Amir Abolfathi is co-founder of uLab Systems. He has over 32 years of operating experience in the healthcare industry focused on developing and commercializing cardiovascular devices, dental products, hearing prosthetics, and genomic diagnostics & analytics. Prior to uLab, he founded four other medical device startups since 1995. He was VP of R&D at Align Technology responsible for product development and clinical education during the first six years of Align inception. Prior to Align Technology, Amir held a variety of executive positions at Pfizer, Guidant, and Baxter-Edwards. Amir holds over 100 issued patents. Amir received an MS in Engineering Management from the University of Southern California and a BS in Biomedical Engineering from the University of California, San Diego.
VIDEO - DUwHF #1280 - Amir Abolfathi
AUDIO - DUwHF #1280 - Amir Abolfathi
Charlie Wen is the cofounder and president of uLabSystems, an AI based software company to enable doctors to create computer assisted treatment solutions in office. A serial entrepreneur, Charlie has cofounded several companies in multiple markets including: OrthoClear, an orthodontic company exit by selling $20M; FourPosition, advanced indoor GPS device, Karegiver, an AI based senior assistant system, Dentul a device distribution company. Charlie is also known as first CTO of Invisalign, built technology to a successful $1B IPO. Prior to Align, Charlie worked for Hollywood, where two movies he worked on nominated for Oscar. Charlie is the inventor of 100+ patents, and won national math award twice in China. Charlie received his BS from University of Science and Technology of China. He received his MS from Caltech focusing on AI research 30 years ago.
Dr. Mic Falkel is a class of 1987 graduate of University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco, California. After graduation he attended his General Practice Residency at the Veterans Administration Hospital at West Los Angeles and has been in general Practice in Monterey California since 1989. Having experienced frustration with the performance of local anesthetic in his practice, particularly around the frequency of failed anesthetic, delayed onset, injection pain and post-operative discomfort, he began research into the pharmacokinetics of dental anesthetic. Based on this research, Dr. Falkel has developed an alternative new paradigm in anesthetic delivery science for dentistry. Dr. Falkel is the founder of Onpharma Company an anesthetic technology and products company. Dr. Falkel has a position as Assistant Professor in Local Anesthesia at The University of the Pacific, Arthur A. Dugoni School of Dentistry. In 2015 Dr. Falkel helped start uLab Systems, Inc. as the clinical founder.
Howard: It's just a huge honor for me today to be podcast interview Charlie Wen BS MS, Amir Abolfathi BS MS and Mic Falkel BS DS. Amir Abolfathi is co-founder of uLab systems he has over 32 years of operating experience in the healthcare industry focused on developing and commercializing cardiovascular devices dental products hearing prosthetics and genomic Diagnostics and analytics prior to uLab he was founded for other medical device star tapes since 1995 he was VP of R&D; at Align Technology law responsible for product development in clinical education during this first six years of Align inception, you remember they own Invisalign and iTero, prior to align technology Amir held a variety of executive positions at Pfizer didin and Baxter Amir holds over 100 patents received an MS and engineering at the University of Southern Cal and a BS in biomedical engineering from the university of california. Charlie Wen on the far left wave Charlie, Charlie Wen is the co-founder and president of uLab systems an AI based software company to enable doctors to create computer assisted treatment solutions in office a serial entrepreneur charlie has co-founded several companies in multiple markets including ortho clear an orthodontic company exit by selling for twenty million dollars four position advanced indoor GPS device caregiver an AI base senior assistant system dental a device distribution company. Charlie's also known as as first CTO of Invisalign built a technology to a successful 1 billion dollar IPO prior to Align Charlie worked for Hollywood where two movies who worked on nominated for an Oscar Charlie is the inventor of a hundred patents and one national math award twice in China he received a BS from University of Science and Technology at China Racine Ms from Caltech my gosh and then Mic Falkel is that right Falkel
Mic: That's it
Howard: Mic Falkel class in 1987 graduate of the University of Pacific Arthur de Dhoni School of Dentistry in San Francisco California after graduation he attended general practice residency at the Veterans Administration Hospital at West Los Angeles and has been in general practice in Monterey California since 1989, in 1972 the Monterey Peninsula Dental Group was formed to provide comprehensive dental care one convenient location and has been successful and serving the Monterey Peninsula for over 35 years their doctors and team maintain a high level of continuing education or to provide care utilizing the most modern dental techniques having experienced frustration with the performance of local anesthetic in his practice particularly around the frequency of filled anesthetic delayed onset injection pain and post-offer discomfort he began research into the pharmacokinetics of dental anesthetics based on this research he developed an alternative new paradigm in anesthetic delivery system for dentistry and is the founder of Onpharma company an anesthetic technology and products company. Dr. Falkel has a position as assistant professor in local anesthesia at the university of pacific, in 2015 he helps start uLab systems as the clinical founder uLab is a disruptive orthodontic service company. I feel like I'm talking to the three smartest people in dentistry and I should be given like flashcards on what to what to ask or what to say my gosh I mean what do you guys do for further for grins just sit around and do calculus or you do trig and geometry in your head when you're bored I mean my gosh so I don't even know where to begin with you guys you guys so much should we start with so we start with Orapharma or uLabs or why don't we start with uLabs because we started it was on the last podcast with Cristian Kenworthy where he basically used uLab systems for his orthodontic software because he wants to make in-office aligners is that the core of uLabs?
Amir: To some extent yes so we started this company the three of us four years ago really on a premise that what we created twenty two years ago kind of took the control out of the orthodontist and the clinician to do the treatment planning because a lot of things were unknown back then twenty two years ago when Invisalign was being created we didn't have the computational power that is available to us today we didn't have intraoral scanning the 3d printing were not in a state they are today as cheap and is inexpensive and also resolution that you get today and by virtue of all those constrained the system that was designed was designed in such a way that it was a centralized model highly controlled by the manufacturer and like anything else as businesses grow and scale their legacy issue and they keep the same architecture so about four years ago we kind of looked at the state of the technology and each one of us kind of arrived at it kind of on our own and we realized that nobody is kind of breaking the mold and kind of coming up with new ideas of doing aligner system differently and that's how uLab got created.
Howard: Man that was genius ly succinct 22 years ago you obviously didn't have that the computers were much slower I hear that from the CAD CAM developers when I would go to Austria and talk to the Sirona people way back in the day they would say that the whole thing was limited by the power of the Intel microprocessor and every time Intel came out with a bigger chip they could add more software so the computational computing power got bigger the 3d printing power got bigger what else besides computation and 3d printing technology?
Charlie: I think things autism and I think we still up to today that co-opt architecture of all the orthodontic companies other than uLab is based on the architecture we kind of figured out 20 years ago and it's basically suitable for centralized manufacturing and I think the new architecture will be much faster and intelligent than the previous one so that the doctor can use little of their time to create a treatment on the chair side and I think that would goal of uLab system it's more like a Sirona for the crown and bridges.
Howard: So the algorithm so would explain to an algorithm what someone who doesn't know what algorithm is how would you describe that.
Charlie: So basically explain the process right before that the doctor has the look at crooked the teeth and they say okay how are gonna treat this patient read write a preschool reform without a kind of dreaming and the goal right but that thing cannot be described in a term that the people founded miles away to interpolate it correctly and the algorithm what we have using corresponding things we cannot disclose in detail because it's our secret and it can't use the single fingertips then we can see the result right away and how the teeth are changing instead of liking the preschool fault we can get the treatment right on the chair side that's the advantage of the uLab system for now so in that way that we have the control back by themselves they can't do exactly what the treatment we want to do instead of telling somebody for themselves.
Howard: So all this algorithm comes from the Persian scientist astronomer and mathematician Abdullah Mohammed ibn Musa al-Khwarizmi often site is the father answer I think it's funny that I'm the word algorithm was the English way of trying to say this poor man's name and they got they mispronounced his name so bad that we call it an algorithm and nobody who speaks Farsi I can look at this guy's name and say how did everyone come up with algorithm for ibn Musa al-Khwarizmi do you know how to say it?
Charlie: al-Khwarizmi
Howard: Khwarizmi
Charlie: Khwarizmi Yeah
Howard: So how do they get algorithm out of Khwarizmi?
Charlie: I have no idea.
Howard: Strange strange choice but yes so how I think it's interesting that this is what people do the the business model gets built and then people just go along with it for 30 40 years until someone comes on like you and just destroys the system so is this going to, do you think this is going to move instead of me scanning with a system and it goes to Invisalign which means it goes to Costa Rica and they do all this processing and mail the aligners back to me do you do you think this is gonna be scanning in your office and milling and making the aligners in your office and no more need for Invisalign someday?
Amir: Well I mean I would say it's already happening I mean so we started commercializing the product about a 15 months ago on a limited basis by limited basis I mean we only have three sales rep and to support staff that they handled clinical education we have about 220 providers that are actively using the product we expect to have about 600 by the end of next year so there is definitely a demand for from the clinic that are interested to do their own aligner and also would say we are not limited to just align your system our vision is much much broader than that we started with orthodontics because that was our core competency because of our background with Invisalign twenty years ago but today's platform that Charlie and his team developed allows the doctor to not only do aligner but also indirect bonding and very soon there they could do combination treatment seamlessly through the software so we are in a way agnostic of whether the doctor wants to use our software for aligner or bracket system or a hybrid system and then longer down the road Mic our partner here wants to use the platform to branch out in other sectors of the cosmetic dentistry and dentistry.
Howard: What do you what does that mean to you Mic?
Mic: So you know it means quite a bit Howard to be honest with you but the idea of being able to do your orthodontic treatment right now in the office so if your let's go back to Invisalign for a second if I started Invisalign case now I'm probably going to deliver the trays in about a month three weeks Tremont's something like that with uLab we're being we're seeing results where you start the case 45 minutes later you're delivering the trays.
Howard: Wow
Mic: So that's that's a significant disruption in the technology that's available today so the orthodontic platform I think is is spectacular where we want to go in the future is we're gonna be doing we're gonna be adding in things like an aesthetic dentistry I'm a big believer in doing a diagnostic wax up but you know the diagnostic wax up I look at it on the articulator and I try to show that to the patient they don't get very excited about that but if I can take an impression of that pour it up in stone make a stent and then put a composite add that onto the patient's teeth they smile on it with their smile and they look at and say now I'm ready to go so that's a great sales technique if you will give the patient a preview of what they're doing. Well with with uLab we're going to be able to do the diagnostic wax up digitally and create the device that we need to bring to the mouth and show them what their end result would be before they've ever left the consultation instead of having them come back after a long wax up procedure is being done so that's really exciting because that's going to allow dentists to show patients what they're gonna look like right away also with or that with aesthetic cases quite often you have to move teeth you know one of the reasons patients want a nice smile is their teeth are crooked but they don't want to go through orthodontics but if you could do a minor amount of tooth movement you could dramatically reduce the amount of tooth reduction you need to do to do the veneer case or whatever porcelain work that you're doing other things we're working on our simultaneous treatment of obstructive sleep apnea and orthodontics so you'll be able to treat both at the same time with the hope that at the end of the treatment they don't need an appliance because their arches have been developed in a way that they can actually breathe better and perhaps not need an appliance at all and that's not available anywhere and I think will be the first to bring that to market. We're also going to be working on tmd treatments so being able to create tmd appliances combining the use of the 3d technologies that we have in diagnostic radiology using cone beam now we can actually place the joint where we want it to be in the comfortable position and then develop the occlusion around that which will be a significant change in the way we can treat TMD cases and then finally we're working on implant site development you know quite often people who need implants teeth of super erupted the teeth the migrated will be able to fix the sites so that the implants can be done in the best possible fashion. So those are some things that are in our pipeline that we're going to be working on moving down the road.
Howard: That's a big pipeline.
Charlie: Yeah Howard, just talking about the trend you asked the question I'm trying to answer is the dental industry is similar to the paper printing industry 20 years ago we probably only want to print something we have to go to centralize the computer lab log a time and the print a piece of paper and after 10 years the Kinkos come out saying okay you just need to give me a floppy disk clogging a Capri needed for you and now the 2d printer is so reliable and a convenient cheaply not people get to buy the printer to their home and office they're on the print and I think the dentistry will go in that way as well from a centralized manufacturing to be regionalised eventually to the chair side but the one pitch is doctors spend years in dental school and we have many years of experience when they see the patient we have much more information than people signing a piece of beta far away and let somebody else to handle it and and also it enable some of the treatment you cannot do you cannot wait and then switch right away for instance that we have we see a big trend that our daughter are trying to debunk braces we earlier than we used to do and put a few pieces of you level and to finish the cases and we have other cases like a Mic mention that somebody wants to put a crown there but he wants to up right the root a little bit and the he can quickly put a few you level honest up route and then just get the crown in so I think that's the trend is going that way.
Amir: Yeah so the key here is Howard is giving true control to the hands of the clinician because when you go to other manufacturers you pay it dental lab fee you get a box that just moves teeth or does a certain things what we are trying to create here is to enable the doctor to not only align teeth but to do anything they want they have a software platform that is not restricted for them to play around and do very customized treatment for each patient that they have so his and you know we hear the word open-source in a software world this is a really open source kind of a product for them if they buy printer they could build any appliance they want using this platform you know related to orthodontia of course right now to kind of treat their patient and that's what we want to do that's what we want to do for this community.
Howard: So if an orthodontist right now has an iTero oral scanner they're using it vis line but it's you know between scanning getting the trays is almost a month and you were gonna do this where you were gonna scan and chairside mill how much capital equipment would you have to buy how much are these 3d printers what would you have to invest to be able to do this within the hour?
Amir: Not much I mean so you could buy a printer as cheap as $4,000 today that would do the job for you I mean we don't recommend those type of printer but I think a good robust benchtop printer that has a good resolution and a good speed because speed is the key here he's probably gonna cost you somewhere between ten to fourteen thousand dollars.
Howard: What printer do you recommend?
Amir: We have preferred partners we have three of them we have Strucktro is one of them there is a Sprint Ray another one and the Envisiontec we ting all three of these manufacturers are really focused at the orthodontic market and so they have developed a machine that is fast accurate and doesn't require too much space and I think is economical and now you have probably two or three dozen other manufacturers that have printers that they do a great job but they are printer for general purpose so you might be paying a lot more for a printer that you might not never use the capacity that it has so that's why we have this partnership put in place so for the orthodontist that are new to the 3d printing industry when they ask us what we'd recommend we will recommend those three right now.
Howard: That's on your website I'm on uLab systems where would the list of those printers be?
Mic: I think its on the website.
Amir: Yeah so that they should be a list on our website that has probably about 12 to 15 printers that we have validated that based on an FDA cleared protocol that works with our software but those three that I just mentioned we call them preferred partners we have no economic interests in that transaction so it's not like we are saying their preferred partner and people buy them and we get some money out of it we get $0 out of it the only reason we call them a preferred partner is because we feel for somebody that doesn't know 3d printers that would be a suitable one for an average orthodontist that wants to start making retainers and aligners and dental products in their office.
Howard: Yeah I don't see that preferred list of printers on your website I am I missing it or....
Amir: You know I I don't go on our website every day but I think it would be what's there.
Howard: Okay did you find it?
Amir: No
Howard: Okay yeah so it's you recommend three printers and the best ones are probably about 10 to 15,000 you say?
Amir: Yeah in that range yeah I think both Envision Tech and Sprint Ray are in the 10 to 12 thousand range and Structure is a little bit more expensive but it does more I mean so they have a machine that not only does the 3d printing but they do a little bit of that post processing which is cleaning and curing so it offloads the labor long-term and it pays for itself so for some offices that's worth it.
Howard: So this seems like it's gonna be very disruptive to invest to align technology?
Amir: Oh yeah we believe so I mean you know we are the three of us here sitting here we are technologists you know and by that I mean that we gravitate toward technology solution and less so toward marketing and sales solution so I mean there is not a I would say a week that I don't get an email oh here we go another aligner company but when you look at all of these new companies they're all are either changing the distribution channel or they're changing the pricing model but there's really nothing unique in terms of the technology and so what we try to do is come up with the technology that is going to change and really benefit in a really a value-added a way for the clinician that's gonna use our product and we believe it's gonna be not only disruptive to I would say a traditional aligner manufacturer but also fix appliances because as we mentioned as Charlie mentioned about how our cases right now with our 220 providers our hybrid cases meaning they're the doctor's realizing that mixing and matching the biomechanics of the fix appliances and aligners actually benefits the patient and benefits them so they debond the bracket cases toward the end which there is a lot of trial and error bending the wire and they switch them to a liner system which is more predict predictive in terms of getting them to the end goal so we think that's that's very disruptive and we are putting a lot of resources or any dollar to make the software even with more capability to allow them to seamlessly program a hybrid case.
Howard: Your out there in california and you've seen the smiles direct club IPO was kind of disaster and last week your california governor just signed a law changing tella dentistry rules what do you think of the smiles direct club who was trying to use a tella dentistry technology to disrupt orthodontics to deliver it you know lower cost versus the Invisalign model that was built around still needing to see a doctor what do you what are your thoughts on smiles direct?
Amir: I'll give you my thoughts on maybe Charlie and Mic could chime in, I mean, first of all, I mean I would say a four billion dollar valuation is not a disaster okay so I they must have done something right but you know I personally I think what smile direct Club did with there was a void in the industry for a group of consumers which are the significant portion of the folks with malocclusion that either cannot afford a three or five thousand dollar treatment but at the same time they want to have a better smile and so they fill that void and unless there is other solution and I think we are one of those solution you know they're gonna they're gonna have a good business now I know in California they're gonna have a tough time but they're gonna build a successful business and they have already built a successful business creating that void so that's just my view on is I don't know Mic what's your view?
Mic: Yeah so my view on smile direct Club is you know from the clinicians point of view I completely see what the American Dental Association American Association of orthodontics are talking about with respect to the potential for danger for the patient and not a bitten no ability for recourse for that patient as well saying that like like Amir said I mean they found a position in the marketplace that that certainly worked to get them to an IPO and that is that means that there's something there that the consumers want so if we could find a solution that would combine the ability for a dentist to oversee the treatment yet not have the level of oversight that costs a significant amount that is a win for both the patient and the dentist as well and the patient is going to be treated successfully under supervision but lighter supervision which may be something that competes with smile direct Club.
Howard: Yeah there does seem to be a low-cost auction option I mean it's either $6,500 orthodontist braces or nothing and then when someone comes in to you build something that's faster easier lower costs it's hard to tell is this just a good old boys stopping disruption and competition to preserve the status quo or like you say there's something there which I think is the market would like a lower cost alternative to $6,500 braces and they were kind of delivering a $4,500 braces do you agree with that that they were appealing to a lower cost?
Charlie: I thought my point of view I just my own personal view and I think that long with our point of view they could be responsible for the patient and they should put quality of care to the patient as well and costly the issue there I think that uLab provides the flexibility that you can use us offer and decree the treatment right away actually a lower the lab bill Oh quite a bit for the doctor and they could provide the quality care to the patient in the meantime give a low-cost offer but I'm not going to the market that lower the cost and without thinking too much on the quality of the care.
Howard: Interesting and also there's another in industry um it's kind of seems like a lot of these companies either focus on and when it comes to orthodontics and say just focus on the orthodontist or are you mostly just focus on the orthodontist since they probably do what percent of the ortho you think in the United States is done by orthodontists as opposed to general dentist?
Amir: I don't know how you still have that number I don't have it anymore I you know I used to know these numbers when we were at Invisalign but right now I don't have it I knew they were about back then about 25,000 GPS that were practicing orthodontist on a routine basis so that was a significant volume and last time I was looking at Align’s kind of a data he looked like their business was split 50-50 in at least in u.s. between GP and ortho but I'm not 100% sure about that.
Howard: So will you guys be agnostic as far as if you're north and honest for general Dennis I mean would you like to try to stay with orthodontist or does it not matter.
Amir: I think long term it doesn't matter for a short term it does matter for us because we are a start-up we have limited capital so obviously when we go to an orthodontist office they have the volume and they do fix appliances and they already do clear aligners so I mean we don't have to spend money on educating the GPS how to do orthodontics you know I mean the one that want to do it but they haven't done it before whereas orthodontist already have that education that they have used aligner system before they have used fixed appliances before from a legal point of view I mean obviously we cannot restrict GPS from using our system if they want to use it but from a practical point of view our focus is right now orthodontic market and our sales force call point is to the orthodontic office right now.
Mic: and I think I'll pick that up a little bit you know as we develop that pipeline we will have many products that give the ability forth for general dentists to use uLab systems in their office and then if they want to learn orthodontics and do orthodontics as well they'll be able to do that.
Howard: and what is when you look at you design and the technology is you design it's at a more AI or is there an artificial intelligence part to your company?
Mic: Yes
Howard: Any more than one word is that your secret sauce that you'd prefer not to talk about you can tell me anything you want because my natural intelligence won't process any information about artificial intelligence I haven't evolved that far.
Charlie: Yeah we use a lot but we don't because nowadays I feel that there are lots of company just use AI to square on to talk to investors and trying to get money but we do use AI and I think that from my point of view I did AI thirty years ago and when I first came to the States the AI is depends on the first a delay is neither data and then you have the linear algorithm and then you run through the training process and get your optimal right and the key is AI can only mimic what your data represent and if you have cracked data although you have a whole bunch of gigabytes of data and the algorithm are gonna be crack right and work what we have is at you design we let doctor to use our software I intentionally we have the treatment already recorded it to the cloud and based on that theme we are learning from it and all this talk is high-end adapter and we know the biomechanics clinic knowledge how to provide a high quality treatment so I think that although our data we have fewer cases than other companies but we have high quality data and so we think that the treat the algorithm come out from our data is it's also more high quality.
Howard: Yeah a lot of people think this AI is brand-new but you've been studying here for 30 years.
Charlie: Yeah it was actually used for the defense industry earlier that's Nestle primary my research my first get to the state.
Howard: So Mic what are you more excited about are you more excited about I mean you've been on with Onpharma for years and years of years they've been talking about it on dentaltown for over a decade or are you more with Onpharmaand are you more with the new uLab systems are seeing patients how our what are you most passionate about today?
Mic: Well what I tell you what I'm most passionate about Howard is is just advancing dentistry you know dentistry has given me everything I have and so if we can make dentistry better for practitioners and for patients then that's my passion so I spread my time pretty evenly between practice Onpharma and uLab.
Howard: Well explain the Onpharma and there's a lot of kids still in dental kindergarten tablets in this show we think about a quarter of them are still in dental school they're always sending me emails Howard@dentaltown.com but for the kids tell them what uniform it is and what that's all about.
Mic: Sure so Onpharma we developed you know my I started at on Pharma trying to make local anesthetic better better for me better for my patients you know we set out to allow anesthetic to work it doesn't always work for me and it doesn't always work for our patients so the idea behind it is to add sodium bicarbonate to the local anesthetic at a very precise pH so then every cartridge of anaesthetic that goes in is delivered in a way that is better for the patient it'll allow for a more comfortable injection it allowed for anesthesia to come on predictably and very rapidly and allow for anaesthetic to fail a lot less often.
Howard: So explain you know there it's very confusing I mean there's they're Sites there's Prolacane there's my pivot cane if someone was as not done 50 fillings in their life and what how would you sum all of all that up what do they need to know and getting someone profoundly numb?
Mic: Sure yeah so what you're describing is there's five flavors of local anesthetic in dentistry in the United States with nine different formulations which one do you use well what I would recommend and when I teach about local anesthesia is you only need a handful two or three but you should have two or three and you should know everything you can possibly know about those and and that's all you need to have in your office, especially if you're going to buffer local anaesthetic because you will be able to make look those three or whatever number of anesthetics you choose to have in your office work predictably every single time and that's the idea behind it is being able to be efficient predictable and as comfortable as you possibly can for patients.
Howard: Well that sounds like an amazing one our online CE course you should make for dentaltown.
Mic: Okay
Howard: You said you spread your time evenly I mean they let me we put up four hundred one our courses they've been viewed almost a million times people love these one our category category killer you know online watching your iPad do you think you could ever do something like that to help them out?
Mic: Sure I'd be happy to.
Howard: Nice especially when they're coming out with two hundred and seventy-five thousand dollars in student loans and really don't want to fly across the country every weekend to learn something the online CE is so much better. What percent of the time do you think a normal dental practice would need buffered anesthetic?
Mic: So I wouldn't practice without it Howard I think that every patient needs it on every injection.
Howard: Every patient needs it on every injection.
Mic: If you want to be predictable you want to be as comfortable as possible and as efficient as possible in your office yeah that's the way I feel put this way if you took it away from me it's time to retire from clinical dentistry.
Howard: Yeah that's I have a couple assistants I've been with me 20 30 years I always our rule is if you call in sick that day you got to call me first so I can call in sick because I cannot stand to go into work with a that with a temporary assistant oh my god there's just nothing more frustrating for me but so what percent of the dentists do you think use it every day?
Mic: You know that's hard to say I'm gonna go and say that it's it's it's a fairly low number I think that it's probably under five percent.
Howrd: Under five percent and you're saying that every dentist would probably if they understood this would probably find it useful?
Mic: I think every patient would find it useful therefore every dentist should find it useful.
Howard: Wow so that is a really big gap and you guys are legends in knowledge technology I mean I seriously it's humbling to read your three resumes I feel like on that Sesame Street member one of these things doesn't go with the other well I'm that guy on this on this pod yes like I don't go with you three guys so you guys are really really out there intelligent why do you think 95% of dentists aren't thinking about this when obviously not getting someone numb is it slows you down upsets the patient it you know they jump they hurt why do you why is there such a disconnect?
Mic: I think we learn you know in dental school and then we get in habits in our office and have it too hard to break.
Howard: So in your office is it all general dentists?
Mic: Yes
Howard: So are you into the clear aligner, are you doing a lot of clear aligners too?
Mic: Yes
Howard: Well that's kind of another bizarre thing in dentistry like when you're in dental school the the endodontists help you learn endo the oral surgeons help you pull teeth but there there's you've no one's ever really felt the support that the orthodontists want to help you learn how to do ortho is that do you sense that in California where you're at or is that just not true?
Mic: Well I will say that I think I'm following your question but orthodontics in at least where I went to dental school we really worked at we really talked very much about orthodontics maybe it's because at UOP there's Arthur A. Gonia School of Dentistry there's only an orthodontic specialty program at least when I was there I think they had
Howard: And Art was an orthodontist
Mic: and Art was an orthodontist as well and so we really didn't understand we were taught really well how to refer to orthodontist but not really anything about orthodontics and so you know I had to get all my knowledge outside of dentists so I treat with clear aligners i creaked i treat with with fixed brackets and I treat the hybrid case that's my favorite way of treating patients.
Howard: and why is the hybrid your favorite way?
Mic: The reason the hybrid is my favorite way is you know i the best way I could describe that is you know when you do an Invisalign case and let's say you get thirty a sets of aligners and at the end of it what's the percentage of time that you have to do a revision and in my estimation it's a hundred percent at the time and another word you could use for revision is failure because if 100 percent of the time I have to revise the case then that is a failure so the reason for that is because there's a lot of movements of teeth that aren't predictable with aligners but are very predictable with fixed orthodontics so if you can take care of those first and then switch to clear aligners to finish the case which is much easier to get to a nice finished case then you've been able to speed up the process for the patients if them out of the brackets quickly and into aligners that have predictable movements so you can finish the case nicely you've got a great combination so that's that's why I prefer hybrid.
Howard: but you feel that you didn't they didn't really teach you orthodontics at Arthur A. Gonia School of Dentistry?
Mic: Not 35 years ago when I was there.
Howard: I mean we're talking we're talking about I have I know dentists who are married to an orthodontist and they're they can go to the aao meeting because only orthodontist can go and your spouse who you slept with last night who's a dentist isn't allowed in the meeting I mean how much more how much more insanity I mean in dental school you could ask anybody can you help me do a molar root canal and then it also run in their pediatric everything but again you asked well can I do an ortho case they say well you should go to ortho school. So do you think this it's the only specialist that does that I mean I mean I own ortho town and I'm I'm not allowed to go on the site I own it but I'm not an orthodontist or as dentaltown all the other specialist paediatric dentists they all talk and share amongst himself so do you think this one weird thing about orthodontics will cause issues as you roll out uLabs?
Mic: Well I think I think to be honest with you I think that you know orthodontists are protective and and you can't blame anybody for being protective of their space but I think what we may find out from smile direct Club is that the piece that the pie is much bigger than we think it is meaning that there's a lot more business out there than then we're able to get to and possibly that's because orthodontics is expensive from a consumer point of view and so if those things open up because because the cost comes down whether it's direct consumer or it's you know some hybrid with it with an orthodontist or dentist then that gives a lot more opportunity for orthodontics to be done and and to be quite honest with you there's not enough orthodontist probably to take care of the need in the United States so the general dentist is going to have to become more educated and have an opportunity to take care of the orthodontic patient and they should be very selective in the cases that they do just like with endodontics you know the general dentist is perfectly qualified to do a root canal but they should select the easy cases and let the specialists take care of the hard cases it's just smart and that's the way orthodontics should be as well.
Howard: Yeah I thought the best thing about the Smiles Direct Club the whole thing is that now the orthodontist I'm the general dentist wouldn't be the bad guy anymore there was actually someone someone worse than us and that maybe we would I thought it you should bring orthodontist and general dentists actually closer. So you also talked about some other interesting aspects of it with with sleep how was I were you going with that with sleep?
Mic: Right so you know sleep obstructive sleep apnea we're really and I think that that medicine and dentistry is in the infancy of learning about that but what we do know is that you know we need to open the airway and so if you can if you can widen the arch and bring the lower arch forward you're going to open the airway and right now we do that with an appliance just by bringing the lower arch forward but if you can treat the patient orthodontically and widen the arches and bring the lower arch forward you actually can treat the airway and make the airway open and so the problem is if you're in an appliance that holds your jaw in one position you can't move the teeth so what if you could move the teeth 24 hours a day but also have the sleep apnea device that treats the sleep apnea while the orthodontic are occurring with the end result being that the patient doesn't need to wear an appliance but they're fixed so that's the goal with that treatment modality.
Howard: and uLab announced a relationship with xin dura with bae materials what's that all about?
Amir: So Ray Stuart the CEO founder of Bay material is a gentleman that both Charlie and I we know very well because he was actually one of the key guy during the Invisalign time in helping us develop three generation of material for alloying technology and after we all left he went on his own and started Bay material and based on that knowledge he started Bay Material and and made a pretty successful business so when we opened the door here at the uLab we called him up you know a few months later to kind of let him know what we are up to and but because for the last three and a half years we've been mainly focused on the software there was really not much interaction between us and Bay Material but as part of our new product offering that we are hoping to launch at AAO or next year or early next year we're gonna have an aligner product where for the orthodontist that don't want to essentially build their aligners in your own lab or they don't want to build all of it because one of the feedbacks we have received from the current customer is hey we are okay making the fuse first stages get the patient out the door and have same delivery aligner but we don't want to turn our back office into a manufacturing facility so we're gonna provide that service as an additive service by that service I mean aligner product and as part of that we needed a material partner and after looking at a number of other materials that are out there we felt that Zen Dora is probably the best material right now and we forge a relationship with Zen Dora and we're gonna use their material in our own manufacturing facility and as part of the deal they also offer the discount to our customer base so both sides could benefit I mean we are you gonna use it in our manufacturing and anybody that is using our software as a licensee could benefit from a preferred discounting as part of this relationship.
Howard: You know it's really I'm amazed you know a really clear mind realizes there's there's market segments based on price on all kinds of market segments and you know there's always a cycle I love the statistics we're 1970 there were 10,000 micro breweries they got all the way down to 70 and now it's back to 10,000 I mean it's always about consolidation and then as soon as they're all consolidated then it consolidates and then it consolidates again and so many people don't realize like there's so many different market statements there's just gonna be a lot of people who don't want to make their own trays and then there's gonna be a lot of people who want to make their own trays and they're just there's so many different markets and so many young people when they get out of dental school they think there's one market that fits all and there's just nothing further from the truth. You guys have been in the in the market for a long time I got out of school in 1980 that was the worst economic deleveraging I'd ever seen it was 21% interest rates then I got out of school in 87 just in time for Black Monday and then there was the y2k bubble popped and then there was Lehman's 10 years ago it just it just smells like teen spirit again it just smells like we're right back where it is you guys live in Silicon Valley your friends are all over Silicon Valley does it smell that way to you again?
Amir: Yeah yeah to some extent yes but I don't know I mean my feeling changes week by week if I have to say you know some weeks I feel very positive some weeks I say oh no you know but generally I think we are I feel we are on a downward trend or something is gonna happen I just have that feeling.
Howard: Well you know Joseph's super got a Nobel Prize in Economics for business cycles and I always thought to take away maybe it was my instructor that jaded me but he said you know at the end of the day it's a bunch of wild monkeys making all the decisions after after seven eight nine ten years a lot of bad decisions gonna get cleaned out he thought it was kind of a it's time for the tide to go out to see who's swimming without any swimsuits on and clean up all the messes but Charlie you think you think it's on you you think we're in another economic downturn?
Charlie: I'm not sure I think it's still continuous for the next two or three years.
Howard: Yeah there's two worlds about bubbles they always they always pop but they always get bigger than anyone ever imagined so I'm sure you've given that time. Well gentlemen I can't believe I got you three come on the show I mean it was really a huge honor and we talked about so many things is there anything I didn't talk about that you wished I would have talking about?
Amir: Not from my perspective but I also wanted to thank you for inviting us to your show it's been a pleasure thank you for having us.
Mic: I really appreciate your time Howard this is great great service for your dentist at dentaltown as well.
Charlie: You did ask a question say what we need to talk to the young dentist what are we going to share with them I think I have some point for them.
Howard: Good let's hear it.
Charlie: and first thing first I think the dentistry is going more towards the digital and whatever the CAD CAM tools like you have software and again a hand on it and it would be helpful second one is I think that now because all the cloud competing and you include uLab we actually have the you design tool facility that people can share information between different professionals and we can learn from each other and I think that's that's critical and otherwise I think they should control their own destiny trust themself yeah you know I think from the bounteous of dentists the why so many ways there are always artists the thinkers and they want have something that we have their own philosophy how to treat the patient and trust themselves and just use the tools in their hand and make magic happen.
Howard: So if all three of you had a baby at home who was 18 years old and getting ready to go off to college and she said I've only got two choices I'm either gonna be a dentist just like my daddy or I'm gonna go there and learn Python and start programming artificial intelligence what do you think would be a better what would you tell her?
Amir: Well I actually have two daughters that are in that age group my advice to them is do something that contributes to the community because at the end of the day you feel much happier about yourself when you come home at night and if it's dentistry makes you happy that's great programming AI makes you happy and contributes to the community that's great too so I have a kind of agnostic of what they do as long as they contribute because I think they will get a fulfillment as an individual at the end of the day.
Howard: Well what scares you more how many cavities a person has are listening to their natural intelligence, where do you think they need more help brushing and flossing or artificial intelligence to augment their natural intelligence? Is Python is Python though the language is that is that pretty much the agreed-upon language for AI moving forward for now?
Amir: Python is an easy AI language for now but I think most AI language is not in Python.
Howard: You think most of AI will not be Python?
Amir: No
Howard: What do you think most of me what language should they learn should they learn Python first and then move on or is Python the intro language?
Amir: Python is the way to call on AI porcedures... not python
Howard: Okay well I look at whenever I go to a family reunion and I pray all day long for artificial intelligence just to come to our family but a gentleman again thank you so much if you ever want to go on dentaltown and tell them those words or tell them where they can go on your site to share those things that's all great thank you so much for taking the time out of your very busy schedules to come on the show and talk to my homies it's been very very fun listening to you guys today thank you so much
Amir, Mic, Charlie: Thank you Howard.
Howard: Alright have a great day