Episode Transcript
[00:00:06] You're listening to the Evolution of Dental Podcast, sharing the stories of the people and the technology reshaping the world of dentistry. I'm your host, Rob Norton.
This podcast is produced by Evolution Dental Science as part of our educational outreach program. It is our goal to share with you the most cutting edge technology and fascinating collaborators that we work with on a daily basis.
I personally have been teaching dental professionals CAD CAM technology for nearly 15 years now and it is my passion and my pleasure to share with you all the latest and greatest in the world of dentistry.
[00:00:39] Today.
[00:00:39] I'm joined by Andy Jakson who is responsible for completely reshaping how we think about dentures. For more than a decade, dentures were the last holdout in the analog dentistry world. Messy impressions, multiple appointments, unpredictable fits. Then in 2011, a company called AvaDent, co founded by today's guest Andy Jakson, changed that conversation forever.
Andy, what made you first think that dentures could even be digital?
[00:01:09] Hey Rob, so thanks a lot for obviously doing this podcast and this subject matter, obviously, you know, it's pretty deep to my, to my heart to think about dentures being digital. I think everything can be digital today. So it's really a workflow and a process that has to be fine tuned. So it was just a matter of creating the right workflows and procedures in place to get the records necessary that are, that are necessary for full mouth rehab.
[00:01:41] Where did you start? What was your first step to begin the world of digital dentures?
[00:01:47] Quite honestly, I mean, it was really a passion of mine at a certain point I worked for an in-tech corporation with Dr. Ron Bulard and Tim Thompson. They both at a certain point owned it. And they had a meeting basically that they would code that they would ask everybody to present the largest problem that they had in dentistry. And mine was dentures based off of the idea that I was owned a lab for approximately 20 years at that time, and maybe even 20, about 20 years and then presented this problem that dentures were very ill fitting, unpredictable and so on and so forth, all of the things that we have. My sister was a nurse and still is about 40 years in a nursing home. And she presented me with problems of nursing home dentistry and obviously missing dentures inside of that arena. And the vision was always that once we make a digital product, it's very easy to reproduce. And so that's kind of where I would say those two catalysts is what kind of gave me the passion for dentures.
And you know, I was very privileged to be working with approximately 60 nursing homes and saw that need, tremendous need at a certain point. And you know, that just accelerated my enthusiasm for digital dentistry.
[00:03:17] So you'd say the repeatability of it is where digital dentures started.
[00:03:23] Yeah, I think the idea of, you know, simple, simple at that point. Right. Because we didn't have all these tools. So at that point I, you know, I had a, I had a box scanner and it was the idea of taking somebody's denture, scanning it and just being able to 3D print it or even mill it at a certain point and just having dentures that these patients can have.
Usually a nursing home patient has to wait somewhere between two months to sometimes up to six months for a denture. Dentists are required in New York State only to come to nursing home practices twice a month. And quite honestly, the denture appointments are not taking priority. These patients are in the liquid diets for that, that period of time. So what I thought it was like if we could scan the denture and then take that file and just reproduce it, I don't care what the aesthetics are like, as long as these people can eat, that would serve in its own self as a viable prosthetic for mastication. Right.
[00:04:26] Absolutely fascinating. Very human driven story.
So what would you say your initial bottleneck would be with pulling these, pulling these dentures into the digital workspace like you have? You said a single box scanner. Obviously we didn't have intraoral scanners back then.
[00:04:44] We did, we had intraoral scanners, Robert. We just didn't have the ones that we have today. Right. Today, intraoral scanners replace box scanners. At that time you had one focal point which allowed you to do basically a 360, both sides separately and then stitch it together in a, in a software and then created the denture. Today scanners, you could use any, almost any intraoral scanner. We, we present the solution from Allied Star. But you know, our Allied Star can scan faster than we did. So at that time, what I would say to you, to answer your question, you know, what was, what was, what was the difficulty is just kind of convincing people that this is possible and that, you know, that we can basically drive aesthetics and the design of the denture from that perspective.
You know, I got, you know, I could go into the whole story of how we got started. But you know, I had Ron Jarvis, Dr. Ron Jarvis, one of world renowned prosthodontists, and my partners, you know, Tim Thompson, Sean Grobet and Scott Keating.
And you know, so, so they, they were very excited and you know, I remember sitting in front of a room with big, basically, you know, 15 doctorate degrees among the four of them. And me, a guy that, you know, didn't even graduate college from a perspective of going into the dental lab space. And I'm sitting there teaching these guys about dentures.
But we sat there, we, we, we talked about everything and, and then started going about how to solve it by doing a tremendous amount of research on occlusion.
And that occlusion algorithm is really what drove the first digital denture software, which is AvaDent.
You know, and we really drove that pretty hard for about two, three years.
Had a colleague of ours that's still working with me, Colin Tremonti, that actually worked really side by side with me. We milled the first digital denture here in Buffalo, New York. You know, we were in Buffalo for almost a year, year and a half, and then moved to Arizona and Scottsdale where, where AvaDent is today.
And, you know, so at that point they, you know, we, I just chose to basically separate and they went their way and I went my way. And this is what.
We basically came back to Buffalo and started, you know, started Evolve, and helped exocad.
And they helped us, obviously, but we certainly were at that point the experts in digital dentures, and they were certainly the experts in everything else.
And we understood their software, they understood us, and we just helped them.
Fifteen years later, you've got exocad the way it is, and it's, in my opinion, the most robust software out there that can handle everything from full mount to single units.
[00:07:43] Absolutely, absolutely. So you going from a box scanner of a existing patient denture to the first denture, what was that like? So how did, Obviously we didn't have 3D printers with that or as adept at production as we have today.
How did, how did you decide to take that and bring that into reality from a digital scan?
[00:08:05] So, once again, I had some awesome partners. Right. So Sean Grobet, which was the, basically the mechanical engineer in the group, really went out and researched all the mills out there, looked at a company called Robocam. He felt that that machine was the best machine for milling. PMMA. PMMA, as you know, obviously it's a very difficult product to mill. You have to watch your speed so you don't burn it. You have to watch, you know, the aggressiveness so you don't rip it out because it's very aggressive, very hard.
So there was a lot of factors that we needed to do, but before that we needed to create our own puck. So we ended up engineering a way to basically create the chemistry in the puck. You know, it's an ectothermic reaction. So that ectothermic reaction in the beginning burnt a lot of pucks because when you put enough material ties together the inside burns. So we had to learn on how to cool that, create the process, create the, the, the pressure points. And we did a bunch of research on and all that. And then we created the ability to basically manufacture and create our own pucks. And to tell you honestly, we, we did an incredible job. And it was something that was manufactured by my cousin Teddy that basically learned the procedure inside and out and making all the pucks for AvaDent. We also, at a certain point we realized that we wanted to mill not only the base because we were putting teeth in it.
You know, we were using basically Ivoclar's Blue Line teeth and milling the pockets and then putting the pockets one by one post curing that.
And that's how we set the first dentures and milling pockets and taking denture teeth and putting them in there one by one.
Every denture that we were hoping that we would get in the house, we were losing money, but we continued the fight and then we wanted to basically create a process that we would, we would have milled teeth. So what we did is we actually milled. It's a patent, it's a, you can read it. But basically what it is is you mill the whole, whole tooth in the pocket all in one and then you backfill it with, with acrylic and then you mill again Incisal and then you mill, backfill that with incisal and then, and then you mill the whole denture again. So it was a three step process of getting to the final product being all in one with basically 100% accuracy. So that's, that's basically the manufacturing part of the, of the dentures is, is and has been solved for a very long time.
I think where we're struggling today and have always struggled is really in the record taking.
[00:10:58] Can you speak more to the record taking?
[00:11:01] Yeah. So Dr. Jarvis and myself created something called the AMD. It's an Anatomical Measuring Device that we allowed the community to kind of look at. And it was a way to capture the only edentulous record that you have. And that's basically a gothic arch tracing. So we would have the CR in the right position and then from there, once you have that gothic arch tracer in the right position, we stabilize the pin and then allowed the dentist to open up the VDO to basically with a little screwdriver to open up the VDO, the pen to where they felt the muscular component of the face was proper. That was our way of getting, and then stabilized all that through like a blue moose bite registration. And then from there we took that and scanned that 360 again and, and did our best fit to the soft tissue of the final impression and created the VDO and CR movements from that.
And that's where we got basically in the first appointment you got all of your records, right? So the whole idea is changing everybody's mind from how many appointments you need to capture those records. It was changing a mindset, changing, you know, the workflow for, for, for doctors. You know, dentists tend to feel like they could correct dentures on the next appointment.
But you know, when, when, when you have that mindset, that's where, that's where we went around. I went around to about 45 different colleges and try to present it as a solution that we would teach ventures this way for a digital venture process.
But we were just trying to get to a position of making people understand that digital dentures are here because of the ability for us to do that.
You know, Dr. Steve Wagner created the Wagner tray, which was a gutta-percha tray that basically gave some aesthetics and ability to create that in that process.
We also, we were the first ones to use thermoplastic trays where we would take stock trays and we had a series of 10 different stock trays and you would pick the size of the patient arch and then put that in the hot water and basically create a custom tray for yourself.
So that allowed us to basically accelerate that process.
But as I mentioned to you, that's always been the challenge. This is a very difficult record.
And even though I've done hundreds of them, they're difficult every single time because different for different reasons, you know. And I think that's the hurdle that needs to be corrected. And that's really what we're working on, is how to simplify that record taking process.
[00:14:01] So you had to not only invent a workflow for this, but you had to invent materials and then select material machines that could be compatible with these materials and then workflows to work with those machines and then workflows to take records.
How was that? I know you said you went around to, you said like 45 colleges, something like that.
[00:14:22] Put it this way, I became a, I became a frequent flyer on two airlines. And let's just say Mrs. Jakson was not very happy with me.
I had. My son was a senior in high school, so I kind of sucked that I missed that. But you know, when something hasn't changed in that many years, you have to reinvent the wheel 100%.
You know, it's really about looking at it from a solution based record, solution based process.
And remember I had engineers in my ear all day long about this is what we need. They don't want a variance of 100 microns. And I would laugh, I'd be like, "well, I'll just give them a little more salt that day" or something.
So, yeah, so the inventions of the AMD and the inventions of, let's call it, these processes came directly from the collaboration between engineers and technicians. And say, this is what the prosthodontic community accepts as records.
And this is what the engineer said, this is what we need as records. And so we basically created this process together.
The, you know what I, you know, as a technician, custom trace was a norm for us to make for dentures, as we all know.
And so, you know, when I saw the thermoplastics and then we made them into trays and I said we could sculpt these with, basically we made it to the equal. The, the Keurig was coming out. So the Keurig's water is like 170 degrees. So we made it basically melt at that Keurig water. So we would just buy people Keurig and they could have that water to melt the pot. Pretty clever workaround. Well, I mean, we could have made the temperature anything we wanted. We wanted to make sure it was, you know, we didn't want to sell them a water heater. So we basically said buy a, buy a Keurig, make some coffee and then do this. So, you know that, that was, you know, so when we started doing make.
[00:16:40] For a denture that makes it very accessible.
[00:16:43] Well, you know that those are type of things that, you know, you've got to, you know, I think that's the business side of us, right? That was Tim Thompson and I would consider myself in that pool. It was like the business side of how do we make this, you know, achievable. Also, like, it's great to have all these tools and have people buy thousands of dollars of our stuff, but realistically, how do we have them buy a thousand dollars worth of our stuff and still be able to create these records, you know, so, so that was kind of the idea behind, you know, some of this invention as, as you said, you know, the idea of, you know, how do we solve the problem with basically the least resistance and also achieve 100% the problem solution?
[00:17:32] Because in the final analysis it still has to be very approachable if you're going to be serving, serving nursing homes where let's be honest, the, the skill set for most of the people assisting there is not typically the level that you'd get at chairside or high end dentist. Certainly not a technology center and not engineers on staff.
[00:17:52] Yeah, no, I, I would say that. But let me just say it a different way because some of the greatest people that I've met in dentistry work for nursing homes. These people are just super caring.
They are, you know, they're not money driven. If they were, they wouldn't be in the nursing home.
They are the most compassionate people and they really put their hearts into the job. So when we came up with this solution in some of the nursing home dentists that we worked with, you know, they were absolutely aesthetic about, about the solution. The problem has always been the manufacturing of the denture was very expensive at that time because we, all we did is mill them at that time. And as I mentioned to you, there was a three step process. So having it lost money on every denture at $450, you know, and that is not a scalable process.
Now we all knew as partners that 3D printing is coming along and where it is today. And, and quite honestly, you know, also milling has come along and you know you've got, you know, the Ivotion pucks that basically you know, have that, the, the, the tissue and the teeth inside of them which is a nice solution for milling processes. And there's other solutions out there that also do that. But you know, I mean milling dentures is absolutely, you know, let's say the highest standard care denture that you can mill.
Is it necessary? Absolutely not.
I think that there today there's tremendous 3D printers out there that mill, I mean that print. Sorry about that, that print dentures very close to what a 3D milled denture would be. They're not still there as the same chemistry but they are very close to what they are what, what we are expecting of them. And that's really. The porosity for the C. albicans is incredible in a, in a properly cured acrylic puck. And also the fit is one to one to the mill. So you know it's, and, and I would say to you that where the fit is there for 3D printing now, 100% there's unarguable, it's there and as far as the porosity, if you're using the right chemistries, you absolutely have incredible chemistry that allows you to keep the C. albicans. And also we are going to be introducing a, a powder that you can add to any 3D printed material that basically eliminates any bacteria growth inside of there. And that would be basically introduced within the next six to eight months that we are working with University of Buffalo on. And, and that that powder will be utilized for obviously anything that is like a full mouth rehab after surgery type of approach or for dentures or for any type of healing specifically for things like immediate dentures that are, that we're looking to create better healing approach for soft tissue.
[00:21:22] That's very exciting. That's very exciting.
[00:21:24] It is.
[00:21:26] How would you compare say the results you were getting from AvaDent to some of the like what the techniques are within evolution dental today and what are you most excited about on the horizon? Obviously the, the, the, the, the powder you were just discussing is very exciting, but as far as like the new manufacturing techniques, newer software, I mean you had to pioneer a software from scratch for AvaDent. So there's a lot of stuff on the horizon. What are you excited about?
[00:21:54] I, I think the things that make me look be excited in the, in the full mouth rehab world is first and foremost it's full mouth rehab. It's no longer just doctors. Right.
So if you're talking dentures, you're talking dentures on implants because that for a digital technician there's no difference in making a denture and a full mouth rehab restoration. You just got to learn how to implant parts and so on and so forth. And obviously there's different things. But, but in the full mouth rehab world what I'm really, if you're asking me what I'm really excited about, you know, to me there's a couple advancements that are happening in our industry.
You know, BiteFinder, it's basically a software that uses patients where facets and creates basically fully functional occlusion, you know, bilateral occlusion that uses the patient's existing wear facets or if you created a denture, the wear facets that they would create within a short period of time. There's ways of creating that process to accelerate the patient's bite and knowing where everything is. So I'm really excited about solving finally the bite problem in the industry and I think BiteFinder will absolutely do that because we've distributed all the other jaw tracking devices. They're all really nice but they're very complex to Work with and to, you know, they do their job. They're just too complex, in my opinion, for the average dentist to appreciate the value of that and spend that time chairside to getting that. So with BiteFinder, you don't really have to do anything except take a really nice full upper and lower scan.
So that, you know, BiteFinder excites me, to tell you the truth. What else?
Yeah, you know, and then what I really like is, you know, as, you know, this day and age, information is critical to everything, right? So getting these scans and putting everything together, you know, and I, I, you know, great Labs is doing an incredible job creating a process, in my opinion, to merge all of this data together and utilize everybody's Strengths and creating APIs to, to work with with all the different software out there to basically create streamlined approach so all of this data isn't everywhere and you're wondering where it is. So to me, I think that's exciting.
The AI is absolutely exciting to me. And, you know, AI is so overused. Right, exocad had AI right from the beginning, actually using the patient's existing dentition to give you a little bit better design than just the proposed design. But, you know, with that being said, you know, exocad is working on their full AI approach towards, you know, obviously it all starts with simple problems, but I, you know, the complexities really get me excited. If there will be days where they could, there will be a day that they can absolutely, you know, present a full solution for, let's say, a full mouth or for veneer case or aesthetic case or so on and so forth, if we put in the right information in there. And, you know, that kind of excites me because it allows our technicians to really, you know, take their skill sets of what they know. What we will do in the United States is create a lot more jobs with this type of approach with our technicians, because there's so much going overseas that really shouldn't be.
And quite honestly, what we need to do in the United States is look at the ways that we could use these tools to be competitive against or against or with. Be as competitive as the overseas manufacturers. And we have other ways that we could be way more competitive, and we just have to be open to that. And I think that excites me to have AI assistance there for our technicians to finalize restoration, understand what we need. And they have all these other tools like BiteFinder and basically great lab, putting it all together and allowing us to basically utilize all these strengths together that's what excites me is the collaboration of all of these tools together.
As long as people are open to creating, creating the evolution or the evolvement of their, of their process inside of.
[00:27:07] Sounds like you are not worried about AI taking jobs much as you are saying AI is going to create new opportunities for good technicians.
[00:27:16] My lab will do three times the amount of volume in the same amount of space and I can't wait for it in the next three to five years.
So am I worried about that? Absolutely not. I think the people that should be worried and if there is people worried should be the people that are over there are sending their stuff overseas.
Because I really believe that that, that is, that is where we need to. I'm not here to compete with United States labs. You know, we've never lost, we never lost an account to a dental laboratory. We lost an account to ourselves. We didn't, we didn't treat them properly. We didn't do something right. And when you lose an account, you have to look at your inter inside and your internal process of what you did to. For that account. If you think that they left you for $5 a unit, you're way mistaken. You're, you're, you're not in the right place.
What you need to do is really look at what value props you're. You're presenting to your customer base and then utilize technology and the skill sets of your technicians to basically get more value in our competition. And I think that's the reality of where we are.
You look at AI and my partner JJ the last two legalese's that we had, he did AI letters to our customer base and to. Not our customer base. I'm sorry. To our people that we had our disputes with. And you know, he gave them to our lawyers and our lawyers said these were as good as I could write them.
You know, he could have, he could have been upset about that. But you know, the reality is, you know, if he knows that we're, we need him for bigger things, you know, and for growth and so on and so forth and if we can handle these small little disputes properly with AI, you know, that basically is something the same way that we are looking at what we do for our, our, our doctors. You know, we expect our doctors to internalize some of their production. Why wouldn't they?
I would hope that they would. And really that's why we created Evolve around is evolve was created really for, for doctors that want to create a, internalize their process.
And we are here to help them. And by the way we only present solutions that we use every day. So we're not here telling people, you know, go use this or this printer and we're not using it. We don't even present that as a solution. The only solutions that we could present on is the ones that we're using. And I open, and I open this really to any laboratory that is out there. If you are a specialist in the product that you have, you should, you should start distributing that product.
You know, there are other labs that need your assistance on how to use it and there are other dentists and professionals that need your assistance on how to use it. This is a very simple model and quite honestly, it's our relationships that we need to, you know, accelerate and help. You have to be a resource to your dentist in a different way today than you were a resource for. You know, when we were, when we started in 1990 with Empress. At that time our resource was our knowledge and our understanding of bonding and understanding of prepping and so on and so forth. You know, today's resource is totally different. It's digital, it's workflows, it's, you know, it's machinery, it's, you know, chemistry that still.
But, you know, those are the type of things that I think that we could create value for our customers and help them quite honestly achieve some of the products that we used to make for them inside of their dental practices simply to help one offset some of their costs. Running a practice is extremely difficult. Also they have a lot of challenges that we quite honestly don't think of. And, and I think we are here to present, try to help present some of those solutions for them.
[00:31:28] So very future, forward facing and sounds like that in spite of technology changing over time, the ethos is the same, to embrace it and move forward boldly with it and not be afraid to collaborate, but to share it with those that you work with. Does that sound right?
[00:31:48] Well, Robert, yes. And you know what I always love to say to people, I have three Ferraris. It used to be one, now it's three Ferraris. Unfortunately, when you open those containers, they're all full of old dental equipment that we bought based off of the idea that we thought that was the greatest tool.
And you know, but you know what that that is. These are the things that allowed us to continue to advance and continue to be on the cutting edge of where we feel we should be, where we have to be to continue to advance our laboratory to the next stage. And we can't be afraid of, in my opinion, you can't be afraid of what is going to happen because it's going to happen.
And you can't be afraid to fail because you will fail if you don't do anything. So the biggest failure has always been in my life is the failure of not trying something. Because when you try something, you absolutely have lessons that are extreme, beautiful.
[00:32:54] And one final thought.
What would you say would be a good place to start for those who are still skeptical in 2025 of the digital denture? Where do you think they should begin to step into this field, either for a lab technician or a doctor?
[00:33:14] Well, if you're skeptical as a lab technician, get the over it.
Like, come on, stop. Just stop. Just embrace it. Go for it. As a dentist, I would say very simply this.
You should go to the place where you're going to give the laboratory the best record.
So to me, the simplest record to give to the lab, I'm talking about the ideal case to start with.
There's enough teeth that you've got a VDO CR position. You've got the patient in a half a decent position. You're going to be extracting a whole bunch of teeth.
That's the best place to start. Take a full scan of that upper and lower, try to capture as much soft tissue as you can see all the way around it, and then send that to your lab, let them extract it, let them do their reduction the way they normally would do it in a cast, and then let them basically present you with a solution of a digital denture that is realignable. So they just have to know which material signs can be relined. And then that would be a perfect position for, for a start of a digital denture. The beauty about that, just so you know, Robert, and I'm sure you do, is that the laboratory never loses that record.
So what it allows them to do is basically create the final denture very easily also, because then all you would have to do is rescan that denture after you do all washing it and basically present that as the solution for the final denture.
[00:35:01] Excellent. Andy, thank you so much for your time today.
[00:35:05] Anytime, you know that.
[00:35:08] Anytime.
[00:35:11] All right, well, thank you, everybody. Appreciate you guys. And I just have one more thing to say. Go Bills.
[00:35:18] Go Bills.
