Enhancing Patient Care using New Procedures and Technology with Dr. Angela Ruff, DDS

Host: Ladies and gentleman, this is the Dental Up podcast, brought to you by Keating Dental Lab, full service, award winning dental laboratory. Each week, you’ll learn tips and techniques from real word dentists. Bringing you in-depth interviews, motivating stories, current events, and sports, here’s your host, Shaun Keating.

Shaun Keating: Hey everyone, Shaun here, welcome to another episode of the Dental Up podcast. Our guest this week is a graduate from the University of North Carolina at Chapel Hill. She completed a general practice residency at the V.A. hospital in Portland, Oregon. She has extensive post-doctorate training, with conscious oral sedation, and has completed over 300 hours of C.E. for dental implants at the Maxi Course in oral implantology at New York University. Praxton from Fayetteville, North Carolina, please welcome doctor Angela Ruff, DDS. How’s it going Dr. Ruff?

Dr. Ruff: Hey, doing great. Good day.

Shaun Keating: Oh, that’s so cool. Thank you so much, I know how busy, you’ve got a busy practice, and man you’ve been sending us work for awhile, and I just can’t thank you enough for it. Heck, I was just talking to you about it, I can’t believe you do all your own model work, and pins, and everything. Tell me about that. Is that something that you’ve always done?

Dr. Ruff: Yeah, I guess my husband says I’m just a little bit over-compensate in that arena, so I would just prefer to do that myself, to make sure it’s right.

Shaun Keating: It’s always, and it’s so good and it’s so accurate so model work, I mean this is the foundation of everything that we do in the lab. Our model guys, a lot of labs will put the, you know, the weak people in the model department and they don’t really ever succeed as a dental lab. I think, it’s some of the most important work to be done, it’s the foundation of everything. So it’s kinda like the pyramids back in the day. If you don’t have that foundation set properly and accurately, nothing that goes atop of it will have a success rate, unless you got really good[crosstalk 00:02:16]

Dr. Ruff: That’s true. You’ve got a good group of technicians there because, I mean, the margins are always perfect. I’ve used other labs before and couldn’t always be said.

Shaun Keating: Well, thank you so much again, that’s back at you too that you’re giving us crisp margins, I mean, we’ll give you good margins if I get them for sure, and you just, you really are knocking it out of the park quality-wise, and we just, we can’t thank you enough, I wish I could clone Dr. Ruff into about 100 other doctors like you. I mean, it’d be great.

Dr. Ruff: That’s very kind, thank you.

Shaun Keating: Well, hey I always like to start off a podcast talking a little bit about sports, and I just, I know you’re North Carolina big basketball area in a way, and Chapel Hill especially.

Dr. Ruff: Yeah, UNC Turnhills, right?

Shaun Keating: Yeah, could you believe that? My brother’s out in Greensboro, so he’s big guy.

Dr. Ruff: Oh, yeah.

Shaun Keating: So, that’s pretty amazing how they have the three college, what do you have, Duke, you have-

Dr. Ruff: Duke, NC State, and Wake too, Wake Forest.

Shaun Keating: Wake Forest right there. Then even that little Greensboro College, they did pretty good in football a couple years back.

Dr. Ruff: Oh yeah.

Shaun Keating: I think that’s like a D2 though isn’t it or something, or D3? I’m not sure.

Dr. Ruff: You know, I’m probably better with hockey than basketball. My husband’s Canadian, so-

Shaun Keating: Ah, you’re kidding, I love hockey too.

Dr. Ruff: We see a lot of hockey.

Shaun Keating: We have the Ducks here in Anaheim and I have a dentist that is the dentist of the Ducks-

Dr. Ruff: Oh, there you go.

Shaun Keating: We see a lot of Duck games, and we have a lot of the Ducks come in, Dr. Rick Moromoto man, he’s the coolest doctor. He’s so chill and laid back. We get T. Mousselani and Ryan Getslaugh and Stoner, and all these guys. They get their teeth knocked out and they’re studs.

Dr. Ruff: A lot of repeat customers, huh?

Shaun Keating: Oh, yeah totally. They’re all Canadian. Pretty much all these dudes are Canadian. T.Mousse, he’s from Finland, he’s the Finnish Flash, they call him. Love the hockey guys, they’re so humble and just the nicest guys, just so laid back for sure.

Dr. Ruff: Yeah, no the fans are great. They’re very, you know, we go to a lot of hockey games, but we were a little late going to this one game, and we were just kind of in the outer arena area getting some food and drinks. A lot of people were there, and then they did the National Anthem and I really didn’t think people would be, you know, would maybe more likely ignore it because they’re not in the arena. But you could drop a pin and everybody stopped, and pulled their hat off for the National Anthem. The hockey players are pretty patriotic for sure.

Shaun Keating: That’s awesome. I love hearing that. [crosstalk 00:05:17] That is so neat, I love hearing that. As they should be, but I see that quite a bit, even at some of the football games, or even baseball games. We’d be in the beer line, and it’s going and it’s like, “Alright put your hand over your heart everyone.” And even saying it out loud, it’s kinda neat-

Dr. Ruff: That’s nice, well your dad, apparently you’re a Navy brat, I was an Army brat, so we probably have a little bit more respect for what it takes for the people that help protect our country. What they go through.

Shaun Keating: Oh, yeah, and all our freedoms because people can sometimes take it for granted. It’s been fought for, and for many many years and it’s an honor for sure. I see too that you did residency at the V.A. there and we work with several V.A.s and we’re very proud to be working for them and trying to give the best dentistry we can to our veterans.

Dr. Ruff: Oh, yeah. That was great, that was a super experience. I was really happy I did that. It was a residency in Portland, Oregon. I love that area. It’s just beautiful. The north western area.

Shaun Keating: Oh, it is. It’s so nice. Shannon, my wife’s grandparents lived in Bend, Oregon.

Dr. Ruff: Oh, yeah that’s beautiful.

Shaun Keating: Oh, it’s so neat. And they were crabbers man, they just got me hooked on dungenous crab way back in the day[crosstalk 00:06:38]

Dr. Ruff: That’s easy to get hooked on that.

Shaun Keating: I love that stuff, man. I got this little place called the Crab Cook around the corner and they get it shipped in from there and they freeze it. But we get it and it’s just so good. I remember grandma used to make these, it was like a crab dish, and it would come in these boats, these lasagna-like boats. It would full of dungeonous crab and cheeses, different cheeses and stuff and she would bake it and it was just so good. They’d catch all the crabs, I mean, they’d have hundreds of crabs they could catch. Pretty neat thing, but so now I get those things and you go to lunch and get it as an appetizer, and we always eat them chilled here, and god, yeah, I get excited when I start talking about my dungeonous crabs. I’m just like, “Yee haw!” Well, heck now, let’s go ahead and Dental Up Dr. Ruff, so tell me, why did you get into dentistry and at what point did you think, “I wanna be a dentist”?

Dr. Ruff: You know, it’s kinda funny, my dad’s dentist, but I’m older so I was raised back in the day, at least on the east coast, where I grew up in Fayetteville. There were no female dentists, so I wasn’t really, I knew I wanted to go into the health care field, but I never really considered dentistry as an option. Actually, what happened, when I was in undergrad, I was a victim of a drunk driver accident which resulted in a lot of head trauma and subsequent dental visits to a prosthodontist, Dr. Buzz King, and I was just so appreciative of the care that he provided and put me back together. Every time I sat in his chair, he used the opportunity to encourage me to become a dentist. So, I switched my major from pharmacy to dental and I couldn’t be happier.

Shaun Keating: What a story that is. That’s crazy. How did that happen?[crosstalk 00:08:40]

Dr. Ruff: Well, just a drunk driver just ran a red light, and it totaled my boyfriend’s little sports car, but you know, it just made me thankful for that I didn’t break my neck, it could always have been worse, and I never had dental work done, truthfully, until then. I couldn’t appreciate what all a dentist could do for you.

Shaun Keating: Unbelievable. That’s a first. I’ve heard a lot of stories and why they got into dentistry, but that’s neat, hey, that’s kinda divine intervention, it’s kinda telling you.

Dr. Ruff: It was, right?

Shaun Keating: We gotta get you into the field of dentistry, Dr. Ruff. That’s so cool. Tell me about your college life. Tell me a little bit about where you attended school. Tell me a little bit about that journey if you could.

Dr. Ruff: Yeah, so I knew I wanted to go into healthcare field. I wasn’t certain as to what area so I studied biology and just the health field in general. Once that occurred I really just was focused on becoming a dentist and just did everything I could to realize that dream. Undergrad was East Carolina, so I graduated from there with biology. It’s funny, my nephew, he’s going through the process of applying to different residencies to become a PA, and he is so thorough, my gosh, he must have interviewed at twelve different programs and he’s been accepted at several of them, but when I applied to dental school, I applied to one school. I never even thought you needed to apply to more than one. I just was lucky that they accepted me and let me go in. But, I think how it’s done now, it’s more competitive and so people apply at a lot of programs.

Shaun Keating: It’s amazing that the dental school, and the different stories I’ve heard going through. Was it good for you? Did you get any bad feelings with certain instructors? Or what kind of stories do you have-

Dr. Ruff: It’s not like this now, but when I went to school, 10% of the class was female, and there were a lot of old school type thoughts from the professors that probably wouldn’t be too politically correct today, but my dad would always, he would remind me that I’m there to become a dentist, not be a dental student. So, just to suck it up and ignore whatever negative stuff that was said and just stay focused. But, I think, from what I understand, dental school is a lot more fun now than it was when I went to school, so it’s dental school lite, in comparison.

Shaun Keating: Yeah, I think so. I hear that too a little bit, but the other thing is, that, it costs about ten times more, and it’s like, I think, we were talking about this. Anywhere from three hundred to five hundred thousand dollars per year, depending on if you get, you know lodging and all that [crosstalk 00:11:43]

Dr. Ruff: It would be worth while to do either the G.I. bill, or do for the public health service, just to get them to pay for your education. You know, save a lot of money so you don’t graduate in great debt.

Shaun Keating: My brother did that. We came from no money and we had six of us with a single mom, and my brother Kevin, the oldest one, he went to the Navy, and like my dad, the Navy gave him a full ride to USC dental school.

Dr. Ruff: Yeah, I mean, that’s great. Then they just have to pay back every year for year that they spend in school. But then you get the experience, and get paid while you’re in school, it’s not a bad gig.

Shaun Keating: I think he just had to put in like eight years and they paid for everything [crosstalk 00:12:31] Then they even gave him, to keep him in until the ten years, he got a two year residency for endodontics [crosstalk 00:12:44] They paid for all that. He said, “No, I’m gonna get out now.” So he got out, and served for ten years, but he had no debt.

Dr. Ruff: That’s fantastic. I can tell you, he’s smart. He’s your brother? Or brother in law?

Shaun Keating: He’s my brother, and actually he teaches over at Chapel Hill on the endo there, Dr. Kevin Keating, so back then, he was a lot earlier than you, he was like 81′, you’re in the 90’s when you graduated, so you’re not that old, okay? I got kids that were in high school, no.

Dr. Ruff: Endo’s a great field to go into. I think they’re overhead is what, about 30%?

Shaun Keating: I think his overhead is like 10%. I mean there’s just no overhead.

Dr. Ruff: Oh my gosh, I’m jealous, is all I’ve gotta say.

Shaun Keating: Yeah. No overhead, but like you said, “Shaun”, he goes, “All I get is the tough nasty ones, you know, the GPs are doing the ones they can do, and I see that”, but he’s in pretty heavy duty surgery all day every day and it takes a certain kind of person to do surgery all day every day. It’s an art to it, after you get it down, it probably is pretty easy for him. There’s still some tricky stuff, but I see these GPs busting their butt and they have so much overhead, I mean, even the lab’s like five, six percent, depending or whatever, and it just, there’s a lot to it. A lot of moving parts, you know. That’s why, if I ever went into dental, I’d probably specialize in something, like probably, I don’t think I could ever do endo, but who knows. GPs are great. Very satisfying job too, that’s what I worked with for 34 years. I worked with general practitioners and I admire them.

Dr. Ruff: Right, well I may have kind of focused my practice to do more cosmetics and implants, but I’m definitely a general practitioner and I enjoy all aspects of it.

Shaun Keating: Yeah, you do. And you rock and roll it, man, we’re gonna get into that for sure. So, tell me, when you got out of college, did you start out as an associate, or did you purchase a practice? Did you go and work at your dad’s practice? Tell me how that started out.

Dr. Ruff: After my residency I really thought that I had no desire to own my own practice. Just the thought of that just terrified me. But, I ended up working for a large group practice in town for a very short while. I worked on commission, but I just found that, I’ll tell you what did it, was that the partners would do the crown and bridge and then they would have me seat the crown and bridge and not get reimbursed for that and it just really ticked me off. So, I decided, that was enough motivating for me to open my own practice. Because I’m like, “Man, I’m not gonna get any better if I’m just doing all the clean up work and not getting paid for this.” I felt under appreciated.
But, it was a good motivator to get over my fear of opening up my own practice. So that’s why I did it.

Shaun Keating: That’s awesome.

Dr. Ruff: I mistakenly thought that the work was going to be getting ready to open a practice, and then you just coast after that, and that’s definitely not true. If you own a business, just like I’m sure you own your business, there’s just a lot that goes into the day and day behind the scenes.

Shaun Keating: Absolutely.

Dr. Ruff: This is why, that you wouldn’t have imagined you have to keep nurturing after you get it going. So, you definitely don’t get to get back on your laurels, right?

Shaun Keating: So true, I mean, even too, like right out of school when I went, I went and worked for a lab and I worked there for like 17 years and a few months. I knew how to make teeth. I worked the batch, I did ceramics, I did wax metal. I did everything and then four years in, I went into management and I ran this lab, and I just learned so much on making teeth, and working with dentists, and I just had it down. I started that in 84′ and left in 2002 and I said, “I’m gonna start my own thing.” Kinda like you guys getting out of college. So it was like me going to college for 17 years and getting my MDA and all this stuff. I got out and I thought, “Man, this is gonna be so frickin easy dude, this is just nothing.” It’s never ending. The business part is just so, it’s hard, but you just gotta get people. I know too many dentists that do everything. They do their books, they do all this stuff, and they’re kinda razzled and stressed and you gotta bring some people in now and then, even if it’s once a week to do books, just so you can have your time to yourself. You gotta know how to manage your time. It’s important. I tell you, the whole thing with dentistry, it’s like in any business, sure you know your field, but then the front desk, the back desk, the books, the taxes, the payroll, the marketing, just everything. There’s a lot to it, and I’m not saying it’s a good thing, but it never ends. When you’re a business owner, it’s 24/7.

Dr. Ruff: No, it’s never ending. That’s for sure. You definitely need to be paying attention to things and hiring the right people. Not necessarily the person with the most experience, but the people with the right emotional attitude. [crosstalk 00:18:38] Exactly.

Shaun Keating: Because you’re gonna be working with them, you’re with them all day every day.

Dr. Ruff: More than the family right?

Shaun Keating: More than the family, and so the whole thing with hiring people, that’s kind of an art to that and I’ve done pretty good on my hires and I’ve just been very blessed on everything that has worked out with us, but you just gotta let your ego go when it comes to running the business, and just always, I still do it. I still bring in people to mentor me in certain areas. I bring in people to, you know, kind of break down what I’m doing to audit my processes and I’m always doing that. You have to do that. And just listening to your critics, and your patients, and in my case, the doctors. When there’s an issue, take it to heart, you know, when you’re the owner and your name’s on the building, and you have to do that, because the guys that don’t do that, or the that girls that don’t do that, you’re not doing yourself any favors. You just put in your dues, like you said, your first ten years probably was the toughest, and it’s getting easy for sure, I’m sure for you, but some of these newer dentists, they come in and just expect the world and no man, you just gotta get in those trenches, just work hard, do the right thing, and just try to practice great dentistry and doing the right thing. Taking care of your people. And it comes to you. It will come to you, and I think it’s just so important.

Dr. Ruff: You know, I think that’s’ it, is that, don’t just, I think it’s important to take pride in all the things that you do, even the things that seem mundane, like a simple amalgam filling, just do the best one you can do, if that’s what you’re doing that day or on that person. I think, overall, just taking pride in the finished product of what you’re doing. I think that helps you become better, you know, in all aspects.

Shaun Keating: And your patients see it. They can see it with your staff and everything else that, these guys care, they really wanna go good, then there’s certain people that don’t really have that passion, and people pick that up. You know, I have so many doctors when I go and ask them, “So, what do you do to drive patients to your practice?” And lot of them, “Well, I really don’t do social media, I really don’t do much of anything when it comes to that. I just do the best job I can on my patients and we let them know that, hey, if you have friends that need some dentistry, let them know about us if you could please.” And they’re like their biggest cheerleaders, raving fans. I have a book, I read Raving Fans, and if you concentrated more on your existing accounts that you have right now, you’re gonna get biggest by just taking care of those guys instead of trying to bring in so many new patients. You just let the people do it for you. Treat them good and have your staff treat them good, and you’ll grow your practice, especially in the field of dentistry-

Dr. Ruff: I think any time I’ve been in any business where I’ve gotten terrible customer service, I think it’s not, I think it’s more of a reflection of the owner of that business, that’s just their attitude. That they’re tolerating that very poor customer service, that that’s probably how they feel, you know, about their customer. I think it’s definitely best leading by example and the staff will pick up on that. Then, if you have somebody that doesn’t share your vision, then it’s okay to set them free.

Shaun Keating: Yeah, absolutely. This is an at-will state where, we are in California, hire at will, you can fire at will, and if you have a bad apple, or a person that’s just not really-

Dr. Ruff: No, because it can ruin the whole staff. It can really taint it. It’s best not to keep them around.

Shaun Keating: You’re only as strong as your weakest link and if you have some weak links, and I remember my old boss used to tell me at the end of the year, he used to drop, I don’t do it, he used to drop 3%, it was a number, 3% of the employees, the ones that weren’t rated the highest. The bottom 3% of the employees, and the bottom 3% of the accounts, and it just [inaudible 00:22:59] and he always did it, and I don’t know. He kinda keep [inaudible 00:23:04] I don’t know. I don’t really let people go here because everyone that I’ve hired is pretty good and they wanna work here, and it’s like, I don’t have any turn over and it’s just kind of neat thing. Tell me a little bit about the lay out of your practice. How’s it grown over the years? Tell me little bit about that if you could.

Dr. Ruff: Yeah, sure, when I first, well, it’s kind of a funny story, when I was working as an associate for this large practice, and I really didn’t wanna tell them I was gonna start my own practice, even though [inaudible 00:23:37] seven miles as the crow flies away from there. I had a realtor and had arranged to meet with the dental rep person and the guy that sold the equipment and their architect from out of town. We all arranged to meet this realtor to look at this space. And who was renting this space at the time, was a telemarketing company and she was refusing to let us in there, even though the owner was trying to sell the location. I ended up using a credit card to break into the place. The police were called, I mean, it was like the whole nine yards. Office Cruz, I’ll never forget his name, but we all end up down in night court. The duty guy from the Thompson rep, and all of us are down, and the chick that was trying to prevent us from seeing the place. So, the judge, and we were all crowded into this little room. I mean it was just, if only it could have been video taped. So, the judge finally, you know, finds out what happened. He says, “Well I wanna see, who was this person that wouldn’t let this little lady in this building.” And he just kind of read her the riot act. It could have gone either way. I could have started off my career in jail, right?

Shaun Keating: That’s great.

Dr. Ruff: He’s like, “Well technically, she wasn’t breaking in because she had permission from the owner.” But the guy had to draw up the plans real quick on this space, so that’s why he had to get in. So we started off with the location that had four operatories, and I took two condos and combined them for that. The person I bought those condos with also sold me a rental property adjoined to it that was housing a tobacco distribution company, so I was promoting health and cancer at the same time. Finally, when their lease ran out, like in five years, I just consolidated that property into my existing practice, and now I have seven operatories.

Shaun Keating: Sweet.

Dr. Ruff: Yeah, it started out in night court.

Shaun Keating: That’s so cool. I bet the lady had, the realtor had another listing or she could double up and get the 6%, like three and three on both sides, that’s probably why she didn’t want you because she’s only gonna get 3% probably or something.

Dr. Ruff: I guess, right? No, the renter from that property that was not letting us in to see it. That was the problem, the telemarketer. So, when she left the quarry, she pointed her finger at me and my chest and she says, “I am never gonna come see you as a patient.” I’m like, “Do you promise?” I don’t think this is gonna be a good fit here.

Shaun Keating: Oh, that’s a good story babe. So, you got that, then the tobacco company went out of business and you expanded over there, huh?

Dr. Ruff: Yeah, didn’t renew their lease. It worked out great. It worked good with cash flow. Having that property available for when I did expand.

Shaun Keating: Oh, absolutely.

Dr. Ruff: But they have Florida ceiling tobacco boxes, cartons, all through the, it would not have passed fire code, that’s for sure.

Shaun Keating: That’s over by my brother, tobacco road out there, I mean, there’s so many tobacco farms [crosstalk 00:27:19]

Dr. Ruff: But hey you guys are the big marijuana sellers now, right?

Shaun Keating: Yeah.

Dr. Ruff: California. It’s recreational.

Shaun Keating: I got one of that stock, TLRY, it was like twenty bucks, it went up to like three hundred bucks, and then-

Dr. Ruff: No way!

Shaun Keating: Then for tobacco, I got this stock way back, it’s called XXII and it’s Twenty Second Century is the name of this company, it’s a small little tobacco pharmaceutical type. They got a hybrid nicotine that is 3% nicotine only and it’s like, drop the nicotine by 97%.

Dr. Ruff: Wow.

Shaun Keating: So, it’s been a while, I got that a couple years ago, but I got a lot of shares-

Dr. Ruff: Hey, you don’t have to work with having stock like that.

Shaun Keating: Yeah, well, you never know because the FDA came up and said all these tobacco companies have to get least amount of nicotine in their cigarettes and this is the only company that’s got it, but it’s been floundering up and down. It’s up 10% today, I’m looking, I made like eight grand just sitting here at the office. No. I got my pot stock, TLRY, I think that is, and then XXII and my tobacco. So, got it covered.

Dr. Ruff: You’re set.

Shaun Keating: Those are my play ones. I always kinda bust my guy’s balls that does my financial advising, it’s like, “Dude, what’s going on man, this stuff ain’t going up.” Because you look at things and just kind of get on them a little bit, but, it’s harder than you think. So I played around, a little TD Ameritrade stuff, and that stuff’s impossible man, it’s like watching grass grow. You get in these like, volatile pot stocks, or you know, this tobacco thing, and “Oh, up 9% today, up down 15%, up 10.” It’s like what the heck, some big waves, kinda crazy. Okay, enough of that. Let’s get back to, tell me, what technology are you currently using in your practice?

Dr. Ruff: That actually is kind of exciting. I don’t know if you have heard of the X-Nav technology, but it was originally utilized by neuro surgeons for brain surgery, so they could see inside the brain while they’re doing the surgery, so they use that same technology and now have created this, so we can use this in your dental office. It meshes with your CT scan data and so when you’re actually doing the procedure, you can see, real time, as you are drilling, you can see inside the jaw. It’s just crazy accurate and precise. I think this is one of those technologies, that say ten years from now, will probably be standard of care, just as now, a standard of care before you do implants to have a CT scan.

Shaun Keating: Absolutely.

Dr. Ruff: When I started doing them, that wasn’t standard of care. We would use an x-ray. But my goodness gracious now, I can’t think of anybody who would do an implant without having a CT scan. But now, this is just a whole nother ball game. Where it meshes in the information. It has two cameras, and you have a hand piece that has an attachment to it that allows the camera to see the hand piece and there is a bite block that you take your CT scan with, so that the camera, picks that up, so in real time, within micro-millimeters, the accuracy is just unbelievable. You’re actually seeing inside the jaw as you’re working. It’s crazy.

Shaun Keating: So, this is called X-Guide right?

Dr. Ruff: Yeah X-Guide, X-Nav is the company. The first company, the first guy that tried to get this going in the dental field was a few years ago was an Israeli doctor. It was just so expensive as cost prohibitive for dentists to be able to have this in their office. But, this guy that developed this company that bought the rights for this, is the same person that developed the I-Cat. Anyways, I was really blown out of the water when I went to the osteogenic meeting this spring, and that’s such a cool meeting because they do it every other year and they have researchers from all over the country come and they present their data. Talk about an accelerated pace of advancing what can be gained in technology is just phenomenal because there are just outstanding clinicians and researchers from all over the world, they’re pooling the data. I think they’re just changing the face of dentistry, at least implant dentistry of how we know it.

Shaun Keating: That’s amazing.

Dr. Ruff: The other thing that was just developed and the patent just came out on it, maybe just a year ago, are the Versah drills. These things are unbelievable. This was developed by a middle eastern dentist. This is just phenomenal. So, all other drills that we’ve used before when placing implants, they would actually be used in a fashion that you would need to remove some bone to be able to place the implant. In a sequential manner to fit whatever size implant that you’re placing. This totally spins it on it’s head. Where the drills are designed, that you use it in reverse order. So, what it does is it auto-attages grafting, so it captures their bone and it auto grafts it into their jaw bone, widens the jaw bone so you end up with a thicker layer of bone around the implant. It can also be utilized to raise the sinus membrane so you can also do a sinus graft at the same time you’re placing the implant. Is that not crazy?

Shaun Keating: Oh, man,[crosstalk 00:33:42]

Dr. Ruff: It blows my mind. If you marry that technology with the live guided computer surgery technology, it’s just phenomenal the results you’re gonna get. You can’t help the patient get a better, more accurate result, because you’re increasing the bone around the patient. They’re gonna end up with less post-op sensitivity because you don’t have to necessarily reflect a flap. You basically have x-ray vision, you can see inside as your working. Anyways, it’s pretty exciting. The technology that they’re coming up with just to be able to be so precise and so accurate. You can just definitely have a better prediction of the outcome patients will have.

Shaun Keating: Is it really expensive?

Dr. Ruff: I went from, two years ago I was paper and I did process x-rays the old fashioned way. So, I went from being paper to now we have computers in every room and digital everything, and now was have a CT scan. So, going from zero to a thousand, that’s expensive doing it in that way. So, probably be better to gradually do it. But, if I wanted to have a CT scan, I had to have all these other things so I had to catch up.

Shaun Keating: Okay. What’s the name of this company again, let’s put it on our podcast so they can-

Dr. Ruff: It’s not a publicly traded company yet.

Shaun Keating: Oh, so where do you purchase [crosstalk 00:35:25] I’m just saying for our dentists who get the system-

Dr. Ruff: Okay, for our dentists who are listening, two major things, three things actually, technology I think is just really helping patients heal faster, is using their growth factors or stem cells, by using the platelet rich fibering technique. Where you get some blood from your patient at the beginning of your procedures, centrifuge it, then you can actually get the membranes created by their white cells, mix that with a bone graft, you’re just gonna get a more predictable healing rate. But that’s PRF technique. The other technique is the Versah, the V-e-r-s-a-h, the Versah drill. They may be based out of California, so you could probably get them on your show. That’s just unbelievable phenomena. All the big speakers, once they’ve tried this, they’re like, “Well now I can get rid of half of the instruments that I have, these tools I’ve spend my money on, because now I can use this drill technique and save the patients so much, as far as being able, instead of doing a lateral window sinus lift, now we can use this drill system and get five more millimeters of height without having a reflective flap.” I mean, it’s just phenomenal. The the other is the X-Nav, which actually I believe they’re based out of, they’re on the east coast, but I’m sure they’d fly out there, or you could talk to them on audio. But Dr. Emerson is the founder of that company. I believe he practices in Washington D.C. I believe.

Shaun Keating: No kidding. That’s a trip. When he starts talking about stem cells and taking out your blood and then put in that centrifuge thing, I hate to say it, there’s a big thing here, they call it the vampire face lift.

Dr. Ruff: Oh, no kidding.

Shaun Keating: They’re doing these stems cells and they put it in that centrifuge thing and then they inject it back into you. Oh jeez. All the ladies, the Kardashians, they all do it, it’s a trip. Not that I would ever do it but, it sounds, you know, they’re doing a lot of different things with stem cells.

Dr. Ruff: Yeah, well it’s a safer way because you’re using their own bio-materials. You’re not gonna have trouble with, I don’t know, it’s probably something that’s been around for awhile but underutilized.

Shaun Keating: Do you sync a lot of implants yourself? What system do you like more than others?

Dr. Ruff: If you use different types, there’s a lot of different type of systems out there. I think a lot of the systems will work well, so I think the biggie is just learning, when I complete that implant, the Maxi Course, really I just, after I finished that, I’m like, “Well gosh, now I really need to focus on learning science lift techniques. Now I need to learn bone augmentation.” So there was a lot of other skill sets that were necessary to help have a greater amount of success. So, I think there’s a lot of great implant systems out there. Personally, I use a lot of Implant Direct.

Shaun Keating: Okay.

Dr. Ruff: They offer a variety of different types of systems. I like the Legacy, so that’s just personally what I’m using. I’ve used Astro-Tech in the past, they’re a really good system. So there are a lot of great systems out there. I think it’s just learning all the other techniques you need to to be able to deal with the situations. When you don’t have enough bone, what do you do in that situation to be able to make this site possible to have implants.

Shaun Keating: Absolutely. It takes big cojones man. I got some guys that are trying to do sinus lift stuff, so you can can do sinus lift, I just talked about it on my podcast. Just recently I was watching a video animation on how it’s done. It’s just amazing, you know, the technology and I’m just a lowly dental tech. We just restore. We get it and it’s here, so it’s just kind of amazing now, you see really what goes in for all the steps and what you need to do, and just the whole osteointegration for it to grow and take and not have to put it to sleep because it failed. For us to restore it, it seems easy for us because that’s all we do. But to hear what a dentist has to go through, and a lot of my dentists, they’ll send it out to an oral surgeon that really does this in and out. So I mean, you’re really pushing it, you’re doing prosthedontics and everything else it seems. We do a lot of big stuff with you. How are we doing on your implants? Restoring them. We doing an okay job? We blowing it now and then?

Dr. Ruff: Yeah, no you guys do a great job. For me, I like having a seating jig when places the abutment, just to make sure it’s lined up correctly. I find that makes it easier and more predictable. I don’t know if all dentists like using that, but I know for me, that makes it easier. An easier process that’s seating the implants. You guys do an amazing with your porcelain department. I just seated, it’s easy right? When you do a whole mouth. You do an entry section, that’s great right? Because then you don’t worry so much. I just seated this beautiful porcelain crown on just tooth number seven. That’s the hard part. [crosstalk 00:41:27] It looks so beautiful. It really looked great. So that’s the hard thing. We try to send photographs. One thing when I’m doing a single crown like that, I try to prepare my patients like, we’re gonna do our best to get this shape matched perfectly the first go around, but we want it right. Sometimes it’s necessary to take a photograph of it in the mouth and have them do a little adjusting. So, I always try to prepare them mentally that we may need more than one appointment to have this the way we want it. I think if you do that, it’s nobody’s fault, this is just a really challenging thing to try to accomplish. We can make it easy on the lab guy and just prep all your front teeth, you know, then I can tell you [inaudible 00:42:15] the first time. But, if you don’t wanna do that, then let’s have a little patience when we’re trying to get this right.

Shaun Keating: Absolutely. That’s such a good attitude that you have because I’ve had it sometimes. I mean they might have some florescent, and just some hyper calcification on a single centrals, are always tough, like do two centrals at least. Laterals area a lot easier than centrals, but sometimes man, two or three times, it’s rare, but when it does happen, I could almost just tell the doctor, “Let me just give you free lab work on the other four teeth, or whatever it is, and it’ll save me just a bunch of headaches.” We get it more so than not, when we get a good photo and stuff like that.

Dr. Ruff: This looked really great. I think having a good camera is important for dentists to utilize that digital camera to, I think I use a Cannon-

Shaun Keating: D10 or something like that?

Dr. Ruff: Something like that. It’s great. It’s so good at communicating. I have tried to email the photographs before but I find the color is not quite as true, so I’ll print the photographs out and send it that way. I think that is a better communicator [crosstalk 00:43:35]

Shaun Keating: You have different resolutions and different computer screens, and it just a picture truly is-

Dr. Ruff: That way you’re in control of that and of course the whole shade guide, but I think the camera is really important. Speaking of technology, I think that’s a very important tool to invest in and the time to invest in that because that’s a way for you to showcase what work you can do.

Shaun Keating: Absolutely.

Dr. Ruff: Show your before and after photographs because just like when I’m trying to find a good restaurant, or a place to stay, I wanna look at their photographs and I want to look at their reviews from people who have experience that establishment. I find that we certainly love getting patient referrals, but, I find that a lot of new patients who come to see us, also find us just through the website, looking through our photographs, or the reviews, so I think that’s super important in promoting your work. Rather than, you know, talking bad about maybe one of your peers in town. Just promote what you can do. I think as long as you stay positive that’s just the best way to be. Just be positive about what you can do. Don’t trash talk your other doctors in town.

Shaun Keating: Hold your tongue. I hear that a lot lately as I get older. You can’t just always say what you feel, and you hold your tongue. Especially this day and age.

Dr. Ruff: [inaudible 00:45:09] and they have guns these days, right?

Shaun Keating: Exactly, not out here in California.

Dr. Ruff: Especially in the south.

Shaun Keating: I had a lot of Texas doctors on my podcasts lately and they’ve all got guns in their cars and shot guns in the back window and I just, we got a lot of guns here, but they’re all just the criminals that hide them from you. But just regular people, day to day, they’re not carrying a concealed weapon, it’s just crazy. What about going forward with CE for some of the newer doctors. Any recommendations on some CE, that you like?

Dr. Ruff: There’s so many options out there. This course I went to, I just gained so much knowledge from it, it was put on by Osteogenic. I like that company. I think that they offer fair research. They make it easy for, they make it such an easy learning environment, they offer a hands-on training from these other practitioners and I think it’s inexpensive. A lot of these guys, theses big name guys, will have a way of learning online. So you have all these different lessons, and videos of procedures that you can have access to for pretty minimal money. Very minimal amount of money. So, I think that’s a great way to learn now. You can learn online, you don’t have to pay a ton of money to go to meetings. Maybe go to some just to kind of talk to other peers and you can learn a lot from them of how they’re doing things.

Shaun Keating: Absolutely. You do the Chicago Mid Winter ever?

Dr. Ruff: I do the Chicago Mid Winter, I usually try to find specific meetings probably more for implants or surgery, things like that.

Shaun Keating: That’s so cool. Okay, what about with practice management at all and work in your office. Have you done anything there?

Dr. Ruff: Yeah, early on in my career I ended up taking a course and it was such a fun course. Are you familiar with Kit Weathers?

Shaun Keating: Yeah, oh yeah, sure.

Dr. Ruff: Kit Weathers, okay, so he’s from Mevin, Georgia, and his partner is Dr. Goldstein, I think is his name. Anyways, he had a course down there to really hone your endo, I think now he’s working with the LVI group, I believe, in Vegas, but at this time, he was doing the course through his office down in Mevin, Georgia.

Shaun Keating: Okay.

Dr. Ruff: And, those guys were awesome. They were filled with so much great practical knowledge of practice management advice. So, I don’t know if they are still offering that.

Shaun Keating: Yeah, I’ve seen them on Dental Town, they were pretty big there for awhile. It’s good to get into some of those, just because a lot of these dentists, they got the great skills, a lot of theory, but to get that management of how to run that ship a little bit, it helps.

Dr. Ruff: It’s such a [inaudible 00:48:13] so much time in school on that, at least when I went to school, so I think you need to be your own best advocate, and it’s so easy online to try to get this different information from different sources. You can have periodicals come in to give you some advice but-
Shaun Keating: And it’s actually, you can get your CE for the year too, through online. That’s what I gotta do on mine. I gotta do it online and then I go to Chicago and get a bunch there, but it’s non-stop. You gotta keep doing that because you gotta get your credits. Well, that’s so cool man, awesome talking to you, and I can’t thank you enough for all the work and you’re a sharp cookie, and you do some of the best model work. I have another doctor that does it out of Georgia too and man, he just, only two people, you and another person is the only one doing it, but that’s fine. Hey. It works. We have no remakes, and if we do have one, we probably messed something up.

Dr. Ruff: No, you guys do some really good work. It’s been a pleasure working with y’all and it’s been great. I can count on the work being right. So, I really appreciate that.

Shaun Keating: Oh, that’s so cool Dr. Ruff. Well, thank you so much. I know you’re taking your time out today for this, and I just thank you for your time. If there’s anything, man, please just ask for Shaun, and I’ll hook you up, and again, anything at all you need, just let us know. We’d love to have you out here too. We have some different seminars we’re doing, we’ll have to get you some info when something’s coming up on the near future.

Dr. Ruff: Yeah, definitely.

Shaun Keating: We’d love to have you out here, you can come see your techs, and to see the facility, and bring that husband along, bring your doctor husband. Now, he’s a medical doctor right?

Dr. Ruff: He is. He’s a medical doctor. So, it’s probably good we’re not in the exact same field, so he does a great job with his practice and he teases me that he’s gonna retire and come manage my practice, I’m like, “Oh, no, no, no.”

Shaun Keating: Stay where you’re at honey, because I like what I’ve got going on here. No. That’s so need. Well hey Dr Ruff, thanks again so much, and I really appreciate coming on the Dental Up podcast, and we look forward to talking to you again real soon.

Dr. Ruff: Yeah, thanks for having me on.

Shaun Keating: Alright, we’ll talk to you real soon. Bye bye.

Host: Thanks for joining us on the Dental Up podcast show this week. Make sure to follow us on Facebook, Instagram, and Twitter, or search the Dental Up podcast on iTunes for our weekly feed. Don’t forget to visit keatingdentallab.com/promo for exclusive offers. Keating Dental Lab is a full service dental laboratory, and we’re nation wide. We’d love for you to send us a case so we can show you the Keating difference. If you dig what you heard, please leave a review on iTunes, and we’ll be back next week.