The Group Dentistry Now Show: The Voice of the DSO Industry

🎧This is the first episode of the Frontline Full Access podcast powered by Group Dentistry Now. In this episode we are joined by Dr. Riad Almasri, Founder and Partner of FastNewSmile Dental Implant Centers. Dr. Almasri discusses:

The value of mentorship
The implant system he prefers
The most challenging case he has ever done
“All on 4” implants
Much more

To discover more about FastNewSmile visit – https://www.fastnewsmile.com/

The Frontline Full Access podcast series blends a mix of the latest full arch insights, as well as operations, marketing and other business strategies from the team at Frontline Dental Implant Specialists. This podcast series provides a peek behind the curtain at Frontline. Discover why this implant partnership model and the people behind it are so unique. To find out more visit https://frontlinedis.com/ .

If you like our podcast, please give us a ⭐⭐⭐⭐⭐ review on iTunes http://apple.co/2Nejsfa and a Thumbs Up on YouTube.

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Full Transcript:

Bill Neumann:

Hi, everyone. Welcome to this brand new podcast series. Really excited about this, being part of this. So, this is the Frontline Full Access Podcast and it’s powered by Group Dentistry Now. My name is Bill Neumann. I’ll be the host for this podcast, and we’re going to get into a little bit about why this podcast series is really unique. So, we’ve got a mix of the latest full-arch clinical insights, as well as marketing, operations, business tips and tricks, and they’re going to be provided from the team at Frontline Dental Implant Specialists. You’re going to get to know the team very well and why they are really unique.

So, we’re going to get a peek behind the curtain at the team of Frontline, what they’re doing and why they’re so successful, why implantologists from around the globe have joined this network of implant centers. You’re going to discover why this model is super unique. You’re going to get to know the people behind it. So, I’m really excited to have Riad with us. He’s going to be our first guest, and I think if you know implantology, you probably have heard of him or maybe you even had the opportunity to see him speak. So, we have Dr. Riad Almasri. He is the founder and partner of FastNewSmile Dental Implant Centers, and you’re in Dallas in Fort Worth, Texas. Is that where you’re located?

Dr. Riad Almasri:

Yup.

Bill Neumann:

All right. Well, Riad, thanks for being here and actually thanks for being the first guest we’re having. So, this is no pressure, of course. We know that you’re a globally renowned speaker, so maybe we could start to talk a little bit about your background, the mentorship that you provide doctors across the globe, and how you really got into All on 4 implants.

Dr. Riad Almasri:

Super awesome. First of all, thank you for having me. I appreciate you guys very much and for this opportunity. It’s with great pleasure and honor to be the first one to speak on behalf of Frontline on this podcast. Again, my name is Riad Almasri. I’m a Dallas prosthodontist. We started FastNewSmile as the brand name for the full-arch immediate load procedure, the one day they’ll implant teeth, in the day, whatever you call it. I’ve been doing this for quite some time. I started getting into the full-arch immediate load back in 2007, whenever I started my residency in prosthodontics, down in Nova Southeastern University in Florida, Fort Lauderdale area.

I had great mentors such as Dr. Tom Balshi or Carl Drago, some really great mentors that held my hand and taught me everything I needed to know almost in full-arch immediate load from just traditional implants to zygomatic implants to pterygoid implants. So, I was very fortunate as a resident to be surrounded by that amount of knowledge. Then I moved back to Dallas for Florida in 2010, and in 2012, I believe towards the end of 2012, we started FastNewSmile. I said, “I don’t want to do any other dentistry. I love dental implants. I love implantology. I want my practice to be exclusive to the full-arch immediate load business.” Yes, about 5% of our patients receive single implant or implant bridges, but about 95% of what we do is full-arch.

In my career, I’ve done close to, if not more than, about 3,000 arches of this procedure, just myself, the surgical part of it and not counting the prosthetic part of it and other things I’ve done. So, in total, I was counting all the number of implants that I’ve done in my career. I’m about 18,000 implants experienced. If there’s anything I know about implants, I know a little bit. With that said, having that knowledge, being able to have mentors and godfathers in implant dentistry gave me the want to teach, to give back. So, part of what I do as a part-time, I say it takes a little bit of my time during the week, sometimes I do it on the weekend, is education. I teach doctors locally, nationally, and internationally. I speak on a local level or on a global level.

With that said, I also offered the one-on-one mentorship training where doctors come and look over my shoulder and I show them how we do this procedure or other procedures. It’s just implantology, period. I try to teach them every single trick that I’ve come up with or I’ve learned in the past and hand it over to them. It is a great pleasure to see doctors’ faces once you’re done with the training and they have a big smile and say, “Well, I wish I would’ve done this long time ago,” or they walk away and say, “Now I know what I’m going to do next to make things better, to serve my patients better.” That’s the fruit or the harvest of all the seeds that we plant with these doctors.

Nonetheless, I actually also worked at Texas A&M when it used to be Baylor. I was an assistant professor and I did that for a year or so. Then I also currently for the past, I believe eight years, seven years, more than seven years, I’m an adjunct faculty at Nova Southeastern University Postgraduate Prosthodontics Department where I go teach the residents surgery before. So, we’ve literally scheduled one day quarterly and I go fly to Nova, do surgeries with the [inaudible] and then turn back around and come back to Dallas.

That’s one of the ways to say thank you to the amazing school that gave me a whole lot and I can’t do enough to give them back. I believe that’s in a nutshell what I do and what we do on a daily basis. I would love to answer any other questions if you have any more questions.

Bill Neumann:

Oh, that’s great. Thank you, Dr. Almasri. I think you recently joined Frontline Dental Implant Specialists maybe about a year ago.

Dr. Riad Almasri:

It’s been a year. Yes.

Bill Neumann:

Yeah. Talk a little bit about the why behind that.

Dr. Riad Almasri:

Yeah, absolutely. It’s simply because I was ready for more. Multiple organizations, and I’m not going to mention name, reach out, knock on my door, say, “Hey, we love what you created. We love what you’re doing. We would like to partner up with you.” Of course, partnering moves marriage in my language. I don’t know what you all think about it, but when you partner with someone and if you have a business partner, you’re married to that person. So, to me, partnering with someone, for better or worse, I needed to find that good partner that the vision is aligned.

So, when the team at the Frontline reached out to me and say, “Hey, this is our vision, this is what we want to do,” it was all aligned with me and that’s why I decided to go with Frontline. In a nutshell, the vision was to better serve our patients, to create a powerful organization that only picks out the best and the best in the country of implantologists and bring them all on one platform and grow this organization to become the number one dental partnership group that provides superior service with dental implants.

Bill Neumann:

That’s great. Thank you. So, we have you on here because you’re an implant specialist. So, let’s talk about implants. Maybe we start from the beginning or simple. What type of system are you using? What’s your implant system?

Dr. Riad Almasri:

I’ve used multiple systems. You name it, I’ve used multiple systems. I’ve been around implantology, as I said, since I worked as a general dentist, but I really didn’t do a whole lot until I started my residency in 2007. That’s whenever I got involved. I’ve got to try all of them, but recently, I would say about seven years ago, 2016, I switched to an implant company called Neodent. Neodent is a strong group company, and that was the best decision I’ve ever made. I love this system. It’s simply amazing. It was made by a dentist, Dr. Geninho Thomé. He’s a dentist. He’s the founder of that company, and it was made from a dentist to a dentist. So, simple, easy, predictable bone maintenance. Multiple reasons why I stepped in the simple system for the past seven years.

Bill Neumann:

Let’s talk about the training behind that. So, how did you get your advanced training in implantology? Because I’m sure we have a lot of listeners that maybe some are just starting out or some are curious about implants. How did you get to where you are and what did that training look like?

Dr. Riad Almasri:

That’s a great question because a lot of doctors ask me that and say, “How do I get to your level of expertise? I want to do what you’re doing in my practice.” Well, you’ve got two options. Option one is to go do a three years surgically oriented prosthodontic residency. The reason I say that is because there are some prosthodontic residencies, but not all of them push the surgical aspect as hard as the school that I went to, as I said at Nova Southeastern University. The surgical component was as important as the prosthetic component, because as a prosthodontist, you had to understand the foundation.

You go build a house. What do you do first? You design it, you do the architectural, you do the foundation, then you build the foundation, you put the house on top of it. We don’t start backwards. So, it is important for us as dentists who are restoring the prosthetic part of it to understand the surgical part of it as much as the prosthetic part of it. So, my advice is to get both training. A lot of doctors, I just want to know how to do the surgery or I just want to do how to do the prosthetic. Well, to be a better prosthetic dentist mean to me a very well-rounded in the surgical aspect of it and vice versa.

So, as I said, that’s one route, to do the three years residency. Unfortunately, a lot of dentists nowadays come out from dental school with a half a million dollar worth of loans, and they say, “Well, half a million dollar worth of loans from college and dental school. I don’t want to get another half a million dollar of loans from a residency program,” or whatever the cost is going to be, 300, 400, 200. It varies by state and by school. So, that’s an additional cost. So, what I say to them is do a lot of continuing education courses, try to attend as many meetings that revolves around implant dentistry such as the Academy of Osseointegration.

The Academy of Osseointegration is literally one of my favorite organizations to attend a meeting, because it is not prosthodontist only and it’s not oral surgeons only and it’s not perio only. It’s the Academy of Osseointegration that grabs general dentist, endodontist, periodontist, oral surgeon, prosthodontist. Put them all in one room and present everything that you need to know about implant dentistry. So, that’s a great organization that I recommend for you to be a member of and then get a lot of knowledge. In addition to that, continuing education classes, do hands-on courses first, hands-on models and then step up your game and then do cadaver hands-on models. Then after that, do a live patient training.

Then unfortunately, a lot of dentists do all of these and still yet, they’re so hesitant about going through a practice and executing that procedure to their patient. So, what I recommend is some type of over the shoulder mentorship, like a one-on-one training where the doctor goes with you and sits with you in the operatory and then holds your hand and guide you in the right direction in the first case or two. So, this way, you feel the confidence and the ability to be able to deliver this on your own once that mentor has left your office. I hope this helps.

Bill Neumann:

Absolutely. That’s great. Thanks for the details there. Next question, we’ve got a bunch of them for you. Do you do guided surgery?

Dr. Riad Almasri:

So that’s actually the number one question, well, one of the top three questions that I get asked quite a lot. I literally do not use guided surgery at any point in time. I’ve used a guide probably once in my career because of the patient. Healing was very poor and I decided to do flatless and I used a guide for that surgery. But I feel that I am faster, more predictable, and just because of the way that my training was, I feel like as I said, faster and more predictable and able to maneuver any kind of surgery in any kind of situation to have the patient’s better outcome in my hands. A lot would argue, I know guided surgery is precise and you could get it right to the dot.

I can argue that with anyone and saying, “Okay, you do the case diagnosis, you send all of your images, CT scan, all of these data to your lab, and the lab makes you a guide and the guide comes back and it doesn’t fit.” If it doesn’t fit, what are you going to do? Are you going to send your patient back home and say, “Oh, I’m sorry the guide doesn’t fit. I don’t know how to do it. Come back in a week”? You just lost a lot of profit at that moment and you have an upset patient and you have a day of zero productivity.

So, what I highly recommend and I tell everybody that whenever I’m on a podium, I say, “Before you teach your kid how to drive an electric self-driving car such as Tesla, teach them how to drive a regular car, because if the Tesla doesn’t work one day and they want to take your car, they need to know how to operate that.” So every surgeon, every dental surgeon needs to know how to do surgery freehanded before they attempt the guided surgery. Another downside to the guided surgery, because let’s say you plant your implants and you have, let’s say, four implants planted on the max, okay? And then predetermined sizes, you go in and put those implants and some of these implants don’t get the greatest stability that you need.

What are you going to do? You’re going to cover those implants and send the patient home and now you’re again at a loss because you’re going to have to come back and do uncover. You have an upset patient that didn’t get an immediate prosthesis on the day of surgery and now you have a hot mess. So, in a case like this, I’m not saying do not use guides. Use the guides, but know how to save the day when the guide doesn’t cooperate. So, in a case like this, you take the guide off, you unscrew those implants, and you try to find better places where the bulk quality is better and then you can achieve primary stability or you might need to want to use some bicortical stabilization.

Maybe you need to use a longer implant, maybe you need to do zygo, maybe you need to do pterygoid, maybe you need to do trans-sinus implant. So, there are a lot of things that you need to learn prior to just go straight to the guide.

Bill Neumann:

Dr. Almasri, are your practices 100% digital?

Dr. Riad Almasri:

So we incorporate quite a lot of digital, but we’re not 100% yet. How do I say this nicely? I’m very OCD, very meticulous, obsession. OCD is probably understatement, because everything has to be perfect, everything has to fit right on. I know a lot of the digital dentistry has evolved. I’ve got to the point where the fit is perfect and I just recently tried it myself. So, maybe in the near future, I would say probably in the month or two, we’re going to go digital on a lot of aspects on the full-arch procedure. Still some of it’s going to probably have to be analog. This also goes back to teaching doctors.

You don’t want to learn digital dentistry before you learn the analog world, because if your scanner falls on the floor, breaks, what are you going to do? So knowing that the analog world is very important prior to going to the digital world. The digital world, the digital streamline is going to help you be in a little bit more cost-efficient. Predictability is about the same. So, you’re going to be probably saving time and material and something like that. But yeah, we’re working towards fully digital.

Bill Neumann:

All right. Let’s talk about your most challenging case. Is there one in particular that comes to mind?

Dr. Riad Almasri:

So I have few of these to be honest with you, a few of the challenging cases. One of them is my oldest patient. She’s 91. She was 91 on the day of surgery, healthy, perfectly healthy, and she wanted to do upper and lower. So, at a 91-year-old, I told her, “Let’s do it in a hospital under general anesthesia.” She said, “I don’t want to do general anesthesia, I want to do it conscious.” I said, “No, conscious is not a way to do it. So, can we at least do conscious sedation?” So we did her case under conscious sedation. The actual surgery is not the complex part. It’s managing the patient. It’s watching the vitals.

At 91 year old, as we age, our body get really frail. You get really fragile and then you are very vulnerable. Then every time a little thing counts from the amount of epinephrine that you push in, from the amount of the marking that you’re using, from the length of the procedure and how long they’ve been sitting down. So, in all honesty, that case, we probably got my heart rate at the highest and I’ve done quite of zygos. I’ve done quite a lot of these.

I’ve done pterygoids. I’ve done trans-sinus implants. I believe my oldest patient was probably the hardest from a mental standpoint and from the patient management. I always say doing the surgery, it’s pretty simple. Anybody who’s got some hand skills and you teach them how to do it, they’re going to do it, but the main challenge in what we do is patient management.

Bill Neumann:

Ninety-one, huh.

Dr. Riad Almasri:

We took pictures with her. She’s on one of our social media platforms and I think all of them. She’s smiling and she’s still up and running. I think she’s 93 now. I still remember that day working on this patient and my heart rate’s still up just looking at her vitals, making sure everything’s okay until we’re done with her surgery.

Bill Neumann:

Well, that actually ties in nicely with this next question, which is let’s talk a little bit about success rates. Can you talk a little bit about that?

Dr. Riad Almasri:

Oh yeah, absolutely. I love bragging about our success rate. So, with prior dental implant systems I’ve used in the past, my success rate, I would say probably about 98, 99. But after switching to the Neodent dental implant, our success rate is 99.5. I would say 100, but we lose an implant after a thousand probably. It’s in the bruxers, smokers, the ones that really don’t listen. I’d call them the bad patients. The bad patients intentionally or unintentionally at some stages can’t control it. They grind so hard, but success rate is extremely high.

Bill Neumann:

You talked a little bit about this earlier. How did you get involved in All on 4 implants?

Dr. Riad Almasri:

Oh, this goes back to my awesome mentor, Dr. Carl Drago, who was in Wisconsin. So, I got involved during the residency. I wanted to do one here and there and everywhere. I was that prosthetist that did an All on 4 one day because I did it in my residency. Then I did a bunch of veneers the next day and I did crowns and bridges and all [inaudible] dentures. But then I was showing my All on 4 cases to one of my mentors, Carl. Then he said, “You know what? You got skills. I want you to come and visit me.” So I went up to Wisconsin and visited with Carl. Carl was running a full-arch dental center back then. He said he’s retired now, but he was running a full-arch dental implant center. He showed me how he ran it and I sat there with him.

I saw those cases and I saw his patients. I saw a patient on surgery day and I saw a patient coming back and the way they did the consult. That’s all they did, and I just got pumped. He gave me that push that I can do it, you can do it too. Look how many people were helping, and you have the training for it. That’s all I heard in my head after I left his house that night, because after visiting his office, we had dinner. After I left, that’s all in my head. I went back to my office. I did a staff meeting. I said, “We’re changing this. We’re going to call it FastNewSmile. The FastNewSmile is all we’re going to do, and All on 4 business is what we’re in.”

Bill Neumann:

So if there are any doctors that are listening in or watching us right now that may want to do the same thing you did, make that leap to All on 4, maybe some advice on how to do it and maybe why not to do it. So, do you do it? If so, what’s the best path and maybe some reasons why you might not want to pursue it?

Dr. Riad Almasri:

Okay, the first thing, here’s my advice. If you’re considering to be a full-arch immediate load dental implant provider, you need first to start with baby steps. My advice, if you haven’t done enough single implants, if you haven’t done enough immediate dentures or implant dentures, the full-arch is a step above. Then you need to have some type of surgical skills before you jump in and dive in.

I train doctors quite a lot and I’ve got doctors that I had to turn down, because after I interview them and I realized that their skill level, I tell them, “If I teach you how to do All on 4, I’m going to be stealing your money, because personally, I don’t think you’re ready. So, what I think you need to do, we need to go back to the basics. I want you to learn how to walk, jog. Then you and I, we’re going to do marathons.” But to get to the marathon stage, to get to that run-in, to that full-arch, we need to do it right, because it’s not just slapping a couple of implants in the jaw and just say, “Hey, it’s a weekend course and we can do it.” It takes a little bit more than a weekend course.

If anybody tells you, “Oh, come to my weekend course, go back home and do it,” they’ll be lying to you unless you’re ready for it. Then as I said, the criteria to know that you’re ready for it is you’ve done enough single implants, you know how to do a flap. You’re familiar with flap design, you’re familiar with suture design, you’re familiar with grafting. You’re very good at extraction and uvuloplasty. You know the implant system very well. So, there’s a bunch of guidelines. Not only that, forget about the clinical component of it. There’s a business component to the All on 4.

Yes, you’re going to have to start thinking about what comes with that business, it comes training that consultants, that comes investing in a CT scan because it’s a must. It comes with maybe some marketing. It comes with creating a system in your office, because I know a lot of doctors that do All on 4, but unfortunately, they’re not profitable doing it because they’re just doing it wrong, not clinically, but in their office, period. The system, the workflow is not a profitable workflow.

Bill Neumann:

Well, that leads to one of my final questions for you, which is when you’re running your own practice, what seems to be the most time-consuming? What’s the biggest obstacle that you’ve run into? Maybe you don’t have it now that you’re partnered with Frontline, but talk a little bit about that, because you’re right. There’s the clinical challenges and you’re making the move from maybe general dentistry to the leap to implant dentistry and then maybe they’ll leap to All on 4, bunch of different leaps there, but then there’s the business aspect of it as well.

Dr. Riad Almasri:

Yeah, to be honest with you, that’s one of the greatest reasons I wanted to have a partner that takes care of that part of it. As I say, the actual clinical work, it’s not hard. The clinical work is easy. You go in, you know the process, you know the implant system, you know exactly what to do, you do it. There’s a bunch of components. There’s patient management, which I think is really tough. Set the expectations for the patients, explain the outcomes, and then you got the team management, and then you’re going to have to work with these two together. Then on top of it, you’re managing team, you’re managing patients, and now you have to worry about payroll, marketing, HR, and all of that not fun stuff.

As a clinician, whenever I partner up with Frontline and they said, “Oh, we got HR, we got the marketing, we got this. You go do more cases.” I said, “Jackpot.” I love doing surgery. Implant dentistry is my passion and I can’t picture myself doing anything else. So, when somebody says, “Hey, you get to do more of what you love,” it’s like handing you a lottery ticket.

Bill Neumann:

Great information, Dr. Almasri. This is, I mean, super concise and put some great detail on the clinical education side of things. You talked a lot about how you became an All on 4 mentor, your partnership with Frontline. Do you have any final thoughts, anything maybe I missed?

Dr. Riad Almasri:

All of it?

Bill Neumann:

Yeah, any final thoughts before we wrap things up?

Dr. Riad Almasri:

[inaudible] here and talk with you for an hour because you’re asking me to talk about what I’m passionate about, about dental implants and education and my partners, because I am passionate about all three of them. I’m very fortunate to have found the team up Frontline between our CEO. Leigh is amazing. He’s been the greatest thing ever for this organization. The team that he runs with, all of them are great people and I’m very lucky to be a part of it, to be honest with you. I’m looking forward to the years to come. At this point in time, we’re very strong and powerful. We have some of the greatest names in the country joined us or like to join us. So, this is very exciting times that we live in.

One last thing I would say that I forgot to mention, to be honest with you, is the collaboration. Having one chat group for us partners among Frontline partners that we reach out to other constantly with questions and advice. One of the things that I do for our organization for Frontline is I run as a head of prosthodontics and I run between our partners and try to teach them as much as I can. My favorite part is as I try to teach our partners is I learn from them, which is amazing. It’s still till this day when I teach anybody, I learn something. But how about teaching somebody that you’re married to, teaching your partners, making their practice better, making their numbers bigger and better? So that only makes me better. So, I would say I’m very excited for our future.

Bill Neumann:

Dr. Almasri, if anybody in the audience would like to find out more about Frontline, I’ll give them the website information in a second. How can they reach out to you?

Dr. Riad Almasri:

You can reach out to me on social media. I’m pretty active on LinkedIn. I’m active on Instagram. Not so much in Twitter. What do they call it, X now? Keep changing, but I’m pretty active on social media. Or you can actually send me an email if you would like to send me an email. It’s D-R-A, dra@fastnewsmile.com. I’ll be more than happy to chitchat with you at any point in time. If anybody’s interested in joining Frontline and they have questions or thoughts or somebody else reached out to you and say, “Hey, you want to join us?”, say, “What? Wait a second, let me consider others.” Because when you marry someone, you want to date first, right? You want to date a couple. You just don’t marry the first person that you go out on a date, right?

At least that’s what I did. You go date one, two, three, and then figure out who’s the best partner for you, who’s going to be that company that’s going to be perfect fit for you. So, definitely weigh your options and hit me up anytime. As I said, dra@fastnewsmile.com, or you can find me on Instagram. It’s @dr.a.dds. So, again, @dr.a.dds on Instagram. I’m pretty active on there and I try to post as many of my cases and tips and tricks and fun things. Again, thank you for having me, and it was great pleasure and honor to be the first and now to get this started.

Bill Neumann:

Thank you, Dr. Almasri. Yeah, we’ll drop your social media handles in the show notes. Everybody has access to that, your email address as well. Then if you want to actually find out directly from Frontline, you can go to Frontline DIS. That’s Dental Implant Specialist, frontlinedis.com. You can find out all about Frontline. They also have LinkedIn and Twitter. I think they have Twitter, who knows? Or X like you said. But we’ll drop all that in the show notes. So, hey, this is where we’re going to finish up. This is the first in a long series of podcasts. It’s called Frontline Full Access and it’s Frontline Dental Implant Specialists. Again, thanks everybody for watching and listening in today.