Evolution of Dental Technology and Techniques Over the Past Decade

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Digital Smile Design

My guest this week is Dr. Christian Coachman and we'll be talking about Digital Smile Design. 

Transcript: 

Speaker 2: [00:01:56] So I'm here with Christian Coach and I'm a huge fan of your work. I'm a huge fan of what you've done for digital dentistry and integrating it into dentistry. I'm a big fan of just everything you've brought. So would you just start by telling us your story? You have a bit of a unique story. [00:02:11][15.4]

Speaker 1: [00:02:12] Thank you for having me here. Great pleasure to participate and share a little bit of my story. And so my story starts in Sao Paulo, Brazil, where I was born and raised, where I went to dental school at the University of Sao Paolo, where I did my dental technician course as well. And in starting in 95, I started to work as a technician for my father and then started to work with other Brazilian doctors. And I was able to grow into this position as a dental technician, creating a certain reputation in Brazil. And because of that, I was invited in 2004 to join Team Atlanta in the US was a big move for me at that time, became their head ceramicist and worked there for almost five years. And of course I was able there as well to pursue another passion of mine that is lecturing and teaching. Since they were all very well-known speakers, I was able to to learn from them and to also they opened doors for me and I started to lecture all over. And during that time as well, I started to develop the concept of digital smile design. That was basically a concept of improving the dentist technician communication, and it grew into something much bigger. And that was 2007 eight nine, when social media was growing. I was able to get that wave and really be one of the first ones to start promoting my work in social media. That took me all over the world and travel a lot. From 2009 to 2014 into 2014, the DST concept got a little bit more mature and 3D technology started to kick in and we then partnered with software company and developed the center here in Madrid. My two brothers. Then I was able to convince my brothers to join the project and moved to Madrid to start running the project here since I was traveling all over. The project grew and two years ago I moved with family here to Madrid as well. And that's exactly what I'm speaking now from my home in Madrid. [00:04:38][145.9]

Speaker 2: [00:04:39] And so I've heard a little bit about your story from our mutual friend Dr. Bill Robbins, also a big fan of his work. And he said that effectively what you've created all kind of started because you were trying to find a way for the dentist to better communicate with you and to have better back and forth communication. [00:04:55][16.2]

Speaker 1: [00:04:57] Mm hmm. Yeah. I remember many years ago, I was hearing I was reading somebody talking about communication outside dentistry, and they mentioned that two thirds of all the problems in human history are related to bad communication from family problems all the way to world wars, the lack of communication skills. So I was always very passionate about communication that combined with my passion for teaching. And I realized that a lot of our problems, they come from not being trained on communication strategies, dentist, technician and also anticipation. So I started to really absorb and analyze the communication process and started to develop ideas on how to improve that dentist technician communication, to improve efficiency, to understand, to pass better information and to minimize errors and to save time in the patient's mouth, basically. And then on the other side with the patient, improve communication with the patient to calibrate expectations and to create perceived value, to differentiate yourself, to increase case acceptance, to to sell better, more comprehensive dentistry, things that we are usually not trained in dental school. So the DST concept is basically focused on those two things, what I call digital dentistry and emotional dentistry. Digital dentistry based on this creation of smart systems to improve the flow of the information and emotional dentistry, everything that we can do to make patients value us more and understand the importance of what we do. Of them. [00:06:56][118.9]

Speaker 2: [00:06:56] So would you start by telling us of what is digital smile design? I mean, this is one of the concepts that you lecture about globally. [00:07:03][6.5]

Speaker 1: [00:07:04] So Digital Smile Design is, is this name that I created to 2009, so 13 years ago now known as DSD. As I mentioned, started in a more technical way for me. Initially, my my idea was to help me as a dental technician work with less stress and be more efficient. Right. So I started to analyze the common mistakes that I was I was doing. And even though I was working with some of the best dentists in the world, and I was a very good technician myself, I realized that we were all making some mistakes, repeating some mistakes, and DST started as a bunch of techniques and workflows to improve the way the information was coming from the patient to the dentist, dentist technician technician back to the dentist, dentist into the mouth. So I wanted to be more efficient. I wanted to waste less my time. I wanted to work less and make more money. And to be honest, so that's how it started. But I naturally started to understand that at the end of the day, it doesn't matter how much more efficient you become, the effort that you put to be more efficient, the patient needs to value that because at the end of the day, they need to pay for it. They need to sponsor your investment in being better. So I realized that the best way to convince people to incorporate my ideas of better systems was to help the doctors create more value towards the patient. So this is when I coined the term emotional dentistry and it became all these strategies that makes us different from the patient's perspective, makes us special from their perspective. How can you make the patient say Wow, for all the little things that you do for them are even more challenging? How can you make them say Wow even before you start the treatment? So how can you become the best spokesman of yourself, of your team? Of the amazing things that you can do for people? How can you incorporate visual communication principles, storytelling technique into the way you sell yourself? You sell your treatments, the way you create your brand, the way you make this experience be wonderful for the patient. Since patients usually don't like to go to the dentist, I realized that we had a huge opportunity to completely change the experience of going to the dentist. [00:09:53][168.6]

Speaker 2: [00:09:54] And so, of course, you know, in this podcast, people are only kind of getting a brief window into some of what you teach, but how do you do that? How do you implement this emotional dentistry and how do you change patients expectations and how do you communicate with patients to get them to say, wow. [00:10:10][16.1]

Speaker 1: [00:10:11] So, of course, this is this is exactly the main topic of what we teach on the course, right? So we divide the concept into two, five steps design, plan, present, perform and lead. So how to use technology to understand better the link between the face and the smile and avoid mistakes? And then how do you make the patient value that? How do you use technology and communication systems to take advantage of collective intelligence, cloud dentistry and make better decisions for the patient? So how can you use technology to make better decisions every single day for every single patient? How do you use technology, storytelling and visual communication to improve the way you present the plan, the way you make the patient embrace the plan, the way you make the patient change their priorities, the way you make the patient, make dentistry priority number one. So that's number three. Number four, how to use technology and teamwork to improve the execution of dentistry in a more streamlined way, in a more predictable way. Delivering delivering outcomes that are more similar to the initial projects that you offer to the to the patient. So how do you bring this close, this gap between what you show at the beginning and what you deliver at the end of the treatment by using technology and what we call guided dentistry and digital quality control. And at the end, how do you become a better leader? Because the magic or the. Happens if you have a great team. How do you build your dream team as a dentist? To make this whole magic happen? So these are the five pillars of the content that we share on our courses. Design better smiles, plan better your cases present and sell better your treatments, execute with more precision efficiency and become a better leader. Empower your team. So this is basically the DST concept. [00:12:25][133.8]

Speaker 2: [00:12:26] What are some of the technologies that you're using to design these smiles? I mean, would you give us practical examples of what you're doing? [00:12:32][6.0]

Speaker 1: [00:12:32] So of course that to design, to deliver better smiles to our patients, we need to follow up. We need to follow these steps. So the first the first step is to rethink the way we gather the information. What technologies can we use to understand better the human being sitting in front of us? So of course using scanners, you know, using CBC DS, but using videography, using all kinds of new technologies that can understand better. The problems of the patient sitting in front of us and of course, also fascinate the patient. So so these two things come together on the floor, right? It's being more efficient, delivering better care, and at the same time, simultaneously fascinating the patient doing each one of these steps, you know. So the first step is acquiring better data, using all the technologies that are available today that are usually underutilized by most doctors. So we teach doctors about the technologies available. And more important is not only about buying these technologies, but is about knowing how to take full advantage of these technologies so you get the return on your investment. Then the second step is how do you use technology to make better decisions? And that is utilizing simple cloud based chat systems and info sharing systems, you know, data sharing. So you can pick the brains of people that can help them make better decisions. So this is what we call cloud dentistry, asynchronous communication and collective intelligence, and using simple platforms that are available, many of them for free. Incorporating this in your daily routine to constantly be uploading your patients in the cloud and allowing the team to brainstorm in an a synchronous way so you don't waste your time. So that's number two. Number three is utilizing 3D software to simulate your ideas. So test driving your ideas before touching the patient. This is a big thing for us. You know, it's like the flight simulator that allows pilots to make mistakes virtually before they kill people for real. So we say you need to use 3D technology not to execute the treatment, but to test drive the treatment before you execute. So simulate your ideas. Make sure you are having the best ideas, compare ideas and use 3D technology to understand better the pros and cons of each one of the options that you are imagining for your patient. I say make mistakes in the computer to avoid mistakes in the mouth. Right. So this is the third pillar of how technology can help us that. The fourth pillar is patient education, patient motivation, expectation, calibration, but also creating excitement. So that means that we we use visual communication tools, digital technology to present better in a much more exciting way. You know, usually the way then does of presenting treatments are kind of boring, kind of nothing special, and we reinvent completely the way we present treatment plans. I usually tell them, General, you need to become the Steve Jobs of your treatment plan the same way Steve Jobs was presenting his first iPhone. You know, watch that video. And in 5 minutes, he was able to move the whole world into believing and batty on that broad project. Right. So when you build a nice treatment plan, you need to use all these strategies to present this treatment plan if you want to really differentiate yourself. So that is pillar number four. And then pillar number five is the treatment itself. And this is when we use 3D software's and printing technology to perform what we call guided dentistry. What I see is that in the near future there will be very few free hand procedures in dentistry. Everything is going to be guided and is very obvious why this is going to happen. You know, first, because patients love the idea of guided them to three. It's a much better way to sell a procedure. They feel safer. You can tell amazing stories about why guided dentistry diminishes the risks of errors and so on. So it's a great story. It's great for your business and it's of course also great for dentistry because you create more predictable results. So we talk about Guide to Dentistry and how to use digital quality control with 3D softwares. And then the final point is leadership and team building. And then we bring smart platforms from the business world on how to incorporate this into your clinic, to analyze the the vibe of your office, how your staff is actually evaluating your work and your leadership, and how pleasant it is to work in your office. And how can you create and transform your office into the best place to be working and and really make people see that they have a future, they have a career inside your your project. [00:18:05][333.2]

Speaker 2: [00:18:07] So many, Dennis, are just using stone models mounted on articulation and then wax to present treatment plans. And this can be incredibly problematic if you're trying to convince a patient of a 30 or $40,000 treatment plan, wax just doesn't translate to the tangible outcome to the patient. You know, and this is primarily what you teach. Would you tell us more about why this way of presenting a treatment plan can be flawed? [00:18:28][21.5]

Speaker 1: [00:18:29] The first thing you know, I did a test. You know, in my old days when I was a dental technician, I showed to a patient a beautiful, properly done wax up. And then I showed the patient a horrible, ugly wax and they had no clue which one was the right one and which one was wrong. So patients don't understand waxes, and even when they shake their hands and they say, I got it, they didn't. They just don't understand. By the way, patients usually don't understand most of the things that dentists are saying to them. We have this tendency to speak as a dentist, to speak, you know, we were trained to talk about dentistry to other dentists, and then we kind of talk to patients in a similar way. And we believe they are they understood, you know, they're shaking their hands because they are under pressure. They're they don't want to you know, he's the doctor. I need to pretend that I'm understanding or whatever. So we need to change completely. You know, we need to study a little bit human behavior and communication strategies. The key for me is to engage emotionally and communicate visually. So engaging emotionally means that, you know, you train, you practice communication and listen, you picking the right words to connect with people. And this has nothing to do with dentistry, right? We know people that are much better with that, other people that are not that good. So you need to practice that. Somebody, the person in your office that is the one presenting treatments needs to understand how to engage emotionally through communication. The other thing is visual communication, meaning that you need to explain things visually and we need to use what we have. The best tools that we have and the best tools we have nowadays is 3D technology. And it's just interesting to see that the few doctors that are using 3D technology, they're only using after they resold the treatment. So they sell the treatment and then they're going to use 3D technology to do whatever they want doing the treatment. And I'm telling people this is not smart because at the moment we need more help, is not on the treatment. Execution is on the treatment building and the treatment selling. Making the plan and convincing somebody to pay for the plan. These are the two most challenging moments in dentistry, right? And nobody talks about it or very few people talk about it. So we focus on that moment, how to build the best plan and how to communicate that plan, how to convince the patient to invest in that plan. These are the two key moments to have a great business in dentistry. [00:21:26][177.2]

Speaker 2: [00:21:27] When you're actually bringing those wax hopes to the patients are the, you know, the digital sculpting, what you've done, are you showing them screenshots of what you've done or are you actually having them sit there in front of the software with you and walking them through and letting the patient make suggestions and then making adjustments accordingly? [00:21:44][16.5]

Speaker 1: [00:21:45] So the way we present the plan, we actually divide the presentation in three moments. We call it the the emotional phase, the problem phase and the solution phase. So this is how we structure the way we present the treatment plan. By the way, this is the way I structure any type of communication in my life, even outside dentistry. Connecting emotionally, then. Explaining. That there is a problem somewhere and you can you can help with the solution and then explaining the plan and the solution. Right. So you need to first engage emotionally with the patient or make the patient engage emotionally with the treatment. That's the first step to make people change priorities. People are coming to you. And dentistry is one of the lowest priorities in their life. They're going to try to find any excuse not to invest on what you are about to present. So we need to know that we have a client that is there trying not to pay for what we going to present. So the only way to make people change priorities is to understand that we humans, even though we think we are rational beings, we are actually much more emotional. So the first step is to gain emotional credit, to even start any conversation. If you don't gain emotional credit, people will not listen to you. Then after you gain emotional credits, you need to then emphasize the problems, emphasize the findings before you explain solutions. This is another common mistake. Since we know the problem and we know the solution, we tend to jump the problem and we explain the solution. That's what you need. Basic vision. You need this. And when we say you need this, we are not allowing the patient to value that solution because they don't understand the problem. So they they know it's very hard to value a solution if you don't understand the problem. So the step number two is to deep dove into the problem journey as we call. And for that problem journey, we use the technology. So we we bring our scanners. We open the scanners in front of the patient. We connect the scanner to a huge TV so they can see everything very big. And with touch screen, we can show in 3D everything that we found. We show the CBCS, we show the face, we show the videos, the images, the x rays. But we connect all these visuals in a very dynamic way to give a complete list of everything that we were able to find as an issue or a possible issue or something that can be improved. So now after they they they went through the emotional journey first. And the emotional journey that we didn't mention is basically what we call the emotional smile test drive, where we do the facial scans, the infrared scans, and then we do the 3D design, we print this design and we place it in the mouth. And without saying anything, we record the before and the after and we present this. So we use 3D software and printing technology to generate the emotional smile test. Right after those ten, the ten minute, 50 minute experience, we go into the problem journey, we use the scanners, the CBCS, the videos, the images, etc. and we go through this deep, dove into all of the issues that we found. And then only after that we get into the treatment presentation. So now that you have, you know, where you want to be with the smile test, right? You know, the problems that you have with this journey, this digital journey through your issues. Now you can validate the plan. And this is the plan that we want to explain to you at that point. What we do is that the lab will create because the lab has the software, the dentist doesn't have the software. So the lab creates a presentation for the dentist with great maps, screenshots and videos from the software and organizes into a storyline. So the dentist can then present this in 3D as if they had the software without having to have the song. [00:26:04][258.7]

Speaker 2: [00:26:04] I love that and I think what you've talked about with actually taking time to present the problem can't be emphasized enough. I'm very much so guilty when I'm presenting treatment plans of just immediately jump to this is what we're going to do for you. This is what's involved in this. And, you know, it's no wonder that at times I'm failing to have a little bit of buy in from the patients where perhaps at that point they're just defaulting. To my expertize, I'm sure I'll venture to say my treatment acceptance is reasonable. I'm not getting a considerable number of people declining treatment, but yet at the same time, how powerful would it be to really spend that time investing with the patient and enumerating for them what the problem list is. [00:26:41][36.3]

Speaker 1: [00:26:41] Is so many ways, you know, because we are not dentists are usually not focusing on that because we were trained to focus on the treatment itself. You know, we know that at the end of the day, we need to deliver good quality care. And that is of course the most important part. So we are usually driven to put energy on that, the clinical execution, so we don't take much care of building the plan and selling the plan. We were not trained. We we don't have the natural skills for that. So this is why, you know, it's so important to focus on that if you are already and I always say that if you are already a good clinician, you're ready to come to a DC course and learn how to make the magic happen. [00:27:25][43.4]

Speaker 2: [00:27:25] So why are you using. Videography when you're gathering data, that's a bit unique. [00:27:30][4.1]

Speaker 1: [00:27:31] Yeah, this is something that we also brought to to restorative dentistry is amazing today to realize it until ten years ago, nobody was doing videos, you know, for us is a mandatory piece of information because the beauty of the smile comes from the movement. A beautiful smile is a beautiful smile in the real life. In real life is moving. You know, you don't want to look just good on a static photo. You want to look good in real life. So we need to analyze faces. We need to analyze the motion of the face. We need to analyze the motion of the lips. We need to analyze the motion between the teeth and the lips. So the only way to do this is through video. Video also captures the patient's emotions. The video captures the patient explaining what they like and what they don't like. Video allows you to understand a little bit of the character of that human being. The video allows you to also understand phonetics, understand the way that job movement is happening so you can see function from a different perspective. So I don't know, in like a one minute video, you can have so much information. And besides that, every second of a video brings an average of 30 photos. There's 30 photos inside every second, all of you. So it means that when you make a one minute video, you have hundreds of photos that you can pause this video in all of these moments and make a print screen. You make a screenshot of that and create a whole documentation out of the video. So for us is mandatory. All the dentists that work with us as part of the basic initial documentation, the video of their face, the patient's face in this interview, the video of this interview, this interaction is a mandatory piece of documentation for us. [00:29:21][110.8]

Speaker 2: [00:29:22] And not only that, but certain critical measurements that are really important for small design, such as incisal display or how much gingiva they show when emoting. You really can't gather in a photo or just even chair side because oftentimes it's very artificial. How often, when you're asked to smile, are you truly giving your true smile? Whereas in videography you can actually see them emoting. You can see how much ginger is displayed. [00:29:43][21.5]

Speaker 1: [00:29:44] Exactly. You know, for example, you mentioned the rest position, the real rest position, understanding the relationship between the wrist position of the upper lip and display on the teeth. We know how important this initial analysis is for treatment, planning, for decision making. Right. And many times when you ask the patient to rest and you take a picture, you know, the patient moved a little bit the lip, and then you have that picture and you think that is the best position. So I don't like to analyze the lip rest position in photos. I always analyze the lip rest position in the view and I move slowly. Video until I can capture the moment where I can see the muscles completely at rest. You can see that on the video, and then you pause and you can make a prescreen and say, okay, this is my real rest position. The same thing with the full smile. Another information that we know is key, you know, and you and me as fans of Bill Robbins in his book Global Diagnosis. It's the whole book. It's all about these two pictures. It's like the starting point comes from these two pictures. And if you capture these two moments wrong, you're going to make wrong decision. So when you ask the patient to actually give you a false smile and you click your picture, usually the patient is not getting your full smile, right? So the patient can usually show around 30% more of gum than what they show on that picture. So it's not a good starting point in the video. On the other hand, if you play the video you have, if you're recording the video, the patient after a few seconds forgot about the video. You know, you see something funny, they're interacting with you, they laugh. And you captured that moment when the patient really forgets about the video, loser loses it up and moves the leg all the way to the top. And you can then see that the exact lip designed, the way the lip moves and how much exposure you really have on that patient. [00:31:48][124.0]

Speaker 2: [00:31:49] What are your thoughts on face photos? Why might this not be a very accurate way to capture data when we have other tools available? [00:31:56][6.5]

Speaker 1: [00:31:57] And this is a good point. You know, I mean, I've been for 14 years, I've been bringing topics into my lectures that many times. You know, people wanted to to kill me. You know, I remember when I ten years ago, I said that the iPhone would become one of one of our major meditation tools, you know, and I posted it on Facebook and and people wanted to kill me, you know, so many bad comments that you're crazy. You shouldn't say that. And nowadays everybody uses. You know, the way, you know, we were the first ones to talk about a monolithic esthetic restorations with high quality. And for many years, people were saying this is impossible, and now everybody's doing it. And the other the other topic, you know, byte registrations with scanners that we were talking about. But registrations will disappear, you know, because you're going to scan the bytes and you're going to remove all the distortions of byte registrations and mounting models on that particular ITRs with that, all the mistakes that we did for decades, you know. So and nowadays everybody's registering by the scanners. And the other topic that for many, many years people would go crazy would be this is the is the Facebook, right? Because I've been telling people since 2014 that the Facebook is completely useless and it is completely useless. There's absolutely no reason. Not even one reason for that is to do a Facebook. If they work with the lab that understands CAD software, if your lab understands CAD software, all you need is an iPhone photo of the face and an integral scan. So if you have facial photos in an inch or scan, you can do a much better job on the software than trying to transfer a Facebook to an articulator. So this is it's pretty young people. Of course, people have a hard time accepting things that they usually don't even want to think about it because it's something new and they fight against the new. But I was able to convince all the major presidents that I have a good relationship. And nowadays it's a common sense. You don't need Facebook's. [00:34:14][137.4]

Speaker 2: [00:34:19] You guys, believe it or not, ratings on the Apple Podcast app actually really matter. So if you benefit from this podcast, could you please be sure it's liberating and subscribe? And as always, send me direct message and podcast Instagram, which is Don't buy this podcast. All right. I'll see you next week. [00:34:19][0.0]

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