Fee-for-Service Without Fear with Dr. David Eshom

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this powerful series, Dr. Melissa Seibert continues her in-depth conversation with cosmetic dentist and AACD leader Dr. David Eshom, exploring the deeper psychological, business, and interpersonal frameworks that underpin a thriving fee-for-service practice. Together, they unpack the realities of transitioning away from insurance dependence, the emotional traps dentists fall into, and the communication strategies that safeguard both the patient relationship and the dentist's peace of mind. Dr. Eshom offers decades of wisdom on how to recognize patient readiness, how to present comprehensive treatment without triggering defensiveness, and how to gracefully identify patients who may not be ideal candidates for complex care. He shares the subtle behavioral cues that differentiate collaborative patients from those who may become litigious, overly exacting, or misaligned with your practice philosophy—and how to exit these relationships ethically and respectfully when needed. The episode also tackles some of the profession's most pressing realities: Why the insurance model forces dentists into ethical and financial corners How to communicate a fee-for-service structure without alienating patients The psychology behind presenting conditions and consequences—not pressure and sales Why slowing down for deeper exams ultimately accelerates practice growth How to block your schedule, restructure hygiene exams, and build time for meaningful conversations The importance of discernment: knowing when a patient is truly a "yes," when they're a "not now," and when they're a "no" Dr. Eshom also walks through his workflow for large aesthetic cases—from shade decisions to motivational mock-ups and trial smiles—while highlighting how these tools improve clarity, set expectations, and reduce risk for both patient and provider. The conversation concludes with a reflective discussion about building a freedom-based business, attracting aligned patients, and creating a practice model that delivers exceptional dentistry without compromising your wellbeing, your values, or your clinical standards. If you've ever wondered how to elevate your practice beyond the constraints of insurance, identify ideal patients, or cultivate a career defined by autonomy and fulfillment, this episode is a masterclass in sustainable, relationship-driven dentistry.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  n Part 1 of this two-part series, Dr. Melissa Seibert sits down with cosmetic dentist and AACD residency preceptor Dr. David Eshom for a powerful conversation that reframes how dentists think about photography, diagnosis, communication, and case acceptance. Drawing from more than 20 years of comprehensive cosmetic dentistry, Dr. Eshom reveals why extraoral photography—not intraoral cameras, not radiographs—is the single most effective tool for building trust and helping patients clearly see the value of comprehensive care. Together, they break down a step-by-step new patient workflow that seamlessly blends diagnostics with psychology, showing how simple point-and-shoot photography placed at the beginning of the exam can elevate patient engagement, differentiate your practice, and eliminate the pressure-based communication styles that leave patients feeling skeptical or overwhelmed. Dr. Eshom explains how co-diagnosis—rooted in permission-based dialogue and visual storytelling—helps patients recognize their own conditions, understand consequences, and ask for solutions rather than being sold to. This episode dives into: The most overlooked use of photography in dentistry: real-time conversation with the patient How to structure a new patient visit that fosters trust, clarity, and long-term case acceptance Why facially generated treatment planning is so effective—especially for patients who "never knew" what their smile looked like Communication strategies that shift patients from an "insurance model" to a value-driven mindset How simplifying photography (yes, even with an iPhone or point-and-shoot) makes comprehensive exams dramatically more effective What to say—and not say—when presenting conditions to avoid making patients feel judged or pressured How this method empowered Dr. Eshom to build a fully fee-for-service practice and drop every insurance plan This conversation is practical, strategic, and deeply grounded in human psychology. If you want a proven communication system that elevates your new patient experience, improves case acceptance, and builds lifelong patient trust—all without feeling salesy—this episode will reshape how you practice.

Join Elevated GP: www.theelevatedgp.com Register for the live meeting: https://www.theelevatedgp.com/ElevationSummit Download the Injection Molding Guide: https://www.theelevatedgp.com/IMpdf  In Part 2 of this powerful two-part series, Dr. Melissa Seibert sits back down with renowned oral and maxillofacial surgeon Dr. Scott Bolding, whose orthopedic-driven approach to TMJ diagnostics and surgery is reshaping how dentistry understands joint disease. If you've ever wondered why TMJ patients get "punted" from provider to provider, why MRI-based diagnosis never became mainstream, or how degenerative joint pathology silently derails orthodontic and restorative outcomes, this episode will fundamentally change the way you think. Dr. Bolding unpacks the historical missteps that led to dentistry's decades-long avoidance of TMJ surgery—from disastrous 1980s implant materials to insurance fallout and a profession-wide retreat from joint management. He explains how this cultural shift created clinical blind spots that we still see today, and why the message of "TMJ will get better if you leave it alone" has harmed diagnostic rigor for an entire generation of dentists. Together, Dr. Seibert and Dr. Bolding explore: How ligament injury leads to disc displacement—and when that displacement becomes surgically relevant Why MRI and CBCT are indispensable tools for modern diagnosis (and what specific radiographic findings clinicians should never overlook) How unaddressed joint pathology contributes to tooth wear, occlusal collapse, postoperative symptoms, and even failed orthognathic cases The truth about total joint prostheses today—far removed from the failed biomaterials of the past—and why custom joints offer dramatic predictability for patients with severe degeneration The critical need for comprehensive dentists to reclaim TMJ literacy and function as quarterbacks—not bystanders—in interdisciplinary care Dr. Bolding also describes the orthopedic model for surgical decision-making, clarifying when joints can be repaired, when they cannot, and how airway considerations should influence mandibular advancement in joint reconstruction. The conversation closes with a call to action for dentists everywhere: joint-aware dentistry isn't optional—it's foundational to predictable outcomes in restorative, orthodontic, and airway-driven treatment planning. This is a masterclass in the contemporary philosophy of TMJ management—equal parts clinical insight, historical context, and future-forward thinking.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   Description: In this episode, Dr. Scott Bolding — leading oral and maxillofacial surgeon and airway reconstruction expert — dismantles the outdated belief that sleep apnea is primarily a soft-tissue problem. He explains why the bone dictates the obstruction, why skeletal repositioning is the true driver of airway patency, and how maxillary advancement, mandibular rotation, and hyoid biomechanics can radically transform patient physiology. You'll also hear how CBCT, DICE, and joint-first diagnostics reshape treatment planning for sleep apnea and complex cases. A must-listen for clinicians who want to move beyond superficial airway conversations and into evidence-based surgical frameworks.

Join Elevated GP: www.theelevatedgp.com Net32.com  Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram His interdisciplinary approach to dentistry is founded in both empirical research and clinical experience. He attended the University of Washington for both his undergraduate and graduate studies where he received his D.D.S. degree in 1995 and an M.S.D. and certificate in Prosthodontics in 1998. For his entire career, Dr. Kinzer has been committed to furthering the art and science of dental education. His unique ability to impart complex clinical processes in a logical, systematic and clear methodology differentiates him from other Prosthodontists and makes him a highly regarded educator nationally and internationally. He is a full-time teaching faculty at Spear Education in Scottsdale, AZ. where he is also resides as the Faculty Chairman and Director of Curriculum and Campus Education. Dr. Kinzer is an Affiliate Assistant Professor in the Graduate Prosthodontics Department at the University of Washington School of Dentistry and an Adjunct Faculty at Arizona School of Dentistry and Oral Health. Dr. Kinzer is a member of many professional organizations including the American Academy of Restorative Dentistry and the American Academy of Esthetic Dentistry, of which he is currently the sitting President. He serves on the editorial review board for several recognized dental publications and has written numerous articles and chapters for dental publication. He has been honored with the American College of Prosthodontics Achievement Award and in 2018, he received the Saul Schluger Memorial Award for Excellence in Diagnosis and Treatment Planning from the Seattle Study Club. In 2022 he was inducted into the World's Top 100 Doctors as part of the Interdisciplinary Cohort. In his free time, Gregg cherishes spending time his wife Jill and their 6 children. He enjoys anything that he can do outside: golfing, hiking, running, skiing, and biking, in addition to a nice glass of wine.

Injection Molding PDF Email me: [email protected] Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this second installment of Dental Digest's conversation with Dr. Jonathan Esquivel, host Dr. Melissa Seibert and her guest push deeper into the artistry, biology, and discipline required to restore anterior implants that are as functional as they are beautiful. While Part 1 introduced Esquivel's framework of space, volume, and time, this episode focuses on the next frontier—provisionalization, emergence-profile design, and the E-B-C concept that defines the biologic foundations of aesthetic implant therapy. Dr. Esquivel begins by demystifying the provisionalization workflow for anterior implants—whether immediate or delayed. He walks listeners step by step through decision-making factors such as ridge healing, tissue phenotype, and the importance of minimizing the number of disconnections to protect the fragile mucosal seal. He stresses that efficiency in implant dentistry isn't about finishing fast—it's about achieving predictability in the fewest biologically respectful appointments. The discussion then turns to the team-based dynamics between the restorative dentist and the surgeon. Dr. Esquivel details how he coordinates cases digitally, sending STL files and mock-ups for joint planning before the first incision. His six-phase system—Acquisition, Blueprint, Confirmation, Design, Execution, and Follow-up—illustrates how restorative-driven implant dentistry must begin with facial and prosthetic design, not with a drill guide. From there, the episode dives into the chairside artistry of immediate provisionalization. Using a pre-milled shell and temporary cylinder, Dr. Esquivel describes how to "pick up" a provisional and sculpt the subgingival contours in real time. But as he emphasizes, the true challenge lies not in fabrication—but in understanding how material additions and reductions influence soft-tissue behavior. This insight leads to one of the most clinically valuable segments of the episode: Dr. Esquivel's E-B-C concept, an evolution of the classic critical- and subcritical-contour framework. The E-Zone (Esthetic Zone), roughly the first millimeter below the gingival zenith, governs margin stability and the visible pink–white transition. The B-Zone (Biologic or Boundary Zone) supports the mucosal seal and should remain concave to create space for healthy soft tissue. The C-Zone (Crestal Zone), the most apical 1–2 mm, must be slim and biologically quiet to preserve the crestal bone. Dr. Esquivel explains how even subtle over-contouring in these zones can trigger recession or bone loss, while proper shaping promotes long-term harmony between implant and tissue. Using tactile language, he describes his preference for pear-shaped acrylic burs to sculpt the concavity of the B-zone, and how digital workflows now allow clinicians to model these micro-contours virtually before any material is placed. The conversation culminates in a reflection on philosophy as much as technique. Dr. Esquivel urges clinicians to focus on mastering the basics—aesthetic symmetry, biologic respect, and patience—rather than chasing novelty. "An implant is not a tooth," he reminds us. "Our goal is to protect the bone, guide the tissue, and understand what we can't see." Listeners will leave this episode with a detailed understanding of: How to design, print, or fabricate custom provisionals that shape the soft tissue biologically The dimensional logic behind the E-B-C zones and how each governs tissue stability Why limiting abutment disconnections preserves the mucosal seal How digital and analog workflows can be integrated seamlessly And the mindset shift required to see implants not as prosthetic devices, but as biologic restorations Part 2 is both a masterclass in subgingival design and a meditation on restraint. Dr. Esquivel reminds us that excellence in implant aesthetics doesn't come from doing more—it comes from doing less, but with absolute intention.

Injection Molding PDF Email me [email protected]  Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this episode of Dental Digest, Dr. Melissa Seibert sits down with prosthodontist and educator Dr. Jonathan Esquivel for part one of an enlightening two-part series that explores the biologic and aesthetic complexities of implant restoration. Known for his meticulous approach and his evidence-based framework of space, volume, and time, Dr. Esquivel brings clarity to one of dentistry's most challenging frontiers: the anterior aesthetic zone. They begin by examining why restoring a single anterior implant is often considered the ultimate test of restorative mastery. Dr. Esquivel explains that implants behave fundamentally differently from natural roots—they lack the periodontal ligament and its vascular support—making soft tissue far less forgiving. Even slight changes in tissue contour or bone volume can compromise long-term success. He introduces his four cornerstones for implant predictability: luck (biologic variability), three-dimensional positioning, emergence-profile design, and patient maintenance, emphasizing that precision and patient education are inseparable. The conversation then turns to three-dimensional implant positioning and the role of reverse-engineered planning. Dr. Esquivel insists that every implant must begin with the end in mind—by first visualizing where the tooth should be. He details how ideal placement, roughly 4 mm apical to the planned incisal edge and aligned toward the cingulum, forms the foundation for natural emergence and long-term stability. But true success, he notes, depends equally on interdisciplinary collaboration—sometimes requiring orthodontic repositioning or periodontal modification before an implant is ever placed. Dr. Esquivel and Dr. Seibert next tackle the aesthetic challenge of adjacent implants and the pursuit of symmetry. Perfect papillae between centrals are notoriously difficult to maintain, and Dr. Esquivel discusses techniques—from soft-tissue grafting to orthodontic extrusion—to preserve harmony between the pink and the white. He stresses that treatment planning is as much about patient selection and expectation management as it is about surgical technique: "The hardest part isn't the implant—it's finding a patient willing to go through the process." The discussion deepens into the critical role of soft tissue in achieving lasting aesthetics. Dr. Esquivel explains his distinction between margin-preservation therapies (maintaining existing tissue contours) and margin-re-establishment therapies (rebuilding lost dimensions). He makes a compelling case that most anterior implants benefit from connective-tissue grafting, since thicker tissue phenotypes promote margin stability, mask restorative materials, and protect against recession. From there, the episode explores ridge dimensional changes after extraction—why bone and soft-tissue collapse are inevitable without intervention, and how provisional restorations can slow this process. Dr. Esquivel cautions against relying on removable flippers, which may accelerate resorption, and instead advocates for properly designed Essix retainers or fixed provisionals that maintain space without transmitting occlusal pressure. His guiding principle: space, volume, and time—allowing tissue to heal in an environment that supports both biological integrity and aesthetic form. The conversation culminates with an in-depth reflection on the biological and prosthetic purpose of provisionalization. Drawing on insights from Dr. Todd Schoenbaum, Dr. Esquivel reframes the provisional phase not as optional, but as biologically mandatory. The provisional guides tissue healing, allows for gradual adaptation, and provides essential information for the ceramist—ensuring that the final crown replicates the ideal emergence contours established chairside. As Dr. Esquivel puts it, "Dentists should take credit not for the white, but for the pink—the transition zone we've designed and stabilized." By the end of this episode, listeners will gain a detailed understanding of: How to apply Dr. Esquivel's space–volume–time model to aesthetic implant planning The biologic reasoning behind connective-tissue grafting and margin-preservation therapies Why provisionalization is central to both soft-tissue stability and prosthetic accuracy How to communicate healing timelines and realistic expectations to patients Part one of this series is both technically rigorous and refreshingly human—an exploration of how aesthetic implant success lies not in speed or convenience, but in respecting biology, sequencing, and time.

Injection Molding PDF Email me: [email protected] Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Episode Summary In this powerful continuation of their two-part conversation, Dr. Melissa Seibert and Dr. David Attia dive beyond digital workflows to confront the deeper philosophical questions shaping modern implant dentistry. Building on last week's discussion of data stacking, SmileCloud integration, and biologically driven design, this episode explores the nuanced realities of aesthetic-zone decision-making, ethical treatment planning, and the human side of high-level clinical care. Dr. Attia opens with an unflinching look at when—and why—implants may not be the ideal solution. Using examples from his collaboration with renowned prosthodontist Dr. Tony Rotondo, he explains why lateral incisors often perform better with resin-bonded fixed partial dentures (FDPs) rather than implants, especially in cases with limited mesiodistal space or compromised interproximal bone. He and Dr. Seibert examine the synergy between partial extraction therapy and resin-bonded FDPs, illustrating how biologic preservation can achieve long-term aesthetic stability with less surgical intervention. From there, the conversation transitions to Attia's mastery of provisionalization strategies in the aesthetic zone. He details how he designs custom healing abutments and Maryland-style bridges that provide patients with fixed provisionals—even when primary stability is limited. Listeners gain an inside look at his precision-driven process for contouring the subcritical zone, controlling soft-tissue architecture, and creating minimal yet functional clearance between the pontic and abutment. His philosophy is simple but profound: every anterior patient should leave the chair with something fixed—even if it isn't load-bearing. The discussion then widens to tackle the moral tension between commercial dentistry and biologic integrity. Dr. Seibert asks the hard question: How do clinicians reconcile high-quality, time-intensive dentistry with the economic pressures of high-volume practice? Dr. Attia's answer is unequivocal—ethical dentistry may take longer and require greater effort, but the money follows the mastery. He critiques the growing trend of overtreatment in both restorative and surgical spheres, warning of a coming wave of revision cases born from expedience and over-commercialization. Attia advocates for a "longevity-first" mindset—prioritizing preservation over replacement, patient education over production, and sustainable outcomes over speed. Drawing from his own follow-ups across fourteen practices, he reflects on the humility and evolution that come with long-term case review: what he did six months ago wasn't wrong—but it can always be better. The episode concludes with a candid meditation on values alignment in practice. Both clinicians emphasize the importance of knowing one's philosophy, communicating it transparently, and being comfortable acknowledging that "you're not everyone's dentist." Attia urges younger practitioners to resist the social-media allure of aggressive full-arch cases, reminding them that truly exceptional dentistry begins with sound biologic principles, refined communication, and disciplined restraint. Listeners will leave this episode with: A framework for choosing between implants and resin-bonded FDPs in the aesthetic zone Strategies for designing custom provisionals that maintain soft-tissue integrity Guidance on educating patients about biologic and financial "costs" of treatment Insight into navigating the ethical crossroads of modern dentistry This conversation is both technical and deeply human—a masterclass on how to balance innovation with integrity and how to practice dentistry that endures not just biologically, but ethically.

Injection Molding PDF Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram   In this first of a two-part series, Dr. Melissa Seibert sits down with Dr. David Attia—an international educator leading the charge in digital and implant dentistry—to explore how advanced technologies are revolutionizing multidisciplinary care. Together, they unpack how tools like SmileCloud, CBCT segmentation, and 3D facial scanning are allowing clinicians to "stack" digital data for unparalleled treatment precision. Dr. Attia shares how virtual patient workflows have streamlined his implant and aesthetic planning, transforming coordination between surgical, restorative, and laboratory teams. The discussion also dives into biologically driven implant concepts, the evolution of partial extraction therapy, and the philosophy that "preservation is the ultimate form of regeneration." This episode will reshape how you think about digital integration and tissue preservation in the aesthetic zone.   Dr. David Attia completed his undergraduate training at Griffith University, Queensland. Following graduation, Dr. Attia completed a Post Graduate Diploma in Orthodontics and Dentofacial Orthopedics through the City of London Dental School. David's passion for surgery led him to complete a Master's in Oral Implantology through Goethe University in Frankfurt, Germany. His Master's thesis focused on a novel approach in full-arch implant rehabilitations and he presented his research at the 6th Annual Congress of Innovation Jumps in Oral Implantology. Dr. Attia now holds a teaching appointment with Goethe University as a surgical mentor for Australian students completing the program. He has also presented on the implementation of photography into clinical practice, as well as the importance of soft tissue management around implants both locally and abroad. Dr. Attia is a core faculty instructor for the Australasian College of Dental Practitioners Graduate Diploma in Oral Implants and is also involved in live surgical training of dentists looking to begin or advance their journey in dental implantology. David thoroughly enjoys the multi-disciplinary approach to dentistry. His unique combination of education and training allows him to implement cutting-edge treatment, offering patients comprehensive, predictable and long-term treatment solutions. He is passionate about sharing knowledge and is regularly involved in training and mentoring recent graduates.

Injection Molding PDF Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram In this episode of Dental Digest, host Dr. Melissa Seibert sits down with Dr. Marcella Alvarez, prosthodontist and educator, to explore one of the most transformative ideas in modern interdisciplinary dentistry—pre-orthodontic bonding. Dr. Alvarez explains how this restorative-driven approach flips the traditional sequence by establishing anatomy and function before orthodontic treatment. The result: improved collaboration, reduced guesswork, and highly predictable outcomes for patients with severe wear and collapsed bites. Together, they discuss practical workflows—analog and digital—diagnostic frameworks from Robbins and Rouse's Global Diagnosis, and the critical role of airway-conscious planning in long-term success. Whether you're a GP, prosthodontist, or orthodontist, this conversation reframes how you think about sequencing, diagnosis, and comprehensive, minimally invasive care.