14 Insights from the Coachman and Apa course: Coffee Break with Coachman podcast

This transcript has been reviewed by AI and may contain inaccuracies.

Christian Coachman: And three, two, one, and we are live with Coffee Break with Coachman, together with my friend Kirk Behrendt. Kirk is going to be in the background, making sure I'm on track and not forgetting the questions. Today, we have an amazing topic, a fresh topic: we're going to talk about the recent course, ‘Designing Smiles with Michael Apa and Christian Coachman.'

Kirk Behrendt: Christian, thank you for coming back, brother. I appreciate you.

Christian Coachman: Great pleasure to be back and to restart our series of podcasts here. Always a pleasure. I just landed from the airport, straight to the studio to connect with you. Of course, everything is fresh in my mind about everything that happened this weekend. It was one of the most intense weekends in my professional and lecturing life.

This event that we organized in Miami has been in the planning stages for many, many years. We've been thinking about doing this and then pragmatically working on it for more than a year, and it happened. It was a big success. We are very happy and relieved, and the feedback has been amazing. Maybe we are even going to do it again. Let's see. For those who don't know what happened: Michael Apa, probably one of the most successful dentists in the world, and I, Christian Coachman, organized this event. Mike Apa developed his brand in aesthetic dentistry and became a huge brand himself with Apa Aesthetics, his practice in Manhattan, then expanding to Dubai, flying back and forth every other week for many years. He later opened a successful practice in Beverly Hills, and this week, during the event, he opened his new practice in Miami. Unbelievable architecture, beautiful practice—all his practices look amazing.

Mike is very well known for a couple of things among the dental community. First, for having an amazingly successful business and brand, transforming the smiles of many celebrities. He's really a Celebrity Dentist with a huge following on Instagram, almost 600,000 followers. He mentors many people who look up to him or want to learn from him. He has an amazing system with his in-house lab: over 30 technicians, some of the best in the world. I actually helped him recruit some of them, many from Brazil. They work full-time for him in all locations, delivering beautiful smiles, which is why he is so successful.

Since forever, we've been trying to put something together. In the early 2000s, in 2004 when I first met him, we almost worked together. Larry Rosenthal hired him to work in his practice and was about to hire me as a technician. So in 2004, we almost worked together for Larry. Apa took over Larry's practice and grew from there, but we kept the relationship. Every other year, we would meet and try to find a way to collaborate, sometimes discussing opening practices together, other times opening a lab together, doing special cases together, or starting an educational program together. But you know how life is—super busy. Five years, ten years, fifteen years went by until last year when I said, 'Mike, I have an idea: we're going to put a course together. The reason it’s going to happen this time is that this course will be all about what really unites us, what really unites me, Christian Coachman, Creator of Digital Smile Design, and you, creator of APA Aesthetic. The topic will be exclusively and purely 100% focused on smile design and not anything else. How do you brand yourself as a smile designer? How do you grow as a smile designer? How do you become a better smile designer? How do you communicate as a smile designer? How do you implement systems to master smile design? How do you interact with the lab specifically about smile design? How do you diagnose smile design? How do you treatment plan smile design? How do you execute smile design?’

He loved the idea because that's what he does every day, that's what I do, and we have completely different perspectives. He's very analog, and I'm very digital. Whatever he's doing is working perfectly for him; whatever I'm doing is working very well for me. Also, he has an in-house lab; I own an outsourcing lab. I help dentists from all over the world design their own smiles; he designs himself for his patients. But as we like to say: even though we use completely different tools and systems, and our vision about dentistry is very different, when it comes to smile design, we have exactly the same starting point and the same final goal.

So with the same starting point and the same final goal, let's go to a course and live on stage, let's debate our differences, our systems, and our philosophies. Let's create a course where we are completely free to interact. It's not like you give your lecture, I give mine. We're going to be teasing each other on stage, picking on each other, commenting, criticizing, and making fun of each other. We'll do whatever we want but with the main intention to get to some common ground, common sense, what really matters in the end.

So with that in mind, we started to put the program together. We met several times, working on each live. Imagine two days, from 8:30 to 6:30, almost non-stop. Two days, almost 20 hours of content, super dense, super intense, and the course came out. It actually happened this weekend, and what we imagined happened: It was a big debate, a lot of fun on stage, some tense moments, and even moments of high intensity of not agreeing with each other, but in a very cool way. The audience loved that, mainly the back and forth.

My suggestion here today is that yesterday, when I was flying back home, I said, ‘Okay, let me take advantage of the fact that everything is fresh and write down everything that he said that I don't agree with, and everything I said that he doesn't agree with. Let me also write down everything that we both said that we do agree on, the main topics of the course.’ As we were talking before we started recording, there are 14 main moments that we covered: 14 main conclusions, 14 consensus, let's say, that I want to quickly summarize here with you.

Kirk Behrendt: There were several hundred dentists that witnessed this, right? Like you had a packed house.

Christian Coachman: We had a packed house, which was also very cool. As you know, we are all about the experience, and APA is also focused on the experience, so the course needed to be an experience. First, it was in an amphitheater, not a hotel room, so it had the amphitheater style. It was a theater for concerts. We had probably one of the biggest LED screens you can imagine on stage, amazing AV team, three tons of AV Equipment. Amazing visuals, amazing layout, amazing ambiance, great music always, great doctors. We had 500 people attending. It sold out super fast; it was a big success.

To start with, it put a lot of pressure on me to actually put the program together and deliver. I was really worried we didn't have time to rehearse much, so I knew things would just happen live on stage. The team backstage did an amazing job, and everything went smoothly. We had several laptops and iPads, a live demo, a live patient, I did a live wax-up on stage, he did a live mockup on stage, we had clinical discussions of case discussions live through iPads, we were drawing over cases, the audience was sharing cases with us, and we were discussing the cases. There was a lot going on, and it came out nice.

Of course, I already have a million things that I want to do better for the next time.

Kirk Behrendt: I think it was a success. If you're looking at social media, there's a lot of people there. It was pretty exciting. So let's go through each one of these.

The first one was the documentation philosophy and smile rehabilitation – walk us through that.

Christian Coachman: So let me quickly read my notes here and then I will comment. This is what I wrote when it comes to documentation for smile rehabilitation cases. Apa and I agreed on the need for high-quality and complete initial documentation with an emphasis on the face. This is something that unites us. He has his own way of capturing the face. These days we have our own, but we both know that this is the starting point: you need to document the face very well. While it does sound obvious, as a lab owner, I can tell you that labs all over the world are still not getting quality facial information with their cases. So doctors are still not fully exploring a systematic approach on how to document the face and how to share this information with the lab. This was a very strong outcome and common sense. Every doctor needs to incorporate in the first appointment how to look at the face, diagnose the face, document the face, and communicate the face. So this was the first point.

Kirk Behrendt: Point number two is diagnosis and planning.

Christian Coachman: Still on the face.

Kirk Behrendt: Oh, still on the face.

Christian Coachman: Yeah, still on the face, there was a kind of different approach here. I believe that a simple protocol with an intraoral scanner and a smartphone is enough. If you have a smartphone and a scanner, you can capture the face and the mouth very simply on the first appointment and then send it to the lab. Apa, he still uses a more sophisticated DSLR camera photo protocol, which is beautiful but more time-consuming. I honestly don't think the extra work is necessary, but he still believes that sophisticated pictures bring added value. This was a conclusion. I emphasized the importance of video, and this is something he totally agreed with. He actually mentioned that he learned from me and started seven years ago making it mandatory. For DSD, facial video analysis is mandatory. So documenting the patient's face through video and then training yourself and your team on how to interpret the video, analyze the video, the motion, the movements, dental-facial harmony or disharmony through motion. This was a common sense conclusion. The 12 o'clock picture analysis is also mandatory in the DSD protocol. Apa showed live on stage how he analyzes the smile from the 12 o'clock position. So the 12 o'clock position analysis and documentation was also common sense there. That's topic number one.

Kirk Behrendt: Love it, love it, love it. If you're listening to the podcast, it would be awesome to dive deep into the mechanics and the why, but we can't do that today. Maybe we'll come back and do that as a follow-up. Point number two was diagnosis and planning. I do love this. I love how you're able to separate those points of view for the benefit of everybody else listening. This is great.

Christian Coachman: Of course, this was the consequence of me thinking for a few hours and writing this down. People at the course didn't get the benefit of this summary. This is probably something that I'm going to share with them afterwards, maybe during this week. But of course, at the next course, I was able to convince Mike we're going to have a next course. Many people who did this course sent us messages that they want to do the same course again. So there will be a next course, and this summary will make the next course even better because we're going to start from this and emphasize each block's conclusions with even better understanding.

Point number two, you mentioned diagnosis and planning. What are the differences and the similarities? I explain my belief in exploring collective intelligence, asynchronous communication, and digital tools to understand all issues and develop a diagnostic design and build a treatment plan to be presented on a second appointment. For me, it's very clear that whatever conclusion you share with your patient on the first appointment, you're missing the opportunity to further explore collective intelligence and digital analysis to understand better the problems and explain to the patient on a second appointment. Apa explains the challenges of postponing this communication to a second appointment because many patients will not even show up on the second appointment, and you're going to miss the opportunity to close the deal. Apa is all about quick analysis, quick diagnosis by himself, completely alone. So no interdisciplinary discussion, no comprehensive discussion. Everything is in his head. He looks at the patient, doesn't leverage 3D technology to diagnose and plan. He relies 100% on his clinical experience, x-rays, and pictures. In a few minutes, he gets the conclusion and immediately presents it to the patient.

Now, of course, you can understand the advantages of having this huge impact immediately. I still believe that his approach may be good for business in this first moment, but when it comes to comprehensive care, I think the future belongs to the dentist that will be able to convince the patient about the value of not rushing into conclusions at that point and scheduling the second appointment to leverage collective intelligence, 3D diagnosis, 3D simulations, and so on. Apa does a same-appointment clinical examination, assessment, x-rays, and photos and believes this is enough to define the plan and present the plan on the same first appointment. That was a great discussion moment there because I appreciate his approach, and it works for him. I still believe that it's impossible, no matter how good he is and how much knowledge he has, that thinking with several brains will always bring benefit. But we both agree the challenge is how to make the patient value that. That's why DSD works so hard on helping dentists create value for the patient so they value this process. But I do agree that sometimes when you see the patient is not getting it, you may need to give something at that first moment and get the patient on board. So, understanding all options and using the best strategy for each situation is key.

Another point, Christian believes in comprehensive care with strong involvement of perio and ortho to diagnose and plan all cases, separating the day of data collection and treatment presentation by a few days. A two-appointment process will allow you to integrate all the specialties. Apa believes he can solve almost all cases only with restorative and prefers to diagnose and plan alone without collective intelligence or 3D technology. He believes that if the plan is not presented on the first appointment, case acceptance chances will drop drastically. Christian agrees with that but still believes a two-appointment approach is key to developing ideal comprehensive care and can be financially successful if you master storytelling. It is more difficult, but it's possible. That was the conclusion for topic number two.

Kirk Behrendt: Now, topic number three: case acceptance and treatment presentation.

Christian Coachman: Comprehensive care we already discussed. He believes that comprehensive care is all in his head; I believe it's a combination with several heads. On case acceptance, performing the motivational mockup and presenting the plan to the patient, Apa and I both believe in the importance of this moment and have created our own powerful workflows to be successful with case acceptance. DSD is known for the case acceptance emotional dentistry approach, and Apa is also known for case acceptance, as his numbers are insane. There is nobody in the world that does more smile design cases per month than Mike Apa. I guarantee you that in four different locations, his numbers are insane. Learning from him on how to generate leads, convert leads, and deliver quality to stay in business for 20 years is something that, regardless of whether you agree with his treatment planning approach, you have to admire his systems for case conversion and clinical execution with high quality and beautiful outcomes. That's something I always admired, regardless of our differences in interdisciplinary approach.

We both believe in setting up the treatment presentation room where you can leverage storytelling and visuals. If you go to his practices, you'll see everything happens around that consultation. He calls it the consultation. I call the first appointment the emotional dentistry approach; he calls it the first consultation. Technology and the team—we both believe everything is like Cirque du Soleil. It's a show; it's showtime. Everything needs to be rehearsed, smooth, perfect, impactful, meaningful, and straight to the point. The patient needs to say 'wow' at least three times in that one hour. We both believe in spending time building the infrastructure and mindset to leverage storytelling and visuals and create this amazing experience in the practice. We both believe that you never have a second chance to create a first impression, and the business moves around that. We both believe there is no one-size-fits-all strategy; you need to master all strategies and customize depending on the patient's character, case, and time. You need to be a master at reading people emotionally.

Apa has a process between the person on the phone, the treatment coordinator, data collection, and when he meets the patient for the first time. He already has a whole x-ray and background of the patient that allows him to come in and know exactly who is in front of him before he meets the person. He has a very effective system for that, and he explained this in the course. I agree; this is huge, to really exceed expectations at this initial moment. Apa explores the direct mockup, though he mentioned he is doing it less now. Direct mockup means that somebody you never met sits down in front of you, and after the initial conversation, you look at the patient and immediately understand what is right and what is wrong. In a few minutes, you build a new smile freehand with composite in 10 minutes. He's very well known for that and very good at it. But of course, it requires a lot of energy, time, and chairside time. It's not for every case. So he's now blending it more with having the lab do wax-ups and him placing the wax-up in the mouth instead of building from scratch, or leveraging, in my case, my suggestion of using smile simulations with software. We both showed how we do freehand drawings chairside on the iPad, mirrored on a big TV in front of the patient. Taking pictures, putting the smile on the face on the screen, and starting to draw on top of it live, 100% improvised, showing the patient we know what we are doing. We immediately know what is right, how to improve it, and we can translate our vision through drawings. The key is to have a smile design tool to express this project to the patient. Use visuals, whether it's pictures, direct mockup, indirect mockup, software, iPad drawings—you need to master all of them and choose the tool depending on the occasion, case, and patient.

I believe in saving time by leveraging the lab to do the design, but both agreed that regardless of how you do the initial diagnostic design, the huge differential comes from dentists who know how to try these projects in the mouth, analyze them, and modify them until they are ideal. Apa emphasized you need to be the one doing it, and I commented you don't actually need to be doing it, but you need to master the process of improving it. If a lab can do a wax-up faster, better, and cheaper than you, let the lab wax it up digitally or analog, put it in the mouth. But one thing we both agreed on: no matter how amazing the software, technician, or wax-ups are, it's never like in the mouth. The mouth will give you the reality of how good or bad the smile is. The fact that you are in three dimensions in the mouth, with motion and soft tissues, means you can only see the true result in real life. So that was a huge take-home message. You will get 90% of the quality with a lab, but you won't hit 100% unless you master the process in the mouth.

Christian believes there are two very different mockups: one is the motivational done before case acceptance to get the patient on board, and the second is the technical mockup done after case acceptance to communicate with the patient and lab and guide the prep. In the DSD workflow, we have two different smile test drive moments. One before case acceptance with the goal of creating the wow effect, and one after to create the rational discussion about smile design. You need to master both moments and how you communicate with the patient in both moments. Apa has a different approach since patients come to him already wanting an elective smile makeover. His first mockup is a mix between motivation and technical discussion. This is important for people to identify their situation with their patient. Is this a patient who has no clue how a smile can change their life, and you want to motivate them to accept the treatment after? Or is this a patient who is already on board and now you want to rationally get them on board with the design? You need to think about the patient’s situation when doing a smile test drive because the strategies are different.

Both Apa and Christian showed similar tricks for mockups with black marks and optical illusion and composite because most motivational mockups happen before starting the treatment, so it needs to be additive. Many cases are ideally not additive, so you need to cut back to do the mockup. You need to find ways to do a motivational mockup on a subtractive case. You need to use tricks to overlap what exists and make it look good. That's why after you reduce the teeth, either through burs or ortho, you do the second technical mockup to guide the preps and finalize the communication with the patient. This is what we're going to get. Both agreed that mockups are not possible in some drastically subtractive cases. Motivational mockups are not possible in some situations. In these cases, you need to rely on other strategies to communicate and motivate patients. Christian mentioned that digital smile simulation can help in these situations, and Apa believes the key is to create a level of trust that the patient will feel comfortable accepting without visualization. This is when I did the demonstration of the DSD app, how you can make simulations on cases where you don't want to do a mockup or cannot do the mockup. Apa is much more about creating an immediate relationship with the patient, where you better trust him. The whole experience is like the patient saying, 'Okay, I trust you, let's go for it.'

Both agree that 2D or 3D software and even handmade work on analog models will never provide the full perspective of dental-facial integration. Actually, we already talked about that. No outside-the-mouth tool will generate the full perspective of dental-facial integration. The only way to have a complete perspective of it is in the mouth. Anything done digitally or in the lab or on models or outside the mouth needs to be validated and improved by the dentist in the mouth. That's the reason why this course was so important. Our goal was to give insights for dentists to become the real quarterback of this process.

Kirk Behrendt: Love it, love it. Did you have a moderator at all that could say, okay, if it ever got heated or a little bit?

Christian Coachman: We didn't, but we could. I was kind of doing that role, but maybe we can explore that idea for the next course, to have a moderator.

Kirk Behrendt: I'm just telling you I want to go next year, and it might be a good idea to throw questions in.

Christian Coachman: You are my guest, 100%. You could be an amazing moderator.

Kirk Behrendt: I think you need somebody who knows something, but I'm happy to ask the questions that somebody else would want to ask. Keep going, my friend.

Christian Coachman: Both agree that branding happens chairside above any other type of marketing. This is a quote from Mike. Mike always says that because he gets really angry when people say, 'Apa, you're very successful because you're very good with marketing.' He gets pissed. 'I'm very successful because I'm very good chairside, because I'm delivering quality in the mouth. That's why I'm successful. Everything else is a consequence. Social media marketing can help you, but magic doesn't happen if the magic isn't chairside.' We both agree that the whole DSD purchase moment experience—we talked about that in the past—the magic isn't in the marketing before or the clinical execution after, but in those first and second appointment moments where you're creating the experience chairside or in the presentation room. I think that was a big point where every dentist needs to ask themselves. One thing is to master clinical work chairside. One thing is to master everything—the whole experience chairside—and differentiate yourself. A great clinician is one thing, but a great clinician who knows how to create a great branding experience chairside is different. You need to think about that. Otherwise, you'll just be a great clinician. The patient, unfortunately, is judging much more the rest because they're not seeing the clinical execution, at least in the short term.

Rehearsing with your team like Cirque du Soleil, how the chairside experience happens in a way that everything is so smooth that the patient is impressed, regardless of whether the patient can identify the clinical quality of what you just did. For me, that is very important. Both agreed that the first appointment experience needs to be so good, so rehearsed, so smooth, so precise, and effective that this will be the number one reason for somebody to choose you as their dentist. You never have a second chance to create a first impression, and that first impression in that first one hour with you in the presentation room and the chair is the key for success. That's what will give you leverage and credits with the patient. Even if something goes wrong with the treatment, you still have the credit, and the credit comes from the first impression. Patient experience is key for both. Apa and I, of course, focus on patient experience. I like something Apa said in the course. He developed systems for patient success. Everybody talks about practice success, clinical success, and he's like, 'My systems are for patient success.' It's a very subtle difference but huge at the same time. The success needs to be the success of the patient. The patient needs to go home after each appointment feeling like this was a success for me. Many things in dentistry, we know that long-term is hopefully a success for the patient, but at that moment, after that appointment, the patient is not feeling very successful. How do you turn this upside down? How do you create situations where everything you're doing generates the sensation in the patient that this is a success for me?

Apa mentioned strategies for patient success, understanding what they want, and focusing on fixing their problem for them. Every good dentist is always fixing problems for the patient, but many times we interpret wrongly what they believe is their problem or their priorities or what really matters for them. What is success short-term, mid-term, and long-term for them? That made me evaluate Apa's work slightly differently because I was often critical of him. We are always very honest with each other. I say, 'Mike, why didn't you consider this treatment? Why didn't you consider that? Why did you prep this way? Why didn't you do ortho?' Of course, I still have many situations where I don't agree with his treatment plan, but today I understand better that many times he is doing what is success for the patient. Patients are grateful and come back after 10, 20 years. If he was just driven by money and aggressive dentistry, he wouldn't be as successful for so many years. It's impossible. He is doing something right for the patients that makes them come back over and over again. This is something we need to be open to listen to.

Apa strongly avoids ortho; Christian strongly encourages people to explore ortho possibilities and advantages but agrees with Apa that too many times ortho can create more problems than solutions. This is my point because I'm all about interdisciplinary, always considering ortho, etc. Philosophically beautiful, but real life is different. Many times when you try to do ideal and things are not perfectly under control or the specialists are not on board or you're not working with the right tools, you take what you learn from courses from the interdisciplinary perspective, bring it to real life, and end up transforming the patient's life into a nightmare and not solving the problem. Having a certain level of pragmatism and honest acceptance that it's much easier to say that interdisciplinary is better than to actually do it and make it better for the patient's life is crucial. Doing that beautiful digital design on the software with ortho simulation and showing that beautiful lecture about integrated approach is great, but then going into real life and having the patient go through one or two years of ortho, not ending up in the right place, one more year of ortho, then changing orthodontists, one more year of ortho, and ending with an open bite and TMJ issue is too common. That's the criticism Apa has with this comprehensive philosophical approach. He's like, 'With a little bit more aggressive preps, I can get this done in two appointments and have a new smile working for the patient for 20 years.'

It's not a very clear line between being pragmatic, being minimally invasive, short-term benefits, and long-term benefits, but I respect where he's coming from. Of course, I still believe we should be pushing more for conservative and interdisciplinary approaches. If the specialists are not doing it properly, we need to understand how to do it properly instead of quitting. This was the debate, but it was a nice discussion into exploring the possibilities from my perspective while keeping the patient in mind and providing a pragmatic solution from his perspective.

Next topic, Christian believes that artistic skills and intuition are key to diagnosing bad smiles and designing beautiful smiles above any rule, scientific article, or guideline. We made it very clear. I spent a lot of time sharing parameters and guidelines and articles and rules and principles, but at the end of the day, being a great smile designer is very subjective and artistic. You can read and memorize all the articles in the world, but if you don't have artistic perception, you will never be a good smile designer. All the articles are interesting to understand what is out there, the norm, the average, and the guard rails. But this is just the starting point. The incisal edge should be 2 to 4 millimeters longer than the lip at rest. That's a starting point. What do you do with that? At the end of the day, this rule will not help you solve the problem because when you talk about 2 to 4, it can actually be 1 to 5. You look at the patient and say, 'Okay, the article says the incisal should be exposed 1 to 5. What do I do for my patient right in front of me?' It's on you. You need to look with artistic perception and define that because of who you are, the face you have, the dynamics and motion of your face, the smile you dreamed of. This is where the incisal should be. Articles will not help you with that final stretch.

Apa was like, 'Don't waste time with rules and parameters,' and I was saying, 'Know them, use them as a starting point, but at the end of the day, we are using and doing the same thing—intuition and artistic skills.' Understanding the norm, guidelines, and parameters is key as a starting point for communication purposes. Knowing the norms and parameters helps you become a better storyteller to communicate with the patient. One thing is to tell the patient, 'Look, your incisal edge should be here. Why? Trust me, I'm an artist.' Another thing is to say, 'Look, your incisal should be here. Articles show that from 2 to 4, you are inside the norm when lip dynamics is below 9 millimeters.' This protects your decision with some science and parameters, usually helping with the patient. The patient sees a combination of art and science in the decision. Starting point for communication purposes to generate authority and give borders to intuition and art. That's how I use parameters in smile design.

Apa believes that Christian spends too much time with guidelines and rules; Christian believes that drawing guidelines helps your brain and eyes see better and activates your artistic skills. The more experienced you become, the more these lines will be embedded in your brain naturally. That's why Apa says don't waste too much time with lines, guidelines, and parameters, mainly because he doesn't notice they are already inside his brain. He does that so much and is so good at it that it's already there. But you need to go through the process to get it in your brain. For Christian, exercising drawing is a great way to activate your artistic brain. I always say that every dentist should, whenever they have time, draw. If you're sitting down having coffee, take a piece of paper, look at an object, try to draw it, draw a tooth with light and shadow contours and perspective. Drawing is the starting point of an artist. You cannot sculpt teeth in 3D if you don't know how to draw. Dentists skip this and try to do things with their hands without even controlling the two-dimensional process of creativity and drawing. If I needed to do a smile makeover myself and find a dentist, I would say, 'Dentist, please draw a smile right here in front of me on this piece of paper.' If you cannot draw a smile on a piece of paper after 20 years of cosmetic dentistry and saying you're an expert in aesthetic dentistry, there's no way you're going to touch my mouth. No way. Because you will not be in charge, you will not be in command, and you'll not be able to work with your hands because everything beyond drawing is more complicated.

Treatment execution is a big topic because the way Apa does dentistry is very different than how I always did and how the dentists I work with, like my father, did. He has a very pragmatic approach. Apa preps teeth to avoid ortho and shows how you can overcome limitations and get great results without ortho and with smart preps, great smile design skills, and great technicians. He showed cool cases where you think you need to do a year and a half of ortho, and he did it in two appointments and solved it with smart preps. Were the preps more aggressive? Yes. How that will play out in 15-20 years is not clear. Did he preserve as much enamel as possible? Yes. Did the outcome look amazing? Yes, and the patient was happy. It's very beautiful to say what is ideal—five years of treatment, three surgeries, two years of ortho, orthognathic surgery, airway, etc. Reality is different. I liked that we blended my more philosophical approach with his more pragmatic approach.

Christian likes the combination of ortho before restorative. I acknowledge that many ortho cases go really bad. If you have a great orthodontist that understands restorative, I believe you should explore that option to become minimally invasive and position bone, roots, gum, and teeth ideally before restorative. But Christian admits that this is much easier to say than to do. Guided preparation is a big thing. DSD has a protocol to guide preps. Apa does have guided prep. When it comes to prepping, we both agree on something very important: preps need to be guided by the final design. If you don't know where you want to go, you will not get there, and your prep will not help you get there. Somehow you need to know exactly what the final smile should be, exactly what the ideal prep for that smile should be, and exactly how to transfer that project into the mouth. DSD has a set of guides, complete digitally designed and planned, to help dentists translate. Apa does the direct mockup freehand himself, defines the project, and preps through. We believe in a project done in the lab, fine-tuned in the mouth. He preps through the mockup, and we prep through the mockup with extra guides to quality control. Apa believes he has the eyes good enough to quality control with the eyes—done is good, let's go for the impression.

Apa uses his direct mockup on the day of preparation to develop the ideal design and guide the preps by prepping through it. Christian believes this is possible and can be good, but it is very hard to develop ideal designs in the mouth fast enough and under pressure. Details will be missed, in my opinion. A lot of experience, artistic, and hand skills are needed. It is possible but not replicable, in my opinion. You can streamline the process by designing in the lab, fine-tuning in the mouth, instead of designing directly in the mouth. Apa has a very consistent and predictable direct mockup process, even though I believe that bringing it back to the software and improving it would make it better. It's all about efficiency. What he does works for him; what we do works for us.

CC believes that developing a digital 3D design leveraging all the know-how from great labs, wasting less time chairside, is smart, always reemphasizing that the dentist needs to evaluate, improve, and validate these designs in the mouth. The end is the same—you need to be in control in the mouth. How you get to that point can vary. CC believes that Apa has one of the best eyes for aesthetics and can develop these designs intraorally with accuracy and predictability, but systems should go beyond individuals. CC believes that labs can help avoid mistakes when prepping and planning cases. Apa believes he needs to have total control, do it himself, and the lab should only focus on translating his vision into reality. Different approaches.

Ceramics are also a big point because Apa is a big advocate of old-school handmade layered ceramics, and I'm a huge advocate of fully digital, monolithic, almost no-hand-involved restorations. We are 180 degrees in different directions here, but we both respect each other. I was surprised Apa showed a case doing exactly what I say: he did a case with handmade layered and a whole digital monolithic restoration for the same patient. He tried both and said in front of everybody, 'I was impressed with the digital. It was hard to choose, but I did choose the layered because the layered handmade old school was a touch better.' This is a big statement showing how digital has evolved from his own words. I emphasize that digital has evolved, and we have to add to that discussion that he does have 10-20 of the best ceramists in the world, like the best. Some of his ceramists today are top 10 for me. Top 10 out of millions of ceramists in the world, thousands of very good ceramists, but only 100-200 of the best. He has probably 10 out of the top 100. This unique situation needs to be considered when deciding what type of restoration to use.

Apa believes that layered ceramics are better than monolithic. CC believes layered may sometimes be slightly better, but only with the very few best ceramists in the world. Christian believes that monolithic can look great if you have a lab that understands how to do it and that monolithic brings many other advantages than layered and can solve most aesthetic cases with high quality. People saw how far you can go with layered in the hands of a few top ceramists, still the gold standard, and how amazing monolithic digital is today. The conclusion is to master both and know how to choose. Mastering monolithic will solve 70-90% of your cases, with maybe some cases leveraging old-school handmade layered. This is the final take-home message.

Both agreed that monolithic with reinforced ceramics can bring other challenges. This was common sense. Harder restorations are not necessarily better. When the restorative material is very hard and you have inevitable interferences, the system will break on the dental side. The restoration won't break, but the tooth and gum will suffer. If something is slightly off, you want the system to break the restoration. Having a material that isn't the hardest isn't necessarily a bad thing. You need some resistance, but you need to be able to remove these restorations after 10-15 years. Hard restorations are a nightmare to remove. This was common sense. Both agreed that monolithic with reinforced ceramics can bring challenges in removal and harming teeth and gum with inevitable interferences.

Christian emphasized that feldspathic can also be milled. A common misconception is that handmade is more beautiful because feldspathic is more beautiful. You can do digital monolithic with feldspathic. Feldspathic is the name of the material, and nowadays, digital has evolved to use all materials on digital restorations. The difference is hand-layered or digitally monolithic.

Christian believes and performs hundreds of cases per month with a complete digital restorative workflow with an outsource lab type of environment, and it works. Apa believes and performs hundreds of cases per month with an analog workflow in an in-house lab way of working, and it also works. It's not about working or not working. It's about understanding the nuances, pros, and cons, and adapting to your style, situation, building your system, and vision. We were sharing different approaches, and it's up to the audience to build their own conclusions and customize the ideas.

Apa believes that Christian relies too much on dentist-lab digital communication. He made fun of me on stage, saying, 'You spend too much time developing systems of communication.' Christian believes that Apa's restorative workflow with analog impressions and hybrid dye models are very complex and time-consuming. It's not easy to find professionals to do analog work, but it's easier to find professionals to do digital work and much easier to train them in the digital environment. Christian agrees that to be great, you need to master analog procedures before mastering digital procedures. Practice handmade wax-ups and ceramics, the best way to gain skills, visual, mental, and hand skills, to jump into digital and master it.

Apa mentioned that the guided digital workflow and communication systems presented by CC are for beginners. I completely disagree, in a respectful way. Apa said, 'I love what Christian just said, all the rules, systems, workflows, digital communication. This is great for beginners. Let me show you what the Masters do.' I don't agree. I admire his workflows, and I learned during these two days. I appreciated his systems even more, but I strongly believe my workflow is the future for beginners and masters. I also believe Apa should never change his system because it's working and he's killing it. But in 2-3-5-10 years, the next Mike Apa will be completely digital and implement systems because it's less stressful. I know Mike, and I know that off stage, he complains about too much stress and too much depending on him and his hands. At the end of the day, he says those things. My systems are for that—to allow us to do great quality with less stress. I believe it's evolving, and I think what Mike was trying to say is that Christian's systems are cool, the future, mandatory, and will become the new normal. But if you want to be the best, you need to go beyond these systems and add that extra final 10% human touch that only great professionals can bring, taking you beyond the systems.

Kirk Behrendt: Well done, Christian. I have so many questions, but I can't see if you've picked a date for the next one. If you have it, don't say. Just say, 'I have it.'

Christian Coachman: No, no, no. We are trying. The event was so intense physically and emotionally, the preparation. I've been lecturing for 20 years, but this was beyond anything else I ever experienced. The responsibility was so big. I felt more responsibility and pressure on this course than ever before because it was new, and I was the one inviting. We had divergent ideas, and I knew we wouldn't have time to rehearse everything. We were charging a very high ticket price to make this make sense for us. We need a certain level of return, and I have no problem talking about that. People need to value our time. Apa never gave a course showing all his systems. He is the most successful dentist on the planet with the most efficient systems to deliver quality with volume, and he never shared his systems before. He shared everything this time. We knew there was a huge value, and I had forgotten how hard it is to build something from scratch, something from scratch that generates so much value that people will pay a high ticket and leave the course saying it was worth it. My main concern is making people pay; that's the easy part. The hard part is having people say it was worth it after they paid. So I was pressuring myself for the last 12 months and especially the last six months and then the last month. My wife was like, 'What's going on with you? You give courses all the time.' I said, 'No, but this is different. This is different.' Day and night putting this together. We are still recovering. It's going to take a few weeks to let everything settle, and hopefully, next month, we'll come with the date for the next course.

Kirk Behrendt: I love it. Let's pull the third person in the room and give them a summary. If I'm a listener, Christian, and I've been listening to this in the car, give me some final thoughts.

Christian Coachman: I actually have the take-home messages. Number one: patient success-driven mindset. It doesn't matter what my opinion is or Mike's opinion is; choose focusing on the success of your patient. Number two: smile design is an art, not a science. It's more art than science. Treatment planning is pure science and clinical, but everything starts from a smile design project. Smile design is subjective and artistic, so ask yourself how good you are with artistic skills because that's the only way to get better. Number three: build your professional vision, leadership, team building, and systems. It's impossible to deliver great smiles alone. You need an amazing team. Apa has an amazing team around him; we have an amazing team here at DSD. We try to help doctors build great teams. Build your vision. Do you want to become a smile design practice because this will become a business itself? Apa is a smile design practice. People go there to transform their smiles. Number four: start with the end in mind in smile design. You need to start from the vision, the prototype, the project. You need to master all of them: design smiles on iPad over pictures, have a smile simulation application, have a technician design in 3D, visualize and identify problems, comment and fix. Do a digital or analog wax-up, a direct or indirect mockup. Start with the end in mind. Build the vision in your brain, see the smile, understand what is right and wrong. Live looking at smiles and constantly saying, 'This is good, this is not good, this can be improved, this cannot be improved.' Number five: branding happens chairside. The magic happens there. Marketing will not save you if you don't have a chairside system to impress. Team building systems above individuals. Systems above individuals. Smile design requires systems if you want to transform people's lives by transforming their smiles. This is complex, you need systems, dentist-lab synergy, communication above individuals. Number six: preparation for success. Prep for success, guided preparation. Visualize the design, visualize the prep for the design, find a way to translate the prep in the mouth. Don't prep more or less than necessary; prep exactly what you need for that design. Prep by design. Number seven: you never have a second chance to make a first impression when it comes to smile design. Rehearse what it means to create a first impression as a smile designer. You can speak as a clinician, treatment planner, general practitioner, orthodontist. Rehearse how to speak as a smile designer. Number eight: patient experience is key. Create a patient success-driven mindset. Understand what success means for them. Number nine: team building and systems above individuals. Leverage your team, build systems, and make sure everything is smooth and rehearsed. Number ten: enjoy the ride. You need to be a little bit crazy to get to the highest level, but you cannot waste your life suffering to get there. Enjoy the process. I can tell you, I work hard, and Apa works hard. He loves it, and so do I.

Kirk Behrendt: Well said, Christian. Now, if somebody's listening and they don't know what DSD is, tell me where to go, what to do, and where to start if I want to learn more.

Christian Coachman: Go to digitalsmiledesign.com. Very simple. The whole journey is there. As our company's name says, we are all about digital smile and design.