Dental Digest Podcast with Dr. Melissa Seibert

Episode Overview In part two of this two-part series on Dental Digest, host Dr. Melissa Seibert and dual-boarded periodontist/prosthodontist Dr. Ashley Hoders challenge the conventional assumption that implants are always the gold standard in the anterior aesthetic zone . They explore why maxillary laterals and mandibular incisors are biologically hazardous sites for implants, how to choose mechanical over biologic failure, and how root submergence preserves vital bundle bone and papilla architecture . Guest Information Guest: Dr. Ashley Hoders, DDS, MS Credentials & Affiliations: Dual board-certified diplomate and fellow of the American Board of Periodontology and the American Board of Prosthodontics; MS from the University of Texas Health Science Center at San Antonio . Clinical researcher with the McGuire Institute, co-creator of Spear Hygiene, visiting faculty at the University of Washington Graduate Periodontics Department, and active member of the American Academy of Restorative Dentistry . Key Clinical Takeaways 1. The Fallacy of the Anterior Implant "Gold Standard" Maxillary lateral incisors and mandibular incisors represent non-strategic implant locations due to narrow space, thin facial bone, and continuous lifetime craniofacial changes . Natural adjacent teeth and jaws continue to move, erupt, and remodel across a patient's lifespan, whereas ankylosed/osseointegrated implants remain static, causing mismatched incisal edges and uneven gingival zeniths over time . 2. Mechanical Complications vs. Biologic Disasters Conservative cantilevered or single-retainer resin-bonded bridges achieve a $\approx 98\%$ success rate over 10+ years in properly managed occlusal schemes . Fixed tooth-supported alternatives fail through mechanical inconvenience (e.g., wing debonding or connector fracture), which is easily repaired . Implants carry biologic risk: at least 50% of implants exhibit inflammation or peri-implant disease, introducing chronic inflammatory challenges into an avascular environment where treatment is unpredictable . 3. Two-Layer Diagnostic & Treatment Planning Dual perio-prosthodontic diagnostics require planning not just for the immediate edentulous site, but predicting what happens when adjacent teeth compromise (e.g., adjacent traumatized central incisors) . 3D planning dictates restorative pathways before surgery, verifying whether crestal morphology necessitates cement-retained versus screw-retained solutions . Placing an anterior implant too shallow or too facial is the ultimate "kiss of death" for long-term peri-implant tissue stability . 4. Biologic Tension and Muscular Equilibrium Bone stability relies on eliminating tension from the surrounding musculature (lips, cheeks, and tongue) and establishing a robust collar of keratinized mucosa . Genetic cell turnover rates and masticatory function continuously challenge crestal bone margins . 5. Root Submergence & Partial Extraction Therapy Anterior facial bone is frequently $<0.8\text{ mm}$ thick; removing the tooth and its periodontal ligament (PDL) causes rapid resorption of the bundle bone, resulting in horizontal and vertical ridge collapse . Root submergence retains the submerged root structure inside the alveolus, tricking the body into maintaining the PDL, preserving bundle bone volume, and sustaining interproximal papilla height for adjacent restorations . "Pro-tooth" dentistry prioritizes buying time with natural root structures (via posts, ferrule optimization, or partial extraction therapies) over premature implant placement . Notable Mentions & Literature Bill Robbins, DDS: Commentary in the International Journal of Periodontics & Restorative Dentistry (IJPRD) on avoiding lateral incisor implants; single-retainer RBFDP designs utilizing the mesial of the canine . Matthias Kern, Dr. med. dent.: Long-term evidence supporting single-wing cantilever resin-bonded bridges (using the distal of the central incisor) . Frank Spear, DDS, MSD: Clinical philosophy on valuing natural tooth retention: "I'm not anti-implant, I'm pro-tooth." Mike Gunson, DDS, MD: Research surrounding facial aging, craniofacial growth, and implant positioning discrepancies .

Detailed Show Notes Episode Overview In part one of this two-part series on Dental Digest, host Dr. Melissa Seibert sits down with dual-boarded periodontist and prosthodontist Dr. Ashley Hoders to examine the latest consensus literature on peri-implant soft tissue deficiencies, biologic bone preservation, and the biomechanics of skeletal expansion . They unpack why soft tissue recession is fundamentally a bone problem, how thin tissue starved of blood supply triggers crestal loss, and why treating skeletal arch deficiencies with dental compensation compromises cortical bone . Guest Information Guest: Dr. Ashley Hoders, DDS, MS Credentials & Affiliations: Dual board-certified diplomat and fellow of the American Board of Periodontology and the American Board of Prosthodontics; MS from UT Health Science Center at San Antonio . Clinical researcher with the McGuire Institute, co-creator of Spear Hygiene, visiting faculty at the University of Washington Graduate Periodontics Department, and active member of the American Academy of Restorative Dentistry (AARD) . Key Clinical Takeaways 1. The Reality of Peri-Implant Soft Tissue Deficiencies Recent joint consensus papers (AO/AAP) reveal that non-diseased peri-implant soft tissue deficiencies have an overall prevalence of 46.2% . These deficiencies worsen over time: 33% at 1 year and 64.5% at 5 years . Clinicians should exercise caution when planning implants in the aesthetic zone and consider alternative modalities (such as resin-bonded bridges) when appropriate . 2. Mid-Facial Margins vs. Interproximal Papilla Interproximal papilla height is dictated primarily by the bone levels on adjacent natural teeth . Mid-facial mucosal margin stability is driven by facial bone thickness (which is frequently $<1\text{ mm}$), 3D implant positioning, and placement timing (immediate vs. delayed protocols) . 3. Soft Tissue Recession is an Underlying Bone Problem Soft tissue recession or peri-implant deficiency cannot occur without an underlying bone dehiscence or bone loss . Bone requires two primary conditions to remain stable : Vascular Nutrition: Thin tissue has inadequate blood supply, starving the underlying crestal bone and causing progressive remodeling . Absence of Tension: Muscle attachments, vestibular pull, and lack of keratinized tissue exert tensile forces that destabilize bone . 4. Proactive Grafting as a Bone Stabilizer Because bone cannot be predictably regenerated over an avascular implant surface or root dehiscence, soft tissue grafting serves as a proactive biologic shield . Converting thin phenotypes to thick biotypes and widening keratinized mucosa delivers blood supply and buffers muscle tension, safeguarding crestal bone before recession occurs . 5. Skeletal Solutions for Skeletal Discrepancies Post-industrial human development (diet changes, decreased breastfeeding) has led to smaller maxillas and contracted arches . Treating skeletal constriction with purely dental expansion tips teeth outside the cortical plate, causing bone dehiscences, severe recession, and mobility . Skeletal discrepancies require orthopedic/skeletal solutions (e.g., MARPE) rather than dental camouflage to preserve the periodontal foundation . 6. Patient Communication & Treatment Planning Utilize 2D/3D radiographs alongside high-quality clinical photographs at baseline . Drawing directly on printed photos helps patients visualize bone anatomy, soft tissue margins, and long-term aesthetic trade-offs before consenting to anterior implant therapy . Notable Mentions & Literature Consensus Literature: Academy of Osseointegration (AO) and American Academy of Periodontology (AAP) consensus papers on peri-implant disease and soft tissue deficiencies . Influences & Citations: Kevin Murphy (AARD literature review), Joseph Kan (interproximal bone dynamics), Mariana Evans (airway, cranial growth, and post-industrial skeletal changes), Jeff Rouse, and Bill Robbins (interdisciplinary diagnosis)

Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin   Dr. Vince Kokich Jr. is a highly esteemed orthodontist, educator, and thought leader in the field of orthodontics and interdisciplinary dentistry. Following in the footsteps of his father, Dr. Vince Kokich Sr., a globally recognized pioneer in orthodontics, Dr. Kokich Jr. has built his own legacy by advancing innovative approaches to patient care, education, and the integration of specialties within dentistry. Educational Background Dr. Kokich Jr. earned his Doctor of Dental Surgery (DDS) degree with high honors from the University of Washington School of Dentistry, a program known for its rigorous clinical training and commitment to evidence-based care. He went on to complete his orthodontic residency at the same institution, where he honed his skills in diagnosing and treating complex malocclusions, facial growth discrepancies, and interdisciplinary cases. Throughout his education, Dr. Kokich was recognized for his academic excellence and dedication to improving patient outcomes. His passion for teaching began early in his career and has remained a cornerstone of his professional life. Professional Career Dr. Kokich Jr. has practiced orthodontics for over two decades, specializing in comprehensive treatment plans that address both functional and esthetic concerns. He is particularly renowned for his expertise in: Interdisciplinary Treatment: Collaborating with restorative dentists, periodontists, and oral surgeons to achieve optimal outcomes for complex cases. Aesthetic Orthodontics: Enhancing smiles through precision orthodontic treatment tailored to each patient's unique facial structure and goals. Education and Mentorship: Sharing his knowledge and clinical experience with the next generation of orthodontists. As an orthodontist, Dr. Kokich is committed to providing patient-centered care. His approach focuses on creating harmonious outcomes that not only align teeth but also improve facial aesthetics and long-term dental health. Educator and Speaker Dr. Kokich Jr. is a sought-after speaker at national and international dental conferences, where he shares his expertise on topics such as: Advanced interdisciplinary treatment planning. Managing complex dental esthetic cases. Incorporating emerging technologies into orthodontic practice. He has been invited to lecture for prestigious organizations and institutions, including the American Association of Orthodontists, the American Academy of Esthetic Dentistry, and various study clubs and universities worldwide. His dynamic and engaging teaching style makes him a favorite among both clinicians and students. Innovator and Founder Dr. Kokich Jr. is the creator of Kokich Education, an educational platform dedicated to elevating the knowledge and skills of dental professionals. Kokich Education offers a range of resources, from webinars and case studies to in-depth courses, empowering clinicians to tackle even the most challenging cases with confidence. The platform reflects Dr. Kokich's philosophy of interdisciplinary collaboration and lifelong learning. To learn more about Kokich Education, visit kokicheducation.com. Publications and Research Dr. Kokich Jr. has contributed to several peer-reviewed articles and textbook chapters that focus on the integration of orthodontics with other dental specialties. His work has been instrumental in advancing the understanding of how orthodontics can complement restorative and prosthetic dentistry to achieve superior outcomes. Professional Affiliations Dr. Kokich Jr. is an active member of several professional organizations, including: The American Association of Orthodontists (AAO). The American Dental Association (ADA). The Pacific Coast Society of Orthodontists (PCSO). Legacy and Vision Dr. Vince Kokich Jr. continues to honor the legacy of his father while forging his own path in orthodontics. His dedication to innovation, education, and patient care has made him a leader in the field. Through his practice, lectures, and Kokich Education, Dr. Kokich inspires clinicians worldwide to achieve excellence in their work and deliver transformative care to their patients.

👉 Join Elevated GP Virtual Study Club Here 🎙️ Episode Show Notes: The Dental Digest Podcast Host: Dr. Melissa Seibert Guest: Dr. Christian Coachman (Founder of Digital Smile Design, DSD Residency Director, Adjunct Professor at Penn) 📌 Episode Overview In Part 2 of this two-part series, Dr. Melissa Seibert and Dr. Christian Coachman tackle the business, ethics, and systemic future of dentistry . They address the harsh reality of dentistry's underlying business model—which historically profits on illness rather than prevention—and lay out a roadmap for "Dentistry 3.0" . Discover how to transform your new patient exam into a "Super First Appointment," build an active referral network with primary care physicians and ENTs, and position yourself as an Oral Physician who thrives by keeping patients healthy for decades . 🔑 Key Topics & Takeaways 1. The Shift to "Dentistry 3.0" & The Oral Physician Closing the Systemic Gap: Research increasingly links oral pathology to systemic health, making the dentist's office the potential gateway to modern medicine . The Relationship Advantage: Unlike standard physicians whom patients rarely see annually, dentists maintain regular, long-term relationships with patients . This uniquely positions dentists to lead holistic healthcare . Embracing the Role: If dentists do not claim the "Oral Physician" domain, medical doctors will eventually step in and overtake it as medicine shifts toward integrative health . 2. Disrupting the "Profit on Illness" Business Model The Problem: The current healthcare, dental, and pharmaceutical systems are financially incentivized by illness and quick fixes . High-margin procedures often rely on an unhealthy population . The Solution: Transition toward preventive care, longevity models, and advanced hygiene/membership systems . Communicating Value: Frame your care around long-term healthspan . Smart patients are increasingly willing to pay for concierge-style preventive care that saves them time, hospital visits, and invasive procedures over 20–50 years . 3. Designing the "Super First Appointment" Beyond the Obvious: The first appointment shouldn't just be checking for decay or missing teeth . It requires gathering systemic data, evaluating airway dynamics, and understanding patient history . Expanding Your Clinical Network: A modern dental practice must actively collaborate with: Primary Care Physicians ENTs (Ear, Nose, and Throat specialists) Sleep Medicine Specialists Endocrinologists (e.g., managing the bi-directional relationship with diabetes) Physicians as Referral Sources: Dentists who practice integrative, body-mouth dentistry often find that local physicians become their single biggest source of patient referrals . 4. Overcoming Unconscious Diagnostic Bias The Trap: Dentists often look into a patient's mouth and unconsciously search for the specific procedures they enjoy or know how to perform . The Fix: Implement standardized protocols, structured questionnaires, and objective diagnostic technology during the intake process to evaluate the entire stomatognathic system objectively . 5. Positioning & Authentic Branding Avoid Gimmicks: Stop relying on $49 exam specials or free whitening trays that attract price-sensitive patients looking for quick fixes . Master Your Uniqueness: Be clear about who you are . Practice your core messaging so you can articulate why a patient should choose your practice and how your health-focused approach protects their long-term well-being . 💬 Notable Quotes "Fixing problems generates desperation, and desperation makes people spend whatever money they have. Health generates no desperation—it generates less need to spend money. We need to reinvent the business model in dentistry so we are rewarded for keeping people healthy." — Dr. Christian Coachman "Modern dentistry will undergo its revolution at the first appointment. The way you collect data, the questions you ask, and the network of physicians you collaborate with on day one changes everything." — Dr. Christian Coachman 📋 Practical Action Steps for Clinicians [ ] Audit Your First Appointment: Redesign your new-patient intake questionnaire to include questions on sleep quality, breathing, energy levels, and systemic conditions . [ ] Build Your Physician Network: Reach out to 3 local ENTs and primary care physicians this month to establish a formal referral and co-treatment protocol . [ ] Refine Your Unique Pitch: Clearly define and practice your response to the question: "Why should a patient choose your practice over the office down the street?" [ ] Implement Checklist Protocols: Create structured diagnostic checklists to eliminate personal bias when evaluating new patient cases .

👉 Join Elevated GP Virtual Study Club Here 🎙️ Episode Show Notes: Dental Digest Podcast Host: Dr. Melissa Seibert Guest: Dr. Christian Coachman (Founder of Digital Smile Design, Dental Technician, Dentist, Adjunct Professor at Penn) 📌 Episode Overview In Part 1 of this two-part series, Dr. Melissa Seibert sits down with Dr. Christian Coachman to challenge fundamental assumptions in modern dental practice . They draw a hard line between treatment planning and procedure planning, break down why dentistry excels at improving quality but struggles at controlling it, and discuss how borrowing mistake-prevention systems from aviation and manufacturing can transform clinical outcomes . Finally, Dr. Coachman dives into the traps of "camouflage dentistry" and outlines the vital shift every clinician must make to evolve from a cosmetic technician into an Oral Physician . Key Topics & Takeaways 1. Procedure Planning vs. Treatment Planning Procedure Planning: Planning how to execute a specific task after the procedure is already decided (e.g., using ClinCheck for aligners, using software for guided implant placement, or marking prep finish lines in Exocad) . Treatment Planning: An interdisciplinary, comprehensive exploration of all diagnostic possibilities before deciding on specific procedures . It defines the overall blueprint and clinical sequence . The Misconception: Most digital dental software marketed today is actually procedure planning software improvising backwards . True treatment planning requires interdisciplinary diagnosis prior to software execution . 2. Quality Improvement vs. Quality Control Dentistry focuses heavily on improving quality (e.g., taking CE, getting better with hand skills) but fails at controlling quality (ensuring consistent, repeatable results without errors) . Chairside fixes or lab remakes should not be viewed as wins just because the patient left happy; they represent a system failure that allowed the mistake to happen in the first place . The Aviation/Manufacturing Mindset: Dentists must act like production line managers . When an error occurs, stop to analyze why it happened and build a system to guarantee it never happens again . "Fixing a problem is successful, but the fact that the problem was there in the first place was not a success. Every time a problem occurs, stop and ask: why did that happen, and what system can I implement to avoid it next time?" — Dr. Christian Coachman 3. Stop Performing "Camouflage Dentistry" The Trap: Placing thick veneers on premolars and molars to create a wider, prettier smile without treating the underdeveloped arch underneath . The Underlying Etiology: A narrow arch directly impacts tongue space, airway volume, and nasal structure . "Camouflaging" it with ceramic leaves the structural, functional, and airway issues untouched . Severe Tooth Wear: Placing veneers on a 30-something patient with severe wear without investigating the underlying cause (airway, occlusion, erosion) misses the opportunity to preserve health for the long term . 4. Cosmetic Technician vs. Oral Physician Cosmetic Dentists: Prioritize short-term aesthetic fixes (immediate satisfaction) . Oral Physicians: Evaluate systemic connections, airway, long-term longevity, and comprehensive function . Aesthetics as a Consequence: When you treat the underlying cause and optimize health, function, and arch dimensions, aesthetics becomes the beautiful consequence of doing the right treatment . 💡 Quick Summary Checklist [ ] Separate your diagnostic treatment planning phase from your digital software procedure planning . [ ] Treat every clinical issue or lab remake as a system failure to investigate . [ ] Diagnose underlying etiology (wear, airway, arch width) before presenting cosmetic solutions . [ ] Communicate long-term health benefits to patients rather than defaulting to quick aesthetic shortcuts .