Key Opinion Leaders (KOL): Dr. David Hornbook and Dr. Ron Kaminer engage in this thrilling interview about Pushing your comfort levels with dental technology & materials. Some of the Topics include CAD/Cam, Caries Detection devices, Spectra and lightwalker.”They’re doing a lot of cool things out there with adjunctive procedures for dentists, and that’s what’s making it so exciting.”-Ron Kaminer DDS
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Dr. Hornbrook: Hello, Dr. David Hornbrook again for our weekly podcast on Dental Up. I hope you’ve enjoyed the ones in the past. You’re in for a real treat today. We have a special guest, a good friend of mine. We’ve known each other a long time. Dr. Ron Kaminer: Many years. Dr. Hornbrook: Dr. Ron Kaminer. Ron, you live in Long Island. Dr. Ron Kaminer: I do. Dr. Hornbrook: Is that where you were born and raised? Dr. Ron Kaminer: I was born and raised in Brooklyn. Everybody’s originally from Brooklyn except for you probably. Dr. Hornbrook: I’m from San Diego. I’m a SoCal boy. Dr. Ron Kaminer: There you go, so it’s close. I live in Long Island now. I have two offices in Long Island and practice full time. Dr. Hornbrook: OK, and you went to school in Buffalo? Dr. Ron Kaminer: Went to school at the University of Buffalo. Dr. Hornbrook: You can’t get much colder than university [crosstalk 00:00:34]. Dr. Ron Kaminer: It was pretty darn cold. We lost some snow days but good school, still a good school. Dr. Hornbrook: I appreciate you being out here. We’re in Irvine, as most of you know, and it’s absolutely beautiful weather today. We had a heat wave last week. It actually got into the high 90s, which we hardly ever get, so this is like San Diego weather, low humidity [crosstalk 00:00:50]. Dr. Ron Kaminer: Wouldn’t know it from today. It’s beautiful today. Dr. Hornbrook: What’s the weather like [crosstalk 00:00:53]? Dr. Ron Kaminer: I got on a plane this morning. It was 8 AM. It was 93 and muggy, about 98% humidity. Dr. Hornbrook: Yeah, we don’t do that. Dr. Ron Kaminer: It was brutal. Dr. Hornbrook: Do you have bugs? Do you have mosquitoes too? Dr. Ron Kaminer: We have mosquitoes and all that kind of good stuff. Dr. Hornbrook: Yeah, we don’t [crosstalk 00:01:05]. Dr. Ron Kaminer: They’re expecting some big rains today and tomorrow. Dr. Hornbrook: Really? OK. Welcome to Southern California for the next four days. Dr. Ron Kaminer: Love it. Dr. Hornbrook: We’re here for the … Actually, I’m going to be part of it, the KOL, which is Key Opinion Leaders. Ron is one for [Curran 00:01:17], so we’re going to spend the weekend in Newport Beach, and we’re going to have a great time. Dr. Ron Kaminer: That’s always a lot of fun. Dr. Hornbrook: It’s always a good time. Let’s talk about some of the things you’re doing. I’ve followed your career through our friendship as well as watching what you’re doing. You have a practice, two practices, and you’re still practicing full time. Dr. Ron Kaminer: Full time, yeah. Dr. Hornbrook: OK, so you’re doing the dentistry that you’re talking about, because I know that you’re talking about certainly lasers. I mean that’s [your specialty], and I want to talk about where you think that’s going. Technology, esthetic dentistry, I mean you’re keeping up on everything I know, which is awesome. Dr. Ron Kaminer: Trying to stay on the cutting edge while maintaining a very diversified practice. It’s fun. Dr. Hornbrook: That gives you credibility. Because I practice too full time, and one of the first things I say to the audience, “I do what you do for a living.” We talked about intraoral scanners, and you bought one. People aren’t throwing stuff at you and [crosstalk 00:02:04] … Dr. Ron Kaminer: No question. Dr. Hornbrook: … You’ve got to make a decision when you’re going to get into technology, when to use a new lab, what decisions you make. You can totally relate to your audience, the people that are listening today. Dr. Ron Kaminer: No question, and I tell them that. I’m sure you do too. I tell them that when I’m out there and I say, “I do what you do every single day when I’m not out here speaking to you.” If you ask me what happens on the [Dissila 00:02:25] 31 when I’m working with my laser, I can answer it because I do it day in and day out. Dr. Hornbrook: Good. What changed? You’ve been practicing how long? Dr. Ron Kaminer: Twenty-three years. Dr. Hornbrook: OK, so similar to about what I’ve been practicing. The changes we’ve seen have been astronomical in the last three or four years. We talked earlier, at Keating we’re very digital and CAD Cam oriented. Somebody was asking about digital cameras and [models 00:02:50]. You said you were doing a lot of models. Dr. Ron Kaminer: Yeah, most of my single units today are models. We’re scanning with the 303 Shape Scanner, which I think anyone would say today is the Jaguar of scanners. Really accurate, getting really, really nice results. Of course, it’s dependent on your design, so to speak, but it makes … Getting the idea of getting crown in a box is something that a lot of people have to start getting used to, because that’s the way it’s going. Dr. Hornbrook: I think … You asked earlier as we walked through the model room and we see all these models, it’s like, “Really? People are using models?” I always say it’s because of people … It’s because of dentists, the dentists that like to do this, on, off, on, off, or they want to look at their preps. That’s the only reason we really need models, especially with single units. Dr. Ron Kaminer: You know what? That’s an interesting point. Here’s something that I’ve started talking about a little bit and I think is really interesting. I believe that scanners are going to make dentists better practitioners. Here’s my philosophy. When you look at something up on a 20-something inch monitor and you’re seeing your prep, and you don’t like that finish line, when you can go back and you do it, there’s a very different mental philosophy and a mental understanding that the dentists go through when they look at the negative and look at the impression. They’re like, “Oh, the lab will figure it out.” I think that what the labs are going to find that our digital scans, the preps are going to be way better than what they’ve gotten impressions throughout the year. It’s curious to see what happens. Dr. Hornbrook: We see that now because … We’ve done this as practitioners. You look at the impression and say, “That looks great.” Then the lab calls you five days later and says, “I can’t see anything.” Dr. Ron Kaminer: Correct. Dr. Hornbrook: Then we wonder, how did the lab screw up that, when it’s us that screwed it up. Dr. Ron Kaminer: I think many labs will even say that somewhere around 50+% of their impressions have some imperfection. I think the scan’s going to totally change that now, and it’s going to be very interesting to see. Dr. Hornbrook: You made a good point. You said in your program you show a slide of the lab technician of 20 years ago, which would have been … Dr. Ron Kaminer: The German technician with the loops applying porcelain. Today it’s the young guy with the headphones on who’s designing crowns. Once he’s taught design and does it well, the computer does the rest of it for you, and the mill does everything else. Dr. Hornbrook: That’s right, especially with the libraries. They can pull that in and if they’re artistic at all … I always tell people that young men and women come in here and say, “I’m looking for a job.” I always say, “Do you know anything about ceramics or dentistry?” “No, nothing.” “Do you play Xbox?” “Are you kidding? I’m one of 400 on Call or Duty” [crosstalk 00:05:22] … Dr. Ron Kaminer: You’re hired. Dr. Hornbrook: You’re hired in our CAD Cam department. Digital impression, I’m so with you. I purchased a different digital impression scanner because I couldn’t afford the TRIOS, but I totally agree with you on that, and it’s exciting. Dr. Ron Kaminer: It is, and that playing field’s going to change dramatically too. It’s expected by the end of the year that two new companies are going to be heading into the U.S. market, Dental Wings and Canary, which should be two low priced or moderately priced dental scanners. I saw them in Europe at the IDS dental show. Small cameras, really, really quick. It’s going to change … This is where it’s going. I swore five years ago I’d never scan, and now I say to myself, I wish I would have scanned five years earlier. It’s pretty interesting. Dr. Hornbrook: Oh yeah, it is. It is very cool. I think the people that haven’t embraced that, they don’t really know what they’re missing, because they’re looking at the [CEREC 00:06:12] of ten years ago, that it was big, bulky, not very accurate, time consuming, lots of power. It’s exciting. Now it’s like … Dr. Ron Kaminer: No question. Dr. Hornbrook: Let’s talk about lasers, because I know you’re a huge laser advocate, with hard and soft tissue. Dr. Ron Kaminer: Yeah, it’s been my baby for 20-something years, since dental school actually. Dr. Hornbrook: Oh, really? Tell us about that journey. Dr. Ron Kaminer: This is an interesting story. Very few people know this, so I’m going to put this on the podcast. When I was in dental school, a sophomore dental student, I was taking a technique lab, crown and bridge technique lab at the University of Buffalo. You needed X number of points in your practicals in order to pass, and I got into a tiff with one of the crown and bridge instructors. He just had a bug for me the whole year. The rule at the University of Buffalo was that if you flunked technique crown and bridge lab, you had to repeat the entire year no matter what your grades were. Dr. Hornbrook: Really? Interesting. Dr. Ron Kaminer: Nine practicals later, I’m like, fine, but I could have not done well on the final practical, and this guy gets a hold of my last practical and literally gives me a zero on it, or somewhere near a zero, enough to fail me out of 800 points, fails me by about 7 points. I contended with the school, and they told me, tough luck, take a hike. But they did allow me, because I had As in everything else, As and Bs in everything else, to do a hybrid junior year, so I did five years in dental school. My junior year was repeating the crown and bridge technique lab but progressing in all my other courses because it was foolish for me to take them again. When that happened, there was an instructor in the oral surgery department, and this guy changed my whole life. His name was Chuck [Lebo 00:07:40]. He said to me … I had all this extra time on my hands because the timing of the classes didn’t work out, so I had an hour here and two hours there. He said to me, “Why don’t you come do some research. We’re doing carbon dioxide laser research in our laser labs.” I’m like, “I don’t know anything about lasers.” He goes, “You’ll learn.” We started doing hamster research at the time with cheek cancers and things like that. Fast forward two years later as a senior, I presented my research at the ADA meeting in Hawaii. I presented it at the Academy of Laser Surgery in Medicine, meaning a medical meeting in front of 300 physicians. This guy who flunked me probably changed my whole life because then I got out of school and I was a laser guy from the beginning. I had one of the first 100 hard tissue lasers in the country. That was when Biolase was doing their thing way back when, and ended up starting Biolase’s first training program, and still today probably have trained more hard tissue laser owners than almost anybody around, then taught for [Fotona 00:08:35], and now of course I know a lot about lasers and I work with our mutual friend, Alan [crosstalk 00:08:42] … Dr. Hornbrook: Who we interviewed on the podcast a couple of months ago. Dr. Ron Kaminer: … Who changed the face of soft tissue lasers five, six years ago. In our office today we use hard and soft tissue lasers all day long. It’s been a fun journey. Dr. Hornbrook: Oh yeah, that’s … I didn’t know that. Dr. Ron Kaminer: That’s a good story. Dr. Hornbrook: That is a good story. I like that. If you would have had a good crown and bridge instructor, you would [crosstalk 00:08:59] … Dr. Ron Kaminer: I might have not been in the same place, and that’s really true. That’s pretty crazy. Dr. Hornbrook: It’s amazing how little things like that change our life, person, or [crosstalk 00:09:07] change our lives. Where do you think … I know there’s a lot of our listeners, the diode, the soft tissue, and you’re right, [Allen Miller 00:09:11] AMD, with Picasso, also had made everything affordable. Dr. Ron Kaminer: No question. Dr. Hornbrook: I got trained by Don [Calussi 00:09:18], who you know, in 1995. The soft tissue was $49,000. Everyone says, “Oh, lots of things are $49,000.” Not in 1995. The CEREC was $29,000. This was the most expensive thing I had in my office, and now we’re looking at diodes that are under $3000 with portable disposable tips. You know all this stuff. Where do you think … I would assume that many of our listeners and viewers, they’re familiar with the diode. Maybe they bought it, maybe not, but they know about it. They don’t know about what else is going on with laser dentistry, whether it’s hard tissue, whether you think in the near future, with your knowledge, is the hand piece going to be something that is going to fade away like an impression [too 00:09:59]? Dr. Ron Kaminer: Yeah, I don’t see that happening because still preparations of crowns can be done with a hard tissue laser, but it’s still cumbersome. I think what we’re seeing is the hard tissue laser was always this big box. Now they’re getting smaller and smaller. I expect by the end of the year a company or two to bring out a hard tissue laser that should be very low profile, probably less costly than what’s out there today. Lasers today, they can rival the speed of high speed hand pieces for operative dentistry, especially if you’re anesthetizing. One of the beauty of hard tissue lasers has been is you can get a lot of minimally invasive type early Class 2 preparations, and Class 3s, and get them done without anesthetic. That still can be done today. They’ve really advanced dramatically. A lot of people have poo-pooed them and say, “Well, they don’t work.” I’m sure like anything else, whether it’s soft tissue or hard tissue, it’s all about training. You have to … You don’t buy an airplane and then don’t learn how to fly it. But once you’re trained on these things … Fotona’s done a great job right now with their hard tissue laser. Dr. Hornbrook: That’s the LightWalker? Dr. Ron Kaminer: That’s the LightWalker. They have some unbelievable adjunctive techniques now doing a procedure called Snorelase where they’re treating the soft palate with pulses of laser tissue to shrink the palate to minimize or eliminate snoring. I think with what’s going on now with sleep and sleep dentistry, that’s going to come into play, and that’s going to be an … They have a patented procedure I believe with that. They’re also doing, with that same laser, they’re doing warming of the inner tissue, the lip tissue, and be able to smooth out some wrinkle lines from the outside just by warming the inside. Dr. Hornbrook: Really? Dr. Ron Kaminer: Yeah. They’re doing a lot of cool things out there with adjunctive procedures for dentists, and that’s what’s making it so exciting. Dr. Hornbrook: Are you doing the Snorelase? Dr. Ron Kaminer: I’ve done a few cases. It’s all about case selection. It’s all about who’s snoring. The interesting thing about that, the way they came up with this technique that this was going to work was a surgeon out in, I believe it was Italy, he started using the same LightWalker laser in medicine for vaginoplasties. What he found was it was shrinking the vaginal tissue substantially. Vaginal tissue, all tissue is very, very similar, and they said, “OK, if we do this, why can’t we try it in the mouth?” Literally, they started trying it in the mouth and they saw these dramatic results where airways were being opened up. Usually 3 sessions, about 20 minutes each, 30 minutes each, and most patients reported a 60 to 90% improvement after the second session. It’s pretty wild. There’s some cool things on besides hard tissue, but hard tissue is still bread and butter for most people, and lasers do work well for that. Dr. Hornbrook: Oh, good. Where do you think we’re going to be in two, or let’s say five years? I have a VersaWave, which you know HOYA is out of the dental business. You look at these lasers, they sell $65,000 to $100,000 for hard tissue, and they’re big. Dr. Ron Kaminer: No question. Dr. Hornbrook: They’re still the way they are now, whether it be … The iPlus Now, is that Waterlase’s new one? Dr. Ron Kaminer: It is Waterlase’s new one, correct, the iPlus. Solea’s got a hard tissue cutting CO2 that they’re selling with training for about 115 grand. Dr. Hornbrook: Yeah, and the LightWalkers. Dr. Ron Kaminer: The LightWalkers, which is selling at about 70 or so. You know what? But at least with the LightWalker, they’ve been able to justify enough treatment procedures other than hard tissue that maybe it could be justified, especially in a group practice. I think in a group practice it’s almost a no brainer because there’s so many people can do different things in a group practice. What I do see coming is low profile hard tissue lasers, maybe by year’s end a laser that’s less than 40,000 bucks possibly, and ultimately a box that you can press multiple buttons to get different wavelengths. Right now you might have an erbium and and an ND:YAG in one, but ultimately you’re going to have an erbium ND diode and a CO2 in one and just pressing the laser source coming, emitting out of one hand piece. I believe that’s going to be not too far down the road. Dr. Hornbrook: Yeah, and you’re right, that would make it all of a sudden affordable. If I can do it with different procedures or if you had a surgeon down the hallway even that somehow you could make this affordable. Dr. Ron Kaminer: No question. Dr. Hornbrook: That’s awesome. Lasers, digital scanners … Dr. Ron Kaminer: Caries detection devices. Dr. Hornbrook: Let’s talk about that. Dr. Ron Kaminer: Caries detection devices are really starting to turn the corner a little bit. If you look back let’s say ten years ago and you thought of what are the three big pieces of technology that affect people’s practice? Your practice, say CEREC. You might say [Diadent 00:14:29] because that was the bare bone type thing. Digital radiography. Those were really the kickers. Today you look at, there’s five or six different caries detection type devices, all working with fluorescence that are starting to change the playing field a little bit. Dr. Hornbrook: Name a few. Dr. Ron Kaminer: Air Techniques has one called Spectra. Spectra works through a fluorescent … It’s a camera that works with fluorescence. It has blue violet LED type lights in there. What it does is it picks up the metabolites of cariogenic bacteria on the occlusal surface. When the light hits it, those will fluoresce red while the tooth fluoresces green, so you have this digital picture of the tooth up on the screen. Now you put a 40 inch monitor in the operatory and you tell the patient you’re going to do a cavity detecting exam. You go through this camera and it’s picking up these areas. These are areas that you won’t see with an explorer. We know the explorers are not all that accurate to begin with, yet we use them as our day to day diagnostic tool. That’s one device. What Air Tech has done very interesting is they’ve created this scale, so to speak, so just pressing a button the camera, and it looks like an intraoral camera, it’ll superimpose a scale on that red reading. Imagine the occlusal of a molar. If it’s all carious, it’ll show up red. You press another button, and now there are little numbers that show up. They quantitate with the approximate location in where the decay is in the tooth, so early enamel, deep enamel, early dentin, deep dentin. Dr. Hornbrook: Oh, really? Dr. Ron Kaminer: Taking this a step further, manufacturers are coming out with clear sealant material. Now if you have something that has very early enamel decay, you might use one of the remineralization agents that we have out there today. We’re getting ahead a little bit, but MI Paste from GC America or Remin Pro from VOCO, put a little bit in the groove, put a clear sealant on it, and these devices can fluoresce through the clear sealant. You can stay in the digital image in the patient’s file, go back four months later … Dr. Hornbrook: Oh, and see … Dr. Ron Kaminer: … See if … I always say, if it was your daughter, what would you do? Would you [inaudible 00:16:38]? I never say husband or wife because you don’t know the answer [inaudible 00:16:41], so I always say daughter, because what’s the worst that’s going to happen? You open it up anyway and it’s still going to be [early on 00:16:47]. Air Tech has one of them. Acteon has one called SoproCARE. SoproCare allows you to pick up not only decay, but it also picks up new plaque and old plaque. It differentiates between new plaque by coloration. New plaque shows up pink, and old plaque shows up yellow. Dr. Hornbrook: How old is old plaque? What’s the dividing line between [crosstalk 00:17:08] … Dr. Ron Kaminer: I guess it’s mature plaque. The patient tells you, “Doc, I brushed my teeth.” You put the camera on there, and this yellow stuff is all over the place. You say, “Listen, you might have brushed them today, but you didn’t brush them for the last six months because yellow’s old stuff and it’s been sitting there.” That’s another one. CAVO’s Care Review now is out there, which is really neat. That’s a whole different level that uses transillumination. We can see through in the proximals there, which I see as a big asset for pediatric dentistry, for parents who don’t want you to take x-rays on the kids, and also pick up fractures as well. That’s a whole another different level of technology. Then the one we don’t see yet but it’s coming down the road is a company called [SRAY 00:17:43] out of Oregon. They’re going to use ultrasound to pick up decay. That’s going to take a level of x-rays and really just bring it down to a very minimal level in the dental office, so that’s cool. Dr. Hornbrook: That’s awesome. I think most people don’t know that. A few of those I’ve heard about and some of them I haven’t. It’s interesting you mention about how literally you could put a clear sealant. Let’s say you put some [IGI 00:18:05] paste, which I use in my practice, or MI paste, and then you put a sealant on and I could say, “OK, you’re at …” I don’t know the numbers but let’s say 70. That’s not great but it’s not the end of the world. “We’ll see you in six months and you’re at 30, we can quantify that based on …” [crosstalk 00:18:17]. Dr. Ron Kaminer: No question. Dr. Hornbrook: I think that’s something that we don’t do. I mean you’re a practicing clinician. You come in and you’ve got a little wear on a canine. Two years later you say, “You know, that’s … You’ve got some more on that canine.” We don’t really know the difference, but we don’t hold on to all that stuff and … Dr. Ron Kaminer: Also, don’t forget, we live in an intervention … We are intervention practitioners. We make a living out of drilling teeth, so the whole philosophy of remineralizing and not picking up a [burr 00:18:43] is a whole different aspect. Dr. Hornbrook: A friend of mine, talking about an explorer, a friend of mine’s son when he was little, this friend of mine’s a dentist, and he says, “Dad, you call that an explorer.” Mark said, “Yeah, it’s an explorer.” He said, “What do you do with that?” He goes, “Well, I look for bad stuff.” A kid that’s going and learning about world history with Columbus, he says, “Dad, how come every other explorer is looking for good and new stuff and you’re looking for bad stuff?” Dr. Ron Kaminer: [inaudible 00:19:09] Dr. Hornbrook: You know what? I never thought that way. I’ve never heard that before. It’s a little kid that brings that out. Dr. Ron Kaminer: That’s great. I’m going to use that. That’s good. Dr. Hornbrook: Yeah, I think you should. It was actually … You know Mark Montgomery? Dr. Ron Kaminer: Yeah, sure. Dr. Hornbrook: It was actually one of his sons. Dr. Ron Kaminer: That’s great. Dr. Hornbrook: I thought that was cool. Caries detection, one thing about this quantifying and being able to measure in the future. I don’t know if you’ve seen of the stuff that 3M is going to get in the future would be that you could take a TRIOS scan, [full art 00:19:33] scan. It goes into a database. That patient moves to San Diego, and part of my initial exam, I scan it, I can pull you from a database, and it’ll show all the … How the teeth were different on my scan versus your scan, where, and loss of [crosstalk 00:19:49]. The problem with that right now is 3M says, “Yeah, that would be awesome except for not everyone has a 3M scanner.” TRIOS may or not say, “Uh, we’re going to join the database” or not, so that would be a problem, but wouldn’t it be cool if I mean literally, whether it’s in your own practice, being able to take just like an oral cancer exam, every year taking it and saying it, “You know what? There’s a lot more wear than should be.” This is the time we get into a night guard or a restorative or [coloration 00:20:13] or whatever we decide to do. Dr. Ron Kaminer: No question. Progression in monitoring I think is definitely something at the forefront that we’re going to be able to literally press a button and get this visual image of that patient’s record, what it was. That’s going to happen very shortly I think. Dr. Hornbrook: Because we don’t do that. Orthodontists maybe do it up to seven years and they throw away the models or we’d have too many models. Dr. Ron Kaminer: No question. Dr. Hornbrook: How many times have you had a patient say, “Does this space look like it’s getting bigger to you?” It’s like, “How the hell would I know? Is it?” I think that’s whether it be digital photography or digital x-rays, whatever we can catalog and hold onto without having a bunch of cupboards full of boxes. Dr. Ron Kaminer: That’s something that’s interesting because I think what has to change in our profession is right now the operatory itself because our operatories are not built for the technology that we have right now. We have cords, and cables, and things like that. I think one of the biggest changes we’re going to see in the next five to ten years is equipment manufacturers just redesigning the operatory, creating space for all these type of caries detections and lasers so that you don’t have a million cords hanging around all over the place. Then of course it’s dental ergonomics. How many monitors is necessary in the operatory? Where do you position the monitors? It’s not good enough to have one anymore. I think you need … We have two, but ideally I think you need three in every operatory. You need one for you on the opposite wall when you’re scanning the patient or doing your caries exams, one for the patient to watch TV, and a computer monitor. That’s the ideal operatory of the future. That’s got to change I think dramatically as well. Dr. Hornbrook: Yeah, and that’s something we talked about last year at this event were these plug and play. Imagine buying a chair that had one foot pedal, and you could plug in your caries detector, plug in your [inaudible 00:21:56] camera, and you push a button and that foot pedal now works for all those things. I mean we all have … Look over there. I have three foot pedals. I hide two of them, but they’re over there. Dr. Ron Kaminer: No question. Dr. Hornbrook: We need to be … Dr. Ron Kaminer: It would seem like it’s not that hard too, but obviously with different manufacturers and different technologies, as the world goes totally Bluetooth or WiFi I think we’ll see that totally change. Dr. Hornbrook: Yeah, but it’s like anything. The iPhone won’t let you plug in their Samsung USB or the [Apple Aire 00:22:21]. It’s these manufacturers saying, “No, I don’t want you to buy a camera from Pelton & Crane to put on my [crosstalk 00:22:29]. It’s just not going to happen. All right, so you practice restorative dentistry, and I imagine it’s mostly probably [inaudible 00:22:34], probably adult restorative primarily, your side of the practice. What are you excited about, I mean as you go in Monday morning and the patient opens their mouth? You’re practicing much different dentistry than you did 5 years, 10 years ago, 20 years ago, just like I am. What motivates you and excites you about what you can offer your patients that you didn’t in the past? Dr. Ron Kaminer: I think part of it is that always having a philosophy of being minimally invasive. I think that I’m changing the way I prepare teeth, even for operative dentistry. We’re doing … Tunnel preps are getting sexy again, and slot preps are getting sexy again as the new restorative. Dr. Hornbrook: Sexy is good. Dr. Ron Kaminer: Yeah, sexy’s great. As the new restorative materials are out there now with the so called bioactive materials that are starting to shed some minerals off the teeth and be able to remineralize or remineralize adjacent teeth, tunnel preps are going to work. Instead of opening up a large … I mean if it’s large, it’s large, but if it’s [Sipia 00:23:26] Class 2, we’re not dropping boxes so quickly anymore. We’re doing a tunnel and restoring it with a bioactive flowable composite like Activa from PulpDent, which is a glass ionomer, or a Shofu’s composite in those situations, and see phenomenal results. That’s exciting, being able to keep things real small. I think it bodes patients well for the future because keeping things small you’re going to preserve and conserve tooth structure, and you think those restorations should last a much longer period of time, and the teeth just stay intact. That’s always a fun thing I think to do. Dr. Hornbrook: Yeah, tooth banking. Dr. Ron Kaminer: There you go. Dr. Hornbrook: People say, “Oh, materials are so different.” Even if I cut a full coverage crown, a patient comes in with a MOD amalgam and buccal mesial buccal cusp. We [evolve a 00:24:12] a treatment plan to do a crown, [cusp 00:24:13] missing, do a crown. Even if someone said, “Well, I did a conservative crown because now I can use zirconia at .5,” ten years from now it’s still going to be a fricking crown when it’s cut off. Dr. Ron Kaminer: There’s no question. Dr. Hornbrook: It should be an onlay now and it’ll be an onlay with better materials ten years down or when there’s a little be a micro leakage, you throw in some biomechanical material that will go in and remineralize it and [crosstalk 00:24:36]. Dr. Ron Kaminer: Active shows a lot of promise in that respect. Activa’s PulpDent’s resin modified glass ionomer that comes out of a syringe, and that’s showing a lot of promise. It has calcium, phosphate, and fluoride, and those are the building blocks of teeth. That’s exciting a little bit. Dr. Hornbrook: Yeah, and things are going to change. It would be nice if we could get a restorative material, like something that we mill that’s made out of that material, so we put a crown on and leaches, and we’re not going to see recurrent decay around restorations. Dr. Ron Kaminer: No, but we’re going to hear [inaudible 00:24:59]. It might be in the works already. Dr. Hornbrook: That’s right. It probably is to some degree. Speaking of sexy, you look sharp. Dr. Ron Kaminer: Thank you. Dr. Hornbrook: Alan Miller, who is both our good friend, I said, “So, what should Ron and I talk about beside the obvious of lasers and technology?” He said, “Well, ask him how to look sharp,” because you’re a very sharp dresser. Let’s talk a little bit about that. Dr. Ron Kaminer: You know what? It’s funny, and here’s an interesting story. You remember [Kirsten 00:25:27], who used to work for [Ker 00:25:29], correct? Dr. Hornbrook: Yes. Dr. Ron Kaminer: About four years ago, five years ago, I was introduced to Kirsten at a Greater New York Dental Meeting. For some reason, and I always pride myself on dressing nicely because I believe that if you’re going to talk the talk, you’ve got to walk the walk, and you’ve just got to look put together. I was introduced to Kirsten. It was my first introduction Ker. Kirsten used to work for Ker. For some reason, that day I wore a bow tie. I never wear a bow tie. I don’t why I put a bow tie on that day, but I did. I met Kirsten and she was, “Hey, you look really good. You look sharp.” I was like, “Yeah, you know, I like my clothes” and whatever. We went out, had a conversation. That was my first introduction to Ker. I didn’t see Kirsten for about a year later. I was giving a lecture in New York. We were sitting, about ten of us, at a dinner table, and Dave [Branchu 00:26:12], who was running the program at the time, says to me, “Ron, do you know Kirsten from Ker?” I said, “Yeah, we met before.” She goes, “I remember you. You’re the guy with the bow tie.” That was a year later. I tell that story because people don’t realize that people do pay attention, especially with what we do when we speak a lot in front of people and audiences. I can’t tell you how often I get a comment back that, “The lecture was great, and you look good too.” That happens constantly at these programs. People realize that when you’re put together, I think your message is delivered smoother. I mean you’re always put together, and I know you like your clothes too. Dr. Hornbrook: Yeah, I like clothes. Dr. Ron Kaminer: You don’t have to go out and spend zillions of dollars. I might spend a little bit of money on my clothes because I like to, but there’s some of our friends who show up and they’re wearing the same jacket they wore for the last nine years. It’s tattered and things like that. They’re good speakers, but you know what? It’s just they don’t look the part. I just think it’s important to go out there and just be put together, and today it’s easy for a lot of guys because if you can’t do it, in every big department store there’s a personal shopper who will go do it for you. Dr. Hornbrook: Do you have a personal shopper? Dr. Ron Kaminer: No, I do it myself. I have fun. I actually go to the stores when I’m not doing anything, and I’ve looked at my stuff and I rearrange the ties and the shirts because I just play with it. That’s my [hetero 00:27:23] in me, but I do that. Dr. Hornbrook: That’s the metrosexual in you. Dr. Ron Kaminer: My metro, yeah. That’s my metro. I have fun doing it, and I have fun getting fun things to wear. My wife thinks I’m a little crazy sometimes but … Dr. Hornbrook: You are crazy, maybe not by your clothes, but I’m sure she thinks you’re crazy. But I think you’re right, I think it’s the image that we portray as esthetic dentists, as restorative dentists, as someone that whether you’re teaching that or you’re discussing with your patient. I don’t know what you wear in your office, but I think that you should look sharp. Dr. Ron Kaminer: There’s no question. Dr. Hornbrook: You should look sharp, and that’s really a calling card to what you’re going to be [crosstalk 00:27:57] … Dr. Ron Kaminer: I used to wear scrubs years ago, and I got away from that because I don’t think you look good in scrubs. I’m not really comfortable with jacket and tie wearing, so usually I wear a [inaudible 00:28:04] type shirt and nice khakis, but I’m always put together, and you know what? The bottom line is I’m comfortable, but they realize I’m not there in scrubs. My biggest pet peeve is when I walk into an office and I see people in their scrubs. What’s worse is when the staff leaves the office in scrubs, because we have that in the office. I said, “Ladies, you can’t walk out of the office in scrubs because there’s dirt on those scrubs. If you’re going over to the restaurant to pick up a sandwich for lunch …” [crosstalk 00:28:27] That’s not cool. It’s just not cool. I think it’s important to look put together. I think it’s … We’ll see a bunch of that when we … Dr. Hornbrook: We’ll see a bunch that aren’t put together this weekend you mean, yeah. Dr. Ron Kaminer: [inaudible 00:28:38] Dr. Hornbrook: Yeah, this is what I would wear. As a matter of fact, I saw a patient this morning. I put a long coat on, but it’s the image I think we need to portray, whatever our goals [crosstalk 00:28:46]. Dr. Ron Kaminer: No question. Dr. Hornbrook: Another fun thing, how’s your restaurant doing? Dr. Ron Kaminer: My restaurant, Tazzina. There’s my little plug. Tazzina in Forest Hills Queens where, as a matter of fact, I’m here at the round table, and tomorrow night is our one year anniversary party. Dr. Hornbrook: Very cool, and you’re going to miss it. Dr. Ron Kaminer: I’m going to miss it. I decided to venture with the restaurant business after I figured I’d throw away some money, because restaurants are a tough business to make money. My chef had a restaurant, a small restaurant not too far away. We doubled the size. It’s still not big. It’s pretty intimate, about 50 seats. He didn’t have a bar. We have a bar. He was a two time chop champion on the Food Network, losing in the third chopped episode of the dessert round. [An Italian guy, Jason Zukas 00:29:25], makes modern Italian food. If you look across at Tazzina at our food ratings, we got 4-1/2 stars on pretty much … Dr. Hornbrook: How do you spell that [inaudible 00:29:36]? Dr. Ron Kaminer: T-A-Z-Z-I-N-A, and it’s in Forest Hills Queens. If you look at Open Table or Yelp, we have 4-1/2 food stars, 4-1/2 stars, so our food’s good. Dr. Hornbrook: How far is that out of Manhattan? Dr. Ron Kaminer: No traffic, 15 minutes. Traffic, 25 minutes. Probably 7 miles or 8 miles. Not long, probably 15, 20 minutes from JFK. That all being said, it’s a tough business to make money. We’re not really making much money. Dr. Hornbrook: I know we had a little bit of a … I’m a tequila … I have about 90 bottles now. We had a little bit of conversation of tequilas before about tequilas and drinking. I’m glad you’re doing well. You look great. Dr. Ron Kaminer: Thank you. Dr. Hornbrook: What are you doing? You’re practicing, you’re lecturing, and you mentioned you’re doing something cool next year [crosstalk 00:30:16]. Dr. Ron Kaminer: Yeah, that’s pretty interesting. I was just asked to give a lecture next September. Anyone who’s interested it go. It’s at Travelandcruisepartners.com. We’re doing a two day, or one day crown and bridge lecture on a cruise ship leaving from Venice, returning to Venice on the Azamara cruise ship. I’ve been on that cruise line. It’s about a 400 passenger cruise line, really high end, high service. It’s actually going to a place, some places that I personally really want to go to, which is Croatia. It’s going to some of the islands in Croatia. I’ve been to some, but I want to go to the others. It’s going to Venice. That should be fun. We’re going to speak on crown and bridge on the day at sea and otherwise have a lot of fun. That’s September 2016. Dr. Hornbrook: Are you the only speaker? Dr. Ron Kaminer: I’m the only speaker. Dr. Hornbrook: Do you need another speaker? Dr. Ron Kaminer: You can come along, no problem. Dr. Hornbrook: I’ll sleep in the little cruise quarters. Dr. Ron Kaminer: It’ll be great [inaudible 00:31:03]. Dr. Hornbrook: Yeah, that would be a lot of fun. If we want to get a hold of you, because I know you’re … How many days a year are you speaking? Dr. Ron Kaminer: I probably speak about 20 to 25 times a year I’m on the road. I still have 2 offices, so I’ve got to juggle it. It’s still pretty tough. Dr. Hornbrook: Because you make your living doing dentistry. Dr. Ron Kaminer: I make my living … Dr. Hornbrook: You have to pay for that restaurant somehow. Dr. Ron Kaminer: There’s no question about that. It’s not paying for itself right now. Yeah, if they want to get a hold of me, my website Nylaserdentistry.com. My email is whiter, the word ‘whiter’, W-H-I-T-E-R TTH, firstname.lastname@example.org. I’m always available for emails. Dr. Hornbrook: I know that a lot of our listeners and viewers, they’re thinking, “God, he knows all this stuff about all these cool things,” and we barely got to touch on all those cool things, and there’s all these other subjects we could have talked about. They’d probably love to see you speak, so if they can get a hold of you. Anything else you want to close off with? We call this our treadmill podcast, treadmill being 30, 35 minutes or in the city your commute, right? It’s been about 35 minutes, so we’ve got to wrap up, but anything else you want to talk about, anything you’re excited about? Dr. Ron Kaminer: Here’s the thing. I think that we’re at a great forefront. We’re at a great time in dentistry right now. A lot of dentists stubborn in getting involved with technology, even stubborn in changing the way they do their crown and bridge. I’m sure here at Keating Lab you guys do a lot more zirconia and Emax now than ever before, but still some dentists are stuck in their ways. I think it’s just important to venture out there and just push the comfort level, whether it’s technology or materials. There’s a lot of great things that we can do for our patients today, and it’s an exciting time to be a dentist. I’m happy to be part of it. Dr. Hornbrook: Yeah, it’s very cool. It’s hard to even envision that we wouldn’t be dentists. People say, “Aren’t you going to retire in ten years?” It’s like, “I hope not.” I mean I don’t want to be, because it’s just going to get better. It’s going to get more fun and exciting. You and I are at least keeping up with technology, that we get to grow and evolve as all these cool things are happening. You were talking about PFMs, because we still do a lot of PFMs because we have doctors that have always done that. They just don’t want to change their ways. I understand that. I accept that, except for you look at, let’s take [inaudible 00:33:06], which is our monolithic zirconia. We’re milling at .5 millimeters occlusal, which means you can’t do a PFM. That’s going to be a PFM with a metal occlusal. The accuracy with our 7 axis mills, it’s as accurate as metal. The porcelain, the zirconia is 10 times stronger than the porcelain PFM, so I’m trying to have them justify, “Oh, it’s been around forever.” Then I say, “What do you think is the most expensive restoration that comes our of our laboratory?” “Oh, I don’t know, Emax maybe.” No, the person’s [gold 00:33:35] crown. Second is the PFM. Third is Emax and Empress. Then way down here because we’re milling all this is the zirconia. You just start looking at why are we still doing those. A lot of it doesn’t make sense to me, and I think what we’ve been trying to do is educate everyone saying, “You know what? Look at this stuff, because it’s going to save you money. It’s going to provide a better restoration for your patients. It fits better. It looks better.” Dr. Ron Kaminer: There’s no question. You know what? I’ll leave you with a little quote. My son’s a division 3 college wrestler. One of his coaches in getting them to really just fine tune their workouts and get stronger, he used to say to them, “You know, if nothing changes, nothing changes.” That’s really the bottom line. If you don’t change what you’re doing, you’re going to get what you got. It’s a good time to start changing and shifting over to zirconia, Emax, and model-less crowns, and scanning, because that’s where we’re going. Dr. Hornbrook: Yeah, [you’re absolutely right 00:34:30]. Thanks for being here. I hope you had as much fun as I did. Dr. Ron Kaminer: I had a blast. Dr. Hornbrook: We could have talked forever. It could have been a marathon run podcast. I hope you enjoyed it as much as I did. Be sure to contact Ron if you have any questions. You’ve got his email address. Maybe all of us will be on the cruise next year coming out of Italy. That would be a blast. Dr. Ron Kaminer: Join us. Dr. Hornbrook: That would be a lot of fun. Check out our other podcasts, Dentalup, all one word, dotXYZ. We’re also doing some very cool things with the videos. We just filmed two what I call David Talks, like TED talks, on our whiteboard today. We’re having a lot of fun with it. I hope you enjoyed it. If you’re ever in the southern California area, if you’re in Disneyland, Laguna Beach, Newport, we’re about seven miles from all those, so stop by Keating Dental Lab, and I’d love to host you. Have a great day.