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721: 14 Insights From Designing Smiles With Dr. Michael Apa & Dr. Christian Coachman

There is more than one way to design the “perfect” smile. Recently, two of the best dentists in the world, Dr. Michael Apa and Dr. Christian Coachman, debated these concepts at the Designing Smiles event in Miami. To share some of his key insights and takeaways, Kirk Behrendt brings back Dr. Christian Coachman, founder of Digital Smile Design, who explains how you can achieve great dentistry with digital or analog, and the importance of building a workflow that’s best for you. To hear more about the Designing Smiles event and the debate about great dentistry, listen to Episode 721 of The Best Practices Show!

Learn More About Dr. Coachman & Dr. Apa:

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Main Takeaways:

  • Whether you use digital, analog, or both, master the process in the mouth.
  • You don't get a second chance at a great first impression in smile design.
  • Focus on patient success. What does success mean for them?
  • Start with the end in mind when designing patients’ smiles.
  • Any work you do in the lab is not like in an actual mouth.
  • Impress patients with your chairside systems.
  • It’s impossible to deliver great smiles alone.

Quotes:

“When it comes to documentation for smile rehabilitation cases, Dr. Apa and I agree on the need for a high-quality and complete initial documentation with emphasis on the face. So, this is something that unites us. He has his own way of capturing the face. We each have our own, but we both know that this is the starting point. You need to document the face very well. And while it does sound obvious, as a lab owner, I can tell you labs all over the world are still not getting quality facial information with their cases. So, doctors are still not exploring, fully, a systematic approach on how to document the face and how to share this information with the lab.” (14:09—14:59)

“I believe that a simple protocol with an intraoral scanner and a smartphone is enough [to document the face]. So, if you have a smartphone and you have a scanner, you can capture the face, capture the mouth, very simple, on the first appointment and then send it to the lab. Dr. Apa still does a more sophisticated DSLR camera photo protocol. It’s beautiful, but it's more time-consuming. I honestly don't think it’s necessary, the extra work. But he still believes that the sophisticated pictures bring an added value.” (15:33—16:16)

“I emphasized the importance of video, and this is something that [Dr. Apa] totally agreed with. He actually mentioned that he learned from me, and he started making it mandatory seven years ago. For DSD, it’s mandatory, the facial video analysis. So, documenting the patient's face through video, and then training yourself and your team on how to interpret the video, analyze the video, the motion, the movements, dentofacial harmony or disharmony through motion. So, this was common sense.” (16:20—16:53)

“Point number two, diagnosis and planning. What are the differences and the similarities? So, I explained my belief in exploring collective intelligence, synchronous communication, and digital tools to understand all issues and develop a diagnostic design and build a treatment plan to be presented on a second appointment. So, for me, it's very clear that whatever conclusion you share with your patient on the first appointment, you're missing the opportunity to further explore collective intelligence and digital analysis to understand the problems better and explain to the patient on a second appointment.” (18:40—19:21)

“Dr. Apa explains the challenges of postponing this [diagnostic] communication to a second appointment because many patients will not even show up on the second appointment, and you're going to miss the opportunity to close the deal. Dr. Apa is all about quick analysis, quick diagnosis by himself, completely alone. So, no interdisciplinary discussion, no comprehensive discussion. Everything is in his head. He looks at the patient. He doesn't leverage 3D technology to diagnose and plan. He relies 100% on his clinical experience, X-rays, and pictures. In a few minutes, he gets the conclusion, and he immediately presents it to the patient. Now, of course, you can understand the advantages of having this huge impact immediately. I still believe that his approach may be good for business in this first moment. But when it comes to comprehensive care, I think the future belongs to the dentist that will be able to convince the patient about the value of not rushing into conclusions at that point and scheduling the second appointment to leverage collective intelligence and 3D diagnosis, 3D simulations, and so on.” (19:22—20:46)

“Dr. Apa does the same appointment — clinical examination assessment, X-rays, and photos — and believes that this is enough to define the plan and present the plan on the same first appointment. That was, I think, a great discussion moment there because I do appreciate his approach — and it works for him. I still believe that it's impossible. It doesn't matter how good he is and how much knowledge he has in his mind. Thinking with several brains will always bring benefit. But the challenge, we both agree, is how to make the patient value that. That's why DSD works so hard on helping dentists to try to create value towards the patient so that the patient values this process. But I do agree that sometimes, when you see that the patient is not getting it, you may need to give something at that first moment and get the patient on board. So, again, understanding all options and using the best strategy for each situation.” (20:48—21:55)

“[I] believe in comprehensive care with strong involvement of perio and ortho to diagnose and plan all cases, separating the day of data collection and treatment presentation by a few days. A two-appointment process will allow you to integrate all the specialties. Dr. Apa believes he can solve almost all cases only with restorative and prefers to diagnose and plan alone without collective intelligence or 3D technology. He believes that if a plan is not presented on the first appointment, case acceptance chances will drop drastically. I do agree with that, but still believe the two-appointment approval is key to develop ideal comprehensive care and can be financially successful if you master storytelling. It is more difficult, but it's possible.” (22:00—23:00)

“[Dr. Apa] believes that comprehensive is all in his head. I believe that comprehensive is a combination of several heads. On case acceptance, performing the motivational mock-up and presenting the plan to the patient, Dr. Apa and [I] both believe in the importance of this moment, and both created our own powerful workflows to be successful with case acceptance. DSD is known for the emotional dentistry approach. Dr. Apa is also, of course, known for case acceptance as well, since his numbers are insane. There's absolutely nobody in this world that does more smile design cases per month than Dr. Mike Apa. I can guarantee you that. In four different locations, his numbers are insane. So, learning from him how to generate the leads, how to convert the leads, and then how to deliver quality to stay in the business for 20 years, it's something that regardless of if you agree with the way he approaches treatment planning and dental execution, you have to admire his systems for case conversion and clinical execution with high quality and beautiful outcomes. That's something that I always admired regardless of if we agree on the interdisciplinary approach.” (23:22—25:01)

“Both [Dr. Apa and I] believe in setting up the treatment presentation room where you can leverage storytelling and visuals. So, this is something that if you go to his practices, you're going to see everything happens around that consultation. He calls the consultation the first appointment. I call the first appointment the emotional dentistry approach . . . We say the Cirque du Soleil. It's a show. It's showtime. That first appointment, everything needs to be rehearsed, smooth, perfect, impactful, meaningful, straight to the point, and the patient needs to say, ‘Wow,’ at least three times in that one hour. So, we both believe in spending time building the infrastructure and the mindset to leverage storytelling and visuals and create this amazing experience in the practice at the beginning. We both believe that you never have a second chance to create a first impression, and the business moves around that. We both believe that there is not a one-size-fits-all strategy. You need to master all strategies and customize depending on the patient's character, case, and time. So, you need to be a master at reading people emotionally.” (25:07—26:55)

“Another thing that Dr. Apa does very well with his team is that he has a process between the person on the phone, the first call, the treatment coordinator, and data collection. When he meets the patient for the first time, he already has a whole X-ray and background of the patient that allows him to come in and know exactly who is in front of him before he even meets the person. So, he has a very effective system for that, and he explained it in the course. And I agree — this is huge to really exceed expectations at this initial moment.” (26:56—27:38)

“The key is that you need to have a smile design tool. You need to be able to express this project to the patient. So, use visuals. If it's pictures, direct mock-up, indirect mock-up, software, iPad drawings — ideally, you need to master all of them and choose the tool depending on the occasion, the case, and the patient.” (29:15—29:45)

“I believe in saving time by leveraging the lab to do the design. But both [Dr. Apa and I] agree that regardless of how you do the initial diagnostic design, the initial smile design, the initial prototype design, the initial mock-up design, or the initial trial smile design, whatever you want to call it, the huge differential comes from dentists that know how to try these projects in the mouth, analyze it, and modify them until they are ideal. So, Dr. Apa emphasized you need to be the one doing it. And I was commenting, you don't actually need to be doing it, but you need to master the process of improving it. If a lab can do a wax-up faster, better, cheaper than you, let the lab wax it up, digitally or analog.” (29:48—30:41)

“One thing that [Dr. Apa and I] both agree on, it doesn't matter how amazing the software is. It doesn't matter how amazing the technician is. It doesn't matter if you're amazing with wax-ups and 3D technology. It doesn't matter, 2D or 3D. In the lab, it's never like in the mouth. The mouth will give you the reality of how good or how bad the smile is. The fact that you are in three-dimensions in the mouth, the fact that you have the motion, the fact that you have the soft tissues, the facial tissues on top of it, the patient's character — so, you can do the perfect design in the lab. You put it in the mouth, and you still have to touch it up in the mouth. That is the key. Meaning, that if you really want to become a smile designer like Dr. Apa and myself, you need to be able to take whatever was done outside the mouth, put it in the mouth, tweak it, fine-tune it, improve it, change it, and shape it with your own hands. You have to do it. There's no system today that allows you to bring the face into the software with the soft tissues, with the motion, with the delicateness. If you add one millimeter buccally, you're going to add a little extra pressure on the lip. And a little extra pressure on the lip will change a little bit of the mobility. That will change a little bit the way the smile looks from a certain angle that can only be seen in real life.” (30:45—32:18)

“[You might say], ‘My technician is amazing. He does the smile design for me.’ That's fine. You will get to 90% of the quality. But you're not going to hit 100% of the quality unless you hire a technician to come into your practice and do everything inside the mouth, to finish inside the mouth. But then, your technician will take over all the credit as well. Your patient will be grateful. But when it comes to the smile design, the patient will realize that the magician was the technician and not the dentist. So, if you want to be the magician changing lives, you need to master the process in the mouth, regardless of the technology.” (32:22—33:02)

“[I] believe there are two very different mock-ups. One is the motivational, done before case acceptance, with the main intention of getting the patient on board, selling the case. The second one is the technical mock-up, done after case acceptance to technically communicate with the patient, the lab, and guide the prep. In the DSD workflow, we have two very clear different smile test drive moments, one before case acceptance with the goal of creating the wow effect, and one after to create the rational discussion about smile design. So, you need to master both moments and how you communicate with the patient in both moments. Dr. Apa has a different approach since patients come to him already wanting to do an elective smile makeover. So, the fact that patients are going to him already, ‘I want to do it. I want to do it with you. I just need to find a push. I just want to understand,’ his first mock-up is a mix between motivation and a technical discussion. So, it is very important for people to identify their situation with their patient. Is this a patient that has no clue how their smile can change their life, and you want to motivate them, and they're going to accept the treatment after? Is this a patient that is already on board, and now you want to rationally get them on board of the design? So, you need to think, when you're doing a smile test drive, in what moment is your patient? Because the strategies are completely different.” (33:14—34:51)

“Both [Dr. Apa and I] agree that mock-ups are not possible in some drastically subtractive cases. So, motivational mock-ups are not possible in certain situations. In these cases, you need to rely on other strategies to communicate and motivate patients. [I] mentioned that the Digital Smile Simulation can help in these situations. Dr. Apa believes that the key is to create a level of trust that the patient will feel comfortable accepting it without visualization. So, this is when I did the demonstration of the DSD app, how you can make simulations on cases that you don't want to do mock-ups, or you cannot do the mock-up. Dr. Apa is much more on creating a relationship immediately with the patient where, ‘You’d better trust me. You're going to trust me,’ and the whole experience is that the patient is like, ‘Okay, I trust you. Let's go for it.’” (36:07—37:04)

“Both [Dr. Apa and I] agree that 2D or 3D software, and even handmade work on analog models, will never provide the full perspective of dentofacial integration . . . No outside-the-mouth tool will generate the full perspective of dentofacial integration. The only way to have a complete perspective of it is in the mouth. So, anything that is done digitally, in the lab, in models, or outside the mouth needs to be validated and improved by the dentist in the mouth. That was a big message. That's the reason why this course was so important. That was the goal of this course, to give insights for dentists to become the real quarterback of this process.” (37:14—38:14)

“Both [Dr. Apa and I] agree that branding happens chairside, above any other type of marketing. This is a quote from Dr. Apa. Mike . . . gets really angry when people say, ‘Apa, you're very successful because you're very good with marketing.’ He gets pissed. He says, ‘I'm very successful because I'm very good chairside, because I'm delivering quality in the mouth. That's why I'm successful.’ Everything is a consequence. Social media marketing can help you. But magic doesn't happen if the magic is not chairside. And we both agree that the whole DSD purchase moment experience — we talked about that in the past — the magic is not in the marketing before nor in the clinical execution after but is in those first and second appointment moments where you're creating the experience, chairside or in the presentation room.” (39:00—40:05)

“A great clinician is one thing, but a great clinician that knows how to create a great branding experience chairside is different. So, you need to think about that. Otherwise, you're going to just be a great clinician. And the patient, unfortunately, is judging the rest much more because they're not seeing the clinical execution, at least in a short period of time. So, rehearsing with your team, like Cirque du Soleil, how the chairside experience happens in a way that everything is so smooth that the patient is impressed, regardless of if the patient can identify the clinical quality of what you just did — that is, for me, very, very important.” (40:26—41:18)

“Both [Dr. Apa and I] agree that the first appointment experience needs to be so good, so rehearsed, so smooth, so precise and effective, that this will be the number-one reason for somebody to choose you as their dentist. You never have a second chance to create the first impression. That first impression of that first one hour with you in the presentation room and in the chair is the key for success. That's what is going to give you leverage and credits with the patient — that even if something goes wrong on the treatment, you still have the credit. And the credit comes from the first impression.” (41:21—42:03)

“Patient experience is key for both [Dr. Apa and I]. So, of course, we focus on patient experience. I like something that Dr. Apa said in the course. He developed systems for patient success. Everybody talks about practice success and clinical success. He is like, ‘My systems are for patient success.’ It's a very subtle difference, but huge at the same time. The success needs to be about the success of the patient. The patient needs to go home after each appointment feeling like, ‘This was a success for me.’” (42:07—42:45)

“Dr. Apa mentioned the strategies for patient success, understanding what they want and focusing on fixing their problem for them. Meaning, every good dentist is always fixing problems for the patient. But many times, we interpret wrongly what they believe is their problem, their priorities, or what really matters for them. What is success, short term, midterm, and long term for them? That made me evaluate Dr. Apa's work slightly differently because I was, many times, critical of him. We are always very honest with each other. I'd say, ‘Mike, why didn't you consider this treatment? Why didn't you consider that? Why did you prep it this way? Why didn't you do ortho?’ And, of course, I still have many situations where I don't agree with his treatment plan. But today, I understand better that, many times, he is doing what is success for the patient, and patients are grateful, and patients are coming back after 10, 20 years. If he was just driven by money and aggressive dentistry, he wouldn't be as successful for so many years. It's impossible. So, he is doing something right for the patients. That is making patients come back over and over again — and this is something that we need to be open to listen to.” (43:23—45:01)

“Dr. Apa strongly avoids ortho. [I] strongly encourage people to explore ortho possibilities and advantages, but do agree with Dr. Apa that, too many times, ortho can create more problems than solutions. So, this is my point here, because I'm all about interdisciplinary, always considering ortho, et cetera. Philosophically beautiful, but real life is different. And many times, when you try to do the ideal and things are not perfectly under control, or the specialists are not really on board, or you're not working with the right tools, you take what you learn from courses from the interdisciplinary perspective and you bring it to the real world, and you end up transforming the patient's life into a nightmare and not getting the problem solved.” (45:04—46:00)

“Doing that beautiful digital design on the software with ortho simulation and showing that beautiful lecture about integrated approach, et cetera, and then going into real life and having the patient go through one, two years of ortho, ending up not in the right place, one more year of orthro, and then changing orthodontists, then one more year or two, and then ending with an open bite and TMJ issue — this is too common. That's the criticism that Dr. Apa has with this comprehensive philosophical approach. He's like, ‘With a little bit more aggressive preps, I can get this done in two appointments and have a new smile working for the patient for 20 years.’ So, it's not a very clear line between being pragmatic, being minimally invasive, short-term benefits, long-term benefits. But I definitely respect where he's coming from. Of course, I still believe that we should be pushing more and more for a conservative and interdisciplinary approach. And if a case is not done properly, instead of quitting, we need to understand how to do it properly.” (46:24—47:53)

“At the end of the day, being a great smile designer is very subjective and artistic. You can read and memorize all the articles in the world. If you don't have artistic perception, you will never be a good smile designer.” (48:59—49:17)

“Every time you study the rules, it gives you more skills to break the rules, improvise, adapt, and go beyond the rules. That's why I still love to read the parameters, share the guidelines, and give some starting points. So, the incisal edge should be two to four millimeters longer than the lip at rest. That's a starting point. What do you do with that? At the end of the day, this rule will not help you solve the problem because when you talk about two to four, it can actually be one to five. That's the whole world. You look at the patient and you say, the article is saying that the incisal edge should be exposed one to five. What do I do for my patient right in front of me? It's on you! You need to look with artistic perceptions, subjective perception, and artistically define that. ‘Because of who you are, because of the face that you have, because of the dynamics and the motion of your face, because of the smile that you dream of, this is where the incisal edge should be.’ So, the articles will not help you with that final stretch. So, Dr. Apa was like, ‘Don't waste time with rules and parameters,’ and I was like, ‘Know them. Use them as a starting point.’ But at the end of the day, Dr. Apa and myself are using and doing the same thing — intuition and artistic skills.” (49:54—51:37)

“Understanding the norms, guidelines, and parameters is key as a starting point for communication. I also defended the fact that knowing the norms and knowing the parameters will also help you become a better storyteller to communicate with the patient. Because it’s one thing to tell the patient, ‘Look. Your incisal edge should be here.’ ‘Why?’ ‘Trust me, I'm an artist.’ The other thing is to say, ‘Look. Your incisal edge should be here. There are certain parameters that we follow. Articles show that from two to four, you are inside the norm. When lip dynamics are below nine millimeters,’ et cetera. So, you protect your decision with some science, with some parameters. It usually helps with the patient. The patient sees that there's a combination between art and science to define and to protect that decision.” (51:42—52:44)

“People love to publish a lot of articles about smile design, about parameters. Don't overvalue them. I agree with Dr. Apa on that. Don't overvalue them. They're just there to give you some insights. It's on your artistic skills.” (53:08—53:22)

“Dr. Apa believes that [I] spend too much time with guidelines and rules. [I] believe that drawing guidelines is a great way to help your brain and eyes to see better and activate your artistic skills. So, that was a cool discussion. The more experienced you become, the more these lines will be embedded in your brain naturally. That's why Dr. Apa says, ‘Don't waste too much time with guidelines and parameters,’ mainly because he doesn't even notice that they are already inside his brain because he does that so much and he's so good at it. It's already there. But you need to go through the process to get it in your brain.” (53:23—54:10)

“For [me], exercise drawings is a great way to activate your artistic brain. I always say that every dentist should, whenever you have time, draw freehand. If you're sitting down having a coffee, take a piece of paper, look at an object, and try to draw it. Try to draw a tooth with shadow, light, shadow contours, perspective. Drawing is the starting point of an artist. You cannot sculp teeth in 3D if you don't know how to draw. Dentists skip [this], and they try to do things with their hands without even controlling the two-dimensional process of creativity and drawings. So, for me, if I needed to do a smile makeover myself in my mouth and I was trying to find a dentist, I would do that test with dentists. I would say, ‘Please draw a smile right here in front of me on this piece of paper.’ If you cannot draw a smile on a piece of paper after 20 years doing cosmetic dentistry and saying that you're an expert in aesthetic dentistry, there's no way you're going to touch my mouth. No way. Because you will not be in charge. You will not be in command. You will not be able to work with your hands because everything beyond drawings is more complicated than drawings — mock-ups, provisionals, final restorations, dentist-lab communication, try-ins. So, that is a good insight.” (54:12—56:01)

“Dr. Apa preps teeth to avoid ortho, and showed how you can overcome limitations and get great results without ortho and with great, smart preps, great smile design skills, and great technicians. So, yes, he showed very cool cases where you need to do a year-and-a-half of ortho, and he did two appointments and solved [it]. Were the preps a little bit more aggressive? Yes. That extra aggressiveness, how that's going to play down the road in 15, 20 years, we're not clear. Did he preserve as much enamel as possible trying to avoid ortho? Yes, he did. Did the outcome look amazing? Yes, and the patient was extremely happy. So, there are many things to be considered. Again, it's very beautiful to say what is ideal. Five years of treatment, three surgeries, two years of ortho, orthognathic, airway, et cetera — the reality is different. And I like the fact that we were blending my more philosophical approach with his more pragmatic approach.” (56:34—57:55)

“[I like] the combination of ortho before restorative. I do acknowledge the fact that many ortho cases go really bad — too many of them. True. So, if you have a great orthodontist that understands restorative, I still believe you should explore that option so you can become more minimally invasive and position bone, roots, gum, and teeth where they belong, ideally, before restorative. But [I] admit that this is much easier to say than to do, being real. I love being real. I have no problem learning live on stage and admitting that reality is different than philosophy.” (57:59—58:47)

“When it comes to prepping teeth, we both agree on something very, very important. Dr. Apa and [I] agree that preps need to be guided by the final design. If you don't know where you want to go, you will not get there, and your prep will not help you get there. So, somehow, you need to know exactly what the final smile should be, and exactly how the ideal prep for that smile should be, and exactly how to transfer that project into the mouth. Three things. You need to know what the final outcome is, you need to know what the best prep for that final outcome is, and you need to know how to transfer that from the project into the mouth, whatever tool you want to use. DSD has a whole set of guides — completely digitally design and plan — to help dentists translate that. Dr. Apa does the direct mock-up, freehands it himself, defines the project, and preps through. We believe in a project done in the lab, fine-tuned in the mouth. So, we are very similar here. He does it himself in the mouth. We do it in the lab and we improve it in the mouth. He preps through the mock-up. We prep through the mock-up, but then we have extra guides to quality control what we did. Dr. Apa believes that he has eyes good enough to quality control with his eyes. ‘It's done. It’s good. Let's go for the impression.’” (59:07—1:00:51)

“Dr. Apa uses his direct mock-up at the day of preparation to develop the ideal design and guide the preps by prepping through it, what I just mentioned. [I] believe this is possible and can be good, but it is very hard to develop ideal designs in the mouth fast enough and under pressure. Details will be missed. In my opinion, details will be missed, and a lot of experience — artistic and hand skills — are needed. It is possible, but not replicable, in my opinion. You can streamline the process by designing in the lab and fine-tuning in the mouth instead of designing directly in the mouth. I have to tell you, even though I believe that doing everything in the mouth directly you may miss points here and there, Dr. Apa’s average is very good. He's very predictable with that. Every case I see with him, his direct mock-ups are very good, even though I still believe that if you make an impression with that, bring it back to the software, you will always find areas to improve, and will be able to make it even better in the software, go back to the mouth, check it, and validate it. But it's all about efficiency. So, what he does works for him. What we do works for us.” (1:00:55—1:02:47)

“[I] believe that developing a digital 3D design, leveraging all the know-how from great labs, wasting less time chairside, is smart, always re-emphasizing that the dentist needs to evaluate, improve, and validate these designs in the mouth. So, we're back to the same thing. The end is the same. You need to be in control of the mouth. How do you get to the point to be able to evaluate? Different tools. [I] believe that Dr. Apa has one of the best eyes for aesthetics and can develop these designs intraorally with accuracy and predictability. But systems should go beyond individuals. That’s my point. [I] believe that labs can help a lot of dentists to avoid mistakes when prepping and planning cases. Dr. Apa believes that he needs to have total control, do it himself, and the lab should only focus on translating his vision into reality. So, you see the difference. His speech to his lab — and it works for him — he's like, ‘I have it all here. I control everything. I set the vision. I set the design. I set the plan. You guys need to focus on translating my plan into reality. Don't mess up. Don't invent. Don't create. If you have suggestions, come to me. I will consider them. But learn how to copy/paste my vision.’ What I'm saying is that you can leverage much more than that. You can leverage the lab to actually build your vision, explore the vision, and treatment plan the vision.” (1:02:53—1:04:42)

“Dr. Apa believes that layered ceramics is better than monolithic. [I] believe that layered is maybe, sometimes, in some situations, slightly better, yes, optically — only if you work with the very best ceramicists in the world. I believe that monolithic can look great if you have a lab that understands how to do it. And I believe that monolithic brings, beyond the optical aspect, many other advantages than layered and can successfully solve the huge majority of esthetic cases with high quality. So, people were able to see exactly how far you can go with layered. In the hands of few, still the gold standard — how amazing monolithic digital is today. So, at the end of the day, the conclusion is, master both and know how to choose. I believe that if you master monolithic, you're going to solve 70%, 80%, 90% of your cases with monolithic. And maybe there will still be some cases that you want to leverage layered, old-school, handmade, maybe because of the patient, maybe because of the clinical situation of the case.” (1:06:49—1:08:10)

“Both [Dr. Apa and I] agree that monolithic with reinforced ceramics can bring other challenges. So, this was common sense. Harder restorations are not necessarily better. If you use these more modern, harder materials, the problem is that, is it possible to guarantee that occlusal equilibration is perfect? Never is it possible to guarantee that. Many times, you do have little interferences that you didn't identify. The problem is that when the restorative material is very hard and you do have these little interferences that are very common, where will the system break? On the dental side and on the perio side. The restoration will not break, but the tooth and the gum will suffer. So, the conclusion is that if there's something slightly off, where do you want the system to break? The restoration, actually. So, having a material that is not the hardest is not necessarily a bad thing. Of course, you need some resistance. But you need to be able not only to have the restoration breaking before the periodontal breaks, but also the fact that you need to remove these restorations after 10, 15 years. And these hard restorations are a nightmare.” (1:08:16—1:09:48)

“To be great, you need to master the analog procedures before you master the digital procedures. So, you want to practice handmade wax-ups. You want to practice handmade ceramics. That's the best way to give you the skills — visual, mental, and hand skills — to then jump into digital and master it.” (1:12:47—1:13:10)

“I still strongly believe that my workflow is the future. I strongly believe that my workflow is the future for beginners and masters. But I also believe that [Dr. Apa] should never change his system because it's working and he's killing it. But I do believe that in two, three, five, ten years, the next Mike Apa will be completely digital and will implement systems because it's obviously so much less stressful. I know Mike, and I know that he is complaining about too much stress. He is complaining about the fact that too much depends on him and his hands. When I catch him at the end of the day, he says those things. And I'm like, ‘My systems are for that, to allow us to do great quality with less stress. That's what I believe. It's not perfect now. It's evolving. And I do believe that probably what [Dr. Apa] was trying to say is not that [my] systems aren't cool and for beginners, but [my] systems are cool, are the future, are mandatory, and will become the new normal. But if you want to be the best, you need to go beyond the systems. That's when you add that extra final 10% human touch that only great professionals can bring that will take you beyond the systems.” (1:14:14—1:16:00)

“[The] number-one message from the course is patient success driven mindset. It doesn't matter what my opinion is. It doesn't matter what [Dr. Apa’s] opinion is. Choose focusing on the success of your patient, what success means for them.” (1:19:57—1:20:17)

“Smile design is an art, not a science. It’s more art than science. Of course, when you treatment plan, it's pure science and clinical. But everything starts from a smile design project, and smile design is subjective and artistic. So, ask yourself how good you are with artistic skills because that's the only way to get better with this.” (1:20:21—1:20:48)

“Build your professional vision — leadership, team building, and systems. It's impossible to deliver great smiles alone. You need an amazing team with you. Dr. Apa has an amazing team around him. We have an amazing team here at DSD, and we try to help doctors build great teams. But above all, build your vision. Do you really want to become a smile design practice? Because this is going to become a business itself. What Dr. Apa is, he is a smile design practice. People go there to transform their smiles, period. That's why he's so successful. It's focused. It’s niche.” (1:20:53—1:21:38)

“Start with the end in mind. In smile design, you need to start from the prototype, the project. That's why we both spend so much time showing how we develop the prototype, how we develop the project. You need to master all of them. You need to design smiles on an iPad over pictures. You need to have a smile simulation application. You need to be able to have a technician that can design in 3D. You need to be able to visualize and identify the problems and fix them. You need to be able to do a digital wax-up or an analog wax-up. You need to be able to do a direct mock-up or an indirect mock-up. You need to be able to start with the end in mind. You need to build the vision in your brain. You need to see the smile in your brain. You need to look at the smile and understand exactly what is right and what is wrong. Crazy people like me and Dr. Apa, we live looking at smiles and we are constantly saying, ‘This is good. This is not good. This can be improved. This cannot be improved.’ That's how we live. So, it all depends on how crazy you want to become about it.” (1:21:43—1:22:55)

“Any person that is at the top of their profession, at the highest level of execution — any athlete, any artist, any entrepreneur, any scientist — are all a little crazy. So, if you want to get there, you need to be a little crazy.” (1:22:59—1:23:21)

“Branding happens chairside. The magic happens there. Marketing will not save you if you don't have a chairside system to impress.” (1:23:24—1:23:34)

“Smile design requires systems. If you want to transform people's lives by transforming their smiles, this is very complex. You need systems.” (1:23:44—1:23:51)

“Prep for success. Guided preparation. I said the three things. Visualize the design, visualize the prep for the design, and find a way to translate the prep in the mouth. Don't prep more or less than necessary. Prep exactly what you need for that design. Prep by design.” (1:24:06—1:24:29)

“You never have a second chance to make a first impression when it comes to smile design. Rehearse what it means to create a first impression as a smile designer. You can speak as a clinician, you can speak as a treatment planner, you can speak as a general practitioner, you can speak as an orthodontist. You need to rehearse how to speak as a smile designer. It's different, and patients love it.” (1:24:31—1:25:04)

“You have to enjoy the ride. As I said, you need to be a little bit crazy to get to the highest level. But you cannot waste a life suffering to get there. You need to enjoy the ride. I can tell you I work hard. Dr. Apa is one of the guys that I know who works hardest. It’s crazy, the amount of hours, and working when you're sleeping, thinking, waking up on Saturdays and Sundays and just thinking, thinking, and developing things, and writing things down. And it is hard. It is a lot of work to stand out, to be different, to be above average. It's very hard. But I have a lot of fun. And I can tell you [Dr. Apa] has a lot of fun doing that. Regardless of whatever is happening, becoming the best he can in what he does, he loves it. And so do I.” (1:25:12—1:26:25)

Snippets:

0:00 Introduction.

2:13 The origin of Dr. Coachman and Dr. Michael Apa’s course.

13:51 1) Documentation philosophy and smile rehabilitation.

17:30 2) Diagnosis and planning.

23:06 3) Case acceptance.

25:07 4) Treatment presentation.

27:43 5) Software.

33:08 6) Motivational and technical mock-ups.

38:54 7) Branding.

41:21 8) The first appointment and first impressions.

42:07 9) The patient experience.

45:04 10) Orthodontics.

48:25 11) Artistic skills and intuition.

51:42 12) Communication.

56:07 13) Treatment execution.

1:13:13 14) Digital is the future.

1:16:03 The pressure of building this course from scratch.

1:19:04 Final thoughts.

1:26:29 About Digital Smile Design.

Dr. Christian Coachman Bio:

Combining his advanced skills, experience, and technology solutions, Dr. Christian Coachman pioneered the Digital Smile Design methodology and founded Digital Smile Design company (DSD). Since its inception, thousands of dentists worldwide have attended DSD courses and workshops, such as the renowned DSD Residency program.

Dr. Coachman is the developer of worldwide, well-known concepts such as the Digital Smile Design, the Pink Hybrid Implant Restoration, the Digital Planning Center, Emotional Dentistry, Interdisciplinary Treatment Simulation, and Digital Smile Donator. He regularly consults for dental industry companies, developing products, implementing concepts, and marketing strategies, such as the Facially Driven Digital Orthodontic Workflow developed in collaboration with Invisalign, Align Technology. He has lectured and published internationally in the fields of esthetic and digital dentistry, dental photography, oral rehabilitation, dental ceramics, implants, and communication strategies and marketing in dentistry.
ACT Dental Team

ACT Dental Team

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