The Art of Blending Modern Technology and Traditional Methodology with Dr. John C. Comisi, DDS, MAGD
August 15, 2019
Our guest this week Dr. John C. Comisi, DDS, MAGD stops by and chats with Shaun Keating on why it’s important for today’s Dental Students to learn both the old school methodology while incorporating the latest in dental technology. Dr. Comisi also talks about the need for basic and advanced training in Dental Sleep Medicine and they discuss the rise and fall of Dental Ceramists and their new role in today’s digital age. You will hear all this and much more on this week’s episode of The Dental Up Podcast.
On this Episode you will hear about:
– The Role of a Ceramist in today’s Digital Age and the importance to keep that role alive.
– Why it’s important to share responsibilities when opening a Dental Practice and it’s long-term benefits.
– Ways to improve your overall techniques/procedures and helping your staff understand important practice management tips.
– Dental Sleep Medicine and its importance in the Dental Industry.
– A quick insight on Dr. Comisi’s Occlusion Theory
– Why it’s important to have a strong mentorship and a community to talk to.
Host : Ladies and gentleman, this is the Dental Up Podcast, brought to you by Keating Dental Lab, a full service, award-winning dental laboratory. Each week you’ll learn tips and techniques from real world 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 received his Bachelor of Science in biology at Fordham University, and he later graduated from Northwestern University Dental School in 1983. He is a respected key opinion leader, author, speaker, and a consultant who contributes regularly to numerous dental literature magazines, both in physical editions and online. Currently residing and practicing in Charleston, South Carolina, please welcome Doctor John C. Comisi, DDS, MAGD. How’s it going, Doctor Comisi? John C. Comisi: It’s going great, Shaun. How are you today? Shaun Keating: I’m fantastic, man. Thank you so much. Dude, you did a podcast on Dental Up way back in September of 2015, man. That was- John C. Comisi: Yeah. David and I sat down and had a great conversation at that point in time. Shaun Keating: Yes, you did. Doctor Hornbrook. He was our clinical director of education here back at that time. I wanted to start a podcast and he was the one that started it. A couple of years later, he went back to doing what he’s doing, practicing dentistry and lecturing more. So I had to take it over. John C. Comisi: It’s what he loves to do, and he’s darn good at doing that too. He’s real, real good. Shaun Keating: He is, man. John C. Comisi: I love David and his work. Shaun Keating: Yeah he’s a good guy, and we’re very thankful that he came, and worked with us for a few years. He’s a good personal friend of mine too and I wish him nothing but the best. I always start off talking a little bit about sports. I don’t know about South Carolina. I think you guys actually have the Panthers stadium. Are they in South Carolina or North Carolina? John C. Comisi: They’re actually in North Carolina in Charlotte, but they do have a new practice facility that they’ve just in the process of building or maybe have built or just in the northern part of South Carolina, just over the border from North Carolina. But they are the Carolina Panthers, so both states own them or at least are very enamored by them. So it’s real good. John C. Comisi: But here it’s college football from what I’m learning over the last couple of years because we’ve got University of South Carolina- Shaun Keating: Yeah. The Gamecocks. John C. Comisi: … which is part of the Gamecocks. Shaun Keating: Yes. John C. Comisi: We’ve got that nationally ranked and national winner of the college bowl last year, those Clemson Tigers. They’re up north. Shaun Keating: Oh my gosh. John C. Comisi: Up near the Greenville area there, so we have a lot of pride in the football team. Not that I hail from South Carolina. I’m a Brooklyn boy myself, but I’m learning quickly the important things to know about South Carolina, and basically you’re either a Gamecock fan or you’re a Tiger’s fan, and you basically try to keep neutral otherwise. Shaun Keating: I bet, and you know what? I knew that this thing was in Charlotte, but I knew something was up, and it’s their practice facility and everything they’re building in South Carolina. John C. Comisi: Correct, right. Shaun Keating: Which is awesome, but God, it’s weird. You never really think of Clemson where it was, and it’s South Carolina, and they’re one of the most dominant football teams in the last several years, and overtaking Alabama, which gosh Alabama is just too stacked. But your head coach is named Dobie or something. John C. Comisi: No, Deebo. Shaun Keating: Deebo, man. And that dude is a great coach. John C. Comisi: From everything that I have seen and heard about him, he is extraordinarily well respected, he runs an incredible program, he builds character, and he builds up his team, and the members of his team. The entire place at Clemson is evidently from what I understand, a remarkable place to be, and I’m looking forward to getting up there one of these here days, and taking a look around seeing, and getting to one of their games at Death Valley where I am told they are killer rabid fans up there. So I can’t wait to get up and get to a game like that. Shaun Keating: They say some of the best in the United States, and they’re just some of the nicest people out of the stadium. But in the stadium, it’s the real deal, man. And Clemson, Clemson I remember back in the ’70s and ’80s they were pretty good, but I haven’t heard of them in a while. But lately, they’re just, and they’re stacked this year that they’re supposed to win it all over again, and they got this long haired quarterback kid. He looks like he’s from Southern Cal here, like a surfer dude. John C. Comisi: He was a freshman last year- Shaun Keating: Yeah, true freshman. John C. Comisi: And he takes them all the way to the college championships with poise, and commanded the field that you do see in a young person too often. It’s just remarkable. Shaun Keating: That’s so awesome. John C. Comisi: He did a heck of a job, and he’s expected to mature, and grow, and do even more spectacular things this year. So it should be a great football season. Shaun Keating: I bet. When his body really fills out, I mean I think he’s six, six or something. I mean he’s a big boy and good looking kid, but kind of like Jared Goff we have on the Rams. Kind of the same similar body style, and I think- John C. Comisi: Ah, okay. Shaun Keating: Yeah, and he was the number one pick. So this boy, he can begin a couple hundred million dollars in a few years probably from the NFL if he can really fill out, and really bring it to the next level, which I think he’s already almost there. He’s really talented, but wow that’s good conversation on football there. John C. Comisi: I wish he was my best friend overall. Shaun Keating: Ah, man, yeah. He’s- John C. Comisi: But not that it’s going to happen anytime soon for sure. Shaun Keating: Hey man, we got to somehow get it in and crack that dental issues they have on that team. We get Comisi out there man, running all, sending them the mouth guards out to Keating Dental Lab, man. We’ll hook them up baby. John C. Comisi: There you go. There you go. Shaun Keating: That’s awesome. All right, man. Well, lets go ahead and Dental Up. So tell me Doctor Comisi, now why did you get into dentistry, and at what point did you think, “I want to be a dentist.”? John C. Comisi: Well that’s a really interesting story. I was originally going to be a physician. I had wanted to be an MD all of my life from grade school on through high school, and through the first couple of years of college. But I got an experience that happened. Basically, when you go to college you want to go into a field. They recommend that you go and volunteer. John C. Comisi: So I volunteered in a hospital, and it happened to be one of the busiest hospitals in the entire world. Mount Sinai Medical Center right in mid Manhattan. Shaun Keating: Oh man. John C. Comisi: And you go down into Manhattan, and you go to Mount Sinai, and you work the midnight to 8:00 shift on a Saturday night, you see some things. Shaun Keating: I’m thinking. I mean- John C. Comisi: And I saw lots of things, and after a while of doing that I went to my guidance councilor at Fordham, and I asked her. I said, “What am I going to do? I can’t do this. The blood, the guts, the death, the challenge, the life and death circumstances. I don’t think I’m cut out for that.” So she said to me, “Have you ever thought about being a dentist?” I said, “Ew, yuck, no. Dentistry? Forget it. What? Are you out of your mind?” John C. Comisi: And she said, “Well, there is a clinic at Montefiore Medical Center, a Saturday morning dental clinic that they need volunteers at. Why don’t you go over and check that out?” So I said, “Okay, Saturday mornings. I can deal with that.” I didn’t have to be out all night carousing with my buddies. So I started going on a Saturday morning, and the first Saturday morning that I went after orientation, they put me in with this doctor and he explained what was going to be going on, and a patient came in. John C. Comisi: A very tall, six foot plus giant man came walking in, big heavy dude, sat down in the chair, and he had an abcess the size of a football coming out underneath his chin. And the guy was in serious pain. So the dentist then said, “John, I’m going to need you to help me here. I want you to put this suction device right where I tell you to, and do move it until I tell you to.” And I said, “Okay, this should be interesting.” And he’d get ahead, and he did an incision into the area. John C. Comisi: The guy just screamed with pain- Shaun Keating: Oh I bet. John C. Comisi: … and he said, “Put the suction right where that is.” And I put the suction at the area where the incision was made, and blood and guts started coming out. I said, “Great, I go from blood and guts from the dang emergency room to blood and guts here in the darn dental area.” And as the relief of pressure from the abcess that was going on in there started to curtail, the gentleman’s hands on the chair, which had been turned milky white from his grip started to relax, and you can see the entire body just calm down, and the relief that went on. Shaun Keating: Can you imagine? John C. Comisi: And after that was done, he put in a suture to try and put a drain in to let it continue to drain, and put him on antibiotics. The gentleman got out of the chair, went towards the doctor, and I said, “Oh god, he’s going to beat him.” And the next thing I know, he grabs the dentist, lifts him up off of the floor in a bear hug. He just swings him back and forth like a little child, drops him to the floor and says, “Thanks doc,” and walks out of the room. Shaun Keating: Oh you’re kidding? I love that, man. John C. Comisi: And I said, “Holy mackerel. This looks like I belong here.” Shaun Keating: No kidding. John C. Comisi: And that’s how I got into dentistry. Shaun Keating: Oh that is so cool. John C. Comisi: That is the story that got me started. Shaun Keating: Now was that at Northwestern over at Fordham or where? John C. Comisi: No, that was in the Bronx. Shaun Keating: Oh yeah. John C. Comisi: I was undergraduate in Fordham University. So the Bronx. Fordham is located in the Bronx of New York City. And so it was just about a mile away from campus, and I got over there on the bus, and did my thing there on Saturday mornings until I graduated, and it was just really a marvelous opportunity, and got to see various things. But that was my first experience other than being a patient in the dental chair, which I was during most of my graduate time period at Northwestern because knowing what the working end of a toothbrush for most people is not something that’s normally taught, and that’s one of the challenges. John C. Comisi: We need to educate our people in this country better about how to manage things. But I didn’t know from Adam how to really take care of my teeth. So needles to say, I had more restorations done at Northwester by classmates and upperclassmen during my four years at school than you could imagine. And the really remarkable thing is, every single one of them is still there. Shaun Keating: Yeah, man. I’m looking. You got a nice grill, nice smile, baby. What do you got? Some old school PFMs in there? John C. Comisi: No, those are all my natural teeth. I just got a lot of gold inlays, and a couple of amalgams here and there in there, but that was it. It was just good old posterior restoration that lasted. All of them gold inlays. Shaun Keating: Oh the gold. John C. Comisi: All cemented in with zinc oxy-phosphate cement, which to this day is still dang good. The problem is, is that it’s old school. Shaun Keating: Yeah, and the people- John C. Comisi: So that’s one of the issues. Shaun Keating: … and their vanity, and gold is the best restoration. I used to work back in the early ’80s with Bill Strupp- John C. Comisi: You bet. Oh yeah. Shaun Keating: … and talked with him, and worked with him a lot, and got me into the JRVT. And man, it’s a lost art, but I still do a ton of gold. I do a couple of hundred gold crowns a week still, and that goes to the grave with you. It really is. If it’s done right, there’s nothing better, and it’s just the people- John C. Comisi: Yeah. When a clinician understands the value and the benefit of placing a gold crown, there’s nothing better in my mind or a gold restoration. The unfortunate reality is we’ve gone more to the ceramics, we’ve gone more to the milled and/or to the pressed or whatever kinds of restorations with the lithium bisilicates or the zirconias or the transition zirconias that we have, now which are all fabulous things. But again, they have their moments. Shaun Keating: Yes they do. John C. Comisi: They have their benefits, and they have their challenges. And if people aren’t aware of where they work best, they can make a mess out of the whole circumstance too. So the key is understanding the materials, understanding how these things are going to work, and where they’re going to work best because even though zirconia is durable, it’s still breakable. Shaun Keating: Oh absolutely. No. Hey, especially how you design it, and the thickness of walls, and how it loads up. I mean I still got a ton of guys still doing PFMs, and it’s usually on a … Most PFMs I do is on a noble. A semi-precious noble alloy, but I still do a lot of white high noble. John C. Comisi: That’s a beautiful thing. Shaun Keating: And yellow high noble, and it works baby, and it’s- John C. Comisi: They do. Shaun Keating: … very predictable, but it’s something that CAD/CAM, and the designs, and the strength. But I can layer four, five, six, seven powders on these PFMs, and the coefficient term expanses match exactly to the metals, and man they can dance like any, all ceramic restoration if it’s done right. And enough reduction and the right ceramist. But more and more guys- John C. Comisi: And also the key is the ceramist aspect. Shaun Keating: Oh, exactly. John C. Comisi: That’s where another part of the issue in the profession is going. We’re losing the fabulously talented ceramists. Shaun Keating: Exactly. John C. Comisi: That is a dying art, and that’s a shame too because their hands are gold because they could make anything work beautifully if, as you said, give them proper clearance, give them proper preparation, and understood where the dynamics of the interactions of the materials have to work. Shaun Keating: Oh, exactly. John C. Comisi: And they could make magic occur. And I love my ceramist. Shaun Keating: And so do I. I’m looking out my window and I got about 100 employees out there, and these are all old school, 25, 30 years, and it’s a lost art. But we got a house full of a lot of seasoned veterans apparently from day one. And I got a bunch more that want to come work because no one is hiring ceramists anymore because they want these designers, and I want to hire every good ceramist I want because at the end of the day, if I don’t have enough PFMs for you, they can finalize on my monolithics where they’re grinding in contacts perfectly, the perfect contact circles. Shaun Keating: They’re giving me the exact shading, they’re getting the perfect emergence profiles, they’re getting the [inaudible 00:14:44]. I mean, there’s a lot to it other than just getting someone that you’re paying minimum wage to design a crown. Yeah, that’s just a “behind the lips, it fits” kind of stuff. You need the real deal, and I love it when doctors really respect that, and talking to you just gets me excited because yeah, we’re keeping our people all here, and we’ll convert them a little bit to some of the other stuff as we grow more in that digital area. Shaun Keating: But I’m still an old school guy, lost wax techniques. I got about 20 waxer finishers that are just brewing up copings. I mean, we could even design them and run them over to the printer, but we’re still doing them a lot by hand, and a lot of lost wax technique, and it’s a neat thing. But man, I get excited, and I do a lot for the VA throughout the United States, and those VA doctors, they want all PFMs. And I’m like, “Yes sir. Yes sir baby.” John C. Comisi: Because they know it lasts. They know it can work. Shaun Keating: Exactly. John C. Comisi: But you see, the blending of the modern technology with the traditional methodology is just so important because we can’t lose what brought us to this place, but we also have to understand that the technologies and the advances that are made have a valuable place as well. So you’re blending of the two as you’re doing there is absolutely spectacular, which is what we’re trying to do when we teach the students here. We want them to understand the basics as to why things are done the way they are, but we also want to incorporate and use the latest technologies wherever possible, so that this way they can be prepared for what is out in the real world when they get out of here. Shaun Keating: Exactly. John C. Comisi: So we try to give them as balanced in overall circumstance as can be done, which is what I think at every dental school across the country. I’m a GP. I practiced for 34 plus years in Ithaca, New York prior to coming down here to South Carolina to teach. I love my patients, I love doing my work, general dentistry is in my blood. John C. Comisi: But coming to the university here at MUSC, which is really spectacular, I’m able to take what I learned over the course of my career, and through the various other trainings that I have taken over the years, and bring it to the students today. And give them an insight as to where their potential is, and how they can blend again everything of the basic sciences, and the basic fundamentals of dentistry to the art and sciences of this beautiful work that we can do both in digital work and in the virtual world, which is part of their life, which is what they do. They live in a virtual world. Everything has to be quick, easy, fast, and they need instant access to it. John C. Comisi: So melding and molding those two together is really the most fun part about being part of a faculty nowadays. Shaun Keating: Oh, that’s so neat. And I bet those guys are so lucky. So tell us, because I’ve always seen you. You’ve been one of the keynote opinion leaders forever out there speaking to the big boys all over, and I’ve always seen that. Heck, I even see your wife. She’s crushing it out there in the socials, doing what she’s doing with all the different programs, and how in the back part of the office, how that runs and all that. Shaun Keating: Yes, your wife, man. My hats off to her. She’s a firecracker for sure. John C. Comisi: I am a fortunate individual to have that lady in my camp, let me tell you. She’s got more knowledge than some of my colleagues to tell you the absolute truth, but I won’t tell you who they are. Shaun Keating: Yeah, I know, man. I hear you there, but- John C. Comisi: But Karen and I, and again, when Karen and I do a program together, it’s really very interesting because we work together for so long that we understand the nuances. She understands that in order for the doctor to be productive and successful, he or she has to be treating patients. Can’t be bothered with the running of the office. You need to trust the individual to run the office, understand what the business aspect is, understanding how things have to be run, how to stay on a budget, and how to make sure that you are working within your means, and always striving to improve upon what your goals were. John C. Comisi: And that’s when we do our energy squared, and engaging, and enlightening, energizing your practice lectures that we do, that’s where the fun comes in because she can talk to the team members and to the doctors, understand what the doctor’s responsibility is, and I can give the to aspects of what the clinical work that can be done to the docs. So the team of Karen and I speaking together is always an exciting and fun thing to do. We’re going to be actually doing our next lecture together up in Greenville, South Carolina for the Piedmont District Dental Society on the 13th of September, which should be just a great blast. So we’re doing that. Shaun Keating: Yeah. I see that. We’ll put that on our show notes on the podcast when it comes out Thursday next week, or actually it’ll be this week, right? We’re straight up. So yeah, this Thursday. But yeah, great program. It’s called Energize Your Practice, and it goes through a lot of different things. Front office, back office, but tell me a little bit about that. Now, this is coming up September 13th, but you’re going to have more in the future and all that. John C. Comisi: Well, because it’s [inaudible 00:19:53], a component of the South Carolina Dental Society, it’s a morning meeting. It’s going to go from about 8:00 AM to about noon, and we’re going to have the opportunity to just go through some of the basic fundamentals that can help a practice try to bring itself to the next level because we all can need a little bit of a push every so often. We need that energy to just move it from one plateau to the next level of the capability of the office, and that helps it energize the team, has the team understand what their responsibility is to the overall practice because they’re a practice as well. Shaun Keating: Yeah, absolutely. John C. Comisi: If you engage them in that manner and during the course of this three or four hours that we’re going to be together with everybody, we’re going to try to give them enough nuggets so they can go back and try to see how they can incorporate these ideas into their day-to-day practice from, of course, the front office, back office, and the doctor’s procedural mechanism. It’s going to talk about how to improve the overall techniques from a direct restoration and an indirect restoration component from the doctor’s perspective as well. But Karen is going to also help to understand infection control, how to make sure that you’re not wasting supplies and materials, how important it is to keep a good running log, so this way you’re on target and you’re not overspending. John C. Comisi: Because one of the biggest problems is lots of offices like to buy stuff in bulk, and then it stips, and it never gets turned over, and it’s basically lost all that cash waiting for you to get to that bulk, and it doesn’t. So on time, as needed, just in time kind of mechanisms. That’s what Karen is going to talk about as well. It helps the practices just get that much more efficient and effective in everything that they do. John C. Comisi: So that’s our program in Greenville. We’re also going to Texas the week afterwards. In that one, Karen is doing two all day lectures for the team members. They’re in El Paso, Texas. So we’re going to be on the 19th and the 20th. So she’s doing two days for the team members, and I’m doing two days. One day we’re talking about materials. The one lecture is called The Battle of Debond, the Dawn of Regeneration. John C. Comisi: That’s one day, that’s on the 19th. And on the 20th, we’re talking about another very important and very near and dear subject to my heart is dental sleep medicine, and how to work with our physician colleagues in treating and helping patients who have been diagnosed with obstructed sleep apnea. And there’s a really big field going on in there right now. Shaun Keating: Yeah. One of my brothers is kind of doing that, but it’s something that is very, it affects a lot of people and even myself. At the end of the day, what is that basically? Bringing the mandible out a little farther? Two, three millimeters in the maxillary, and keeping it that way? John C. Comisi: Well, actually more. It’s a lot different than that. It’s not just giving a piece of plastic, and slapping it into the mouth, and telling the patient to advance until they look like Jay Leno. That’s not what sleep medicine is nowadays. Shaun Keating: And their condyles click in the morning. It’s kind of like that movie The Jerk. Remember when he made those glasses, and then everyone started getting cross eyed after a while? It’s kind of- John C. Comisi: Yeah. There are a lot of snoring devices that are out there, but we’re not just treating snoring. We’re actually helping to find the right vertical dimension, and find the right positioning to open up the arrow with the maximum spacing. And that’s the key, we’re not just guessing anymore. The way that I teach, how to do sleep medicine dentistry is I try to find where a maximum airway is going to be opened up. And using computer systems that I use, I’m able to find that and actually verify before we go back to the secondary sleep study, which is always an important component, that we have a successful result, and that’s what we do, and that’s what I’m doing here at the university as well. John C. Comisi: I’m starting a sleep medicine program not only to treat patients here, but also to teach the students on what we need to do to identify those patients who are at risk and can be helped by being screened properly, getting the sleep medicine physicians who can then give an accurate diagnosis, and help get them to the correct therapies necessary. So we’re an important part of medicine. Shaun Keating: No, that’s huge, but I mean what are you going to get at? Is it the soft tissue in the throat? Are you going to laser that or is it applied? Are you going to do build up? John C. Comisi: There are many different ways. The main three ways, of course, are CPAP, which is the positive air pressure machines that make you feel and look like Darth Vader type. Shaun Keating: Yeah, that ain’t happening, man. Jesus. I feel like an alien. John C. Comisi: There are various surgical procedures that may need to be accomplished, and there are needs and reasons for that. But most people are going with some kind of an oral appliance, some kind of an oral device, but not every oral device is created equal. Shaun Keating: Exactly. No, I hear you. John C. Comisi: Because you have to make it so that it will work for that patient, and you can’t just let the lab create that. With all due respect to my good friends here at the laboratory, we need to guide the laboratory to what it is. It’s the same thing when you’re making a crown preparation. You need to reduce properly, you need to give good, accurate records so that this way when it’s mounted, when it’s articulated, when it’s created, when it’s fabricated, my lab technician can make me the perfect crown or the perfect prosthetic device. Shaun Keating: Exactly. John C. Comisi: Well, the same thing goes with the sleep prosthetic device. It needs to be exactly rendered to the proper vertical dimension, and the proper protrusion, but that is individualized based not airway of that patient, and you can’t test that. You have to have the appropriate instrumentation to know where it is, and it’s not just George Gauge. Basically, guessing by just having a person bring their jaw- Shaun Keating: Yeah. One, two or three millimeters. “Which one you want?” You can change it yourself in the office, and it’s kind of a little hokey, but it works for some. But I’m sure it would be a much better to get it really dialed in. Yeah. John C. Comisi: The natural result. Shaun Keating: Yeah. John C. Comisi: Right. So when we use the computer technology that I use and that is being used by many docs around the country, you’re actually going to be able to help your patients to a greater degree with less pain, with less problems, and with a higher degree of success overall. So that’s sleep medicine in a nutshell there. Shaun Keating: That’s awesome, man. No, that would be neat for sure, and heck we might have to get you guys out here in the So Cal area so you can do the west coast, but I’d love to have you and your wife for a day program. We’ll come up with something neat. John C. Comisi: We would love it. Shaun Keating: Touch a few areas with you with technical, and product selection, and then get the wife in there and help all those assistants in the practice management part. That would be huge. No, that’s really neat. John C. Comisi: Yeah. Karen would have a blast doing it. She is dynamic, she basically we call our company that does lecture in Energy Squared, and basically she’s the energy and I’m the square. Shaun Keating: She’s a firecracker. Yeah, that’s what I was saying. I’ve seen her, man. She’ll get right in your face and tell you how it is, baby. That’s the New York in her. John C. Comisi: That’s true. Shaun Keating: That’s so cool dude. Well, tell me a little bit on your collusion theories. Do you go more towards a Pankey, a Dawson? What’s your collusion philosophy or what do you think just in a quick snapshot? I mean, I know Kois got it, Spears got his things, and there’s a lot of other guys that probably got through and set ups going and everything. John C. Comisi: They’re all remarkable people. I wish I could be half as smart, a quarter as smart as all of those people that do that. Shaun Keating: Oh, you’re so humble dude. You’re very, very smart. I know you. Come on now. You’re right up there with them, so don’t put that over. John C. Comisi: The key is that it’s always trying to find what is going to be balanced, getting rid of the posturing in the posterior is key. Understanding the envelope of function that goes on, and I don’t care which of those philosophies you work in. They all will work beautifully if you use their basic fundamentals. The Pankey philosophy, the Dawson philosophy, and just losing him recently is such a big loss to the entire industry. Shaun Keating: For sure. John C. Comisi: Remarkable. And again, all of the guys, Spear and Kois, they all understand that if we do have a balanced overall occlusion that is functioning properly, nothing is going to work. Shaun Keating: Exactly. John C. Comisi: It’s going to be destroyed. And you’ve got to understand what is the causality that brought the patient to that place where you find them? If you can identify what was the cause, you can then try to overcome that and bring them to harmony again. That’s the basic bottom line in a nutshell. Shaun Keating: Oh, they’re lifesavers. A good occlusion guy and when a person is messed up, maybe they’ve been over [inaudible 00:28:45] or whatever to get saved by someone that really knows the whole setup, and can get rid of your ear aches, and your headaches, and get you back into comfort. It’s a lost art there too. Not too many guys practice occlusion because they want things fast, quick, “Let’s do the crown prep system that,” but it’s a lifesaver. That’s why I just brought it up. I just hear a little bit about that. John C. Comisi: Oh yeah. Interestingly enough, there’s also a correlation between the damage that occurs to the teeth and sleep problems too. Shaun Keating: Yes, exactly. John C. Comisi: So we talk about that. So there is that issue as well. So again, we got to go back to the causality. What’s creating the problem? If you can stop the problem, then you can rebuild, you can readjust, you can help a patient in so many other ways. But you got to go back to the prime mover, whatever that happens to be, that brought that patient to that aspect. We always have to place CSI Dentist. We’re going to the crime scene, we got to figure out backwards from where we see it. What brought us to that place? John C. Comisi: And if we play CSI Dentist, we can identify the problem and not make the same damn mistake over and over again, which we can do. Shaun Keating: Yeah, exactly. That’s the whole thing to be able to diagnose when a patient comes in, if you do your right education and learn from the right people, you can diagnose everything on a patient, and give them the truthful thing. Kind of like a mechanic. You can go to find mechanics, unless they’re trained properly, you’re not bringing your Ferrari to the Toyota mechanic, but you’re bringing the guy that knows, and it’s hard for the people out there. It’s all word of mouth really, a lot in life on any business. Shaun Keating: It’s who’s good in this. Right now, I’m looking at back doctors. I’ve got an L5 that I got to get fused, and it’s just a nightmare man. I got to go in from the front and the back, and it’s like, “Dude. I got to find the best, man.” John C. Comisi: Oh, exactly. Shaun Keating: I’m going to one out in Arizona or where is it at man? What are the best hospitals? That one is, I forgot the name of it, but I don’t want to mess around. I want to find someone that knows what they’re doing just like the people in dentistry, and there’s dentists that can save a person and relieve them of so much pain. Like you said, even that guy with the abcess. People die from untreated abscesses all the time, man. Shaun Keating: It’s not in the papers or news. I had a friend die from one, and I went to high school, junior high with him, and died from an abcess. He just didn’t take care of it and just let it sit there and fester, and it went in and got septic or whatever that’s called, and he just … Yeah, it’s just nuts. John C. Comisi: Yeah. Dangerous. Shaun Keating: Yeah, it is. So we’ll wrap up pretty quick here. I’ve got a few more questions. So what made you pursue a career as a speaker and a professor? How? Just the love of the field or what? But you’ve been doing that a long time, and as a professor, tell me exactly where you’re at in South Carolina, what you’re doing there, and a little bit about that if you could. John C. Comisi: Yeah, sure. Well, I got lucky a bunch of years ago. I was always a CE junkie because I always wanted to know more than I had been trained to do, and that’s one of the things. When you get out of dental school, you need to always continue to learn. I’m a perpetual learner. And I happen to go to a class by my good friend Howard Glazer years ago, and he was talking about materials and different composites, and I said, “Why didn’t I know about this stuff prior to this?” John C. Comisi: So I called up the company, one of the companies that was there, and I said, “How come nobody knows about your product?” And they said, “What do you mean?” I said, “I’ve been in practice now for 15 years, and I’ve never heard of your company or your product. Something is wrong.” So I told them, and I said, “Well, what would you do differently?” And I explained to them, and the next thing you know they invited me to come to their shows and start to talk to them, their salespeople and to the doctors, and we just started to share knowledge and information, and the next thing you knew I was getting invitations to start lecturing. John C. Comisi: And then my other good buddy, Lou Graham, we met each other once at a Chicago mid-winter meeting, and we started talking, and Lou invited me to join up and be one of his speakers with his group. And that was fun, and I did that for a bunch of years too. Shaun Keating: Isn’t he the- John C. Comisi: My two good friends, Howard Glazer and Lou Graham, I couldn’t be where I am without them as far as being a speaker because they influenced me in such great ways. Shaun Keating: That’s awesome. John C. Comisi: And then time went by, and suddenly some friends of mine who were part of the university here, the University of South Carolina in Charleston, South Carolina said, “John, you really need to come here. We need you to teach our students.” And I said, “Guys, I can’t. I got a practice. I can’t do that.” So a couple of years back when I was in the process of selling my practice in New York, my buddies found out, and they said, “You’ve got no excuse. Send in your resume, put in an application. Let’s see what happens.” John C. Comisi: So I did, and the next thing I knew I’m down here starting to teach. I got the position. Shaun Keating: Really? That’s a leap of faith, man. John C. Comisi: I started out as an assistant. Yeah. So I started out as an assistant professor two years ago, and now I’m an associate professor. So moving up the ranks, and moving up the chain of command, and trying out- Shaun Keating: What’s the next level of professors? What’s adjunct professor? John C. Comisi: Full professor. Full professor, that would be the next step up, but that’s going to be a few years away. I’ve got to earn that credentialing in another aspect. But that would take some time, but it’s good to be here as we are. Shaun Keating: What about where that is? Is that College of Dental Medicine? Is that by the coast? Are you in the middle of Carolina? Where is that at? John C. Comisi: We’re right on the coast. Charleston is located just on a lovely peninsula between the Ashley and the Cooper rivers, and it’s a gorgeous area. So if you look at the map of South Carolina, you’ve got Myrtle Beach to the north, which is the north most positioning of South Carolina, and you’ve got the Hilton Head at the south. That’s the south most position. And right dang smack in the middle in the coastline is Charleston. Shaun Keating: Beautiful. That’s so beautiful. You got those big storms coming your way just like us on the- John C. Comisi: We do have those at this time of the year. We always have to watch out for hurricanes. But other than that, as Karen likes to say, she loves it down here even in the summertime because she doesn’t have to shovel humidity. Shaun Keating: Exactly. Exactly, man. You had the weather in New York for sure, and to go there is just amazing. How’s the food? Some nice little private restaurants? No commercial stuff? John C. Comisi: The food in South Carolina is to die for. There’s a great restaurant practically in every street corner in Charleston itself. You go a little bit on the north side, you go out to Mount Pleasant or to North Charleston, there’s great venues there. You go south down to West Ashley and down past that, every place you go there’s a fabulous restaurant with fabulous food. You can’t eat bad in South Carolina, let me tell you. Shaun Keating: I’m going there. My brother and my son lives out in North Carolina in the Greensboro area, and they have a little beach house down there in South Carolina. I don’t know, I’ve never been there, but it’s a four, five hour drive I think. John C. Comisi: Man, Shaun, you got to come out. Shaun Keating: I’m ready, man. John C. Comisi: You don’t know what you’re missing. You got to be here for sure. Shaun Keating: I’m telling you, that’s a neat thing. So tell me a little bit on your thoughts on the technology in dentistry now. The impression scanners, CAD/CAMs, chairside mills. What are your thoughts, pros and cons on that? John C. Comisi: I love them. I think that I couldn’t work in my practice without my scanner when I was using it. My scanner was great. I used a pre-shaped free-outs too with that at the same time. Shaun Keating: Yeah. See, you used the Rolls-Royce of scanners, baby. I thought you were going to tell me you got a CEREC. I’m like, “What?” No, CERECs, they got the new prime scanner. John C. Comisi: I love my pre-shape. It’s a great company, and it’s a great product, and I loved it. But again, the key was that I didn’t mill. I did everything with my lab. I had my lab do the work because I didn’t have the time, nor the capability of messing around with the mill, and I figured who is going to better be able to create my crown and bridge work than a great technician, and a great lab guy? And that’s what I did. Shaun Keating: Beautiful. Hallelujah. John C. Comisi: So basically, I got the top of the line scanner, and I worked with my lab guys, and we did everything with it. Shaun Keating: Beautiful. John C. Comisi: And again, I still needed my impression material- Shaun Keating: Absolutely. John C. Comisi: … and I used my cutting back material when appropriate and necessary. Cutting back, make some of the best impression material in the entire world. Shaun Keating: Exactly. John C. Comisi: And hats off to Dan Pirelli and my friends in [inaudible 00:37:21]. Great company, great product. You got to love that. Shaun Keating: Yeah, good for you. John C. Comisi: Even when you have a scanner, you got to have a backup in case something goes wrong. Shaun Keating: Oh heck yeah. John C. Comisi: You got to have good impression material to do the job when something might otherwise go wrong. So that was our one-two punch. Shaun Keating: Even a little [inaudible 00:37:39] in it here and there you might need. John C. Comisi: Heck yeah. Yes, indeed. Shaun Keating: And real save your cases, get some damn impregum baby, some polyether. That’s the real deal. I love that stuff. John C. Comisi: Yeah, exactly. Shaun Keating: Patients hate it, but- John C. Comisi: The key is that again, it’s a blending. It’s a blending of the technology with the basics, and understanding why you do what you do is what happens here because we didn’t get the technology magically. It had to be developed and worked on, and it had to be created so that this way it would simulate or mimic the basic science, the basic protocol, the basic premise of what we were trying to do, and that’s where you’re going to. John C. Comisi: So for all the young folks out there who are in school or who are just graduated, you want to make sure you understand why you do things, so that this way it’ll enable you to do the how to do things better, and that’s the key. Shaun Keating: That’s awesome. That’s awesome, man. Well, let’s wrap it up with this one. What kind of advice can you give some of our newer dentists starting out out there? Some of the dos and don’ts, and maybe even some of the guys that are in it for a few years. What’s some advice you can give some of our guys, and our dentists out there? John C. Comisi: Go slow. Don’t buy that Ferrari. Start out with the Volkswagen, and begin to make what you got. You will get that Ferrari if you pace yourself properly, get to learn what you need to do more, and continue to learn from the experts. Go to CE, go to meetings, become part of the associations, the American Dental Association, the Academy of General Dentistry, and in all of these organizations, the National Dental Association, they’re there to help support and help you grow. Shaun Keating: Absolutely. John C. Comisi: You need community. We are not isolated. We can’t be isolated even though we practice in 10 by 10 cubicles. You need the membership, you need to be part of groups in order to help yourself grow as a professional because you’ll learn from other people, and they’ll help you learn how to avoid the mistakes that they may have learned at a previous time period. And if you buy a new practice, don’t go in and change everything all at once. The old doc that you just brought that from built up a rapport with the patients based on that mechanism. John C. Comisi: Take it slow, change it to where you would envision it to go, but do throw the baby out with the bathwater because it’ll come back to haunt you. Trust me. Shaun Keating: Oh man, words of wisdom there, Doctor Comisi. Thank you, man. I can’t thank you enough. What a great podcast, and heck it’s at 40 minutes already, man. We just bounced through that. It felt like five. John C. Comisi: That went fast, let me tell you. Shaun Keating: We didn’t go over a lot of questions, but that’s what it usually is. I get rolling, you get rolling, but no, that’s so cool, man. And God bless you and Karen for sure, man. Your family, and thank you so much. And if there’s anything we could do, let us know. But thank you so much for coming up on the Dental Up Podcast. John C. Comisi: It’s a privilege, and a very great honor to be with you. Thanks so much, and I look forward to having another opportunity some time. Shaun Keating: Oh, excellent. Thank you so much, Doctor Comisi. We’ll talk to you real soon. John C. Comisi: Thanks so much. Shaun Keating: All right. 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 nationwide. We’d love for you to send us a case, so we can show you the Keating difference. Host : If you dig what you heard, please leave a review on iTunes, and we’ll be back next week.