How One Dentist Uses a $20 iPad App to Achieve Near-100% Case Acceptance

I was able to marry my two biggest passions, which is, you know, dentistry, which I love doing, especially I've been an aesthetic restorative dentist my whole career, but then 3D got into it. And I just said, you know what, it has to be a simple, straightforward approach or a dentist won't want to do it. And personally, I won't want to do it. Welcome to the Phil Klein Dental Podcast. Today's episode is all about innovation made simple and how one general dentist with over 30 years of experience is transforming the way he presents and plans his aesthetic cases. Our guest, Dr. Chris Pescatore, is using nothing more than his iPad and an off-the-shelf app. He performs digital diagnostic wax-ups right in front of his patients in only a matter of minutes. With just an intraoral scanner, his iPad, and the app, which costs only 20 bucks with no residual fees, he can create a realistic 3D visualization of the final case before treatment even begins. This isn't just a tool for planning the aesthetics of the case and prep design and occlusal adjustments. It's also a powerful way to wow patients. In fact, Dr. Pescatore’s case acceptance rate has been hovering close to 100%. So here's what's interesting. He introduced this workflow into his long-running general aesthetic course. And the response has been so strong that he's now launched an entirely new course devoted specifically to teaching dentists how to use this iPad app. So stay tuned to learn how Dr. Pescatore has integrated this simple, inexpensive piece of technology into his daily practice and why it's been such a game changer for both him and his patients. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases and our entire production team will really appreciate it. Dr. Pescatore , welcome to the show. Well, thank you very much. It's great to be back, Dr. Phil. Yeah, we've had some great podcasts in the past that have done really well. And I encourage our listeners to check that out. Just go to VivaLearning.com. type in Pescatore in the search field and you'll see all of Dr. Pescatore’s content, P-E-S-C-A-T-O-R-E. Just out of curiosity, Dr. Pescatore, have you listened to any of those that we did in the past? Do you listen to them? It's hard listening to yourself. I listen to a little bit and then I kind of cringe at myself. Yeah, meanwhile, the feedback's been great. People are critical. So I'm on my 700th episode in that range. Wow. You know that I'm not listening to too many. Well, you do a great job. You and your crew do a great job. You really do. Yeah, we do our best. Thank you. We appreciate that. So we're going to be talking about today a couple of things. One is you have a workflow system in place that you've kind of developed and nurtured over the years, and you've built a course around it, which we're going to be talking about in this podcast. But first, before we get there, tell us about your whole approach to clinical dentistry. how it centers on simplicity. It empowers clinicians to implement modern digital workflows. Nevertheless, your approach also enhances communication with labs. It improves patient experience and restores focus to chair-side dentistry. What sounds to me, Dr. Pescatore, there's not much your approach doesn't cover. And what's interesting about this is that in spite of all the expensive equipment and software and technology that's out there that is being sold to dentists, you do this all with a very inexpensive iPad app. It's that simple. Tell us about that. Well, thanks, Bill. You know, when I started presenting in the mid to late 90s and I got my first laptop computer, I got bored with 2D presentations. So I started to learn 3D and I learned, you know, hobby level 3D programs. But then I learned all the way up. to professional-level industry standard programs such as Maya, ZBrush, and all those other ones. And so I have a real foundation in 3D, and I've done a lot of work in 3D on the side. It's always been my hobby and my passion outside of dentistry. But then when I got my first in-office CAD CAM in 2005, I thought, hmm, how can I bring my 3D passion into dentistry, which is my other passion? I slowly started to use desktop 3D applications to create my own teeth. How did that connect with your scanner, your intraoral scanner? Well, you would get the scans and export the files. It was a little cumbersome. The workflow was definitely cumbersome. So I would have to export the files to the 3D application I was using at the time. And that can get a little cumbersome. So over time, things got a little more simplistic. But they still weren't as simple as I wanted them to be because I knew no dentist would want to adapt it if you had to jump through these hoops. So I learned digital sculpting, which is a real fun part of 3D. And in 2018, fast forward, you know, what, 18 plus years later of my journey into 3D, a really novel 3D sculpting app came to the iPad. And it's almost an industry standard. But I've used that app nonstop since I've got it to make my digital wax ups. And the process is very straightforward. And in this course you talked about, which I'm going to start giving, I and the course came about really because I was giving a program a few months ago and I was showing my workflow. And almost every dentist came up to me afterwards and on the break and said. Where can we learn this? I said, well, it's easy. You just get your iPad and your Android tablet and you do this. Where are the courses on this? I said, well, there aren't any. I just do this in my office. So let me ask you this. Some of that 3D design work, isn't that now part of the intraoral scanner? There's design software that can do that same thing? Absolutely. A lot of the scanners now have their own modules, which are design software. And that's great. What do you like about the iPad with this application that you're talking about? Why do you prefer that? Well, first off, I'm not making a final restoration with it. I have to make that clear. This is for your digital diagnostic wax up. This is... The whole point of this is to build that patient rapport, that patient buy-in, the confidence. But within that program, within the course, what I teach is how you can actually simulate prep models. So you can actually simulate prepping it in this application. You can then make... your prep guides if you want although in general i don't know if i print a prep guide i print models and then i use something like a really great putty like coltine's putty to make my matrices because i think their putties is one of the best on the market i love the flexibility and the flow of it so that's why i use coltine's putties for my matrices most of the time but if you want to print them i show you how you can do these reduction printing guides so there's really easy but the problem is i find with a lot of The software is that you're making a restoration, so now you have to have a mill. And what about doctors who don't want an in-office cam system? What if they want their lab to make their restorations for them, which I think most dentists do? I think this is a great go-between. This is a program that gets you and the patient face-to-face or your staff to show them what's possible. with this program. And then you can print the models in office if you want. And I recommend these very inexpensive printers because we're just doing models. My whole printer setup costs no more than between $600 and $800. And my bottles of resin cost no more than $40. So it's a very inexpensive way to get into this without having to invest and continually invest. and all this stuff. They're very inexpensive ways to get into this. But that low cost printer that you're talking about, that's not designed for fabricating things that go in the mouth, is it? Well, actually, some of them you can. It just, there's a lot of different guidelines you'd have to make sure you're following. But I don't want to get into that because the whole thing about printing and washing and curing. There's a lot of still debate out there about are people doing the right protocols? Are these very toxic things? Printing is a very toxic thing. You have to be very, very careful. You know, when I first got into printing and this is, you know, mid, mid 2000. This is 2015, 16 or so. The only people to follow were people on YouTube and they were hobby printers. And these people would glove up and mask up. It's almost like they were in hazmat suits when they handled something that was printed because they always talked about the toxicity of these resins until they're finally washed and cured. And then I see dental videos where people are like holding this stuff. You have no idea what you're really touching. So you have to be very careful. That's why. I want to get minimal printing in my office. I just want to print models. Until a true ceramic material comes to printing, a true, true ceramic material, I'm really not interested in printing except for models. So when it comes to the digital wax up, why don't you just have the lab do it and then you don't have to worry about it? I, you know, I did that. I've done it until I started doing my own. It was because the control you have and the patient buy-in, the patient rapport. and just the whole confidence it sells the package i know some dentists you know they get the patient and they might do a 2d smile imaging thing and that's all great and But boy, I'll tell you, I have never had a patient say no when I sit there with their scan models. I throw a set of teeth. I mold them. I shape them. I go, this is what you could look like. And I can change the rendering quality on the iPad so it looks like they can actually touch the 3D model. I've never had someone say no. Because it's such a visual thing. And you have a library, your own library you've built of teeth. Well, right. I fine-tuned this library. Probably in the last 15 years, I fine-tune it all the time, and I have built into it different things. I have different sliders built into it so I can make a central look wide, narrow, short, long, round. I just want to do my dentistry. I want to get the patients to feel confident, and I like the fact that I can control it because when I'm doing the case as digitally like I am, it's almost like I've done the case already before I even pick up the handpiece. Yeah, that's what I've been hearing. do a digital wax up you have there's no surprises you you understand your prep design before you even prep it in the mouth you've got it all figured out and you know where it's going to go right and i even talk about i even show people how you can put the actual functional movements from your scanner into this app. So I can create a right and left canine, a protrusive, and therefore I can adjust the lower and see where I need to adjust in the mouth, like reshape. I can talk about pre-preparation recontouring of an arch. I can show people how to do that prior to actually digitally prepping it and then putting teeth on it. When you do this, do you ever change your mind and say, hey, I don't think we can go this way? Every time I do a case, I say, oh. There's something here I might have missed or, oh, look at this. And one of the great things about doing it this way is, and just over my 35 plus years of bonding porcelain to teeth, you know that certain areas of certain teeth require a little different preparation for functional reasons. And so I built that into the library, but I also built that into how I digitally prep. the simulation because I know these certain areas need to be covered with porcelain versus I know this is a possible interference so I can automatically do that and then I basically print my model up of my digital wax up sometimes I even print the opposing that I've adjusted And I'm ready to go. I have everything. I'll put the probably, well, most of the time I remember I did in this last program I did where I actually, when I was prepping the person, I actually had my printed models on the, on the tray so I could. see them while i'm working and it was because i never met the patient before they had given me this patient they just sent me the digital files so i did my complete digital workflow and that's when i brought it there and people said well how did you do this you never met the person i said well here it all is this is the plan yeah it was almost done already it was absolutely virtually it was done already and then you just had to do it on the person now that's amazing what does it do for case acceptance Is it 100% they jump on it right away? No, I've had people hem and haw maybe in six months, but I've never had a person not buy into it, not go, wow, this is amazing, because a lot of times I will do it right in front of them. For me to do a full upper, say, 10 veneers, it takes me no more than about 15 minutes. to do the diagnostic wax up and show them. And a lot of times they like watching it. And I charge for a consultation. It's usually on their consultation. I say, hey, can I scan you real quick? It takes about five minutes to scan, throw them on my iPad, import my library, put them in position. I can even color the teeth a little bit. I can do whatever I need to do. And then they go, wow. So tell us why you started your course using this software, this very inexpensive software on the iPad. Only since the last course I gave a few months ago, like I said, dentists were coming up to me about doing this. So I thought to myself, I love doing this stuff. Again, it's my passion outside of dentistry is the 3D stuff. Maybe I should put a course together. And the people who sponsored the course were contacting me saying they want a course on this. We have so many people asking because I think people will have their eyes open. to a simplistic way of doing this stuff in office without having the overhead and being bombarded by all this very expensive digital equipment, which. I'm not saying don't buy. I mean, if your practice utilizes it and utilizes it well, God bless, go for it. I just don't think that's mainstream dentists. What kind of app is this? Is this something that's designed specifically for dentistry, right? No, not at all. It's designed, no, it's not. It's a 3D sculpting app on the iPad and it's not designed for, but it's easily used. for stuff like that so you just download it from the app store yep android store or the uh apple stores twenty dollars one it's a one-time here's another thing i like one-time cost things I don't like recurring subscriptions and stuff like that. So this is a one-time $20 purchase. You have the app forever. Any upgrades. And they've made tons. The inventor who I've contacted once, he is constantly making upgrades to this app. And it's just an amazing app. And people say, well, I don't want to learn 3D. This is too much. Believe me, you don't need 90% of the program. You just need to. have a really nice tooth library. And then it's just a few little tools to get them in position and get it right. And that's it. And then I show some advanced things if you want to do it. But to do it... Are you going to tell us the name of the app or you have to take your course for that? It's called Nomad Sculpt. Nomad Sculpt. Okay, cool. So tell us about the course, Dr. Pescatore. I know it's coming up soon. Today's September 22nd. I think this is early October. And it's at the Center for Dental Ceramics in Cleveland, right? Well, the October 3rd program is me. This is one of my anterior programs. So I lecture in the morning and then I actually live prep. a person for 10 veneers in the afternoon. On Saturday, so that's one program. And then a month later, I come back and I lecture in the morning and I seat the case. And I've been doing those programs since the 90s. On Saturday, they wanted me to stay over the next day and do my first digital program. So it's an all-day digital program. You just need to bring your tablet and have the app already bought, although you can just buy it there. And I'm going to go through the app, how to use it, and what is 3D, a very simplistic approach, and then how to put teeth on your models, how to look at occlusion, how to look at everything, because you can fine-tune occlusion, too, in this app very easily. I'm going to show them a very straightforward approach. Now, are you going to be a 3D expert after one day? Absolutely not. You weren't an expert at prepping teeth after one day on typodons in dental school. So practice makes perfect. And the more you practice it, the easier this is going to get and the more you're going to be able to streamline it into your practice workflow. So to get that workflow going, what is the minimum armamentarium needed? Well, all they would need is to have a tablet. An iPad or Android tablet? iPad is probably preferable. And here's another thing. It really depends. Now, if you're on a PC, where a lot of people are, I'm on a Mac completely because my scanner is also Mac compatible. And that's one of the reasons why I chose the scanning system because it's Mac compatible. So all you need is for the course, you need to bring some scans, which are STL files or PLY files, or have access to them somehow on a cloud and bring your tablet. And you'll have a stylus with that, an Apple Pencil or your... Android will have a stylus. And that's really it. We're going to provide some demos of my library for people to use for the course so they can see the ease of using a proper library. And this is all built within the app. So it's not really transferable to other software. Because like I said, you know, having experimented with so much stuff, and I guess it's not that I'm inquisitive, but I always want to prove something wrong. But I'm always like, okay, I lick that way. Okay, I see it. Then how can I prove it different? I was able to marry my two biggest passions, which is dentistry, which I love doing, especially I've been an aesthetic restorative dentist my whole career, but then 3D got into it. And I just said, you know what? It has to be a simple, straightforward approach or dentists won't want to do it. And personally, I won't want to do it. Did you do in the past traditional wax ups on models before your cases, just with wax in the office? I did very few. I did do some, but mostly I delegated it to my lab and my technician in my lab because I trusted them and they did a beautiful job. I was just wondering whether this was a transition for you from traditional wax ups in the, you know, the analog wax ups to a digital, which would be something you would probably have a passion for. Well, wax ups have changed with the digital environment. Your diagnostic wax up you get from a lab, to me, is not the same as we used to get before digital. Before we used to get digital wax ups that were usually made with the lost wax technique, where you basically take that part of the tooth away and you just don't grind the teeth down and give someone a complete wax up. Because when you do that, there's a lot of... extra material and bulk and occlusal adjustments. When I just take away what I need to take away and add and do that. So digitally, we're doing this old technique, this lost wax technique, because it's the most accurate. Digital wax ups come back. And a lot of the times there is just a lot of excess material and work I have to do that I never had to do before. So that's another reason why I decided to take control. digitally myself. So just to confirm, you do the digital wax up on your iPad app in front of the patient, correct? And how long does it usually take? I do it while they're there. And, you know, I wasn't sure about a timeframe, you know, but I did time it one of the last times I had a patient in and it wasn't for six, it was for 10 teeth. So I timed from the scan to when I had something. for them to look at, I think it was between 15 to 20 minutes. It was five minutes to scan and 15 to 20 minutes when I could present them something that they were like, wow. And in doing so, and they sat in the chair. Like I said, they come in for a consultation. It's a paid consultation. So I give them their money's worth. I'll scan them. I'll throw it on my iPad. I'll show them. And at the same time on my iPad, I say, you know, you want to smile, but look at this opposing tooth. And we need to do something here. So they see the whole picture of their mouth on this iPad. And then I throw the teeth in there. And sometimes they say, oh, I like that. Can you make that longer? And I'll do it right in front of them. And they are just blown away. And they go, I've never seen this before. And I go, cool. And as I said, there are tools out there that come with equipment, CBCT, scanners, everything. There's all this AI built-in stuff that could render these images rather quickly. But we're talking about an iPad and a $20 app. Yeah. And this is really great also. some of my direct resin work in the interior i use it because what i'll do is someone with pig laterals or whatever i will actually scan them put it on my ipad And then make my digital maca. I'll print the model real quick or they'll come back. I'll have the printed mile and I'll make a lingual matrix so I can do the direct resin veneers or whatever I'm doing via that. And, you know, it's awesome because when I'm using and I use the brilliant Everglow from Colty and they're amazing composites for interior aesthetics. It's some of the best. anterior composites I've used, patients are just floored. But I have a lingual matrix, which you all know if you're doing anterior composites and you have some kind of matrix, it makes it a lot easier. So I'm just... So much faster. So much faster. So much faster. And it's going to look a lot better. Absolutely. It's really fascinating stuff. So in your course, which you're doing in Cleveland first, when someone's... Let's say someone attends that and they're done. How long do you think it will take them to get, I know it depends on the individual and how much artistic skill they have. There's a certain amount of obvious skill involved with using 3D software. How long will it take them to get to the point where they could scan, do the stuff on the iPad, show it to the patient where it's 30 minutes or less? My goal for them, by Monday. Oh, really? Yeah, my goal is they leave the course knowing the process, knowing what they need to do. And so if a patient comes in, they can do it. Now, maybe it won't be print ready, but it'll be something they can show the patient for the buy-in, for the rapport building. And then maybe later they can fine tune a few things and then print their model or send it to their lab and have them print models and get it back. Because, you know, laboratories aren't going to charge you much for printed models. It might just be easier to get those printed models, especially if you're not doing... tons of cases all the time like this, it's just easier to get a printed model from the lab. I want them right away. And I'm doing a course on that Saturday, but the following Friday, I'm doing another digital course in San Diego. So we're covering both courses, both coasts within a week. Yeah. You still have time to practice? Yeah, I practice four days a week. So you're certainly keeping busy between practicing and teaching. And I think that's a great... And I think it really enhances anybody's career in dentistry to teach and share with colleagues the experiences and things you've learned over the years. And once again, regarding your course, basically all they need to do is show up with an iPad, which a lot of people have, or a tablet, and spend 20 bucks for the app. It's just a fact of buying the app and coming to the course. And what about having STL files? Well, you need to have some scan files. And some people have scanners, some people don't. But you could get some random, and I haven't decided yet, maybe I'll provide some. STL files or PLL files for people who don't have them for the course so we can all work along. There's that possibility too. But it would be helpful if they bring a patient case so they can work it up. And I can go over the issues and things that the pitfalls will find as they're doing it. So any dentist that takes your course that goes back to their practice that has an intraoral scanner can start utilizing this iPad app immediately. And I think, you know, inter-all scanners are becoming more and more necessary. for the simple reason of it's not just to replace impression material. It is to just help with the rapport and the patient education and all that. And those are the almost more valuable things to me. I mean, there's nothing wrong with, you know, people are so against impressions. I think impressions are fine. I, for all my digital cases, my big digital cases, of course I scan them, but I still take an impression because to me, impressions. are your backup. Because like I had a patient just last week flying from out of town. And I scan her. But what happens if something happens to a scan? On the small percentage, it might. What happens if something happens to that scan and it gets corrupted? I'm going to fly her back and take off the temps? No, I have an impression. And impressions are still very viable in today's profession. They just are. People don't want to admit it because they want you to buy a scanner, but they are. And I still take a lot of impressions, even though I'm scanning. And I use what I think is one of the best impression materials. It's a Finnis. That's a Coltine's impression material. I just love the flow. The flow is like no other impression material I've used. So I'm really, really happy with how it flows. There are advantages to impression material over scanning. Scanning is what you see is what you get. And impression material has those physical attributes that can push the tissue away to capture the margin. Yeah, there's no question about that. People don't realize it. Yeah, I mean, that is a big advantage and it's a great backup. But from the patient standpoint, when they go to a dentist that scans and they don't have to have that tray with goop in their mouth, they're sold. If they go to a dentist that has that scan and then they say, my other dentist is still sticking trays in my mouth. You know, from that standpoint, you know, the dentist is probably looking to get an intraoral scanner just to be up to speed with wowing the patient and patient acceptance and all that other stuff. It's more perception for sure. Yeah, without a doubt. But I agree with you from the standpoint of actual technique and having that backup impression, no doubt about it. So I think we covered a lot here. So if someone is interested in your course, how many people, what's the capacity over there in Cleveland? for your course on October 4th? I think it's October 4th. Good question. Since this is the first course we're doing, I probably don't want any more than 30, just in case there's some individual questions and I have to go, because I'm going to be the only person teaching it right there. It's not like I have instructors helping me. A smaller group would always be better because I think it's going to be more one-on-one. Ideally, I would want them to bring a case they want to do in their office. And when they leave, I want them to have their digital wax up ready to roll. And I want them to also understand how they're going to prep the case. And if they need to adjust any of their posing, they have all those questions answered in their mind because they virtually did it on their tablet. in the course. Right. And where do they sign up for that? You're going to go to the Center for Dental Ceramics website. Center for Dental Ceramics. Look for their courses from Dr. Pescator. And again, he has something over there on October 3rd. He has something on October 4th. He'll be staying over. Go out there and visit Cleveland. Yeah. What's the weather like? Or San Diego. Yeah. San Diego is following. Yeah. Now they're going to all want to go to San Diego. That's it. Being in California, I prefer San Diego. Yeah. That's just the way it goes. That's right. I lived out there 15 years. We moved our company to Austin, Texas. So I know a lot about San Diego. All right, Dr. Pescatore, we are out of time, but I want to thank you for joining us. Great, innovative discussion about a $20 app that could sell cases left and right and wow the patient. And I think it's worth every dentist to check it out. And good luck with your course. And thank you so much for joining us. Have a great evening. Thank you very much, Dr. Phil. I really appreciate you and all your crew there.