Jun 21 / Dennis Hartlieb

Prepless Veneers and Building Patient Relationships with Dr. Dennis Wells

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When are prepless veneers the best fit for patients? How do patient perspectives impact decisions about dental procedures?

Dr. Wells has a fascinating career that he has built up by naming his goals and putting in the hard work to make those goals a reality. Listen in to part 2 with Dr. Dennis Wells to hear about his pathway into prepless veneers, how he established his practice in Nashville, TN, and what it has been like to be a dentist for the stars. 

Did you catch part one of this riveting interview? Be sure to watch or listen if you missed it! 

For more about Dr. Wells, check out the Nashville Aesthetic Dentistry Website.
Don't have time to listen right now?

Read the Full Interview Below

The Pathway into Prepless Veneers

Dennis H 0:02  
Hey Dental Online Trainers, Dr. Dennis Hartlieb here with you. And welcome back to part two of our conversation with Dr. Dennis Wells. If you haven't listened to part one, I encourage you to go back and listen. Because you can hear the background of one of the leaders of no prep or prepless porcelain veneers.

Dennis truly has a unique background, but one I think many of us, many people, can relate to in various ways in their own life. Now in the second part of the interview, Dennis and I talk about what led him into sort of no prep or minimal prep veneers, what he's learned, and some of the challenges along the way. We finish our conversation talking about being a dentist to the stars. It's truly a topic that I have no personal experience in but I found really fascinating. So, Dental Online Trainers, enjoy part two of my conversation with Dr. Dennis Wells. 
Hello, Dental Online Trainers! Dr. Dennis Hartlieb, back with you for part two of our conversation with Dr. Dennis Wells. In part one of our conversation we talked about Dennis's background as a musician and as a young man growing up in Arkansas and essentially his move on to Tennessee where he attended University of Tennessee dental school and then drifted off to Nashville, Tennessee and that's where we sort of left off as he started his practice in Nashville.

Just a little more background on Dennis. He's the... I guess you're the inventor...? Is that the term? For dura thin veneers... You were certainly involved in the the concept and the development of dura thin and microthin veneers. Essentially Dennis's acclaim is a no prep or prepless veneer technique, minimizing tooth removal, minimizing drilling, and maximizing the health of the tooth, maximizing the enamel that we get to keep for our patients.

He's the founder of the Nashville Center for Aesthetic Dentistry. He is essentially dentistry to the country music stars and many of the people in the entertainment industry, and probably a lot of others that I'm not familiar with. So Dennis, thanks for joining us for part two!

Dennis W 2:09  
My pleasure, my brother! Glad to be here and talk about one of my favorite subjects, which is very conservative, restorative dentistry.

Dennis H 2:21  
So I'll tell a story. So, my study club went down and took your program at your teaching center, at your office, where you did live hands on. So it was presentation and live hands on with patients. And we went down... I'm guessing about six years ago, it was pre-COVID, so five or six years ago with my study group. And it was a great experience.

Number one, great presentation stuff, great information. The stuff was awesome. Number two is doing dentistry on a patient with a large audience. Man, that's tough stuff. Have you have you developed a sort of a thicker skin for that? In the beginning, did you get nervous doing live patient stuff? And now it's just sort of becoming more, yeah, I've done this and not such a big deal. I think that's hard stuff. Tell me about that.

Dennis W 3:12  
I think like anything, the first time you do it, it's got more angst associated with it. And obviously, the more you do it, the more confident you become. And so it's been a progression there for sure. But by the time we were doing these courses, we had already been deeply invested into practice dentistry for several years and felt real confident about how we were doing it at the time and sort of what we had landed on as our prototype and technique guide, and so forth. So it's pretty much been a pleasant journey for us to start trying to teach that.

On the other hand, what we now are in the midst of is... In fact, next year, 2023, it will have been 20 years since we first started doing prepless dentistry, which I can't believe it's been that long! And then we've been teaching it a little over 10 years. In fact, probably more like... I need to go back and look at when the start date was on our first in office teaching thing, but let's put it this way, safely 12 years. And so we're now starting to completely have data that's almost 20 years old.

And we can see some things we look back on and go, we need to do it a little differently now. It's almost like when you're teaching, it's hard to keep up with what's current. And you don't want to just be throwing out ideas that just come out of top of your head that you don't have a good bit of experience with, and on the other hand, you don't want to keep teaching the same thing that you know there's a better way to do that. And I've got this body of work to show that, and so, the challenge is trying to keep that up to date and and feel like you're always on the on the front edge of what you're describing and teaching.

Dennis H 5:03  
When you started developing these concepts of minimally prep and prepless veneers... For dentists who weren't around it, there was sort of a pendulum switch, or a shift. Early on, we were sort of prepless, minimal prep. And then the preparations got super aggressive in probably like the early 2000s, mid 2000s, like 2000 to 2005 or 2010, where the preparations...

It was almost embarrassing showing patients the preparations because they were essentially three quarter crown preparations. They were so stinking aggressive. So what lit your fire? Were you then in that camp like I was where I'm doing super aggressive preparations. This is what I'm being told by my technicians is what I need. And looking at it and saying, Man, this is super aggressive! Or did you never fall into that? Where were you with all that going on?

Dennis W 5:57  
I did go the direction... Well, here's my journey. I started out, as we've already acknowledged, early early in the whole veneer world. And we hit a groove in the late 80s and early 90s where we were doing feldspathic cases and seeing largely great success, not a lot of weird things happening to them. And even on people with chewing systems that were hard on their teeth, and thus hard on the restorations, we saw a reasonable amount of success. Enter into our world, the whole press concepts.

And of course, Ivoclar, a super great company, was early on with that. And Empress was a really popular product almost from the day it was introduced. And it touted, you know, higher strength and a lot of advantages and better fit and so forth. And I think that's when our industry started getting pressure from laboratory support that almost began, as I described it, as the tail was wagging the dog. They were telling us dentists how we needed to prepare the teeth in order to make their materials fit that criteria.

And we introduced, and we saw into our practice, suddenly problematic things occurring that we had not experienced in the earlier years doing it the way we were doing it, more conservatively. Problems such as debonding, because we're pretty much bonding completely to dentin, which as we grew in that whole process in learning, we started recognizing some of the limitations and how aging can affect and degrade the dentin bond, for example, and things like that, that we had no clue about. We started realizing that flexural strength matters.

And when you start reducing too much flexural strength on a tooth, that can be an easy place for adhesion failure to occur, as you flex the material that you're bonding on. So we began to see another phenomenon, which was you had your basic press restoration, but then you had an add on. There was a lot of motivation on my part, to get out of some of those headache issues and areas that I was in.

And it was immediately this thought that I need to get back to more of what we used to do, which was leaving more enamel and staying in the enamel bonds. Mark Freeman was another guy, a mentor, that had lots of nice articles in restorative dentistry magazines talking about keeping the enamel borders, and things like that. And all that was really ringing true to me during this period of time. And I kind of began to be the guy that was the outsider, it felt like, in the cosmetic world because I was like, "I don't want to keep doing this this way. I'm seeing issues and problems. It can look really nice. And I love this company. But I don't think I agree with this approach, you know, based on my experiences."

And so we started looking for other ways to do things. And then, we actually had a patient one day that I give credit to, in 2003, for actually starting my journey of doing absolutely no preparation. And this happened to be a young lady that was a music artist, just got a record deal.

And she had pretty nice teeth but she had a bad habit of sucking on lemons a lot. And so she had some natural erosion on her enamel and things that were -- not natural; it was created by the lemons, by the acidic environment -- and we said, "We have the solution for you. We'll put some porcelain veneers on your teeth and they'll look great!" And she goes, "Well, but you don't have to drill the teeth down, do you?" And I said, "We do." And then, of course, she asked a very fair question. "Well, why do we have to do that? Because I've got my teeth a little bigger. I've lost some enamel." We would say today she had a diminishing enamel volume.

And so our answer to that dilemma? Well, we're going to diminish some more enamel volume with our drill, and that made no sense to her. And I pondered that. And I told her, "Well, that's the only way we know to do it." And the only way we could do it because of this reason and that reason that we've all been told. I go home that night, and I'm bothered by that conversation. And I really do want to do something for her teeth. She needed it.

And I could just only imagine somebody else doing something that we had opportunity to do. So I had another conversation with and I said, "You know what? I'll talk to my lab and see if there's any chance they could just build us something here that we don't prepare, that we just try to bond right over your teeth." And that's when I call Mark Willis.

At the time, he was with Utah Valley Dental, but I'd met Mark, through Path Live, a live course program that David Hornbrook led for years in San Francisco, that I was a part-time instructor there. And Mark and I met. I was really impressed with him. And he was a very energetic young man that had lots of talent and was willing to probably do anything to try to, you know, work with us a little bit. And so kind of naively he said, "Yeah, I'll give that a try."

And that's our very first case was this young lady. And it came out really, really above any of our expectations in terms of the way it looked, in the way we were able to finish the margins down, and make it healthy, and, you know, compatible with the tissue health and all that. And so man, that was all it took for me to go, "You know what? This is another possibility for us to think about when people have almost prepped the teeth for us."

That was kind of what was in my head, and later, which I began to include, teeth that are just not prepped, but they were born small. And our goal is to augment them. So that's kind of how this all kicked out in 2003. And then, slowly but surely, we began to totally embrace the fact that a lot of people can be served well without reduction of enamel.

We've always had to fight off the naysayers and the people who... what I call the elite of our industry -- the people that are so good and talented and so capable, and have immaculate systems of preparation and everything. And they produce these incredibly great results with what we call minimal preparation. And yet, we felt like there's still a place for the patients of the world who don't necessarily seek the most elite of elite end results that even dentists can't tell the restorations. But they seek something that's close to that, that we can do, and not put them through these irreversible processes as they view it.

So all of that was a transition and journey, a time of trying to determine what the limits will be optically of some of this, and what the limits would be in terms of aging and longevity. And then also, you know, is there a place where this is absolutely the right thing to do? And all of that, as we look back with hindsight, proved to be we were onto something that to this day, we still feel strongly. It's a tool that that any restorative person should keep in their toolbox.

The results you can get with it can rival traditional dentistry, in our opinion, if the right cases are chosen, and the right techniques and the right approach are used. And then we've also learned, and with humility, we've learned there are limits. There are times where that's absolutely not the right thing to do. And we've stretched those boundaries, we've made mistakes, we've done cases that I've had to... That either I want to do over or we have done them over and gone back and done some reduction.

We found, at least in our world and in our practice, kind of where those boundaries should be. And that's the teaching part. You know, a big part of trying to teach this is not so much the technique. We all pretty much know how to bond on veneers, whether they're prepped or not. The teaching comes in having the ability to understand what your patient is seeking, to gain that knowledge from them and communicate well, and then to be able to deliver that to their expectations.
The results you can get with it can rival traditional dentistry, in our opinion, if the right cases are chosen, and the right techniques and the right approach.
Dr. Dennis Wells

The Benefit of Minimizing Invasive Techniques with No Prep Veneers

Dennis H 14:21  
What are the the cases, as you look back on, you say these are cases that are not appropriate for no prep techniques. What are some of the landmarks that we should be thinking about?

Dennis W 14:36  
One has to be really cautious about when people from an orthodontic perspective and maybe a cephalometric perspective their teeth are already what orthodontists refer to as full, meaning that they're anteriorly in the right place or even beyond the right place a little bit in terms of torque or in terms of labial presence. And then anytime you're talking about adding more teeth surface without reduction, then you're going the wrong direction. So we pushed the limit on some people that were really eager to get improvement without reduction. And we've kind of gone against our better judgment sometimes.

But part of our teaching in our courses is to learn where those limits are, how to identify those limits, either with cephalometric kind of analysis, or with, again, with prototypes that you do test drives with to see if you can stay in the expectation levels of your patient and stay in your own standards as a dentist that you know you don't want to violate. So those are things you learn with experience, you know, where your boundaries are going to be. And, of course, some people have lower expectations than others. And so you've got to know your audience of who you're treating and a lot of X factors there as well.

Dennis H 15:55  
Yeah, for sure. So when you talk about prototypes, are you using bonded prototypes, where they actually take them and they use them for function? Are you talking more like a smile preview or trial smile, where you will do like a visacril? Something that's non functional, but aesthetically, like, "Hey, this is what it would look like," or something we're bonded on and say, "Hey, let's see how this works for the environment?"

Dennis W 16:18  
The answer for that is kind of long. And so I'm going to try to make it very short. We have a bias, as you know, Dennis, being in our course, that we like to do hand-sculpted permanent composite bonding materials, and determine directly on them in the mouth and on the teeth, what our limits are, and are we in the zone where we can add, you know, in the range of three to five tenths of a millimeter and be appropriately in the right place facially, and can contour appropriately and so forth? I say it's a long answer, because there are certainly some cases that the teeth are so undersized.

And there is no question that even wax ups and we'll call it a little bit more crude and less accurate types of, you know, indirect onlays, and things that you can... overlays that you can put on the teeth, can be very adequate for people to determine they like it and be adequate for the dentist to assure himself that he can do this and not just assume.

But the cases that are more precision demanding and the patient's expectations are a lot higher, many times those type of indirect overlays will run them off, we, in our practice at least, we have found some people get scared when they see things that are just not very finessed. And so we like, as a result of all those concerns, we like to do direct bonding and either not etch it and use it as a trial look, or in our cases where it's a go, and we're definitely going to accomplish the case and finish it. We'd like to spot etch them on and let them run through... have the three or four weeks to test drive to, as you're saying, to even check out to some degree function and things like that.

Dennis H 18:04  
What's the biggest challenges for doing no prep veneers? Is that the impression? Is that the cementation? Is it all of it? Is it communication with the lab? I mean... Are there others that I haven't brought up? Where's the challenges?

Dennis W 18:20  
Well, I'm going to say that I think the whole process can be a little bit more challenging in the way that we choose to approach it where, again, we're trying to hit high level marks and high level aesthetics. And so definitely the prototype phase of it can be challenging to go through that whole hand bonding process and hand shaping and contouring and polishing and all of that, and then I'm going to say the bonding process is more challenging because the fit and the finish relies on some post-cementation work smoothing and finishing and resurfacing of those marginal zones. So that's extra burden that you're assuming from the get go doing it as we do it. So there is a learning curve with it.

And one thing that's for certain, if you're using feldspathic powders, as we like to use a lot, they're very, very easy to break and to put you in a tight spot in a hurry if you drop one and things like that. So we found there to be more effort involved in doing the prep plus approach at a high level. At the same time, you quickly... Those we've taught for years and everything else, the first few are tougher for you, and then you get to a place where you're pretty savvy at getting it done. And I think that's the journey for a lot of other dentists besides us.

So there's several pieces that are tough, and now I'm going to add another part that maybe we struggle with more than ever now that we've been bonding for years and, and we've got that routine all down. Again, it's back to which cases should we prep, and which ones should we try to do the prepless? There's a lot of X factors that come into play.

For example, are there other existing restorations and damage to the teeth and compromises to the teeth that begin to kind of take away a lot of your motivation not to touch them to begin with? Do we have some people that their expectation is they're going to take their powered magnifying bathroom mirrors, and they don't want to see any transitional zones or any start and stop or anything like that? And they don't want to even see a darkening of the body of the tooth as you get toward the...

They want to see what we call surreal kinds of results. And I'll tell you something. If you're trying to do a lot of cosmetic dentistry, and you don't have a place in your soul, in your head, for the people that want surreal dentistry, look, you're going to struggle! Because there's a segment of people that have that!

Dennis H 21:00  
I just did all white resin veneers on a patient that... You know what? As Marshall Field who, if you don't know Marshall Field, he owns stores around the country and is a Chicago guy, and he said, "Give the lady what she wants." And, you know what? If they understand that they're surreal, which I love that term. You know, we tried explain that this is not going to be like nature. And she said, "I've had dark teeth my whole life. I hate dark teeth. I want my teeth white. Give me the whitest you've got!"

Dennis W 21:32  
We've had a lot of conversations. Yeah, that that rings so true, and we've had a lot of conversations about adornment of humans. And adornment... You know, for ladies, for example, artificial nails, are super popular among people that can afford them, and there's definitely a surreal appearance to those nails that if you get into this a little bit, you start recognizing that the length, the size, the perfection of all that can't be typically achieved with natural nails in the way you can with the with the add ons. Eyelashes have become very popular now. You know, add on eyelashes that thicken and become surreal. You can see people walk in the room and go, "Those eyelashes are not hers..." You know, those... but it's still considered compelling and adorning.

And of course, you can go on and on... hair extensions... on and on. And so, when it comes to teeth, there's no law of the land or law in dentistry that says you can't have surreal looking teeth and be very aesthetic. In fact, some would argue it's absolutely hand in hand. You can create higher aesthetics if you're willing to go a little surreal.

We've embraced this in some of the cases we do. We just simply have feel like, at the end of the day, we're not violating any rules. We're doing the right thing! We're trying to serve people. That's our ultimate pledge, you know, when you become a doctor. It's not about your agenda, it's about making sure you're serving them well. It's not your place of decision making to decide what they want and don't want, and things like that. It's your duty to inform, and it's your duty to educate. But at the end of the day, we've had a lot of education given back to us by our society.

And think about all the things that people do for adornment. They punch big holes in their ears, they tattoo all over. They, you know... It's tribal kinds of stuff that goes back 1000s of years. And, and you know, it's not for me necessarily, but... Or maybe it is! I may have all kinds of things y'all don't know under my clothes here, you know? But in all seriousness, we have had to have a lot of paradigm shifts in our heads about how we approach, and so conversation becomes so paramount about the pros and the cons of prepless veneers. Because, you know, I can have what I... Again back to my...

It's a flattering comment when I say this; it is not a demeaning, an elite dentist, who says, "You know what, you can't create the absolute perfection in interproximal contouring if you don't prep away some of the tooth." I'm not going to debate that. But I'm going to say what I can do is create contours that look very pleasing, and are really, in some ways, by some segment of the country, appreciated more than your perfection contours that they might consider flawed or consider gappy or things like that.

And so we get back to some real struggles to know how to relay this, and how to size up your consumer and your patient. And then to figure out which matches them in its entirety the best way. And some of that is in my camp to decide, you know, whether I can deal with these old existing restorations or we can deal with, you know, some of the compromises that were given with.

And some of it is in their camp to go, "What do I expect when we're done? Do I expect it to be in the surreal category? Or am I one of these that would rather keep my enamel at all cost." And all those things make it much more difficult to do business than it used to be. It used to be real simple for us in our practice: you want veneers or do you not? And if you want them, here's how we do it! And now there's this whole plethora of things that we feel responsible and charged to do in the sake of educating and informing. And then, of course, obviously to deliver whenever we decide what they want.

Considering Which Cases Should Be Prepless

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Dr. Wells shares about times when it's best to consider the limits of prepless veneers so that dentists better know which cases are good candidates for the prepless approach.

The Benefit of Minimizing Invasive Techniques with No Prep Veneers

Dennis H 25:28  
That's great. Yeah, that's, that's super, super helpful information, I think, very, very valid points. And this is a struggle, I think, as anyone gets into doing cosmetic dentistry is separating your ego from the desires of the patients and recognizing that what we may or may not want isn't really the issue. It's about serving the patient, making sure we're doing great dentistry.

And sometimes it's like, yeah, this is not what I would choose. But if I can make the margins, right, if I can get the functional components, right, and if I can do the shape, contour, if I can do all the other stuff right, and give them something that'ssurreal in color, and, you know, lack of lucency, lack of chrome in the cervical, if it makes them happy, then we're doing our job, and we're serving our population, the clients. So...


Dennis W 26:20  
Agree! And one other little example of that would be in today's world, we're doing a lot of lip enhancement out there in the world. A lot of ladies gravitate to that. And as we age, our lip becomes, you know, less... It becomes deficient in many cases. And so it's a very understandable and, I think, a very appropriate thing to do for a lot of women.

But some people do exaggerate that and go into surreal zones. And suddenly, their teeth are not even very visible. They've overshot... The frame has taken over the picture. And so, in those cases, we've been charged many times, with, okay, we want to augment and make the teeth become more visible. And so our prepless world fits real nicely into that where they otherwise have pretty nice teeth, but they just need them to be longer and more visible.

And so we're going in, and in many cases -- dare I say this on air? -- but, you know, 14 millimeter centrals... Now, when you see them in a party or somewhere, and they smile for you, you know, you don't know that those are long, long teeth. And we've also learned things like this: you put a 14 or 15 millimeter extension on a tooth, what we call now in our practice enamel extensions, you get into leverage issues that we didn't used to think about. We used to claim in our no prep world, we're doing no harm. These actually can even be taken off, especially if you have a laser that you're you know how to use well, you can help remove them. And even if you don't you, you drill them off. You can get back to pretty much where you started with the teeth, pretty much.

And I say from practical observation, from normal observation, they look like they are reversible. But what we didn't take into account is that when you put these enamel extensions on, and suddenly you've increased your lever force on the end of that tooth dramatically. And then two years later, they come in, and I see recession that I had never seen prior to that, and it's own us. We've created...
Because we didn't demand a night guard and we didn't demand a counseling on if you have these longer teeth, you have a more proneness to more force. And so, we've got to be cognizant of that. We do that now as an example.

So, so many things that come along with when you take the human body and you exaggerate it in some way, you know, need to be figured into your prior conversations before you get started. And all of these things have been along our journey to where we feel like every two years we need to redo our courses and add a whole bunch of new thinking and ideas that we learn as we as we go.

Dennis H 29:04  
I want to talk about being a dentist to the stars, but I've got a couple clinical questions first. Is there a place for pressed ceramics in a no prep technique? Can you get the margins than enough in a pressed technique? Or are we ultimately needing to do hand layered feldspathic veneers or a combination for this? What's your world today?

Dennis W 29:29  
That's a super hot question super, you know, a common one. And I have my own journey and experiences with that that I'll answer from, my humble opinion. We are years and years into using the feldspathic powders and producing margins in the mouth post-cementation that are what we call infinity margins that, man, they're as good as it gets, you know, in our opinion. You can't see them; you can't feel them when you explore. The tissue doesn't even know anything's happened because we're stopping just short of the tissue line.

And we know that works really well. But we do also know that the strength of the edges of those teeth, the binding force edges, it can be sometimes inefficient in terms of... and certainly not not strong enough. It depends on some people's habits and occlusal systems. That led us... Back when the, you know, the lithium disilicate became so popular... that led us... We thought for a little bit there we'd got the magic answer now, because we got something that even when you get it thin, it's going to be strong, and it's going to have all the answers.

What we didn't expect is how brittle those materials are when they get super thin. When you start trying to knife edge those and finish those down, like we had done the feldspathic for years. Number one, you burn out your typical finishing diamonds and stuff real fast, because they're no match for it. And then number two, when you would finish them down, sometimes instead of just knife edging like our feldspathic, they would chip. You'd get a little chunk here or there, and then you'd be back to a ledge again. And so that was discouraging.

So what we have evolved to in our practice is, and we're big fans of some of the new lithium disilicates, we like the amber press material a good bit, just optically. But we have now recognized we have to turn around and put a burden back on either the ceramist or us, the dentist, prior to segmentation. After they're pressed, and they're as thin as they can wax them, and press them and make that predictably work, then we have to take rubber wheels and knife edge those margins and not finish them in the mouth.

And what we have found is that when we take lithium disilicate and knife edge with rubber wheels, cement it in the mouth, and basically clean it up as though it was a traditional prep veneer that we have, we don't have is as exciting of a transition... We definitely have a little bump that we can feel with with an instrument, though it's slight, but we can feel it. But we're seeing absolutely no real negatives with that, not optically or not health wise or anything like that. As long as again, you take the time to really knife edge them well... and assuming your veneers are intimate with the tooth, so that there's not some other reason that they're elevated off of the tooth.

So there's two burdens that you have to... And, as we all know, they're not if you don't nail the fit on it, for some reason, there's no torque in that. It's not going to release somewhere like a feldspathic might, in one little edge of it, you know, chip a little bit and then it'll seat. It's going to stay up. And so, generally speaking, we think it's harder to do the cases and get the same level of optical end result with the lithium disilicates. On the other hand, we have a segment of society that we think that's the best way to treat them, if we're going to do no prep, is to use lithium disilicate. With all the things that we consider to be slight disadvantages, that's better than them having a nice feldspathic case that ships and breaks before it's been on a year.

Dennis H 33:14  
Last clinical question then I want to talk about being the star dentist. Where are you with digital design, and how much is that influencing what your you're doing with your your veneer stuff now?

Dennis W 33:27  
So you mentioned our trademark brands, the durathin and in the microthin veneers. Both of my ceramics that we kind of developed the whole pathways that we're on, prepless stuff, to this day don't feel like the digital world is quite ready for some of the di-preparation things that we need to have in order to get the results, the fit we're looking for. So we're still hanging back in the analog space a good bit in terms of digital impressions for it.

We take digital impressions, but not for our prepless stuff at this point in time. I rely on those guys a lot for the truth in those arenas. I see a lot of it. I see a lot of buzz going on about all of this digitally being applied. But we're slowly entering into that world right now. I'm not sure when I see these things that maybe I don't need to really check up on a lot of what's happening out there, but according to my two ceramists, that's our story at this point.

Dennis H 34:30  
Yeah, no, I would say for if you're trying to get these infinity margins, trying to do that with a digital impression technique, I think, is not going to be as accurate as using a PVS. I think everyone would agree to that at this point. All right, so I've always been super curious. So you talked a little bit about I think it's through your contact in the music industry, your brother Kent, being in the the country music world... That got your introduction to start treating famous people. Were you nervous the first time you started like working on famous people?

Dennis W 35:13  
Absolutely. 

Dennis H 35:13  
Like a star? 

Dennis W 35:17  
Absolutely! 

The Role of the Dentist in Serving the Patient

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Dr. Wells shares his thoughts about adornment and the role of "surreal" choices and patient preferences when it comes to aesthetic dentistry. 

Being a Dentist for the Stars

Dennis H 35:18  
I can't imagine, quite honestly. Do you still get nervous? Like, you know, I don't know who you're treating... Say someone super famous comes in. Are you like, "Oh, I better not blow this case!" Or have you gotten over that?

Dennis W 35:29  
I don't struggle with that at this point in time too much at all, but, boy, do I remember vividly my my first celebrity, quote celebrity guy! Now, remember how old I am. And when I was in dental school, the show Dukes of Hazzard, which probably most of y'all don't even know what that is... But it was a very popular show that came on every Friday night. And some of my reward in dental school was like I would take Friday, and stop my studies and stuff during the first year or two when I was really busy, and just watch the show. And so one of the main actors for that show came into my practice in 1991, I think it was. Early. And man, I could barely speak to him! He was just bigger in life to me at that time! And so yes, I have had my share of anxiety.

And one of the early on stories I love to tell is that Dolly Parton is probably one of the most visible people I treat. And she came early in my career, about '94, right after I'd gotten my accreditation. And I treated several of her siblings and her brother-in-law, and a few people. And I was just praying that she would maybe come in one day. And sure enough, one of her sisters referred her, and she came. And so we decided we were going to do porcelain veneers for her at that time. And I was talking to my good buddy Bill Dorfman, who had treated quite a few Hollywood people. And he gave me a list of recommendations.

He said number one, I would have two labs do her case. And boy, did that save me! Because the lab that we worked with at that time, did not deliver it. We had some things we didn't like about it, and the other one was perfect. So he said to do that. That was great advice. The other thing he said, which was not good advice, is he said, "If I were you, I would like cater in some food and stuff and have this nice little area where she can snack and stuff like that."

And so when she walked in our office, she chuckled because we had a spread of things out there that we spent a lot of money on. And then she goes, "Oh, I'm just not hungry. We just went through the Burger King drive thru, and I'm full!" And I don't know what it was about that, but from that minute on, I relaxed! It was like, we're gonna be fine, you know? So it is interesting how people can make you comfortable or uncomfortable. I still have some that definitely I'm more uncomfortable with than others.

And our list of celebrities has grown from being country music... I actually treat more pop and rock people than I do country people right now, which is crazy! Only because they've all migrated to Nashville so much. And then quite a few actors and actresses now... We see soap opera stars, and all kinds of people like that. I better not go into naming here, but definitely Nashville has really blossomed in the last 10 or 15 years into a very broad entertainment city. And so that's cool, you know... Professional athletes, and all types of people, have come to our practice.

We have broadcasters that I have watched on TV broadcast golf games for years, and big championships games, that are now patients. So it's been an interesting journey for me to kind of grow up and be comfortable around these people. And most of the time, I'm just intrigued and mesmerized by their success and what they've been able to accomplish... and how normal and human they are! You know, that's a grown up journey, don't you think, that all of us do? They're just people!

Dennis H 39:18  
And do you find treating celebrities any different than treating quote unquote normal people? Do they have a different expectation of how they're treated when they come to the office? Do you have expectations that are different?

Dennis W 39:34  
They are, but they won't generally state those to you. You have to be aware that there's a game going on that most people don't know is even being played. But generally speaking, at least the people we see, for example, they don't want to come in and demand a bunch of extra services or extra attention or anything else. They want to... They don't want to be perceived as all up into themselves. But by the same token, they like protection from unnecessary conversations from others, and things like that. They like privacy, clearly.

So having obscure doors, like we have in our practice and stuff, was a big part of our strategic planning from way back so that... And they simply like to be assured that whatever goes on there stays there! Whatever happens. And all of that you kind of have to figure out, and you kind of have to figure out that they're used to demanding schedules and things like that, so many times, you have to flex a little harder than you do for an average individual in terms of cancellations and changes and things like that.

There's a real challenge that celebrities have that people that are not don't generally face of just trying to have their privacy and be themselves and be treated in a fair way, not have prices elevated on them... All those kinds of things that they experienced a lot, when they have repairmen come to their homes, and things like that. So you have to pick all this up as you go along. And I think just be as comfortable and yet aware of what they struggle with and how to deal with it. 

Dennis H 41:20  
When you started your practice in Nashville, did you dedicate it just to Cosmetic Aesthetic Dentistry? Did you say, "I'm only going to be doing appearance-related dentistry?" Or did you do basic restorative dentistry with an emphasis on appearance-related dentistry, and then just gradually be doing more and more... What did your practice look like when you first started?

Dennis W 41:43  
Well, it was very humble start from scratch situation that I was doing my own hygiene cleanings and had a small team of one or two ladies, and then we literally built from from the ground up... But I always --

Dennis H 41:56  
Can you pause for one second? I want everyone to hear that. Dennis Wells did his own hygiene cleanings. And this is important for our young listeners or our younger dentists, newer dentists. We did that! Right? This is part of growing a practice. We did our own hygiene, right? So if you're an associate and a practice, and they're saying, "Hey, I need you to pick up hygiene!" If Dennis wells could do hygiene, guess what? 

Dennis W 42:21  
Well, and make note that this was after I'd been out of school four years. This is after I'd already stopped practicing, and then came back again and started all over, and definitely had to do that. And along those lines, I will tell you, too, that I had a clear vision of what I wanted, what I dreamed to have, which was a practice that was focused on cosmetics only. And we had a lot of people, I mean, we had a lot of celebrities in the practice. That was...

I would name that, and write that down, and everything else. And then working real hard on the focus to get there, I had to jump through a lot of other hoops. I had to, you know, do anything that would pay the bills, and I had to take on patients that were clearly druggies, sometimes. I had to go meet them on the weekends. And it was a crapshoot. You might meet somebody that ended up referring you to other people, because you bailed them out or something, you know, really early, and they said, "This young man is going to be great! And I'll trust him." And then we had others that would show up, and they just want to drugs and stuff like that. But I kept my own emergency beeper and phone and did all of that for some period of time.

But always with the focus of what I was trying to grow to, and I would state this to my patients: I really want to be more and more focused on cosmetics. And then the AACD was kind of that path for me. The minute I saw... That's a group of people who are doing what I want to do. Then from there, I just began to soak up any skill sets and learning and things that would get me there. And then, as early as when Dolly started coming in, around 1994, we were successfully at that place of pretty much just limiting our practice to what we call appearance-related dentistry.

And so it happened relatively... It happened faster than I thought it would; let's put it that way. But she was a key piece of that. I mean, her endorsement was priceless and was a great stroke of luck and it's awesome that she's who she is, and the kind of person she is, and so forth. But that's the part you've got to sit back and wait on. You do the hard work, I've learned, and you get luckier. That's kind of what happens.

Being a Dentist for the Stars

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Listen in as Dennis shares about his first time working with Dolly Parton and how his practice has grown to include many different types of celebrities. 

Reflecting on Balance within a Dental Career

Dennis H 44:33  
Well, the luck is well deserved. This has been great. Dolly Parton is my... I have a 26-year-old daughter, about to be 26 this week, and Dolly Parton is her her biggest idol. My daughter is also of diminutive stature. My daughter is just under five feet. And so I think she... 

Dennis W 44:50  
Very relatable. 

Dennis H 44:53  
Yep. And so she relates very much to Dolly. She's a big Dolly follower. So she she told me that Dolly actually put out a list of her doctors so others could get the treatment that she hadn't. And my daughter wondered, Becca wondered, did Dolly put your name out to others and say, "Hey, this is the dentist that you need to go see!" She was curious about that.

Dennis W 45:19  
I need to hit her up about that! I've never seen that in print. But I think that I have seen, in one of the books she wrote about herself, an autobiography, she listed some plastic surgeons. So that happened a good while ago, that book, and I don't know if I was intentionally left out or what!

But I will tell you this! Just three or four months ago, we shot a magazine cover together for one of the local magazines here in Nashville, and man, you know, when she gives you her endorsement, it's big. And so, I'll be content to know in my heart, at least, that we've done all her dentistry! And maybe one day, I'll make that list. Tell your daughter I don't think I'm on it right now, though.

Dennis H 46:10  
All right. Well, maybe it was in that book that she had read... So again... So my daughter said... I had asked her, I said, I need some good Dolly quotes to pull this up when we when we finish up. So I'll say one, and then I want to ask you to give a couple of plugs. Dolly said, "Don't be so busy making a living that you forget to make a life." What are your thoughts on that?

Dennis W 46:37  
Well, I'm at a stage in life, where where, boy, does that ring true. And trying to keep yourself in a great, healthy and prosperous and thriving place in your whole life is obviously what you eventually figure out at someplace along the way is what you should be doing and should have been doing your whole life. It's difficult for all of us, I think, in this field of dentistry that we're passionate about, to not get out of balance sometimes, to not have such high goals and ambitions that you get a little out of balance.

But I couldn't agree more! Making a life, and recognizing how important the connections are, the people, the patients you treat, your staff... You know, if you get all busy trying to treat your patients, and you don't appreciate how important your staff is and how... I was just reminded this morning, in fact, in a staff meeting that we have to really keep that in focus. So building that life is certainly what I'm all about these days. And hopefully I'm better at it today than I was in recent decades where sometimes the focus was so much on just other things.

Dennis H 47:54  
Yeah, it's easy. We especially when you love doing what you do, it's hard to keep keep track of the other priorities in your life.

Dennis W 48:02  
That's right. It's easy to get a little sideways.

Dennis H 48:06  
Dennis, do you have a little plug for your for your educational program?

Dennis W 48:11  
Well, I have to tell you, I don't really have one to give at this point. Because we, ever since COVID, we, of course, were forced to stop for a while there. And then it timed out were my two sons that I alluded to earlier, they're juniors and seniors in high school right now... And it just felt like a time -- it actually kind of ties in very nicely with the quote you just gave me -- we just decided that we had to pull back on a few things.

We've tried to pull back on our practice, and we're blessed for the years we spent working hard, that we have a good demand on what we do. And it seems like as hard as we try as hard to pull that back. But it was, it was not challenging to say let's pull back some of the educational stuff to traveling and lecturing. And the courses even in our office. Back to what I was saying earlier, it's not just a rinse and repeat kind of program. We always felt like we had to update, and do things, and prepare quite a bit.

So we're enjoying a little hiatus right now. We just built out a new office right before COVID hit. We have a lovely little teaching center there, and a lot of things that are just not being used much right now. So one day we hope to return back to that, but at the moment, we don't have official formal courses. I'm turning down a good bit of opportunities to move around and travel and lecture to study clubs and stuff. But one day when my kids are in college and kind of aloof from parents anyway a little bit, we will likely return back to that.

So I'm going to just say stay tuned and don't hesitate to reach out to me personally if you have questions or comments or concerns or anything I can possibly help you. I'm a big believer in paying it forward. A lot of people have helped me get to the place that I'm enjoying a lot right now. And so reach out to me DJwells@comcast.net is my I email. DJwells@comcast.net. And that's the best way to catch me.

And I hope this has been meaningful to all the listeners today in some way. It's just my story. Sometimes it feels like it's a little to me focus to even enter into all these things, these questions, but it is an interesting story. And I love stories. I love Dennis's story. As I delved into that a little bit earlier. And I encourage all of us to keep on fighting to be the best possible dentist we can be! We're blessed to be in this profession.

Dennis H 50:33  
Amen again. I want to finish up with another quote from Dolly. I have... and this is abbreviated. It's a little longer, but she says, "I have to not harden my heart because I want to stay open to feel things." And she goes on to some of those feelings. And she finishes, "I'd like to experience whatever the feeling is and whatever I'm going through."

And I bring this up because in our world, and in the world around us... So much is going on in today's world, and you know, maybe post-COVID or still COVID, whatever we are at... And, as you talked about, having our team that is so important to us, and our patients that are so dear and valuable to us, it's important to be able to feel things, and it's important... I think, when I was in a certain part of my career as a dentist, maybe I tried to block off those feelings, but it is about making life, about being around the people that we're around, and making these connections, and making sure that we're there for the people who need us, our friends or family, and taking care of ourselves.

So Dennis, I can't thank you enough. I was super excited to hang out and spend time with you today. I'll be honest, I was a little nervous. I was feeling like, "I'm talking with a celebrity!" And I... And truly, you are one of the most humble people that I've had experience. I would guess it comes off as shyness. I think you you have these very, we would call it midwestern, but I think it's very southern, that you don't want to talk about yourself. I appreciate you sharing openly sort of your background, and your history, and your story because it is... I think it's really, really interesting. So I'm I'm grateful that you shared this with us today.

Dennis W 52:19  
Dennis, thank you. I'm honored to be a part of this. And kudos to you, by the way! As a new member of the AARD, I know the deep investment in work you put into that organization. And I appreciate all that you do for that because talking about a big life, that's a group of people that understand that the real goal is to create not just great dentistry, but a great life, and kudos for all you do for there. And I look forward to seeing you, if not sooner, I'll see you in Chicago next February.
But that's the part you've got to sit back and wait on. You do the hard work, I've learned, and you get luckier. That's kind of what happens.
Dr. Dennis Wells
Dennis H 52:50  
Absolutely. Well, hopefully sooner than that! Well, listen, Dental Online Trainers, iit's been a gas. It's been a blast! I cannot thank you enough all for hanging out with us and listening to us today and enjoying our conversation with Dr. Dennis Wells. And until next time, yours for better dentistry, I'm Dr. Dennis Hartlieb. 

Alright, Dental Online Trainers. I hope that you enjoyed my conversation with Dr. Dennis Wells. I mentioned in our conversation that I had attended his course in Nashville several years ago with my dental study group. It was really eye opening for me to see his techniques. And it's really influenced me quite a bit when I do porcelain veneers.

Now, what I did not mention is that Dennis entertained our study group following the meeting at his home. And in his little follow up, he actually brought out some moonshine for us to sample. And I have to tell you, that was my first foray into moonshine, and that was pretty doggone tasty. So I hope that you enjoyed hanging out with me and Dennis, as much as I enjoyed the moonshine that he shared with me that night.

Listen, don't forget that DOT has so many other great opportunities from our wine and unwind -- these are a monthly webinars where we engage real time with our viewers and we answer your questions and we bring in leaders throughout the dental industry to talk about things that matter to all of us in dentistry.

We also have our monthly Study Club sessions. This is what I call our coffee and donuts study club. We meet one Friday morning a month and we look at cases that you're working on, and we try to help work through those cases to make it more predictable for you in your dental world. We also talk about managing our team and our leadership responsibilities. So something... as a member of D O T, hang out with us. These are Friday mornings once a month.

We also have our blogs and, of course, our endless selection of hands-on pre-recorded technique courses to help you improve the quality of dentistry that you provide to your patients. So check us out at DOThandson.com. And thanks for joining us! And as always, yours for better dentistry, I'm Dr. Dennis Hartlieb.



Dennis Hartlieb, DDS, AAACD

DOT Founder

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