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1365 Dr. John Flucke, "Dentistry's Technology Evangelist" : Dentistry Uncensored with Howard Farran

1365 Dr. John Flucke, "Dentistry's Technology Evangelist" : Dentistry Uncensored with Howard Farran

2/28/2020 3:00:00 AM   |   Comments: 0   |   Views: 362
Dr. John Flucke is in private practice in Lee’s Summit, Missouri where he spends four days per week in direct patient care.  He also serves as Technology Editor for Dental Products Report magazine as well as Chief Dental Editor where he writes, edits, and does video demos of products featured in his “Technology Evangelist’ columns. Dr. Flucke uses technology in every aspect of his practice and and personal life; pushing himself to constantly be on the leading edge.  He loves testing, and breaking, the latest gear he can get his hands on.  He lives his life by the motto “you can’t have too many toys.”

VIDEO - DUwHF #1365 - John Flucke

AUDIO - DUwHF #1365 - John Flucke

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Howard: it's just a huge honor today to be podcast interviewing my classmate all the way through dental school Dr. John Flucke DDS he's probably the only guests I've had on that needs no introduction you all know him from dental products and report the technology editor he's the chief development officer of cellar and consulting he was born and raised in Kansas City that's why I'm wearing the Kansas City Chiefs so what was greater for you John the Kansas City Chiefs are the Royals the Royals

Dr. John Flucke:  the Royals I'm a baseball guy but the cheese thing was pretty cool but you know I mean I've got one of these in my office that I play with when I'm thinking I don't have a football for that well you know

Howard:  they won that they won the World Series when we were in school and then they just did it again a year ago so that was when everybody was saying how long ago was it's like dude don't say that cuz that means we're old now

Dr. John Flucke:  that was like last week to me so it's totally cool but I missed the parade in 85 I made the parade in 2015 I wasn't missing that again oh my gosh 

Howard: so you were on so he received his doctor dental surgery degree from the University of Missouri Kansas City in 1987 and it was a foreign and flukie and neil for he so I stopped by this guy for four years he has practice in Lee's Summit since 1989 and was pleased to open his new state-of-the-art facility in 2007 his passion is technology and he is always looking for the latest development to benefit his patients his knowledge on technology makes him a frequent lecturer major dental education events contributing editor to dental publications and an internationally recognised opinion leader dr. fluke enjoys spending time with his family messing around with computers and techno stuff and running I I love I'm looking at now in our contact our picture of you and I together and Burt Reynolds Burt what was Sundance Robert Redford Robert Redford Sundance Utah so my gosh so John I'm you know when we got out of dental school that the new hot technology was the automatic garage door opener did you see of this thing coming laptops and Facebook and everything I mean what does this surprise you or what yeah actually it kind of does surprise me you know

Dr. John Flucke:  I mean I remember that when we when we were in school the big thing was that I basically sold every piece of garbage I owned and had a car phone put into my car in January of 1987 because I thought it was cool and you know that was the state of the art that in fax machines so the fact I mean I thought we'd probably get some really neat communication tools over the years but I never envisioned the explosion that we've seen now and do you think it's just gonna keep going I mean 

Howard: do you think do you think two kids could walk out of dental school right now and have the same experience you and I did we're thirty years from now they wouldn't won't even have seen it coming

Dr. John Flucke:  I think so yeah I mean it's amazing clinical knowledge according to some experts doubles every 18 months and that's just massive you know we get more information in a day now than people in the Middle Ages got in their life I saw a staff that said that like one issue of the New York Times is more in somebody that lived in the 1400s you know their life time so yeah I think I can it'll be just you know it'll be like you know 50 years now be like us looking back you know into the 1950s when you know state of the art was black-and-white TV I mean it's it'll it'll continue to expand there's stuff out there that we haven't even thought of that somebody's gonna come up with it's it's a great time to be alive

Howard:  it's a great time to be alive on that note it is well I'm a I'm a big fan of your it's blog dot tentacle calm now your patient website is enlightened smiles Kansas City I'm I I love your waits on Twitter your @j flucke but where does work what is the word denticles and where did that come from okay 

Dr. John Flucke: well denticles I happen to to love sharks I've always had a thing for sharks my entire life and fat well I can't find it my here we go my post-it notes these are the post-it notes that I leave around the office but that's our key identical  if you've ever if you've ever felt sharkskin it's smooth in one direction and very rough in another and on shark skin there are little microscopic projections called dermal denticles and they literally are triangular they look like little teeth embedded in the skin and they perform a lot of functions for the shark to streamline it they they make it more steady in the water and back in the good old days of the 90s when the internet was starting to break I read an article that said you know people who are theorizing in six to eight months the whole idea of one word websites will be a thing of the past at every single word that has any real meaning will have been snagged and I thought holy mackerel I'd known about denticles for years and I thought I should see if that's available in low and behold it was and I grabbed it it's short it's sweet it's easy to remember it's got a thing to do with you know my passion which is you know dentistry and  it ties the whole shark thing in so it just it worked really well for me 

Howard: I could read your blog's all day long they're a must read I almost think I should just start going through them the last one you wrote was on Monday it's ultra dense Gemini laser gets upgrade with photo modulation tip 

Dr. John Flucke: yeah  they  just upgraded the laser they've had the Gemini laser on the market for about two and a half years now and one of the things that laser light does is it has this profound effect on on cellular metabolism cellular cellular energies and it also decreases inflammation and other things and what the photobiomodulation is is it spreads that laser energy out over a larger area in a diffuse beam that allows you to do things like TMJ treatment you know and after sleazing treatment it treats larger areas of the mouth photobiomodulation is something that you don't hear a lot about but it's a real phenomenon and a lot of people you know will take a laser tip and just you know apply it to an area in the mouth and kind of dance around and paint it but a true what they call a PBM tip a photobiomodulation tip will allow you to spread that energy out over a greater area and basically just hold your hands still and pump all those photons directly into the area that you're trying to treat

Howard:  and your other one was you used to go back from Chicago midwinter right 

Dr. John Flucke: yeah just got back on late Saturday afternoon was up there for three days four days so it's a blur you know what it's like we've been there together it was four I think on one day like 40 so was it so what was it there was a lot of cool stuff there yeah yeah anything 

Howard: what would capture your mind as Chicago midwinter what did you see that you weren't expecting or what do you think excited or passionate

Dr. John Flucke:  you know right now we're in kind of a development phase and and you know evolution according to Darwin goes what they call punctuated equilibrium which is a huge amount of change and then it kind of holds for a while small incremental changes and then suddenly a huge change again so we're in one of those incremental phases but what we're seeing on things that are really getting me excited are things in the 3d world it's becoming so much easier to use intraoral scanners companies are now putting together software packages that allow you to import the STL files from your 3d scan and put those inside of a cone beam to where you literally can get virtual articulation you know of the situation and and those kind of veins to stuff dealing with 3d of mils and printing and all of that that's gonna be our next big any change in dentistry is going to be this whole idea of moving now to a totally three digital world 

Howard: Wow and you think that song that's around the corner mm-hmm yeah we're definitely closing in on it already um so what would you say hit a lot of changes what would you say that you and I have lived through it from 87 I I thought the first revolution we walked out to was the big materials revolution we're going from amalgam and gold to composites and I remember we got out the big news of the day was always a composite and a bonding agent and then it slipped into the digital computer revolution so do you say that that in our 32 years since the class of 87 that it was a materials revolution followed by digital revolution or did I miss a revolution or do you name them differently

Dr. John Flucke:  no I think I think you got it spot-on you know we went with the whole idea yeah when you and I were in school it was a big deal to your like to etch enamel you know you only edged enamel I remember that you were getting huge trouble if you add two dentin that was you know verboten father exactly holy Queen if you really you know overdid it with the accent but anyway you know after that whole thing of composites and then you know wet bonding and all that kind of stuff yeah then I think we did jump into the digital thing and the digital one of the reasons I'm excited about this this 3d piece is that we jumped into this thing of digital and first it was you know things like digital x-ray and then it was interaural cameras and they were you know all these individual parts and they all kind of worked but you know there were carts and you were always hauling things in and it was very inefficient and then we had the launch of the PC thing which you know when personal computers suddenly went from you know tens of thousands of dollars down to you know reasonable costs and  then we got this way to link all of those technologies you know our cameras our x-rays all of our charts into the computer and so we kind of started out with  what I call the technology phase then we had what I refer to as the integration phase when all of these pieces you know became talking to one another and  then once we got that then we I think now we've kind of moved into the 3d phase of the idea of having you know all of these 3d pieces and once again we're back to the thing now of there's a cone beam unit and there's an intraoral scanner and there's a mill and there's a printer and I think we're gonna see another integration phase probably in the next five years or less where we begin to pull all of those 3d technologies together and they become much more seamless than they ever were 

Howard: so you know you can't have hot without cold I mean I mean you know you start off the first level math you have addition followed by the inversion of subtraction then they take you at a level to multiplication followed by the inversion of division you can't have hot without cold so like when you talk about this whole digital revolution the flip side of that is security now you're you're hacking me do you ever worry about the cybersecurity part of that and what are your what are your thoughts saying cuz I have a lot of a lot of older dentists and by older I mean the Class of 86 and back not the young ones out of 87 but I mean I still have some  friends that always rant about how they stuck with paper they never followed the digital guys like you they still have paper to write um do you think there's Oh cyber security issues to ever make you wish you saw a paper chart

Dr. John Flucke:  they don't make me wish I had a paper chart that they do concern me you know it's the same thing kind of as you know I love my car now that car can get stolen but does that mean I want to you know a bicycle or a horse again no absolutely not but the security aspect of this really is something that I think dentists need to pay attention to what I want people to really get the gist of in the digital world with security is I'll tell you a quick story I had a friend of mine that said I don't get this whole thing about security because who cares if mrs. Jones just had a crown on tooth number 30 and I get that nobody does care about that but what they do care about is that your information has mrs. Jones social security number her driver's license number all of her insurance information you know all of this information that we need to keep secure and that's what concerns me is the security issues behind that and it's making sure that people understand that they're not wanting to steal information about people for you know for their dental procedures they want to be able to have enough information to go in and crack the bank's you know and open new loans and you know hijack credit cards and all that kind of stuff so it's it's one of those things it's like you said every up has it down every left has right and unfortunately it seems like as soon as somebody invents something whatever it is you know the the dark side comes along and figures out a way to profit from it you know in an illegal realm and we've just got to watch out for that and be prepared for it as much as possible 

Howard: so I how much you paying for masks right now with the coronavirus what will get see even sell you a box of masks these days hey you know what I actually have when when it hit when the coronavirus started to make you know fairly big public awareness

Dr. John Flucke: in what like mid January I bought masks I was like I'm buying extra masks and extra gloves and stockpiling them so I'm good so you're loud you wrote a blog on the coronavirus on February 13th

Howard:  um do you uh and then today the market went down a thousand and of course they blame whatever but do you um are you starting to get concerned about that or what what are you what are your thoughts on the corona virus now honestly you know it's I think back to and I might have the numbers wrong but but the gist of this will be right which is you know a few years ago we had the h1n1 and 

Dr. John Flucke: everybody panicked and there was this thing of oh you know there's going to be 40,000 deaths from the h1n1 and I don't know if there were but there could have been but the part that I think is interesting is they didn't tell you that every flu season like 30 to 35,000 people died of the flu anyway you know so okay so h1n1 was serious in between five and ten thousand more people passed away because of it and is that important too to know oh yeah and is it a tragedy absolutely but it's not like you know forty or fifty thousand healthy people that we're gonna live long lives suddenly just fell over because of this virus you know universal precautions and being aware of that you know people not not coming into an appointment you know when they're feeling well and things like that but I'm not overly concerned that we're in a sudden pandemic like the Black Death or the flu that you know swept Europe in you know what was it like the nineteen but late 1919 or 1920 or something like that and you know why they called the Spanish influenza when it was a pandemic in every country because all the other countries had militaries and were shooting people

Howard: so they called it Spanish because those were the only ones that didn't have a tank or a ship or a Jeep outside your country but that's why Spanish got a blame it but when they trace it back it started in our great state of Kansas it was traced back to a oh my gosh there was the biggest crimes in the world and I caught it from a pig and then he was a for the military what do you call that drafted yeah and went to let loving love and worth living work and that was a first for networks and that was the first breakout and then they transferred that group to bring Glenn and that was the second breakout and but yeah I was all traced back from a pig to a human and Christine from from our home state you and me from our stay as you grew up in which yeah and of course the the pigs though that had those viruses they were more closer to Kansas City than Wichita the ones the ones in Wichita a little little cleaner but yeah we're near those pigs I just want to specify that for the record I wasn't born yet and I was nowhere near those pigs but you know that the real gift was the pandemic before that was a during a Newtons life that's when one-third of Europe got wiped out by the plague and my gosh I use always wonder if Sir Isaac Newton would have fallen from the plague how much longer would have taken for someone to just come out with calculus I mean and gravity and most oh

Dr. John Flucke:  yeah oh yeah you see that these people these brilliant people make these you know brilliant deductions and you do you wonder - if one thing would have happened you know if one little you know one little straw would have gone somewhere else you know what would have happened to the whole thing and it's an interesting thing to think about sometimes

Howard:  I would ask you I mean I can't think of anybody who knows more about technology than you I mean really my hats I mean I've been following you for 32 years I love your blog's love your information I hope I don't blatantly steal too many of your lines and your material but I try to but you know a lot of hey that's ok I'm stealing yours - Howard you know we're even um some of these kids get caught up on there's like what are we on that 89th generation of bonding agents and you know it's a it just keeps going going and then I'll talk to the reps like I was talking to have been corrupted other day and she's like you know these dinosaurs are obsessed about what type of bonding agent on that and then I go tests are curing light how they're curing light doesn't even work it's like so yeah so I know you you wrote a blog on alternet some Balogh curing light but I'm where are you at what generation of Bonny agent are you and I'm let's see a Super Bowl 57 Isis it figure you're on Super Bowl 69 a bonding agent what are you doing for bonding agents curing lights okay interestingly enough with all the technology that's out there I am still using a fifth-generation technique

Dr. John Flucke:  so I'm uh you know bevel your enamel that's the enamel etch the dentin this total etch technique I go in with a you know primer and bonding agent in a single step you know primer and bonding agent and separate step or fourth generation in a single steps fifth generation cure that and and then layer my composite in two to three millimeters and and that's why I've been doing it for absolutely ever I mean you know since probably late 90s and it works I don't have much sensitivity I think a lot of the you know the big thing on all these extra generations of bonding agents I don't think they've been that amazing personally I think a lot of it is marketing and I think some of it is just because for whatever reason people get sensitivity with different techniques and rather than troubleshoot their technique they just assume it's the material and they go on for you know from there but the curing light piece of it is huge and you know the curing light in in my opinion I call it the stepchild of adhesive dentistry because it's always there but nobody ever pays any attention to it and it's really important to know how to cure an a/d cure properly and like you said a lot of people never check their caring lights they don't know what their depth of cure is they don't know what the wavelength of their light is and there's a ton of people that are missing the boat on that you know they buy these $50 lights online that are you know made you know somewhere you know you don't even know the wavelengths of them you don't know the intensity of them all you know is you only paid $50 for them and there are some changes that are coming out in curing right now I mean I've got one right here that I've been playing with this one was just launched at the Chicago midwinter and this is this is the Monet carrying laser from  AMD they're located in Utah and this is the first handheld curing laser on the market this thing will give you a depth of cure of around 8 millimeters on my bench so far 

Howard: so that's a that's a phenomenal debt the cure when you say AMD that was originally Alan Miller dentistry Alan Miller energy lasers yeah Alan Miller I think news from Indiana but now he's 

Dr. John Flucke: he got out of dentistry and he sold his company the company is now owned by a CEO group out of out of Utah oh yes Alan Alan is actually it's interesting he is starting a vodka company called Blue Marble I believe it and he decided he got out of the dental game and decided to go into the the consumption game which is you know kind of cool and good luck doing this great guy

Howard:  yeah I recommend the the vodka I mean I can recommend out he's a good dude and ha that is amazing and he's and so he's out of dentistry completely sold that to see a oh that is odd that is amazing see a Oh is actually kind of running it to the best of my knowledge you're running it as two companies they do still you know run AMD as a company and 

Dr. John Flucke: then they have CEO group which is you know they do other things research and develop and you know they did a lot of third-party manufacturing for a while but now they've kind of decided to get into it and do their own branding you know so they've got this this laser peering light on the market this is one of the first things it's not just a clinical diode laser like you know AMD is famous for

Howard:  so I went I was switched gears completely because I'm your attention right and you're talking about printing and all that stuff when you and I were in school the orthodontist basically kept that out of the curriculum and we had endodontists like Bambi dura organ to be teaching us endo we had right Charles white and Brett Ferguson teaching us anything where they could share us for the oral surgery but then when it came to orthodontist they taught us like embryonic facial growth and development and and quite you know all this stuff baby say was like we're gonna teach you nothing that would apply to orthodontics well now this clear liners taken off and the the patents went off and I've now found over forty clear aligner companies and I know I've read your blog about the sure smile liners I mean you got Invisalign you got I say big blue's Invisalign Big Red's 3m oral care big purple smile direct Club what color would you give a big Stan Bergman with Henry Schein reveal clear liners you got to give me a color for what killer do you think of when you think of Stan Bergman that's a toughy hot green maybe drink green oh my god that's perfect I'm stealing that because he's got to be the richest man and Dennis so big green oh that is hilarious

Dr. John Flucke:  so yeah Henry Schein is a very successful company obviously so Green is probably a good color for them so then what color would you give to dense Weisser Onis your smile what color are those boys oh gosh it making me think of colors purple 

Howard: well purple is to smile smiles drug club they own purple so gold is a regal color and they're a huge manufacturer so yeah I like that so are you um are you agnostic to aligners do you think in aligners and aligners in a liner or do you think that um you know some people wanted to stay with the Invisalign that was the tried-and-true blue are you doing clear liners yourself or are you setting that all to the orthodontist actually

Dr. John Flucke:  no we're doing clear aligners and as of now I am still aligned with big blue I'm an Invisalign provider I am really excited about the way this is all going to shake out and I'm you know one of these things I always say is if you give me some hardware I'll you know I'll tell you hard I'll break it I'll figure out what makes it work I'll figure out you know where the faults are and stuff but when it comes to patience I'm slower to adopt I want to see you know how the market shakes out I want to you know if it's a new material I bench it a little bit I mean you know I've been  playing with this laser on the bench for about three weeks now testing it and you know I finally went live clinically with it about a week or so ago and  so I'm a little bit slower to adopt things that directly affect my patients but what I think we're gonna get to with the  increase in high speed Mills and high speed 3d printing is I really think that at some point in time you know you were talking about is there something you know that maybe we'll miss that in 50 years Dentist ago well of course one of those things I think is diagnosed a need for ortho today and then start the case tomorrow because will be either milling or printing our own aligners quickly easily you know predictably and you know it's all about the precision in all of this and the precision in speed and when you can make those aligners you know quickly and easily in your office and we are you mean people are doing it already but we are rapidly approaching a point when that's not gonna be anything maybe an afterthought you know take some images loaded into your system have the software run the simulation here's this break it down into how many aligners bangbang bangbang and write out they come that's where it's dull when it happens filmy that laser 

Howard: yeah and that's that CA oh group yep and I just wanted to I could only be podcasting John fluky when I go on the sea a group under laser and it's not even on the deal that John's got one holding in his hand it is not on their lips I hope it's okay that I'm showing it now I'm probably in trouble so we look today with

Dr. John Flucke: oh yeah this is what's the name of that was just a Monet the Monet you know they have Picasso which is their law soft-tissue lasers so I think kind of trying to keep with the great artists they're calling this one Monet but this is a 450 nanometer laser and like I said on my bench I'm getting adaptive cure of eight millimeters with this bad boy

Howard:  okay so that the first thing I thought of when you start saying that when you said eight millimeters is um are you are you attempted to do the bulk fills you know once again I 

Dr. John Flucke: yes and no depends on the situation I don't think I'd throw eight millimeters that composite in there because I'm worried about material shrinkage and some other stuff that goes along with that but I think you could certainly do a three or four millimeter depth of cure with a lot of these materials that have a fairly low you know coefficient of shrinkage and definitely do that you can also you know it was something like this that has that much intensity you can click you can if you're doing something that'll transmit light like Emacs you know you can send the light straight through that and you know help set your cements when you're doing it obviously if you're bonding things into place for ortho you've got you know things like brackets if you're doing wire ortho or whatever be able to go and and you know work around those situations a high intensity light is great for those kind of applications

Howard:  you know what is it about Utah it's it seems I I mean literally I'm certain to wonder if there is something in the water it's like ca ca oh groups from Utah I mean altar dance from Utah right I mean there's there's gotta be 20 high tech company and you being the high tech guy I'm suppose you ever moved to Utah I mean you had Silicon Valley then you have the Yukon Utah silicon slopes but what do you think it is what wait is there it seems like a third of all the high tech dental companies are in Utah from dentures you know what 

Dr. John Flucke: I agree you know dendrix well yeah Derek Henry shines whole electronic solutions you know branch is in Utah dental Intel is in Utah we've the patient communication companies in Utah curved dental you know the cloud computing practice management system there in Utah it is amazing a lot of smart people in Utah and I don't I'm not really sure why you know one of the other things if you're a black helicopter kind of guy the Utah data center is in Utah which is where the NSA is storing all of their stuff they've got this massive huge building out in the middle of nowhere that supposedly you can't even get a cell signal within like 30 minutes of the place but it's just nothing but hard drives and storage for all the information that the NSA and the CIA are you know vacuuming up about us supposedly but yeah I don't know what it is about Utah but there are a lot of smart people and a lot of really smart companies that are out in that part of the world and I wish I knew why what Gordon Christensen in Utah for God's sake maybe it's all directly related to him 

Howard: my god it there is something about it 

Dr. John Flucke: I don't know what it is but it is I he may he and relevé have sprinkled like the magic dust I don't know something that made everybody so smart but yeah you're right I mean and there's a lot of high tech companies just in general that you know are located out there either headquartered or you know have divisions I know Adobe's got a huge presence out there as well as some others yeah

Howard:  so you uh you wrote an article on one where I'm axis dental solutions versatile five times four hundred  

Dr. John Flucke: yeah that is a really cool 5 axis mill the axis 5 X 400 we are putting that through its paces in the office now you can mill just aren't here anything with this you can you know you can do crowns you can do bridges you can mill any material in dentistry that you can imagine you can you know you can mill titanium abutments for four implants you can mill gold with it you can mill zirconia it's a phenomenal thing and what's interesting about that particular device is people think when they think of mills they normally think of something you know like a CAD CAM device for dentistry where you know it mils a crown and in layer and on lay in like 20 minutes a true five axis milling this axis dental company there are actually a branch of a larger company that's been making CAD cam systems for industry for quite some time but this thing you can mill anything with it and it's phenomenal when it comes out of the machine it looks like it's ready to go in the mouth it's just stunning what this thing will do now we've only had it online for about a week and a half and we've got a couple of cases that we've done with it so far that we're really really happy with but I am excited to get this thing cranked and then really do some stuff with it 

Howard:well let's uh let's talk about that because when you and I were in school oh my god I always think of a fluke e4r and gentlemen as endodontists or chapter 8 for pathways to the Paul was Stephen Cohen um CAD cam what was a real thing I mean it was in France and they were programming this when we were in school and they were talking about at UMKC well now you've been out of school 32 years and I would say you know when  radiology came out I mean it just like a domino effect went clean across dentistry but chairside yelling absolutely chair side milling hit a wall at about 15 percent I mean I don't even think I got to the am 20 is that you did either is it stuck there or do you think chair side milling all they could come back or did the fact that it never got to 20 percent because there's something what why did it only disrupt 15 percent it did it missed the 85 percent why do you think so 

Dr. John Flucke: I think here's what I think happened Howard is I think number one it was a great technology if I knew it's really funny is your time but it was around when we were in school I remember our last semester in school spring of 87 and I can't remember who it was but it was one of the very last crown Umbridge lectures we had and the gentleman that was discussing things with is talked about he said there's this thing and they're using it in Europe now it's you know they're trying to get it to work but you know it grinds a block of porcelain into a crown and we think that point in time you know you won't need impression and I remember thinking myself would geez I gotta get one of those right now because I hate taking impressions but anyway so jump forward and I think it's a great technology near a couple of hang-ups I think number one dentists weren't ready for it in the age group that you and I are in I'm an outlier you know I started taking computers apart in my office in the 90s because I was curious about what made him work and that kind of led me and you know I was a like a dental hacker I was taking things apart and forcing them to work and do things that they weren't made to do you know back in the day when you couldn't just call somebody how do you do this or buy something and so when you know when I got a chance to get my hands on a CEREC I bought a CEREC to which booted with a floppy disk and I'm gonna go into describing that for anybody born after 2000 but you know it took some work to do these and the other thing about milling back then was it was like a kid you know when it was good it was very good and when it was bad it was horrid and I think some people got tired of fighting it and they just you know they didn't see an immediate clinical result in it and they thought I'd rather I don't want to be a computer guy I want to be a tooth guy now I think things have totally changed we've got a much more digitally literate generation in practice now there really understands it plus we've got these phenomenal interaural scanners that are you know just allowing us to you know basically really create the stuff right there in real time on the screen and you know now when you can send that out and mill it and doggone it it looks just like put there you know before you prepped it and it happens in 15 or 20 minutes I think now people are starting to see the upside in it and and the other thing is it's become so easy and so predictable that you don't need to be hacker to grasp it anymore you know now I mean in my office when we brought this access million when you know they came and trained everybody the last person that I wanted trained was me you know I want because I'm a big believer like you are of find smart people that do a great job at what they do and then let them do it and get out of there doggone way so I wanted the staff and the associate doctors trained on that way before I was because I want them to know how to do it I don't want to have to do design and do all that stuff that's not where my specialty lies you know my specialize in treating patients and breaking stuff that manufacturers send me just you know to see how durable it is and I think now we've got a generation that understands it but we've also got companies that have now simplified this to the point that it's really predictable and so I think it's gonna take and why and 

Howard: what do you think specifically about a accidental solution oh I mean there's so many see the kids are telling me that you know like when they come at a dental school there's now 400 different dental implant companies there now that the patents come off clear aligners there's now 40 right so they're looking at old dogs like you and me saying I'm if I was gonna chair sight mill today for whatever reason what do you have a dog in that fight wait which one would you would you go after and why 

Dr. John Flucke: you know right now if you want to just do you know single units for instance I would look at the prime scan it's a good unit it works really really well what I love about this is prime cam that's that's doc on it I gotta look it up I can't think I'm just drawing a total blank on it we are be just one second I am old you know your gums are old and I got so much dental stuff rattling around in my head that it's Eric so it's gonna thought it was yeah I thought it was Sirona baby want to say because I was having kind of a glitched I wanted to make sure yeah it's the new it's basically the new szerik version  scan and it does a tremendous job the the axis unit that I have literally has multiple tools multiple burs and the little milling arms actually will stop and pick up a different instrument depending on you know what you want to do depending on the material depending on the size and other things and that's what makes it so doggone precise that allows you do all these different things but if you just want to do you know single unit kind of things there's a bunch of really good Mills on the market that will do that for you the prime scan when combining that mill with the scanner is really pretty amazing I mean when you when you scan with that I've heard it described I thought this was a great description I said it looks like you're just pouring water over the image you just you know that it just flows over it there's no you know individual little clicking or photos or whatever and so that would be the that would be the dog that I would turn loose if I was looking at you know doing some single units in my office by all by all means 

Howard: okay now I'm gonna have to and by the white kids when I'm asking John this you know it's really easy to get them in trouble because when you ask someone like I'm about to ask his favorite I mean we're all friends with a lot of these people and you know we don't want to run into them at the bar and they say oh I'm sorry of your eye minutes at the yoga studio eating yogurt you pick the other one but here's here's a big high-tech problem and this is what I want to get you on the show the most about is I'm if you talk to an oral scanner guy I mean the oil scam there's so much what I like to call mish information after Karl mesh get it mesh information that's what that's what the founder of who is implants to Iraq to is that dog are you talking about yeah oh my god what is that guy's name up my hair I'll go to my anyway the implant there I don't feel so bad for having to look at prime scan he lives in Palm Springs he's got a jet implant strike sounder Jade Airinas neck so his neck when Jerry would argue about what anything with Carl he'd call it mission formation but here's the deal I like that if you talk to the oral scanners they say well you know all scanning is better than impression you have less remakes then I go then I go talk to the lab people and they say hey if you're a sloppy schmuck with a polyvinyl Polly slaw saying you're a sloppy schmuck scanner like they say they say you either have either care you know and if you really really care you do it with anything and then but then if you're blood and guts and you're just want to do it be an implantologist a lot of them like bio lace that the three shape scanner I Matic open hanging right but then the other fast-growing segment is clear aligners and then they're like well due to a line owns that dill and they own I taro so so right are you sitting there thinking well if you're gonna be an orthodontist need to go I taro if your blood and guts implant you need to do three shape and how do you in fact do you even think that oral scanning increases the quality of impressions I mean do you do you think it does or do you think it's I it's hype

Dr. John Flucke: it's not hype it's not hype at all the digital world in that is tremendously better however garbage in garbage out if you don't care enough to take a good impression and you don't care enough to take a good scan you're not gonna get good stuff I mean that's just the bottom line if you're sloppy it just allows you to be sloppy faster you know but it is a lot more accurate I'll tell you the interesting story is the reason and you mentioned a line which is it's a great little piece of this story and you may know this how you know the business better than I do but what I heard was the reason a line bought I taro was you know the original model was send us your polyvinyl siloxane impressions we'll pour them and then we'll use that information basically basically to create our whole Invisalign process and send you the aligners and supposedly they were getting such lousy impressions that they said we got to figure out a way to get rid of all these poles and all these bubbles and all these discrepancies and so they started looking and they said oh my gosh we should look at this digital scanner thing because you know it's much more accurate it's much more smooth people can see their mistakes you know and hopefully fix them so in that regard they bought that company based on the fact that they wanted better results so it is better I mean I can tell you it's better it's more accurate I don't spend nearly as much time making adjustments on my fixed prosthetics I mean we even scan nowadays we're scanning for partials with our eye Terrell and I haven't have a night arrow system but you can make any of them work and the nice thing is now things are really going cross-platform to wear Invisalign integrates with a lot of different companies so it doesn't be a night arrow to go to Invisalign you can have several other options and still go to Invisalign you can still have you know you can send to pretty much the lab of your choice no matter who you're using but the accuracy of this stuff is there it is it is proven beyond a doubt in fact with the clear aligners space that this was really interesting I saw a study I think it was done by the Navy I think just recently where they said that dental mills are so accurate that clear aligners that are milled versus clear aligners that are printed can cut one week off of each aligner meaning basically you know if you're going through 18 aligners you could take off 18 weeks of treatment because there is the the milling is so much more accurate on the digital aspect that you can move teeth fast so I don't have a doubt about how accurate it is I do have a doubt on how dedicated people are to use it accurately

Howard:  but you just nailed it it gets rid of the stack so if I take an impression and for easy math just say it's plus or minus 20 microns then I pour it up in stone and for math it sets up plus or minus 20 microns then I wax up a crown and take that out plus 20 microns then I invest it but so by the time I get to the crown I've got a hundred microns built in so if a scan can get rid of all these steps I mean yeah I mean it can take a week off no doubt about it but I wanna I want to ask you about your views on technology and  in dentistry and how they're different for views for everything else like when you and I got out of school a big-screen TV was a meter wide a meter deep you and I probably together couldn't lift like a big-screen TV in the 80s and every year gets better faster easier higher quality smaller lower price the price always comes down well now my first big-screen TV was $5,000 and it was a big box my last one is bigger and it's $500 and it can hang on a nail so everybody loves it when that happens but then smiles direct comes out and says hey when you and John got out of school or that was sixty five hundred thirty two years later guess what still sixty five hundred dollars they haven't gone down one dollar right so we use a lot of technology we use oral scanning we use AI we did all this stuff eliminated the middleman that's what Walmart does by direct cell Dirac and now here it is for twenty five hundred dollars and the dentists say hey you know that was good for big screen TVs and I'm glad I'm not listening to 8-track stereos and CDs but you're not doing that to my profession and they come out with guns loaded so it's almost like it's a double standard what why why is it a double standard for TVs and ortho

Dr. John Flucke:  I don't think it's a double standard I think it's an apples to oranges kind of thing my thing on on ortho and smile direct Club is if you don't know the patient has decay do you want to be moving a bunch of teeth you know that need root canals where my snap under the pressure you know do people understand what they're getting into you know one of the things that I think is really interesting now is this whole deal where smile direct Club is has been telling people well we'll refund your money but we'll only refund your money if you sign this airtight non-disclosure agreement and then plus you go out on the internet and you remove every bad thing from every website that you ever said anything negative out smile direct Club you know what if I treat a patient poorly and they go out and hammer me on Yelp and Google and everything Facebook you know what I can do zip I can't force them to do a thing and my thing is how about you just provide a really good service and if people aren't happy with it you offer them a refund and tell them we're sorry we couldn't you know meet your needs maybe you should see an orthodontist and you know there are several good ones in your area as opposed to well we're thinking about giving your money back but the first thing we want is this ironclad contract signed and we don't want you to ever you know remove everything you've ever told about us online the other part of it is you know electronics are totally different electronics you're not living breathing things great joke one time and I think it really kind of goes to this surgeon goes in to a car shop and the mechanic says hey you know what you know I just I just replaced you know a piston in your car and it's sort of like a heart transplant how come you know you get thousands of dollars for heart transplant and I got you know five hundred bucks to change a piston and the surgeon said change it while the cars running and it kind of goes with that you know me we're talking about living breathing things that can have bad outcomes if I screw up my TV and I plug it into a 220 inside of a 110 all I've lost is some cash and probably a lot of pride maybe some ceiling tiles depend on how the smoke goes but I haven't caused permanent damage to a living structure living thing and I think that's where all of this goes you know do no harm not do harm but then cover your tracks really really well so that the mass market doesn't know about it you know um you talk about getting in trouble with people I probably just signed my own death warrant right there but so be it we can talk about you know technology can be anything from a laser to contact some

Howard:  I still thirty two years out of school I mean the hardest thing I do is still when I walk in the room and it's like God and it's a quadrant of mo D composites you know mo D two three four or five main there's that I mean that's just okay I'd rather do a molar root canal I'd rather pull for Wizard days I mean it's just you're just gonna sit down and burn an hour and the hardest thing is still the damn contact I mean yeah I know you you wrote a blog the pallidum what so it's the non sexy thing that everybody suffers with no one you know they want they want to talk about an apex locator not a contact on it posit but well is there anything sexy about an class-2 interproximal contact you wrote a deal on pala death

Dr. John Flucke:  yeah so one of the things that people don't think about is you know I love the expression where well why do we do it this way well because that's the way we've always done it and we don't really think about the why and I've written a couple of articles in the last couple of years about why why do we do things you know I'm a white guy or he's one I know why you should catch all kinds of flack when I was in school because they would say fluky you know turn the wedge at this angle I never go why and then they'd get all bent out of shape and they'd think I was questioning their authority and really all I wanted to know was why is it important that you like the flat part of the wedge be against the band I just you know if they'd have told me because it provides you know better shirring holds a band in place I'd have been happy but instead end up doing push-ups you know but people don't think about the whys sometimes and why are we using TOEFL Myers while using TOEFL Myers because we've always used them but TOEFL Myers would deform when you were condensing an amalgam and you could really you know I mean you could shove that amalgam in there and if you had that band wedged well you weren't gonna get an overhang but you would distort and burnish that band with the pressure you know lots of pushing and the band would move and give you a good contact well now you can't do that because it's not as viscous and material so a TOEFL my are trying to get a good contact with the TOEFL Myer is a lot harder so Paladins priya dents garrison they all make these sectional matrix systems I call them see bands just cuz you know they look like a sea and I just think it's easier to say when you're clinically doing something hand me a see band then handed me a sectional matrix you know system or whatever but those things if you ever look at those bands they're contoured completely differently they look like the side of the tooth you're replacing and so there is a height of contour and those kind of things and it's not sexy at all but it does give you the good anatomical contact that you want as opposed to the patient comes back and you look at your bite wing you know and rather than having a contact like that which is kind of what you want you see a contact like that where you know the marginal ridges are the only things touch and you've got these big food traps underneath and you think garbage what you just said I just spent 60 90 minutes doing this four months ago and you know now I'm pulling hunks of of frito-lay out of there because the contacts aren't right and by thinking about the why of you're doing it and using these matrices that are you know pre-configured to recreate the part of the tooth that you're removing or that have been removed by decay just gives you a better clinical outcome and my big might be buzz in what I do is clinical technologies that improve patient outcomes I mean there ought to be a reason why we're doing these things and you just need to kind of think it through and think why am I using this or why would not use something else why are my contacts all points at the marginal Ridge and I'm not getting the same contacts that you get when you see these amalgams that were done 20 years ago on a bitewing you know what's the difference it's not the doctor usually it's the technology

Howard:  interesting I sit there and we've incurred it sounds its own to me I don't get it I mean why would McDonald's want to have 40,000 locations where each place had a server and had to have security software and updates and I it just seems like the cloud would just be the obvious but then again you look at your homies and it's most people don't do that is it because the cloud is bleeding-edge is it not quite leading-edge what are your thoughts on weave and curve dental at a Utah 

Dr. John Flucke: okay if I was a guy graduating today or maybe even graduating in the last ten years I'd look at the cloud big-time they solve the security issues they solve the hardware issues their device agnostic they don't care how you connect as long as you know can connect to the internet weave is  a patient communication company you know when you're using voice over IP which is the technology that does that you know patients never get a busy signal because you have an infinite number of phone lines people when with weave people can call an office and the minute the call comes in the system identifies who's calling pops up on the screen with all the patient information that you might need about that patient before you ever pick up the phone you know I you know for instance with you know if you were a patient in mine you know we and you called and we're using a we could pick up the phone and say how are Howard how are you how was that lecture in Tahiti you know because we've got that in the system so I think that cloud is hugely important and I think the reason a lot of the old folks like us don't the reason I don't use the cloud is I'm so data heavy that trying to get all of that in the cloud for the amount of time left that you know that I have to practice I don't know if the payoff is there for me I mean I'm sitting on literally terabytes of information because everything I do is digital so I've got comb beam scans I've got you know digital impressions I've got photographs rated graphs all of that stuff and I don't know if it's worth it for me in the long run to learn a new software system and be in the cloud but if I was a younger doctor and I didn't have all of that information I'd be looking at cloud patient management in a heartbeat I mean I just had to go through at the end of lifecycle of Windows 7 just recently I had to replace every computer in my office 20 workstations in this facility and all the reconfiguring and all the other things it wasn't just the cost of the 20 computers it was putting the whole network back together it was ridiculously expensive and with a company like curve doesn't matter as long as you've got a computer you know that has a browser on it you can connect and with we've having all that information that you can you know connect to your patients send messages manage things with them they also do paperless intake you know so that patients can you know I'm a new patient great we're gonna send you you know securely all the forms you fill them out securely that you send them back they get dropped into our patient management system all of that is done automatically if people should be doing that in a heartbeat because who wants to mess around with you know even with an iPad who wants to check in in an office when they can do it at home you know where they're working on a split screen or two monitors they've got Netflix on one and they're you know putting their demographic information into another and they walk in and they're like hi I'm Howard Farran I'm here for my one o'clock appointment they look and they go oh yeah Howard gosh I can see that you've checked in online let's just get you right on back I mean that's that's the way of the future and people should be doing that I think a lot of times older people just don't see it and it's kind of the old thing to of well I've always had a server I've always had workstations and that's one of the things that drives me crazy is we've always done it that way 

Howard: you mean the Chicago midwinter meeting was always in the middle of winter always been colder than dirt 

Dr. John Flucke: yeah during the ice ages and the ice age never left unfortunately it's a great meeting I just wish it was warmer um I

Howard: I love your blog on aamna chroma again the other all this information on blog tentacled comm but what way correct what would impress you about aamna coleman enough to write a blog on it okay

Dr. John Flucke:  hey real quick I do want to say one thing about blog tentacle comm I am just so it everybody knows this is kind of cool I think I started the blog I'm not even sure how long though but I started the blog because writing for dental products report as you know its dental town you know you you write for a paper publication and you could write the best article your life but if nobody if everybody reads it or nobody reads it you don't know because it's paper so I started the blog because I thought now I can see if I write something you know does it strike a chord with people do a lot of people read it do they not I just got I just passed 2 million unique visits on the blog in the last week and anyway I'm very happy about that and I'm honored that people love what I've got to say that's huge 2 million man congratulations on yeah but I have a feeling I have a feeling you would have done everything the same if you never even wrote a blog cuz I get I've just known you from dental school you're just into this I mean it's just it's you you just you just love it dentistry you love technology it's like if you got paid for this or didn't get paid for this or had one view or no views that wouldn't wouldn't change it's just what it just what's you it's how you roll in you're damn good at it well thank you I appreciate that you know getting back to your original question about omni chroma omni chroma rocked the dental world you know the idea of a composite that pretty much matches every clinical situation as far as shade that's phenomenal you know we've all been in those situations clinically you know where you're looking and you're like okay this is gonna be you know some some shade that you know there's only one I only got you know one shade in the whole world is gonna fit this and then you pull it out of the container and it expired in 2004 and you think oh my gosh what am I gonna do or you sit down and you say okay hand me the a 3.5 and you get the we're out of 3.5 you know and you're like oh my gosh what are we going to do the inventory part of that and you know is huge the part or the piece of it where you actually have to buy the inventory and keep it and then maybe toss it because it expires you know composite is is something that's kind of hard to keep track of and so you know how many times we opened a drawer somewhere and found a bunch of you know syringes or cartridges of composite that you didn't even know you owned but they're too old to use so Omni chroma came along with this concept of hey guess what one shade pretty much matches everything and and I personally think it probably works in about 90% of the clinical cases that I've used it in that's that was phenomenal to me they turned the industry on its ear by coming up with this idea of faster easier better simply by coming out with a shade where you know you've heard the other thing you're one size fits all kind of one shade fits all and I was just blown away by that

Howard:  so do you think it's gonna be a bigger bigger bigger thing I mean these that you expect but what is it Tok Tok II Yama Yama Yama Yama I'm nekoma do you think it's gonna I mean basically it's it's a scale breakthrough on light on light and translucency and reflection I do that it's gonna be a big deal of Dentistry 

Dr. John Flucke: oh yeah absolutely you look around now and you see other companies trying to do the same thing which is phenomenal I'll tell you the other thing Howard not really many people know about this but I'll throw it out here so that people will know in in June of this year there is going to be a composite that's released by a company called no Bo it's a no bi oh no bo is out of Israel and this is a material it's a composite material with an additive in it that is antimicrobial it's not it's not an antibiotic it's actually a nanoparticle that causes cell lysis it doesn't decrease it's just when cells come in contact with it kills them but it's not something you know where you start out with a high concentration over the years it goes down it stays constant it's just it's almost like an electric fence for bacteria they can't stand to be near it and they're gonna come out with their composite this summer and that's gonna turn the industry on its ear again because what is it now five years I've heard is the expected lifetime of a two surface composite and the normal reason for that is recurrent decay and if you could put something in the tooth and know that bacteria can't survive in that environment how cool is that

Howard:  dude I flew all the way to Israel to podcast that guy I am I flew I was in Israel the week before Christmas and did some lectures and podcasts and I went to that place and I think that's a gram bigger because to me dentistry to me it's really bad I feel dentistry went in the wrong way after we graduated the fact we were in school we did amalgams I did we did had to do 5560 amalgams 75 75 beforehand a mercury amalgams you recall is half mercury and you'll never find that in multivitamins they never give that stuff to kids the other half is silver as in silver diamond fluoride tin as in Stannis fluoride silver zinc everything in that is a toxic bomb to life and those fillings last 38 years and these morons on the lecture circuit would take it out and show look at the recurrent decay they point to blacks cause it's like dude can you throw that on a petri dish and see how that works out for I'm pretty sure it's just a bunch of dead crumbs and then we replaced it with it a Newark plastic that frickin mold will grow on your milk carton I mean I mean my god it's like and then we went from the crown with all my all seven of my crowns are gold crowns inlays onlays and zinc phosphate cement and we said now let's make him something really pretty like empress it's like dude I'm short fat and bald and it's a back molar who who would want a translucent I mean if you told me that I said that translucent molar I would say you're drinkin whiskey or something it doesn't make any sense so I always felt like dentistry the aesthetic health compromise really took us down a different path I mean we went from an 87 fillings lasted 38 years and now we have data on hundreds of millions of fillings and they don't last six and a half years and cool course not in my hands not in my hands every dentist has special magic hands I've been informed about this you know they never Konkona x-ray they never do anything wrong but I'm yeah it's been a crazy the aesthetics but but what is the number one goal of every species to reproduce now fostering I mean I could explain this amount of thing and I I don't anymore because you can explain it for an hour and a half or how it's just a superior restoration everything that when you're done this I want to colored you're like okay dude it's a second molar normal I'm the only one that knows I still wanted to I mean they wanna they're a peacock they want to spread their wings and put you in their hypnosis thing and they're they know the only job you have in life is to replace yourself before you drop dead and so that means amalgams are gone and these composites are out but that omni chroma that is a cool thing and this no BIA I was in um Israel at that plant and I think that it's the holy girl dentistry I see - holy grails gonna all the implant companies are trying to make us cement that you do something to you touch it or something and it goes soft again so you could take it off so they're they're all all these labs are trying to make it reversible cement and all the composite companies whether it be IVA Claire whatever they're all want an active ingredient in a composite they all want something antibacterial so in a bunch of anaerobes eat that stuff they're all gonna die I feel like I mean I I know I've gone over word over time I'm just trying to make sure I don't I know I know when I get you on I want to uh I want to get you on and by the way you want I said I'm getting paid time and a half now that we're over time I don't know why I have tried to pay you for forty years every time I see I say what are you gonna leave did a dental products report and come work for dental town I'm reading on your own website the best publication on the planet and it says dental products report and by the way I do I think you're the rock star of that magazine I have to tell you that I mean you and uh Paul Paul Fierstein he's silver yeah we're great friends he's he is he's still around but he's not with the publication currently well so if anybody's looking for a good guy to write you know hey jab low is he's on the market so we have you been the single rock star of dental products report of every time I've read it I mean thank you you have them must go to read column in that whole damn magazine I mean it's kind of like it's yeah I mean it just is you're the signature of that magazine and you're the reason I pick it up and read it

Dr. John Flucke:  well thank you

Howard:  pick up and read dental town so you know I know comes around but well I know that the only time you pick up dental town is when you're in the bathroom and you're out of paper and you're like wipe with the inside cover or the back page which I had how do you tear the paper oh that usually it's usually the the product card is hey is there anything I wasn't smart enough to ask you is there anything that you're thinking I bet he's gonna ask this and I didn't or it is there anything I missed

Dr. John Flucke:  no you know I'm just real quick on the whole thing with CEO group and AMD I got was out there and met with them those folks in in January and I'm you know you know how it is you sign these agreements and you can't talk about things that you know aren't on the market yeah but I would tell people to to keep an eye on on CEO and AMD they've got a lot of cool stuff in development that's gonna come out I mean this is this curing laser is just one of those things and I can't talk about a lot of them but there's some really cool game-changing stuff coming out of that company and so I would tell people that you haven't heard of them because they've normally for years and years been making products for other manufacturers and you know third-party manufacturing labeling but there's a lot of cool stuff coming from that company so keep your eyes open for it I'm trying to think of anything else that we we could have covered and didn't can't think of anything off the top of my

Howard:  well I'm let's just have a let's just have a moment of audio honesty before we got the phone now you know whatever two men from dental school get together they always ask each other who was the best-looking girl in the class so we at least have to be honest we Lisa because this is what we would do if we make a bar and it's got a Stephanie car mater but you didn't look so bad quite honestly and I blew that joke I blew the joke because it was I was supposed to be Woody Oaks wife on the deal but they put me in a two-piece bathing suit and a wig and so much makeup on no one knew it was me no one knows me I mean hell I'm a bald guy with a wig on and makeup and everybody was like who's that chick that you can't overdo you can't overdo the makeup girl thing but hey John fluky technical editor dental products report chief development offer a seller and consulting tell Lou I said hi thank you for all that you've done and if  ever gives in he should say well you know Howard he wants me to go to dental town and on that note i hope you have a rockin good day go chiefs go Royals 

Dr. John Flucke: thanks Howard it's always great to talk to you who to every thought in 1987 when we were sitting next to each other in all those classes and you kept trying to wake me up and say fluky pay attention I think this is important who would ever think that we'd be doing this you know life's been good to both of us and I appreciate you thinking enough to let me do this with you thank you man thanks for all you do for Dennis everybody

Howard:  have a great day buddy you’re a rock star  

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