I want to reach over you know webinars or personal connections like this that's what we need and that's what I'm focusing on as a matter of fact I came to realize I enjoyed clinical dentistry but I cannot just do clinical orthodontics and I enjoy teaching but I can't just do teaching so what I want to do is I want to join the two worlds so I'm gonna keep practicing but I want to share my knowledge and I want to share my experience then let me and you probably Howard of all people appreciate that more than anyone else you know how much I learned by teaching the questions that come your way and I'm never ashamed of saying I don't know let me tell you but on the flight back it's nagging on the back of my head and as soon I go to as I get to the office I go in and I look it up or I try it and then I find hey I learned something so I'm always willing to listen I'm always willing to learn and no matter how much you know there's always someone out there that knows something more about you on one specific topic so what I want to do is I want to keep reaching out I want to teach I want to use technology to reach doctors just to give you an idea in November I was invited to speak in China I was there I was in six different cities starting with Hong Kong and I must say I spoke live to maybe 2,000 doctors but you know how many doctors I reach by webinar while I was there probably close to 50,000 and that was really an eye-opener for me because you know you get to Shanghai and you can only fit two three four hundred doctors in a in a room but then there's live streaming it and then I turned to the lady who's translating I go how many people are you reaching she goes I don't know let me get you that number I think between twenty and twenty five thousand and your jaw just drops and it is an eye opener so you do reach a bigger volume and one of the last thing I want to mention is how wrong and how unethical it is to take your knowledge to the grave whether you get paid for it or not how wrong is it for our special to take that knowledge to the grave share it out there and then what your colleagues do with it is they take it and improve on it and then the next generation will do the same thing so I certainly want to take that knowledge it is new technology there are not that many text books out there on clear aligner treatment or clear aligner therapy I want to share that knowledge what they do with it is up to them but you know one day hundred years from now someone's gonna mention my name and they'll smile and they say hey that guy helped improve that specialty to me that's where good enough

Howard:  reward a human condition is extremism and like I remember when I when I got out of school 30 years ago a lot of the orthodontist a lot of them half their cases work for bicuspid extraction too much right today for the ten thousand eight hundred orthodontist in the United States it's only about a quarter but on dental town when you talk to general a good third oven thing I would note there's no indication for for bicuspid extraction like really dude there's eight billion Homo sapiens not one of those sapiens meat needs to do the guy manages our that's crazy it's the same thing now with Invisalign so now these people are sent and they're saying well I only do Invisalign it's like really eight billion cows in this herd and you can treat everyone I'm with the clear aligner so deal with those two extreme isms or is there one case out of eight billion humans that needs four bicuspid extraction or is that procedure dead and could you treat all eight billion her to humans with just clear aligners or would there ever be an indication for fixed because they are they're extremists 

Dr. Sam Daher : there are let's start with the first extreme so I'm I referred to myself as a nun extraction is but let me clarify that I still ten percent of my patients are extraction cases you can get away you said it eight million or a billion Homo sapiens all of them to treat not extraction is wrong the gingiva cannot afford it they low loss whatever the case may be you will still need extraction but we will need we needed today a lot less than we ever did in the past I admit to that because technology moving each slower will allow the gingiva to react the soft tissue and the hard tissue to react so a lot of cases the vast majority can be treated that extraction but to say I will never do extraction is wrong it's almost unethical to say that so ten percent of my cases are extraction cases even though I consider myself not extraction is so you know you can you certainly can treat without extraction but you can't treat everybody without extraction it's  unheard of it's  not possible there's also a discrepancy between jaw size and to size just because of genetics you inherit jaw size from one parent to size from the other and you they can't always fit it's humanly impossible to have everybody treated without extraction so that goes without saying but we do generally speaking we need to extract less today than we did 20 30 years ago and I hope that makes sense

Howard:  well in my in my family  reunion it's  a lot higher but they say that's because of inbreeding so that so then go to the other one kid could you treat all eight billion humans on earth with clear liners or would you ever need an indication to use fixed 

Dr. Sam Daher : okay so as of now I started an Invisalign only practice in 2010 my Vancouver practice was Invisalign only so I did surgical cases I thought out of the box that it extracts an impacted canine but there are times where you get indications where you do need fix appliances it may not be braces but you do need fixed appliances for instance impacted canine I still treat some of those with  clear aligners but depending what the impaction is sometimes if it's too deep palatal or if it's too high up luckily you do need fix appliances so you can treat today a lot more than we ever did in the past but to say we'll never use fixed appliances not necessarily braces but fix appliances that's a tall order at this point maybe ten years from now we'll say that but there are indication for fixed appliances at this point of our career for sure so the orthodontic they can't have it both ways

Howard:  I mean you can't have your cake and eat it too they say well you know these guys you know they go learn how to do or tow and they learn you know short term or two or six month smiles and they really need to learn comprehensive ortho I'm like oh well guess what you didn't teach him that in dental school and you won't teaching that in the United States so what is your thoughts about short term  because I think before a person did the most minor crowding ortho case that the most important thing would be to learn comprehensive ortho education I mean I mean you would want to over educate yourself before you even started not the reverse so what do you think of them when you think of a short term ortho six month smiles things like that or let me just ask this she just graduated from dental school Friday she didn't do one ortho Invisalign case what how would you tell her to prepare for this you were saying go to where 

Dr. Sam Daher : so I will say but the first you need to do again and go back to the certification course bye-bye online technology you know the makers of Invisalign because you need to get it gives you sort of general gives you - gives you a general idea of what you what you need but it's not going to educate you on being an orthodontist there are courses out there are speakers either part of the Invisalign team or on their own for instance I took Rick let's course 25 years ago so died Rick yeah did you okay so Rick is actually we turned out being friends and after a couple of years he turned to me he goes you got the brain of an orthodontist apply to all four school you do need to take a course like Rick let's course or someone of that caliber who are who are educators but by training by DNA so taking just that intro and Invisalign course alone is not gonna cut it one of the questions I get sometimes you get a patient sitting in the chair and they're sitting in there and in one lower incisor is blocked out buckling completely and they'll sit in there and they say well I have to talk about 10 15 minutes they said that's great it'll be 18 months I'll be X dollars what do you mean for that one tooth and they say ma'am or sir to fix that one tooth I have to you I have to move 28 teeth not only do I have to move the adjacent teeth I have to move the opposing team so I can change the bite so patients don't think of it this way and maybe new grads don't think of it but they ought to it's you do move all the other teeth to make room for that one too so like it or not every orthodontic case is a comprehensive case but what I would say is limit your practice if the teeth were straight at one point and then they got crowded over the years well you know space was there so you can unravel the crowding by moving six or eight teeth maybe at that point now these are the cases that you want to begin with once you get into 100% D bite or three four millimeter open bite you know this is not a tooth problem this is a lot more than that and it's more than just one - that's a lot of teeth but you do start start at the bottom of the ladder get comfortable learn how to three-act and then you'll learn how to react in return as well so every case so six months ortho and all that that you're cutting corners you probably doing a lot of interproximal reduction or disking or stripping or maybe the idea the solution is not ideal there's certainly room for it but very limited room for short-term orthodontics

Howard:  well you and I are both in love with Richard Lent he was the first orthodontist to ever make an online CE course on dental town that was from the United States of America and if you ever met this guy I mean he used to teach or throw at you a P in San Fran then he went to Detroit he doesn't give a anything what anybody else thinks of him and he said he was effectively for all practical purposes blackballed from the orthodontic society and he said he should I mean it just and he didn't care because he's that guy from Detroit thinking I get a lot of poor people in Detroit or and in the rural areas these general dentists they need to and what was his course to question as you sweeping away the myths and orthodontics the extraction non extraction debate by Richard ladle it and I remember taking his ortho course it was like four three-day weekends and some guy he thought he was all that from the you know they're always from the AACD you know I'm a cosmetic dentist and you don't understand the face oh my god he reduced that guy to a pudding I mean they just he just knows what he's talking about and  I and I hope you put on a course when I'm with Richard and tell Richard needs to come back and add another one because that one got he got so many views it was it was crazy so we're talking about learning aligners and all that kind of stuff um how successful is clear liners right now what technology is missing in clear aligners you know you're obviously that one of the top five users the clear aligners and the globe what do you think is still lacking or needs improvement is a bleeding edge leading edge or is it just done we know everything about it you know

Dr. Sam Daher:  there's that's an amazing question there's a lot more that can be approved they did the obstacles sometimes is the  licensing bodies or the college can put up walls sometimes these aligner companies they don't want to spend the money to  try or sort of test new things so here's what we can do I think if we can include or merge the intraoral scanner with 3d cone beam now we can see the roots so we don't have to guesstimate where the root position is you can actually see it on your treatment plan software and I think this would be the first and probably the most important step so nowadays we move the crowns but we know that crown movement is relatively easy on a little cartoonish video it's what happens to the root that's the defining factor is what the shape of the root the length of the root the width the volume all of that has to be factored in and that helps us apply the right amount of force and in alignment ease so having combining cone beam with intraoral scanning I think is a must first and foremost the second thing I think that we need to do is have that 3d animation being shared between several people basically it could be the periodontist the periodontist wants to know hey am i grafting here how much expansion are you doing and below an anterior region should i graph free or Thor post or Thor but if you have that cone be if you excuse me if you have the 3d animation and you can forward it to them that'll be amazing they'll have a better idea and then they can make an educated guess but right now you can't do it unless you're an Invisalign user or if that user or that software user and you need to you need to download it and pay for it but I think it should be available to the public because that would be nice when it's Faust goes back home and shares it with their spouse as well or with a friend to educate so I think we need to have that technology readily available as well you know we'll look at CSI Miami and all these shows on how you can get them up in the air or those hologram and all that I'm not asking they'll be nice if we can get there one day but I'm not asking to that point where at least everything can be maybe cloud-based and we can manipulate and that allows us to communicate a little bit better but also educate a lot better but first certainly the first step combining cone beam and an internal scanning that's a must and I know some companies are holding back because of radiation others are holding back because of the cost of the research but whatever it is I hope they they get over it and I hope we can have that available soon there's a lot more to come as what I'm saying 

Howard: but I know my home is because they always email me you know I always tell them email me your listeners email me Howard at dental town comm with the question put it in the comments on YouTube I know the first thing I ask is well he didn't say what 3d scanner he uses or what CB CT he uses so they always want to know the dentist's name the product so what 3d scanner do you use and why and what CBC tico baby use and why so cpct

Dr. Sam Daher: I looked around at everything I love Cerrone I Alexa Rona because the field is limited to the upper and the lower jaw you're not getting into the site you can if you choose to get it to the sinuses and and  deepen the temporal mandibular joint or what have you but then if you miss a lesion when you have a full scan of the head and you missed a lesion there's a liability and also there's a lot more radiation so I pick Sirona because you can simply focus if it's an impacted canine you can actually focus in that area or you can do eight to eight you can check all the teeth and just the TMJ and not much beyond that so you can pick your field and this one of the main reasons I love Sirona I'm in terms of what scanner I did the pilot study for allied technology on the ITRs scanner so as of now I'm using the ITR scanners but I've already also ordered the scanner from dental wings which is from then which is from straumann the reason I like it is because the wand is a lot a lot smaller than the ITR so I love the idea I love all the bells and whistles that go along with it but that war that the wand did a scanner from so we're from straumann is smaller and it's also cheaper and it does the same thing that the ITRs canada's so these are the two main ones that i like and enjoy and you can scan in motion other words you'd have to scan and stop you scan like a video so you end up scanning a full upper and lower jaw with the bite in a minute and a half maybe two minutes if you're having a day if you're having an off day

Howard:  okay so you said on the CB CTU's Sirona and so everybody in York Pennsylvania is bawling right now and saying he left out the name DENTSPLY it's dead Switzer or they got married a year ago and you're only talking about the wife from Germany not the man from Penn but anyway then splicer ona makes three cbc tsa op ortho false SL new ortho for two Foss X G Galileo's comfort Plus which one of those CBC T's retire now XG

Dr. Sam Daher:  the one I use is  X G huh and so that's ortho Foss acts G 3d they got the new ortho Foss ass 3d and they got the ortho Foss L 3d but you went with so they have three different ortho Foss so you went with ortho Foss XG 3d 

Dr. Sam Daher : correct because I it was we added we had a renovation in my office about three years ago and we went with that at the time that we knew that at some point we need to change or upgrade or what-have-you when the time come it just so happened that at that I treated the the Sirona Canadian president him and his wife and his kids as well so when time comes for  an upgrade or change we'll go to him and see what's available at the time so at the time three years ago I looked at all the options and I like the energy and

Howard:  I actually no one's asking but I actually went with the the etch-a-sketch I found I could us just draw my own I remember the etch-a-sketch yes it's a poor attempt at a joke my favorite joke is um I went to the there was a there was an earthquake and all the art at the etch-a-sketch museum is now gone okay so when we talked about so CB CT what would done slicer ona and then for the 3d scanner wine technology owns the I taro scanner and Invisalign and you're on the I taro scanner but you're thinking about switching to strongman's dental wings

Dr. Sam Daher:  yes I already ordered three scanners action three scan I should be receiving yeah three of those and I'll be receiving them it should be sometimes in June okay so  I'm sure this podcast will do well on dental town but I'm sure it'll explode on Ortho town so I know my orthodontists already asking well what's differencing dental wings is Dromund a night arrow with a line technology

Dr. Sam Daher:  one of the main things is the wand the camera itself is the size of a pencil or the size of a pen so it's the  wand is a lot smaller than the eye tiara for most part the actor works beautifully well but you do get the odd patient that has a TMJ locking issue and you don't want to open wide and you're trying to scan the distal of the 7 or if the 8 is presently you're trying to just candidate you have them open wide that scanner falls short a little bit also if you're working one of the reasons I use the scanner is you got a fidgety six-year-old and you want to put a space maintainer in there and good luck taking an alginate you'll never be able to take analogies so what you want to do is you want to scan and send and email it to the lab they'll make a 3d model and then they'll make the appliance for you beat the band a loop spacer or lingual arch or a TPA or whatever the case may be so I want to go in and out fast and when you have a smaller one four six seven eight eight-year-old kid that's a lot better as well then then the bigger wants so the size of the wand is probably the main reason the other thing is in Germany they released it at the the in in Germany in Cologne in March and I actually had a chance to test it the results were amazing so I liked it it's portable it is a few thousand dollar cheaper than the eye tarot and the wand is smaller so I like it you don't need to powder it you don't need to add any powder and it is collected in my initial home town which is Montreal that's where it's put together so I had a chance to talk to the lady that's in charge of that and I was impressed with everything that that I heard now that it's available I'm ordering that so I really like it for those reasons

Howard:  so did you meet the CEO Mike Ryan what is it ray nursin Mike Renison in Montreal the CEO Diddley's

Dr. Sam Daher: know I know I didn't meet him we were supposed to meet actually in switzer and it didn't work out so I didn't meet him in person okay so then um so then then the last thing the animation where were Saturdays and the 3d animation so the what we're trying to do the 3d animation by  Invisalign for instance called the clincher trying to try to combine it with a cone beam and let's talk about it at some point the idea was dropped for whatever reason I was never privy to that information but the other thing that I had asked for which I was hoping will be available one day is to have that 3d animation to the people that don't own the software that don't pay for or download the software so and again I don't know where we are with that but I hope these companies will have it available I'm working with the Clear Connect and straw man and hopefully having that available that's why they want to make it web-based so when or cloud-based some point we'll have that available for everyone how far is a LAN gone with this I'm not sure yet 

Howard: well you know um Stroman is the number one selling implant in the world you're talking about you've mentioned strummin several times or Tad's or orthodontic implants is that a growing bigger is that flat is that contracting where are dental implant in orthodontics right now 

Dr. Sam Daher : yeah well we use we certainly for maximum Anchorage or what we call absolute Anchorage right now we use mini screws you know but what happens is you get the aligners let's say from a line or credit correct and then you get diminish crews from another company and you're already stealing my thunder Howard and you already have I don't know you're an intelligent man so we're already talking about with straumann incorporating mini screws and aligners so that they work together instead of getting the aligner from one company diminish group from another we're talking about pre-planning the use of finish group positioning type size so on and so forth I would get all everything about orthodontics and switch to the most difficult the  best part of life is the people

Howard:  I wouldn't want have been born in Hawaii all by myself that have been very weird but the most challenging part of life is dealing with other people and these dentists they're scientists they're physicists they love math and geometry cosines and tangents and now they have to manage staff and then their most stress is the patient and when you're sitting there you know having a beer with a dentist and they and they're just having a pity party it's always human relations between the staff and the patients they're managing 50 people in three cities so my first question everyone so who's more challenging the french and montreal  so so what would advice would you give of just getting along with the other cows and their herd 

Dr. Sam Daher : yeah well let me tell you what we what I started with  my office manager at the time was my business partner now Samantha Leonard we started Stream Dental HR Stream Dental HR is an HR firm or company that will help the doctor manage the team so and I found that to be a challenge being a being sort of at a distance I found that was one of the biggest challenging you get someone who's working with you for years they quit now you have to educate someone else so on so dealing with your staff your team members are your biggest assets but there can't be your biggest headache when they leave two as well now there's legitimate reasons why they leave and you can't blame him for fault them for that so what Samantha and I did we said well now that we've learned along the way what to do and what not to do the questions that we need to ask in an interview how to set up an office manual I can't believe how many doctors work without an office manual so they sort of wing it and that winging it doesn't work in this day and age we hire Millennials need structure we can't just say well if it happens or when it happens or when we get to that bread to across it you can't do it that way so what we decided to do is based on our experience based on our trials and tribulations we came up with stream dental and now what we do is not only to provide sort of the  interviewing process and come up with the processes there to help the doctors run the practice but we want them to be the least amount of headaches so we have an in-office manual we created a software whereby the doctor can enter each or the office manager can do that obviously whereby they enter each employee's name date of birth they each have a file on each employee whereby when the license is up for renewal you get a reminder hey Alexandra's license is up for renewal or when you do interviews what have you all that information is there it makes your life easier so that you as a doctor can focus on what you do best which is Steve which is or the patient attached to the t's so your staff should always remain your biggest assets so Stream Dental managed to do that and Samantha Leonard My partner and I and she's done an amazing job we've created this software that anybody that sees it said I want this how do we do this so you it's a subscription it's a monthly subscription and it's not a big subscription because we want it available to everyone whereby you can use the software will train on how to do it and it's meant to make your life easier as a doctor so whether you have five employees or 50 employees it doesn't matter it's limited to how many employees you want to use it for but it always does the same thing and takes the stress and the time the time management that the doctors spend on working in the practice you want them working on the practice not in their practice so I'm very proud of that accomplishment Stream Dental HR

Howard: now is she in your British Vancouver Columbia office or she in Montreal 

Dr. Sam Daher :she was in my Calgary office so it's the third one that you'd have meant him and so then the business got that stream dental get so busy that she actually get what guess what quit she goes I'm quitting as your office manager I'm remaining as your business partner I go what you know what you have to do before you leave she goes yeah I know used dead stream dental to find my replacement sure enough she did so so is she with you now she's not unfortunately I'm in Vancouver and she's in she's in Alberta but we connect on a date on a weekly basis but she's not with me right now huh love to bring her off yeah well that is just so important 

Howard: I mean it's just HR is everything my buddy Fred Joyal writes these amazing books called marketing is everything and I just think HR is everything I mean marketing is so important but gosh HR is just so tough so uh my gosh I can't believe we went over all this is there anything you were hoping that I would talk about that I was uh did not bring up

Dr. Sam Daher:   one point is just because and it comes out of pride more than anything about I have a product that is called sterilized I'm sorry mission yeah that's your i that my name is on the bottle so after mention it you understand so a sterile liner is a solution that cleans aligners we got it fda-approved in and health canada proved it it's selling all over the world but the way it was born the story behind it is amazing I have a lady an older patient was 73 years old we're treating her with Invisalign because she wants a nice smile for her daughter's wedding but she comes to me she pulls me aside you know with her generation being privacy goes doctor door I want to ask you is there anything I can use these tablets you've given me to clean the aligners they make them look white but they still smell and they still taste funny these aligners so try this try that nothing would work out so finally I met with a classmate friend of mine and a PhD chemist and we worked out a solution for about at least 11 months and then we came up with sterile liner so what sterile liner does is it will clean your aligners in three minutes not only its antibacterial 100 percent antibacterial and it will kill the bacteria but get rid of the taste and the smell and now we're selling it all over the world sterilizer calm the reason I'm proud of it is because my partner now we personally worked at it we tested the different product and my name is on the bottle did I mention that so it really has to do more with ego than then than anything else and I'm proud of it and it works and we had to test it against any control product whatsoever via retainers Hawley retainer mouth guard sports guard bruxism applying sleep apnea you know a Health Canada and FDA made us test it against all that so we passed with flying colors so I'm proud of that well 

Howard:  I just I just retweeted your last tweet at on Twitter stair aligner com - are my gosh we got a 25,000 Dennis following me on at Howard Frantz TWitter thank you so much for following me I know you're driving to work and it's hard to take notes so he talked about that product so I just retweeted that it says our revolutionary a liner cleaner is to use just a few minutes a day can keep your liners or retainers spic and span and there's this guy's name on there named Sam don't yeah I don't know where that's going from and free Americans he's so sweet instead of just having 473 milliliters he went ahead and converted it to ounces for us cretins here don't know metric but by the way on your sterilizer I was wondering about you because you have a lot of tweets about kind of meditation or are you a meditation guy 

Dr. Sam Daher :yes we so III believe in and you know did the old at it you know a healthy a healthy mind and a healthy spirit helps would be with the worldly health as well so I certainly am and into meditation into taking a step back into counting until ten before you know your anger takes over so I'm certainly into that well we're the land of Lululemon I just all that's all I have to say Lululemon was you know Chuck Wilson as a Vancouver right so I just want to mention that 

Howard: yeah so anything else I was uh so we talked about your sterile liner anything else I didn't talk about no you do you did you did well hopefully next time we will connect we'll talk a little bit more clinical if your doctors are interested or um you know I owe you an extra hour I'm happy doing that let me know what your listeners want and I'm happy to come back and talk about what they choose 

Howard: okay and I know one thing they're gonna ask cuz I get this question all the time but by the way a lot of people always ask me they say hard why do you put doctor dr in front of people's names you just put their name and then their initials afterwards just like oh that's very North American of you I could show you Arabic names and you couldn't even tell me if it was a boy girl and  so in Portugal in Portuguese it's draw and dray I mean so we do all the things we can do to help the two million dentists around the world try to communicate better and you know we know the DDS value name doctor dental surgery the MS master in science but a lot of people don't know what FR c d and then why there's a c in a posture in brackets explain that to them 

Dr. Sam Daher : so that's fellow of the Royal College of dentists and the C is Canada I don't understand why they put the C in brackets so fellow of the Royal College of dentists of Canada and in Canada all graduates have to write an internet sort of a 2-day exam to become a specialist above and beyond what you go through in in graduate school so it's quite an accomplishment so that's what it is fellow of the Royal College in Canada you're not allowed to put anything other than DDS and a CE fellow of the Royal College of dentists of Canada despite the fact that I was an associate professor at the university of Pacific for five years or a professor you can't put any of that unfortunately so we're limited to that so I'm a fellow of the Royal College of dentists of Canada 

Howard: well I would if you speak two languages you're bilingual you know what it's called if you speak one language unilingual no American and the America and the Americans are the only dentists on earth who on their website never bother to put a country on there they just assume that you knew they lived in Oklahoma it's like dude there's 220 countries you're writing me an email asking me why I'm putting doctor and for the names it's incorrect you don't even have what country you live in on your website there's a big world out there and you and I  still think the biggest gift that ever had me at August 4th will be my 30 year anniversary of lecturing and when I gave my first lecture I never had any idea that one day I would have lectured in 50 countries where I took anywhere from one to four of my boys with me I mean we became I mean so this planet to me is like a small little backyard thing it's or it's really really cool but Sam love what you're doing I really hope you put an online CE course on dental town to be the best marketing for you all your dollar liner into your everything you're doing because I know my homies and they just they just love to what see one hour at a time and those  courses on dental town are coming up on 1 million views and when I ask and they I say why do you why do you like to all night  they go dude it's cheaper than taking an uber just to the airport let alone flying to another country learning ortho and then and also what they tell me is they're not sure if they would want to listen to this guy all day so they want to deconstruct and listen to him for an hour first in fact pinky said it was our Dawson Academy and pinky thought it was great marketing because you know they have like all these week-long courses they'll say well let's just do a one-hour course about week one and that deconstructs it so now that after an hour they're like damn I would like to go listen to that all week so online see is great richard list as a trailblazer you live in the greatest city in Canada love that we love that place it's the only i mean it's the only it's the best authentic Asian food hands-down and the other thing that you don't realize this if you never got up there is when you think of Canada you think of this cold area British Vancouver is a rainforest and you don't you have to see it in fact let me tell you this if you don't do the Alaskan cruise which starts in Vancouver British Columbia and then you sell up for a whole week and you probably see what a billion trees and order isn't it I mean it's just absolutely the most gorgeous place on earth probably second only to Wichita Kansas and thank you so much for coming on the show I'm so it was an honor to podcast you today thank you so much Sam I appreciate out it's so good to see after all these years it's good to see you my friend here  

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