How Same-Day Smiles Became Real — with Dr. Costa & Dr. Petros

Antonello Croce 00:00

Imagine landing in Dubai this morning and working out this evening with a fixed, full, large smile. Uh, we have turned that, uh, promise into a reality. Our guests are Dr. Costa and Dr. Petros.

Dr. Petros 00:13

I met a weird gray had guy who was telling me that he can place teeth on top of implants immediately.

Dr. Costa 00:21

So the question is what makes it possible? We are we, we are adapting the implants to the available bone rather than creating bone for the implants.

Dr. Petros 00:31

Yeah. And depending on the bone quality, sometimes. We are using some specialized drills that you don't drill clockwise, but you are drilling anti-clockwise

Antonello Croce 00:42

so you're not fixing everyone in the same box.

Dr. Costa 00:45

Exactly. It's not one treatment for all. And we can do a dry run, we call it a dry run that is model surgery on the 3D printed model of that patient. They're very relaxed. And usually at the end of the treatment, they don't even remember anything. I think the next frontier is robotic surgery.

Dr. Petros 01:05

You cannot stay behind. You need to take advantage of any technology which is resurfacing.

Dr. Costa 01:10

A patient should not die with their teeth sitting in a glass of water.

Presenter 01:19

Who is shaping the future? Who should we invite next? Just drop their name in the comment below.

Antonello Croce 01:27

Imagine landing in Dubai this morning and working out this evening with a fixed, full, large smile today. A next dental, we sit down with the dentist who turned the that promise into clinical procedure. Routine Welcome listener to Next Dental podcast. This is the new episode where we, our guests are Dr. Costa

Presenter 01:50

Dr. Costa Oral and maxillofacial surgeon, specializing in same day, full arch and zygomatic cases, 50,000 plus implant placements. Graduated with distinction from University Fellowship in maxillofacial and oral surgery. I, coy Diplomate, international speaker

Antonello Croce 02:06

and Dr. Petros,

Presenter 02:10

Dr. Petros, specialist prosthodontist and co architect of same day's immediate load, full arch protocol. Top of his class at Emel Vice Summa cum Laude. Completed a three year prosthodontics program at Tufts University, clinical assistant professor at Boston University and adjunct faculty at Tufts leads prosthetic planning and same day delivery together. Co-founders of Same Day Dental Clinic, Dubai, and co-directors of the Branemark Osseointegration Center and Zaga Center Dubai, delivering next day full arch treatment via an integrated digital workflow from CBCT to in-house design and lab.

Dr. Costa 02:47

How are you guys? No, we are very well, and thank you for inviting us here. And yes, as you said, uh, we have turned that, uh, promise into a reality.

Antonello Croce 02:58

Yes. And

Dr. Costa 02:58

it's something that we do basically on a daily basis, and we've been doing it together since 1998.

Antonello Croce 03:07

1. That was the first question when everything started.

Dr. Costa 03:11

Well, I started this in 1994. The very first case I did was. Back in South Africa, believe it or not, in 1994. And, um, things went very well. And then when I teamed up with, uh, Petros in 1998, uh, we, uh, basically have been doing it ever since on a very predictable and, uh,

Dr. Petros 03:33

successful. Menner. It was 1998, just about when I finished my postgraduate studies at Tufts University in Boston, United States, and I met a weird guy, gray hair guy, who was telling me that he can place teeth on top of implants immediately. But you know, back in 1998, nobody was doing that. I said to him, Costa, how is that possible? He said to me, I'm doing that already for the past seven years. Past seven years. Yeah.

Dr. Costa 04:04

Yeah. And, uh, in my, in our opinion, it's definitely the correct way to do it. And, uh, with the patients in today's day and age who have either a busy professional or a busy social lifestyle, they actually expect that patients today expect to have. For example, some teeth removed or all their teeth removed, have the implants and the teeth in the same day. Of course, I mean, we, we, it's 2000 and, uh. 25. 25. Now it's possible. We want, it's possible to do it.

Antonello Croce 04:46

Yeah,

Dr. Costa 04:46

of course not. Not everybody does it, but if you have the surgical skill, yeah, the surgical training and the prosthodontic expertise, and if you have the right team, remember we said we teamed up? Yeah. It's all about a team approach. If you have the right team of a maxillofacial surgeon, a prosthetist, a dental laboratory, which is. Crucial to the success of this treatment. You have to have a dental laboratory under the same roof, all under one roof. And of course, all the digital technology that goes with it, both in the dental laboratory as well as the diagnostic, um, digital. Uh, technology, the cat, the, the, the 3D scans and the cat cams and the milling and the printing. You need to have all that under one roof in order to make it happen.

Antonello Croce 05:39

Yeah. Okay. So you started, even though the internal scanning was not, uh. There at the moment. So you started with, uh, with, um, silicone,

Dr. Costa 05:48

we started with the analog old fashioned silicone and, uh, analog and 2D x-rays. Of course,

Dr. Petros 05:56

things were not the same almost 30 years ago. Yeah, they were completely different. Uh, at that time we were not doing, uh, 3D. Scans for our patients. Cbct, it was just a panoramic x-ray. It was a 2D x-ray, basically two

Antonello Croce 06:10

DX. And what was the tech that, um, um, changed, uh, drastically, let's say the workflow from, uh, 30 years ago? I mean, you started in doing this same day in 90, 94 I started and together we started in 1998. Okay. And so far we. What was the tech that drastically improved?

Dr. Costa 06:38

I think that the 3D scans, the 3D diagnostic imaging.

Dr. Petros 06:43

The CAT scans. It was a gradual process. Uh, until 2006, we were providing temporary teeth, uh, same day. Uh, but, uh, we were waiting for temporary teeth for about two months and afterwards we were gi we were providing the permanent teeth, but after 2006, we were providing. T teeth same day, but the permanence were made for the patient ready in about five days, maximum one week. Uh, nowadays we do it even faster, the permanent teeth for a single crown, we are providing the permanent tooth same day within four to five hours. And for a full mouth, within two or three days, the permanent teeth are ready.

Antonello Croce 07:29

Yes, because, uh, we are talking in the same day for the. Temporary. If it is a full arch. Full arch, yes. Yeah. If it is a single

Dr. Petros 07:37

crown, same day, the permanent,

Antonello Croce 07:40

which is good because, uh, you are not without your teeth. You, you are never without, you're never without,

Dr. Costa 07:46

without a tooth or all your teeth. So nevermind, irrespective of how many teeth will be removed, you will always have teeth on the same day.

Antonello Croce 08:00

That's really, uh, too s asthmatic for, uh, people who are flying. And, um, I would like, uh. B, um, I imagine myself, okay, I'm flying to Dubai. I'd like now to, to see what is the workflow, what, where I'm going to, I think on the website, you, you promised extractions and, uh, um, implants and, um, all the related, um, procedure for in the same day. So with the first consultation on, um. Online, is that correct?

Dr. Petros 08:34

Yeah. The idea is that, uh, you can make an online inquiry or you can give us a phone call and our patient coordinator will get in contact with you, will ask you for certain, um, x-rays that you can provide us, okay. Through an email, for example, and we can make a Zoom consultation with you and implement a treatment plan for you, a potential treatment plan for you. One sec. Accepted. Yeah. Once you accept that, uh, then you can fly over to Dubai.

Antonello Croce 09:05

Okay.

Dr. Petros 09:05

And, um, theoretical, you could come directly to our clinic or you go to your hotel where we can send our courtesy cardto collect you

Antonello Croce 09:15

courtesy card guys, that's really, uh, that's really good. Yeah.

Dr. Petros 09:19

Yeah.

Antonello Croce 09:20

We're in Dubai.

Dr. Petros 09:20

Yeah. So our courtesy car will come and collect you and bring you to our clinic to have the actual consultation. And

Dr. Costa 09:31

even the treatment if you decide to have the treatment. Yeah. Okay. I'm coming from

Antonello Croce 09:35

Italy, I wanna go and go back. Um,

Dr. Costa 09:38

so, so you can have your consultation, any additional scans, x-rays, um, and we can even do the treatment and you'll get your teeth. On the same day that, that's a promise we make is a promise we keep, you will get your

Antonello Croce 09:55

teeth on the same day. Okay, this is from the patient side. Now let's talk about the technical and, um, clinical side because, uh, not everyone can deliver this kind of, uh, service. So what is the structure that, uh, can, uh, give, uh, that, um, what is the structure to have that can. Give you the possibility to,

Dr. Costa 10:21

so the question is what makes it possible?

Antonello Croce 10:24

Yeah. What makes it that possible?

Dr. Costa 10:25

So you, you need, first of all, appropriately trained specialized dentists, oral maxillofacial surgeons. Prosthodontists who have been trained to do this technique, who have the skillset to do it, who have the expertise to do it, and of course the experience to do it. So, uh, you can't expect someone that just came out of. Dental school a few months ago. To do it, you need somebody that's done postgraduate training and specific training for this type of treatment.

Antonello Croce 11:03

Yeah,

Dr. Costa 11:04

so definitely it's possible, but with the correct continuing education, with the correct training, it's all about training. The next thing you need is the infrastructure

Dr. Petros 11:16

petrol. Yes. Uh, our clinic, it's like a small hospital which provides implants and teeth in a day. Uh, that means, uh, that there is, uh. Two very well equipped surgical rooms. Where Costa is doing his surgery, uh, he's extracting teeth and on the same day he's placing the implants. And, uh, we have a dental laboratory

Antonello Croce 11:44

inside,

Dr. Petros 11:45

inside our clinic. Now there is this laboratory, it's fully digital. In the old days, it was not digital, but this is how we evolve slowly. So today it's fully digital and, uh, at the end of the surgery, uh, we're taking an impression of our implants and the technician, the in-house technician, fabricates, actually have three, three technicians, uh, fabricate the temporary teeth in a matter of a few hours. Usually printed.

Antonello Croce 12:16

Usually printed. Printed test. Yeah. Yes. Okay.

Dr. Petros 12:20

So those are placed inside the patient's mouth are tested and evaluated by myself and the other, uh. Prosthodontist. We are a team of prosthodontist, uh, in our clinic and once we are satisfied and the patient's satisfied from a functional but aesthetical point of view as well, then we can proceed for the fabrication of the permanent teeth.

Antonello Croce 12:45

And is the patient, uh, waiting, uh, wait. Waiting here for the permanent teeth. How do Yes, they approach this, this, the idea? Is that just,

Dr. Petros 12:55

just Yes, very, uh, very nice question. The idea is that just after the surgery, we have a recovery room. So the patient is waiting for those two, three hours inside the waiting room, uh, recovery room. We are replacing the permanent teeth, evaluate the permanent teeth on the spot, and the patient can wait in Dubai for two or three days maximum for the fabrication of the permanent teeth. So basically within five working days, you can have everything ready. If we are talking for a full mouth rehabilitation now, if we are talking for a single crown for a single tooth, then you can fly in the morning in Dubai and you can fly away from Dubai the same

Dr. Costa 13:36

day. That's, we have done that a number of times on this very same day. The patient flies in.

Antonello Croce 13:43

Yeah.

Dr. Costa 13:43

Has. One and even two. The last case we did was two implants and the, the patient flew back the very same day. Wow. In the afternoon. Came early in the morning and flew back home in the afternoon with two implants and two teeth permanent teeth.

Dr. Petros 14:00

It's very important to specify here that our permanent teeth, they're not acrylic teeth because many clinics are promising permanent teeth, which at the end of the day ended up being. Acrylic teeth. We are talking about zirconia teeth, and this is very important. So nowadays we have the technology to finalize our cases with zirconia teeth, with the help of fast centering furnaces within a matter of a few hours, usually in order to bake. To center the zirconia teeth, you need more than 12 hours for big cases. But with the help of fast centering furnaces, you can finalize those in a few hours.

Antonello Croce 14:40

And this is, uh, this is something that I like if I want to see myself in this situation, I like the fact that I can find in the morning and I can walk out to the clinic with a smile. But I will not go out Dubai. I will enjoy the Dubai.

Dr. Costa 14:56

Yes, exactly. So, so what we tell are big cases like the full arch or the full mouth. You have your surgery done today?

Antonello Croce 15:06

Yeah.

Dr. Costa 15:07

You have your temporary teeth placed today?

Antonello Croce 15:10

Yeah.

Dr. Costa 15:12

You can go away for three to five days. Go and do some touring. Go and have a holiday. Do whatever you, uh, want to do in the area and come back. We'll tell you the day and the time. For example, in five days, and we'll put your permanent teeth so you don't have to stay in Dubai, but you can choose to stay in the UAE. And we have some patients from surrounding, uh, GCC countries. They sometimes they fly back to, uh, Saudi or, um, uh. Qatar, Qatar or one of the other countries, it's

Antonello Croce 15:48

their choice. Yes. It's their choice. And then

Dr. Costa 15:50

they come back Qatar after five days and replace the teeth.

Antonello Croce 15:52

Yeah, yeah, yeah, of course. And, um, regarding the testing, um, did you, you started, uh, in Greece with this procedure in the, this kind of workflow? Well, in South

Dr. Costa 16:04

Africa originally by myself and some other colleagues in South Africa and with Petros, uh, in Greece, I'm younger.

Antonello Croce 16:13

So same day clinic started there? Yes. And

Dr. Costa 16:17

the same day concept started there. Concept and uh, then we came here in 2011

Dr. Petros 16:23

11 in Dubai Healthcare City. We stayed there for three years and then we moved, uh, in Ju Road, beach Road, uh, as we grew and we needed more people,

Dr. Costa 16:39

we needed more people and more space and better parking, of course. And we have, uh, our own, um, villa, uh, self-contained villa, which. Purpose built for our same day clinic with all its infrastructure and, uh, of course the convenience of parking for the patients who choose to drive to us. And those, as Patro said, that, uh, want, uh, our chauffeur drive, uh, courtesy car to, uh, collect and deliver. We do that routinely.

Antonello Croce 17:06

What make you different from, uh. Others. So the, the concept, uh, we understood the concept, but there is something, uh, that you do that others are not doing.

Dr. Costa 17:18

I think it all boils down to the surgical skill and, uh, expertise that you may have in order to do this treatment. And of course, I, I don't believe I'm the only one, but. Um, I don't think everybody has the appropriate and necessary surgical skillset to do same day extractions, implants, and teeth.

Dr. Petros 17:48

Usually when you're placing an implant inside the bone, that implant is not one with the bone immediately. It needs two months for the implant to become one with a bone. And this is called O osteointegration.

Antonello Croce 18:00

O integration. Yeah.

Dr. Petros 18:00

For OS integration to happen, that implant should stay still. It should not move. If it moves more than 150 microns, it'll never also integrate. That's why most of the dentists, they're placing the implants. They're waiting for two months without teeth because they're afraid that if the patient bites onto the implant with the tooth, it'll move and it will never also integrate. That's why they're waiting without teeth for two months and two months later, they load the implants with teeth. What we do, it's called immediate loading. We are loading the teeth, the implants immediately with teeth. How are we able to do that? There is a lot of scientific research which says that if an implant at the time of the placement, it's placed with very high torque and we can measure the torque. It means that it is because it is so highly, it's placed with so high stability, it's difficult to move. And that's why you can mo load it immediately with teeth. So this is what Kosta does. He's placing, he's specializing in placing implants with very high torque inside the bone. So when the implant

Dr. Costa 19:11

is, when I place the implant in the bone, it's very stable.

Antonello Croce 19:15

Yeah. It's

Dr. Costa 19:15

difficult to move that implant

Antonello Croce 19:16

if that is the bone. If there is the bone and then we have a solution. Also, if there is the bone, we

Dr. Costa 19:21

certainly have a solution which we can discuss if there isn't enough bone. But if there is enough bone, we place the implant in the jaw bone. Yeah. Either upper or lower. And I place it with good stability. So the question is, why can't other people place it with good stability? Well, some can, but the idea is. To draw the hole in the bone in a very precise manner so that when you put your implant in, there is maximum bone to implant contact. And there is an this very intimate adaptation of the bone to the implant causing the implant to be fixated very nicely and not move.

Antonello Croce 20:03

Yeah. So the secret is. Stability. Stability, which from the first

Dr. Costa 20:08

exactly, which is which in dental terms is called. Insertion torque value, you want a high insertion

Dr. Petros 20:16

torque value, and depending on the bone quality, sometimes we are using some specialized drills that you don't drill clockwise, but you are drilling anti-clockwise. So instead of drilling out. All the bone from inside the osteotomy, you compress all those bone particles inside the osteotomy, so you increase the mineral mineral density of your osteotomy and place the implants with higher torque. So with this amazing

Dr. Costa 20:45

technology, it's called Versa Technology. You can make bone harder. Some patients, especially elderly ladies, women, they have soft bone. They call it osteoporosis or osteopenia. And uh, in those cases, you need to use these drills that Petros is talking about. To increase the density of the bone. So the IS technology, it's all technology is helping us. Both. In the dental laboratory? Yes. Yeah, in the imaging, the scanning and in the bone drilling. So all these things are optimizing the treatment in order to give us an accelerated, the word is accelerated treatment protocol and finish the treatment either on the same day, if it's one or two teeth or in the same week with permanent teeth.

Dr. Petros 21:34

The other thing that we're doing is. Other than making specialized osteotomies, we're using something called specialty or site specific implants. Those are implants which are designed for a purpose. They're designed for a specific area. The idea is to customize your implant to be fitted to native bone, not for you to have to go through complicated grafting procedures. Which have a lot of morbidity, pain, complications. The idea is to utilize the native bone and take advantage of it and place the implants immediately without having to go through those difficult grafting procedures, which take time. You need sometimes to wait nine to six months and sometimes

Dr. Costa 22:24

even a year. Yeah, so, so it's, we, we don't like to do that unless it's absolutely essential and it maybe once every few years we have to do a case like that, maybe once every five years, if that. Um,

Antonello Croce 22:41

because yeah, you're, yeah, you're, you're adapting.

Dr. Costa 22:45

We, we, we are. Adapting the implants to the available bone rather than creating bone for the implants. Yeah,

Dr. Petros 22:54

so we have specialized drilling technique, specialty implants. To take advantage of those osteotomies. But you know, sometimes even though that we do those techniques, bone still is not enough. The regular areas where usually you're finding bone, and this is where the expertise of cost are very handy because he's able to find bone which are remotely placed.

Dr. Costa 23:20

So what we do in those cases, patients that do not have enough bone, yeah, enough jaw bone. The

Antonello Croce 23:25

bone play a crucial role. Of course. Absolutely. The stability, if there is, it's good if there is, but it's not hard. You can increase the density. Exactly. But what if there isn't?

Dr. Costa 23:35

What if there is no bone at all? Yeah. And unfortunately there are those cases. We say that the bone is extremely atrophic, the atrophic jaw, and what we do in those cases from our 3D scanning, we use the DICOM files, convert them to STL files in our laboratory, in-house laboratory, and within three to four hours we print our laboratory prints, a 3D bio modelof that particular patient's. Skull facial part of the skull so that we can see exactly where the bone is missing, and we can identify remote areas like the zygomas, the cheek bones, or the egid bones, which are located behind the last teeth in the upper jaw. And we can do. A dry run. We call it a dry run that is model surgery. On the 3D printed model of that patient, we can drill and see where the best position is to place these special implants, zygomatic implants, ortego implants in order to take advantage of remote skeletal sites. Which means sites, not exactly in the jawbone, but slightly remote to the jawbone. And we can use what we call the zaga

Antonello Croce 25:07

concept. Yeah.

Dr. Costa 25:08

Which means zygoma anatomy guided approach to even optimize the result of these severely atrophic case treatments even more. Uh, and of course, always giving them teeth on the same day.

Antonello Croce 25:24

For the listeners, uh, same date in the clinic is the first certified Zika center in UAE? Yes.

Dr. Costa 25:32

Uh, in the UAE and basically in the whole GCC area.

Antonello Croce 25:36

Okay.

Dr. Costa 25:36

We are the first and the only one at the moment,

Antonello Croce 25:40

and the only one at the moment. And, uh, what the, the zaga, uh, concept, um, um. What is this about?

Dr. Costa 25:49

Okay, so the Zaga concept was developed by a, um, famous and, uh, genius specialist, dental surgeon, um, by the name of Kalo in Spain. And, uh, what he worked out is that not all zygomas are equal. Some patients have big zygomas, some patients have smaller zygomas, and even the one zygoma on the one side and the zygoma of the other side in 58% of patients is not the same. And also depending on the degree of atrophy, how little bone you have and the anatomy of the zygoma, the treatment, the surgical technique of placing the zygomatic implant changes. And it is a patient specific. Surgical treatment for placing these zygomatic implants.

Antonello Croce 26:51

So you're not fixing everyone in the same box.

Dr. Costa 26:53

Exactly. It's not one treatment for all. Yeah. It's not one technique for all. It's patient specific technique. And that decreases the complication rate significantly and increases, uh, to a great degree the success of this treatment. And we give, um. Karich a lot of credit for working out the zaga concept. And uh, yes, we do apply it, uh, on all these cases.

Antonello Croce 27:20

You do apply it on all, all these cases, on all these zygomatic cases, zygomatic cases.

Dr. Petros 27:27

Another title that we hold, it's the so-called Brandmark, also Integration Center, Dubai,

Antonello Croce 27:33

also integration, you

Dr. Petros 27:35

know, the father of, uh, dental Implantology. Uh, it was Professor Brandmark from Sweden. Um, so there is a network of clinics by the name, uh, Brandmark Ocean Integration Centers, and we are. The Ocean Integration Center brand. Ocean Integration Center of Dubai.

Antonello Croce 27:55

Of Dubai. Yeah. Because you are d giving courses also? Uh,

Dr. Petros 27:58

yes. We are, both of us, we are national and international lecturers traveling a lot. Uh, but, uh, we were very fortunate to be able to, uh, have met, uh, professor Brandmark. Uh, unfortunately he passed away, um, 12. We met him 12. Mm-hmm. But he passed away for 13, 14. Um, and we're extremely lucky to be able to meet him, uh, in Burg, Sweden. Uh, and, uh, we follow his lead. Uh, his motto was, treat, uh. More patients with less surgery. So he wanted to avoid complicated surgeries and treat as many patients as possible with the less amount of trouble. Yeah, he

Dr. Costa 28:48

said his, his, uh, take home message was lesser surgery to treat more patients. So he was, although he did a lot of bone grafting and big bone grafting procedures from the hip and from other parts of the body, he was an orthopedic surgeon. Um, at the end, he decided that the best is to use the. What he called mother nature's bone. In other words, native bone in remote areas. And in actual fact, he was the first guy to describe the zygomatic implants. Just modified and optimized the technique with a zaga concept. Uh, another very interesting thing, and it always stays in my mind, that uh, professor Pi Branemark said, he said, we should be treating these patients because. A patient should not die with their teeth sitting in a glass of water. So basically a denture sits in a glass of water. Yeah. So he said, patients should not die with their teeth sitting in a glass of water. They should die with their teeth in the mouth.

Dr. Petros 30:00

Yeah, I like that. And nowadays we have the surgical knowledge and the technology literally for every patient for that to be achieved within a day.

Antonello Croce 30:10

We are talking about using the, the technology available today at a hundred percent. Exactly. Yeah. We want to achieve the best result using the technology that we have at our disposal. And regarding the quote on your, uh, profile Emersonquote, uh, say that leave a trail rather than choose one. So from the be beginning of starting this. Uh, concept and in the clinic. What was the biggest risk of starting this?

Dr. Costa 30:45

Um, well, first of all, yes, I do believe in, uh, leaving a trail instead of following one, uh, because I've always believed that if you want to succeed, yeah, you should. Do something different. You should take a different route to achieve a better result. So you don't want to only take a different route, a different trail. You wanna take a different trail to achieve a better result and do it better. Otherwise, you, you're just one of the crowd. If that's what one wants, it's okay. It's not wrong, but if you want to make a difference. To your patients, to society, uh, to people, then you probably need to choose a different trail rather than follow one. And the risk in doing that is, um, that it may not work out. But because we had done this already, well in South Africa, yeah. Uh, we. I give credit to other people that pushed me into that trail. Uh, a prosthodontist in South Africa by the name of Dr. Andrew Ackerman in Johannesburg. Uh, he, he was a big driving force for me. Uh, we had worked out the, the way in the trail. We worked out the trail, so it wasn't really a risk when we came to Dubai. It was no longer a risk. It

Antonello Croce 32:07

was a risk over there.

Dr. Costa 32:08

There it was a risk. Yeah. But by the time we got to Dubai, there was good scientific literature to, and scientific research to support what we are doing. So what we did was, um, scientifically, um, uh, evidence based

Antonello Croce 32:22

for Dr. P instead, Beverly Seals said, you are doomed if you don't try. So what was the mindset that shaped the foundation of this, of this concept to this clinic?

Dr. Petros 32:37

Again, uh, we wanted to. To, to bring in Dubai something different because, uh, in 2010 we did, we, we basically, we took the airplane with Costa and we came here and we made the research to find out who else was doing same day teeth. Actually nobody was doing same day teeth. And uh, that was the reason why. We came here, uh, to provide the service in a place that nobody was doing that, or nobody was even claiming doing that. Because nowadays many people are claiming that they can do it, but in reality they don't do it.

Antonello Croce 33:16

Yeah, because you're focusing on it like it's a routine. And do you see the difference of the location? So is the Dubai also, is Dubai working more than um others because of maybe. There are more, a lot of people flying in and out, or how do you see the role of the, the city

Dr. Petros 33:38

Dubai? It's a hub. Uh, it's so easy, uh, to access Dubai. Uh, there are many tourists coming here, but, uh, many people they want to travel to Dubai to do, uh, for medical tourism. Uh, so yes, definitely Dubai is the place to be in if you wanna do something similar. So that was the one of the motivations for us coming here.

Dr. Costa 34:02

Yes, Dubai definitely has, uh, a lot to offer. Uh, being a hub. Like Petra said, it's very convenient for people to fly here from almost anywhere in the world. On the other hand, uh, it's not the most densely populated, uh, city in the world or. UA is not. So, you know, there are countries that have a far bigger population and they probably do more implants, but, uh, Dubai is nice with, uh, with everything that goes with it. And it's certainly a convenient, pleasant place to come and have this type of treatment. Yeah.

Antonello Croce 34:34

Especially with this type of treatment that it's. For flying people. So that's, it's for people that are busy. That are busy. Yeah. Yeah. And it is not only for flying. Yeah, of course. But, or even for people that,

Dr. Petros 34:45

and certainly we are grateful to the local authorities that they made it possible for us to come here. Uh, they have strict procedures, uh, how to get licensed to practice here, um, and, uh, strict regulations, but everything's possible. And, uh, that's very important.

Antonello Croce 35:03

Okay. Now, now let's say I wanna come to Dubai to have this kind of a treatment because I'm really scared. So I'm happy as, as soon as I finish. So, but still I'm scared. 'cause if I see, okay, now I wanna do the treatment, but it takes me a lot of time. For me in the mindset, I, I will never go because it takes too, too, too long. But, um, this situation, it's good for me that, uh, I, um, have a phobia for, for, for that. And, uh, it's, but seline is something, uh, that convince me to, to come. So how do you treat this kind of patient that, uh, that they're scared?

Dr. Costa 35:42

Okay, so we, we have three groups of patients. We have patients that. Not really scared. And we treat those patients with normal dental, local anesthesia, like a dentist. And then we have patients that say, no, no, no, I, I'm a bit scared. Um, then we treat those patients with sedation and local anesthetic in our office, in our clinic. What does sedation mean? It means that you give the patient. Usually a tablet. Mm-hmm. Which is a sedative and it makes the patient very relaxed

Antonello Croce 36:25

but awake. Uh,

Dr. Costa 36:26

semi awake, semi awake, semi awake, but conscious, in other words, conscious.

Antonello Croce 36:30

Yeah.

Dr. Costa 36:31

They breathe by themselves. They can cough. You can tell them, do this or do that, and they will respond to you. Uh. But they're very relaxed and usually at the end of the treatment they don't even remember anything. Okay, so that's called sedation. That's conscious. Which means they're conscious oral sedation and we do sort of 90% of our big cases that way.

Antonello Croce 36:57

With 90%

Dr. Costa 36:57

with 90 with with conscious oral sedation. Then you get other patients that say, no, no, no, no. I don't even want to be a little bit awake. I want to be totally, totally sleeping.

Antonello Croce 37:08

So less than if it is your case.

Dr. Costa 37:10

So if that's your case, then across the road from our clinic, we. Are very fortunate that we have a excellent private hospital. It's the Dubai London Hospital, and we take our patients exactly across the road. Okay. Which is convenient for us. Yeah. And for the patient. We do the procedure there under full general anesthetic, and they either go home the same day in the evening or if it is really a big procedure and they don't want to go home because they are, they have flown in and they don't have people to look after them at wherever they are in the hotel. Then they sleep over in the hospital for one night, and then the next day they go home with their teeth.

Antonello Croce 37:55

That sounds amazing. There is a solution for everybody, so, so there is a

Dr. Costa 37:58

solution for every, uh, type of dental patient.

Antonello Croce 38:03

Yeah. Yeah. That's really, really a good service from a, to, to, to the end. Um, regarding the, the tech that we were talking about, um, the structure, the infrastructure that, uh, you need, um, inside the, the clinic, that also means inside the lab team and the, the clinic and the lab. The internal scanning, uh, played a crucial role of improving the, the timing of the, this communication as, as well. Um, but inside of it, inside the internal scanning, do you use any kind of technology for taking the, the scanning like photogrammetry or, um, yeah.

Dr. Petros 38:46

Yeah. There are different kinds of photogrammetry. Uh, the first appear something like, uh, 10 years ago, uh. Not many people were using that, uh, nowadays. And more specifically, the past, uh, year, eight months, uh, there's something called intraoral photogrammetry. Yeah. Uh, it's a technique, uh, that we are using an intraoral scanner to take, uh. Implant impression using the tech, the photogrammetry technique, which has a lot of advantages. Uh, the most important is that, uh, we have an accurate impression, uh, an accurate, um, scan of the 3D position of the implants into space, uh, which is of paramount important for us to fabricate teeth which have passive feet on top of the implants. Uh. If the prosthesis doesn't fit well onto the implants, it'll fail. So it's so important to have an accurate scan and the technique of photogrammetry, uh, it's a warranty for us.

Antonello Croce 39:53

Okay. We understood the old workflow from a flying in, flying out, um, from this experience, what do you think now will be the next shift change in digital dentistry?

Dr. Costa 40:09

I think. I think the next frontier is robotic. Uh, surgery.

Antonello Croce 40:16

Surgery,

Dr. Costa 40:17

yes. So based on the treatment plan that we make on our digital, um, uh, diagnostic images, and so we plan the, the implants on the scan, and then the robot will place the implants exactly where we planned them. But of course the robot should always be, um, guided, uh, guided and also be able to be intervened by the surgeon because, um, at the end of the day, the responsibility is not on the robot.

Antonello Croce 40:54

Yeah,

Dr. Costa 40:55

it's on the human. Uh, I think that's where it's gonna go.

Dr. Petros 40:58

What about your site petrol? Yes. Uh, many people are talking about the digital smile design. Um. Yes, it's very useful. But, uh, if you don't have the concept, uh, as a dentist to put down the basics, uh, you cannot only do it with, uh, digital. Yeah, you need to have. You need to know both analog and digital. And this is a very soft line that nowadays the universities, um, they have to go through. And I know that because, uh, I'm teaching in the Boston University and in Tufts University in, uh, Boston, Massachusetts, uh, all universities, gradually they're going. Towards the digital part, but, uh, they realize that it's important for the students also to know the analog part.

Antonello Croce 41:47

Yeah. Uh, and education plays a crucial role. Exactly. You

Dr. Petros 41:52

need to know both in order to optimize results. You cannot know just one. And I see the same the field of, of, uh. Of the dental technicians, uh, in the past you had the dental technician who was an artist. He was playing with the porcelain. Yeah. Placing the porcelain layer by layer. Nowadays you don't see that, or you don't see it as much,

Antonello Croce 42:15

as much, just someone is,

Dr. Petros 42:17

you have young boys and girls, which are experts in designing. So they have two mouses and one screen and they're designing two screens, sir. Yeah. Yeah. I mean, uh, this is different. But, uh, you cannot just do that. I mean, you need to know everything. You need to combine knowledge, analog and digital. Of course, that

Dr. Costa 42:37

also applies to robotic surgery.

Antonello Croce 42:40

Yeah.

Dr. Costa 42:40

You know, if, if the robot does something you don't like, because you didn't expect to find soft bone in some area, you need to be able to redirect the, the surgical, um, pathway.

Antonello Croce 42:51

We're talking about robotic and smile design without mentioning ai, but. Might be integrated in,

Dr. Costa 43:00

integrated into that. AI will be part of that.

Dr. Petros 43:02

You cannot stay behind. Yeah. Uh, you need to take advantage of any technology which is resurfacing. Uh, but um, you need to combine everything. You need to combine everything if you wanna be on the top front.

Antonello Croce 43:17

Well, I think that with this we covered, um, most of the topic that, uh, were, uh, interesting for, uh, all the listener out there. So. I would like to, to thank Dr. Pedro and Dr. Costa for, um, for being here and sharing all your, um, inputs.

Dr. Costa 43:36

We thank you Antonello. Thank

Dr. Petros 43:37

you

Dr. Costa 43:37

Antonello, so much for your time. It was very interesting discussing this with, uh, you and we, uh, believe the audience will find it interesting

Antonello Croce 43:45

as well. Thank you Edo for sponsoring this podcast and uh, I'll see you in the next episode.

Presenter 43:51

Want to use AI in your clinic? Try Edco EMR sponsor of this episode. They are pioneering AI for dental clinics. Go to edco app and request a free demo now. EDCO software for modern dental clinics powered by ai. Hey, and don't miss. Next episode. Search Next Dental, one word, no spaces on all major podcast platforms and click subscribe.