Nobel Biocare

Personally, I was glad to see someone step up and post something of merit, not reality computer gossip crap. To the PP, if you are a nobel employee then you need to rethink your message. CAD/CAM is all about precision and it is here to stay, if your not discussing it openly with your docs, you can bet someone is.
Just because you have sold implants the same way year after year, and it has worked, does not mean it will continue to work, especially ignoring the hottest restorative movement in years.

 

Let me enlightening you lab rat. Nobel reps derive 95% of their income from implant and restorative sales. CAD/CAM Procera about 3%. If we sell a local Dr on the merits of Procera, this micron, that precision, etc, and the Dr buys in and decides to order a Procera crown, bridge or abutment, and calls his lab, and that lab happens to be Glidewell, or Morotta, or any lab outside of my small little territory I don't get paid for that crown. bridge or abutment, the rep where the CAD/CAM product is produced/scanned gets credit. So, if you were me, and you can increase the 95% portion of your income that is derived by selling more implants, would you do that or learn everything there is to know about Procera and become an absolute expert so you can increase your 3% portion? You lab guys are a bizarre group, but to provide for my family I will sell more implants. Like I said earlier, keep getting yourself excited about CAD/CAM, that's great, if I did that I would be broke. Understand the internal processes that happen at Nobel, and then comment. Otherwise stay out of the discussion because you are to some extent an ignorant bystander. I chase the money, as any business person should. Procera is great, precise, etc, but we don't make any money it as reps, there is the fundamental problem in one sentence.

 

!! You are so right! I wonder if he is so f…. lame when with his wife…PS. You were so kind with “3%”…
Who gives a shit about Procera or NobelProcera or whatever!
Jerry Vogel , go put some of the remaining zirconia copings on the last stripper from NJ man! Maybe she’ll take the vouchers, milk out the remaining 3% man !
It is not that far away to retirement, both for you and your C-team….and that was a goal wasn’t it?
But hurry up, these guys from Switzerland are burning the last 3% even faster than your previous pals from Sweden. As structured as they are, they are going to f…up everything on the road man- it is hilarious!
Or maybe you can call your B-friend from Biocad and ask him to become his boyfriend, maybe he’ll like “vintage” also so you can survive?
You guys are stupendous …. God Bless the Queen .
PS. Healiana helped Nobel to “hide” numbers from that Procera division in their books for a couple of years ago by not reporting it as a separate division but it doesn’t help !
Mark Jackson & friends, what a f.... go away to dentaltown or your other BS boards

 

No, I like you guys. I think I'll stick around a while. It's refreshing to hear the truth about the products I'm promoting.

Out of curiosity, did I make a mistake buying NobelGuide? I got the feeling that at $300-500 a pop, plus all the hardware I'm buying, I'd be getting alot of support from the company. It should add a nice pile on top of the $60 grand or so I spend on Procera and parts etc...

Seems like the territories just got realigned again?

 

No territories were realigned. We have never been paid for Procera copings, bridges or abutments. The territory where the scanning is done is paid. So, if there is a huge scanning lab in bum fuck Oklahoma, and the rep out there knows zero about Procera, the Oklahoma rep gets paid for the sale I made to the Dr in Maryland who sent his Procera prescription to The Oklahoma lab. Get it? So as much as you think I should know tolerances and that I am unmotivated because I don't want to learn "my" Procera product, the truth is, I don't work for free, and selling Procera restorations as a Nobel rep, that is what you are asked to do work for free. I agree with the PP, Jerry Vogel is an unethical piece of shit liar. He would fuck his own mother over if he thought it could make him some money or get him laid. The worst of the worst when it comes to ethics.
So now that you were humbled can you go to the lab boards.

 

No, dude. Don't think for a moment you humbled me. I'm humble by nature, and because I sign my name, I maintain some professional dignity. I'll rattle swords all day, but I don't need to name call or curse to make my point.

The territory here seems to have been realigned, as Tim Trapp is no longer my NobelGuide rep, Jeff McMann is. Call it what you want, but he's been realigned.

 

Kind of strange didn't know there was such a thing as a "nobelguide rep". Selling NobelGuide falls under implant sales, sold by regular implant reps. There used to be Procera reps that sold Procera products to labs, but Vogel did away with them.
Selling Procera CAD/CAM resto stuff is something different. If we sell NobelGuide software, and NobelGuide surgical kits it falls into the implant revenue bucket. If, by a million to one shot we sell a Procera coping or bridge it is something completely different. If we sell a Procera Scanner something different again. NobelGuide is not one specific product per se. There is the software which the Dr buys and we get paid, there are the surgical kits, then there is the surgical templates, which no one really buys. If you look at the utilization of NobelGuide software sold versus how many surgical guides are produced the numbers are horrendous, in the single digits. People buy the setup, then rarely have surgical guides produced. Learning curve maybe too steep.
As far as scanned restorations, i.e. CAD/CAM, we get paid literally like a .50 cents for each, if that, and that is assuming they are scanned in one's home territory. Needless to say very little incentive for reps to promote the procera cad/cam resto products, no money in it. That doesn't mean its not a good product, it just means we have to chase the money, and the money is not in Procera copings/bridges for the reps. Maybe profitable for a lab. Different business model.

 

About time someone started telling the truth about the percent of guided surgery utilization. Make my own tube guided stents and even when carefully doing the model surgery I often make minor adjustments after the initial pointed flapless pilot drill penetration. After raising the flap it is usually time to tweak things. I'm not sure CT's give you enough detail to avoid the same, but while I often order a CT, I don't have any experience with guided surgery.

 

You are correct, I'm sorry. He was my Procera rep, but I considered him the NobelGuide rep because frankly he is darn good at it. My new rep Jeff McMann is supposed to be just as good, and maybe even more experience, put Tim's a great guy and I'm sorry they changed his territory. Jeff and I both worked at Vident when I was an implant product guy there, so we'll work great together I'm sure. For the record my implant rep Josh Tanner is great as well.

I agree that most doctors buy NobelGuide, but don't use it much, which is why I decided to buy it. I think it's much smarter to have the lab own the CT scanner, take the scan, plan the case and order the guides. I'll bet my model will move a lot more guides than most doctors would.

Clear Choice sure seems to do a lot of them...enough to steal Momo.

 

A few comments, first, doctors are under utilizing NobelGuide Surgical templates(stents) not because the product is inaccurate or faulted, they fail to order them because they don't take the time to fully learn and understand the intricacies of the procedure. In your case, you state that "after I raise a flap" well in Nobelguide clinical procedure there is no flap raised, the soft tissue is removed through the guide with a round cutting bur. Removing your in house produced guide and then repositioning it after you raise a flap would definitely diminish your accuracy since the guide would be now sitting on bone after flap is raised, and possibly be positioned incorrectly since it was made from an impression that did not include a flapped soft tissue area. Also I bet you don't use a bite registration or guide pins to secure your stent, absolutely essential if you want a guide that does not move and decrease accuracy. CT Scans are the most accurate representation of anatomy, they are exact. NobelGuide is super accurate and works great, if one puts the time into learning it. Doctors are very concerned about chair time and sometimes do not put the time into learning these products. When they do, NobelGuide is a great procedure, I have assisted docs in many of these procedures with tremendous results. The under utilization is an ongoing challenge for Nobel because it is indicative of a training deficiency on Nobel's part, the docs are not being trained throughly to use the system so rarely buy the guides after purchasing the software/surgical kits.

 

I understand more than you will ever know. Implant reps are conditioned to chase the money & implant sales are a walk in the park when compared to restorative sales. I have been there, I know. As this company moves into a new restorative direction so will the implant sales rep - the times they are a changing.
PS Be thankful you have a lab rat as part of your team

 

Wow, this guy was really smacked down, and he trying to get up. OUCH, Lab Rat that must have hurt!

 

This so called lab rat you are referring to is about 6'7" tall so I'm not too worried about who would be going down...................(G)

 

First, most of my cases involve tooth supported guides so they do go in and out the same way twice because I take the time to make sure they do. Secondly I don't like the flapless approach since that very often compromises the amount of attached soft tissue.

As for other more involved cases which I seldom see in our practice I would send them down to ClearChoice because I know who is involved in Chicago and believe they will treat the patient well. But based on the ClearChoice TV commercial it doesn't sound like they are routinely using guided surgery.

If Mark's lab was in the Chicago area I wouldn't have to do that because it would be very cost effective to work with him. (His model sounds great but you reps must not like it very much since the surgeons probably wouldn't have to buy your software package) Unless you have your own scanner getting predictable data isn't always possible and this could be a factor in guide utilization. Working with Mark Jackson who now apparently does scans at his lab would avoid all the potential problems. Doing the surgery is rather straight forward and the prosthetics isn't all that involved either. It's the lab coordination at has to be perfect............

 

There have been a few labs that have tried to do the treatment plan and scanning for NobelGuide and Simplant. None have been exceedingly successful. One of the fundamental problems is that a doctor should be doing the treatment planning, not a lab person. Of course a qualified lab guy could very well be proficient in treatment planning, but at the end of the day, if I am a DDS, and I am doing the surgery, and taking the liability I want to do the treatment plan. If a lab treatment plans a case, and the Doctor impinges on the mandibular nerve and causes parathesia, will the lab or the Dr be sued? If a lab does a CT Scan, and fails to interpret the scan properly, and misses a cancerous lesion who is responsible? Labs are just that, labs, not medical/dental patient care givers.

 

I do not know of a single lab that would risk their business planning nobel guide cases, in california for example how can Mark provide a service like this legally since he is not a DDS - he probably has a DDS on staff that will vouch for the design of the guide and there are probably waivers and other agreements that a dentist will sign. In some states where the laws are not as strict probably can get away with doing this but frankly I find it crazy. I know one imaging center in the south that wil walk the doctors through this and probably have them sign something.

I am not convinced of the accuracy of Nobel Guide having been invovled with this and other softwares for years- way too many issues pre and post - other softwares hold greater promise and a longer track record- Simplant mainly

Plus Blue Sky Bio is another one with a free software that provides cost effective surgical guides.

I do agree with the accuracy of CT data though

 

I assume there is going to be interaction between the dentist and the lab much the same way I have with ConeScan so I don't think you have a valid objection as to who is actually planning the case. Don't be a control freak and get stuck up on your degree like too many of our colleagues. Remember 80% of impressions that reach dental laboratories are not considered to be an accurate representation of what is in the mouth, and while the technician should routinely return these cases they don’t because we are the dentist...............BS in my opinion, because there is no excuse for our rather remarkably poor track record in this regard.

Then you can question the other 20% because what is impressed correctly is all to often not prepared in a clinically acceptable manner to meet the technicians requirements.

 

The lab doing CT scans directly in their office, then treatment planning a Simplant or NobelGuide case on behalf of a Dr is a slippery slope, and different than a simple impression. An impression goes wrong, the crown doesn't fit, lab has to redo it. A surgical treatment plan goes wrong and a Dr accidentally severs an unseen artery in the oral cavity or slices the mandibular nerve the patient's treatment and maybe his life has been negatively effected. A lab gets a bad impression, and has to redo crown the labs profits are negatively effected, very different. You can use the "its only a degree" argument, but that is what separates a Dr from a lab guy, and a lab guy from a lawyer. It is something that needs to be respected.

 

For the record, I only post under my name, so you don't have to guess if I'm the Lab Rat being referred to or not.

The way we set up our scanning center is thus: I have a dentist who oversees the scan, and I have a dental assitant with her radiology license to operate the machine, though I am scheduled to get mine in April, but every scan is done under the RX and supervision of a dentist. Secondly, I have a Board Certifed Oral and Maxiofacial Radiologist who will review each and every scan, and also also review our implant plan before it is submitted to the dentist. The dentist is the only one who can approve the order for the surgical guide.

I also have a professional liability policy, which is above and beyond our corporate product liability insurance. Even our scanning suite and dental operatory was designed by a OMF Radiolgist and OMF surgeon. I think the plan has been well thought out, though the execution hasn't been as fast as I'd like. If I were in any other state, it would have been a lot faster.

Anyway, I think you'll see this business model to be the most viable one for the use of NobelGuide, Simplant, EZGuide or what have you.

 

Sounds like the model involves entirely too much start up and fixed costs. I have heard of the "dentist on staff" thing. Are you saying you have a dentist there full time, doing nothing but CT scans? Doesn't sound financially feasible. With a stand alone dental CT scanner requiring a minimum of 10-12 scans a month, to break even, add to that a full time dentist, which has to be $100K a year, a radiology report which is $45-65 per scan, then the labor, of the radio technician, your cost basis doesn't seem to be in line with a dental CBCT radiology center or a dentist owned CBCT scanner. Scans are on average now $275-325 per scan and headed down, how can you make any money with the cost basis you have?