Hello, this is Anthony Chadwick for the webinarett welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast, and I'm delighted on this veterinary dental month of February to have Ivan Crotaz on the line who is the one of the founders of Bonivate and the maker of the Dentonomic range of dental instruments which are excellent ergonomic instruments that we'll no doubt be talking a little bit about later on in the podcast. But first of all, Ivan, thank you so much for for coming on. I think we, we passed briefly at BMX didn't we?
We were both fortunate enough to go there for. Chatting to our American colleagues and it's a, it's a fascinating place because of course culturally there's a lot of similarities, but there's also some differences as well, isn't there? You, you tend to work over there for 4 or 5 days before it hits you, and then suddenly you realise you're somewhere very, very foreign, they, yeah absolutely.
Ivan, tell us a little bit about yourself, obviously a veterinary surgeon, like myself, very proud, I think, to. Have been a GP probably still a bit more GP than me because obviously you still go out and do some practise, but obviously dentistry. Is one of your passions, er, I think also maybe solving problems as well.
I was gonna say that's, yes. So I, I graduated in '99 from Povet College in London. I went straight into general practise working for Kyne and Partners in Berkshire.
And I worked there as an associate for the next 1011 years running one of their clinics. And in that time, I started to, well, first thing I started to realise was that I didn't want to run a small animal vet practise for the rest of my career, dealing with all the problems, all the staff issues, all the clients, all the rest of it. So I enjoyed the work, but less so the management, .
And then I happened to meet a group of people who were doing interesting things, so. I would say my career is low boredom threshold, I like doing new stuff and I like doing the things that other people aren't interested in. So I got into rabbits, we had a rabbit rescue centre open up down the road.
Nobody else was interested in rabbits at the time, so I ended up doing all of their work, learning enormous amounts by doing that, and then started teaching for BSAVA. Got into working with a human anaesthetist, developing anaesthetic equipment for animals at that point, and I think some of that work's gone back into human anaesthesia as well. And then I was in a consult one day with a guy who'd cut his lampshade cone collar down with a pair of scissors to shorten it down.
His dog had an ear infection. And I said to him, that's a good idea, you should patent that. And then two days later he walked back into the practise saying, my mate's a patent lawyer, do you want to start a company?
At which point I was bored and said yes, and the rest is history. And it was, it was literally as straightforward as that. So the three of us have been working together since 2008, developing initially a whole series of things that didn't work.
And then over the years we got better at figuring out good ideas that other people would also be interested in. And that that's, that's where it came from. I'd be fair to say, you know, a problem solver, a creator or inventor.
Problem solver is a better term. I don't like inventors suggests that you have an idea and then try and shove it onto somebody else. Problem solver, what, what we do, I'm still in general practise.
I don't do specialist practise work. I do whatever comes through the door. Still quite a lot of rabbit, rabbit work, dentistry, medicine, a lot of geriatric stuff these days with the rabbits, because they're living much longer than they used to.
But I'm just doing whatever comes in. And the advantage of that is that I'm seeing the, the real stuff, rather than the specialist once a year case, I'm seeing the everyday cases. So what I'm doing is looking at the equipment and saying, well, that doesn't work very well.
Going back, designing, testing, retesting, that sort of thing. I think this is what, this, this is what happened with Thomas Edison, you know, he, the problem was, you know, it was very dark in the night to read your books and things, so what's the solution, and obviously the old fashioned solution was gas lighting and candles. And actually he wanted to solve the problem of something that was more consistent, didn't run out.
But I think he had 10,000 goes of it, so actually, if you are a problem solver or an inventor or whatever word you want to use, you have to be really resilient to cope with failure, don't you? You have to use failure as an advantage. So there's the system fail early, fail cheap.
So you probably can't see behind me, but I'm sitting in the workshop area of the office at the moment. And when we make prototypes, I literally hand make them here very fast. So we've figured out ways of very rapid prototyping that doesn't involve digital imaging.
You, you can make something physical very easily, very quickly. Feel it, pick it up, feel the weight, feel the balance, whatever it happens to be, and then say that's useless and start again. And you're 20 minutes in and you've learned what you need to know.
When we were doing the anaesthesia work, we cut the product, prototyping down from something like 6 months per prototype down to about 3 weeks per prototype. So the idea is to fail frequently, learn something from every failure, and then bring that product out much better without having wasted 5 years in the process. So yeah, failure is an advantage.
And sometimes. You have to obviously have that feedback from your clients because sometimes people create something which they are so pleased with. It's an amazing product, but actually nobody wants it.
But you're so committed to it that you carry on, no, it's gonna sell, it's gonna sell. If what what, you know, similarly with obviously the Dentonomic instruments, but also with Webinar vet. There was an immediate attraction and traction to that product when I set that up.
Almost from the first, well, it was from the first webinar that I did. There was success and you know on each stage, we could see this was something that obviously wasn't just me that struggled with trying to do his training, you know, purely in a physical way. It it was lots of vets and nurses and so.
That growth happened very quickly, it was never something that was sucking cash out, it was bringing cash in. It's always a good sign that you've got a, a good product and if you haven't got it, as you say, stop doing it. Yeah, physical products tend to suck the cash out for quite some time.
So our dental instruments took us 3 years of development work, even with their prototyping method to get them to the point that I was comfortable and a bunch of specialists were comfortable, and then we only launch when we got that. So, yeah, that was, that was a hard process. Yeah, I think that's the, that's the thing with any physical product or a physical business, you know, bricks and mortar business, there's there's a huge cost to set up.
And I think now digital is catching up with that because actually if you want to get a good website, you know, developers are very expensive, etc. They often don't give you exactly what they promised you. So yeah, I can see the, the difficulty of that.
I mean the. The dentonomic instruments are are so beautifully ergonomic that it just makes it so much easier to do the job, but I suppose also with dental instruments. It's often the sharpness of the instruments, you know, if we don't look after them, they dull, so how do you work with that with with the denton it's, in fact, Antony, it's not the sharpness of the instruments, that's, so that's where we started as well.
It's thinness, not sharpness that makes the difference, so. Dentinomic was a little bit of a journey. I sat there, I was catching up with my CPD, and I was listening to one of the UK vet dentists.
I thought, fine, hate dentistry, I'm gonna go and sit in this lecture and finally after 15 years, figure out how to do it. And what she was talking about was the fact that everybody's struggling with blunt dental instruments. So yes, we started and we said, could you make a dental instrument that works like a scalpel?
Can you make something with a replaceable blade? And of course with the dental instrument you're twisting left and right, and you're pushing and you're pulling. So the first thing we worked on was a connection system so that you can lock and unlock the blade really easily and not break it because let's face it.
You know, put something in the hands of a vet and the first thing it can do is figure out how to break it. So that was the first thing, having a connection system that was stable, left, right, push and pull, because a screw thread or a little snap lock like a scalpel blade. Just can't work.
So we, we, what we ended up doing was combining several different shapes together and when they're working all together, then the instrument is locked in. . And then what we did is we started sitting down and looking at manufacturing methods and we already had an association with a very, very specialist machinist who's just on the west side of London.
And they make all sorts of high-end military stuff, they make turbine blades, they make, oh it's amazing when you, when you walk in there, very, very, very good machining. And they started making blades for us. And because they're making them on on a machine, you're getting the same blade edge cut every time and those blade edges are really, really, really fine.
So it's a very sharp point. Yeah. What we found over the years, we started using them and it was a shock.
It was so much easier to use and we assumed it was because they were sharp and the steel was really good and all the rest of it. It turns out, no, it's the thinness of the point. So it's like the difference between using a hunting knife and using a sushi knife.
It might be the same steel and it often isn't, but it might be. It's the fact that one of them's got a fat sharp edge, that's the hunting knife for strength, and one of them's got a thin sharp edge, that's your sushi knife. So the reason that the instruments work is because the edge is thinner than the periodontal ligament space that you're trying to shove them into.
If they're just fat and sharp, it's really strong, but it is not gonna go down into that space. If you make the little bit of metal that you're shoving down there thinner than the space, then it works. Forgive my technical language.
So, wonderful, wonderful, wonderful. All launched, all doing beautifully. Then we found all sorts of weird things.
We found that some people loved them and some people bent them in seconds, and we were trying to figure out what was going on. The first thing that we did, we, we had somebody snap half a blade off down inside a dog's tooth. And what we were doing at that point, we were using a very hard metal that kept a beautiful edge, but unfortunately, because it was hard, it was also brittle.
So in the hands of someone using gentle technique, it was great. In the hands of someone using a more brutal technique, it wasn't. And we switched to more malleable metal so that when it failed, it failed by bending rather than by snapping, and that was one of our turning points.
And then the second thing that we realised was that the instruments on their own aren't good. So Instrument without technique isn't giving you any benefit. If I, if I came to your practise and showed you how to use these, then it would work.
If I come into your practise and just leave them with you, and you use them like a crowbar, because that's. Let's say, how much dental training did you get at college? It's like I got a day and most of that was was a lecture slides.
It wasn't practical training. There are people graduating, they get 1 or 2 hours' worth of a PowerPoint lecture now. They're not taught how to physically pick up and hold the instrument.
So what we do now is very different to what we do when we started out. It's not so much about the instrument itself. So what we do is we sit them down and say, please do not buy this without the training session.
It's either me or one of my team every Thursday, twice a day on Zoom, free of charge whether you purchase instruments or not, and we'll go through and we'll say, here's how to hold the instrument, finger goes on the end. Actually that's an interesting, so that little curve sits into your palm muscles, finger goes on the end, rest of your fingers gently wrap round without tensing up. Now, here's where the edge of that instrument goes.
Here's how to use your hand for this kind of blade, here's how to use your hand with that kind of blade, and we'll sit down with with models and talk to them like this. It's not a PowerPoint session. So you say.
Elevation does this, luxation does that. Here's where the blade goes, here's how to use it. Here's how to combine the two techniques.
And then once you know that, then the instrument is worth something. I was going to say, presumably Ivan, unlike in the old days, you discourage people from perhaps as the gentleman who broke it or the lady, not wishing to be sexist, you probably discourage people from using mallets on top of the engine. I did have that a couple of weeks ago, I was teaching at a conference and I finished the talk and he said, so I, I'm not quite sure when I use my mallet, and I thought.
You're just, you're just not going, cat dentist as well, which terrifies me. So yeah, it does come up occasionally in conversation. Perhaps, perhaps just for those vets and nurses listening who are not old farts like you and I, we should just remind people that before the high speed drill, mallets, chisels and hacksaws were, were not uncommon in the veterinary dentistry world, were they?
Completely. It was a hacksaw blade. We were, we were advanced.
Yes, I have to say I have never, never felt the need to use a chisel and a mallet. Thank goodness. So I have used a hacksaw blade back in the day, but I, I never, I never have picked up a hammer and put it on a cat's jaw, .
Yeah I'm. That that ends well, does it? I cannot begin to imagine, you can be moderately delicate with a hacksaw blade, although I do think the high speed drill was a big step forward.
I think for me, actually, the other thing that I noticed at the time was non-steroidals. I don't know if you found the same thing when Remidor first came out. It was just night and day for anaesthetic recoveries.
That, that's been the, the single thing in my career pharmaceutical wise that's made a difference for anaesthetics was non-steroidals. Anyway, on the subject, so teaching wise, we'll sit down and we'll show them how to do it. And then what we do is we guarantee stuff.
We've developed this over the last few years, so. I don't ever want someone to take one of my instruments or one of my products and have an experience that means that they felt badly done by not backed up, that sort of thing. So what we'll do with people is we'll say, look, it is a different technique.
You can't use it as a crowbar, it will bend. You've got an edge that's slimmer than the periodontal ligament space. It's not a strong piece of metal, it's a sharp piece of metal.
If you bend a blade, and you probably will over the first month of using it, we'll replace that blade free of charge. If you don't like it in that first month of using it, you send it back and you get a refund. So then people can try something new, they get really good teaching and they won't get let down.
And I'm really very proud of that one actually. We've been running that for 3 years. We've only had 1 person send the instruments back, and that's the whole of the EU and the whole of the US.
We replace plans every week for people, we have. I would guess between sort of 10 and 40 people a week that we're training. And it's just good basic instrument technique, it's nothing clever, it's not specialist dentistry, it's just what we do in practise.
And I think of all the things about the product, that's the thing I'm proudest of, that we're actually helping a very large number of people. We, we're the same with Webinar that, you know, we have a 100% guarantee because we know if people. Commit to training, you know, as Benjamin Franklin said, if they, if they pour their purse into their, into their brain, that will be the best investment they will make.
And of course there's no point in spending money on an expensive dental instrument if you then don't spend the time to be trained on how to use it properly. Exactly. We, we can make people, it's, it's all about precision, .
Think about, I, I always, I always, it's a slightly weird analogy, but think about a retained testicle operation. If you don't know how to do it, you're gonna go into the abdomen and you're gonna search around for half an hour, and eventually you'll find it. Or you can go to the bladder, find the vase, follow it, you're there in 30 seconds.
Dentistry, if you put the sharp bit of metal in the periodontal ligament, then it's soft tissue surgery. And I'm not saying in every case it's easy, but it's precise. You go, here's the tooth, here's the ligament, here's the alveolar bone, you work on the soft tissue and not on the hard stuff.
And most people, I mean 30 to 50% faster at extracting teeth and no more snapped tooth roots. And that's, that's what we're aiming for. And it's and that's quite stressful.
That's the huge improvement, Ivan, because, you know, when we were using hacksaws to actually cut through a tooth, I mean it built up your muscle, but it took a huge amount of time, whereas high speed drills now obviously to, you know, section the teeth and then go in with a decent dental instrument that is. Correctly designed. You, you don't want, you know, the old cat, my own, when I say my own cat, of course I don't own the cat, I'm his actually his chief butler.
He, he, he's our CFO now our chief feline officer, he, he adopted me during the pandemic and yesterday he had to go in. To have dental work, he has very, very few teeth left, but he had a snotty nose, and we think it's one of the canines and if you have that animal out for 2 to 3 hours as an older cat or an older dog, it's not nearly as good as having it out for 40 minutes, so the, the shorter the anaesthetic, the better, isn't it? That's within with my anaesthesia head on, not necessarily the case actually.
A controlled, safe, planned anaesthetic. That extra half an hour if you have the patient under control is meaningless. So.
Rushing through a procedure to knock 20 minutes off the anaesthetic isn't a sign of a safe anaesthetic. That's that person. So touching on anaesthesia for a second, my, so my background is rabid anaesthesia, which is thought of to be on the tricky side.
In fact, it's not. Rabbits aren't, they do have a higher death rate, but most of that is because we're not used to dealing with things. But you start beforehand.
You don't start the anaesthetic on the day. You take your elderly cat with mouth pain and you say maybe we should be supplementing the food here, is he thin? Is he skinny?
Have we taken bloods beforehand? Have we actually realised that his kidneys are not looking so hot, liver's not so good, thyroid's out of control. Just get the nutrition sorted out, get the mouth pain sorted so that guy can be eating pre-op and get some nutrition on board so that they're warm.
Start temperature monitoring before you pre-med. Most of that temperature loss is between admission and induction, not induction going forward. So you start them in a warm area with some insulation, take that body temperature, check that it's not too low, pre-med, keep monitoring.
I think for dentistry. Personally, continuous temperature monitoring probe, so in order of importance for my anaesthetic monitoring machine, the CO2 number one, I don't want to do an anaesthetic without carinnography. Probably #2 for me with dentistry is a continuous temperature probe.
It's so, so, so useful, and for those of you who maybe think, well, it doesn't matter, I'll just take a thermometer every 5 minutes. So many people forget to do that, it's so easy to forget to do that. And then you realise the temperature's 36.something in a 17 year old cat.
And then after that blood pressure and all the rest of it. But CO2 and temperature for dentistry, my goodness, it's important. So I think careful planned dental with good analgesia.
I don't mind whether it's a half hour procedure from the cat's point of view or a 1 hour procedure. I mind if people are rushing and not thinking. That's, that's quite important, I think, and particularly analgesia, a good balanced analgesia protocol.
Taking things like long term pay into account, so using. Foronists if that's required beforehand, . Personally, I do use non-steroidals pre-op.
There's a lot of different opinions on that these days. It's not good if you let the blood pressure drop, so I monitor the blood pressure and I don't let it drop. .
Non-steroidals take 45 minutes to start working, so in an elderly cat, I will use them in the pre-med period and monitor the blood pressure all the way through. But, but the proper anaesthetists argue with that one, and then nerve blocks so that those animals can wake up without pain. So at that point, I absolutely think we shouldn't be doing 3 hour dental procedures on elderly cats, but whether it's 45 minutes or an hour probably doesn't make as much difference as we.
Yeah, no, I agree, but obviously if you've got a. You know, cutting recumbency for 2 or 3 hours because you're just needing a long time to take a tooth out rather than doing it in 2 hours because you've got better instruments, that's obviously, well, you know, got to be better for the. And I think dental surgery, if you're being precise and you're planning things for elderly cats, 1 hour to 1 hour and 15 minutes is probably what you need.
2 to 3 hour procedures are happening because we're not being precise with our instruments. And for things like a full mouth extraction, I'll do one side at a time. I never ever do both both sides at once anymore.
So you do two lots of an hour and it's much, much better for those animals. Yes. And, and again I'm saying that from a GP's point of view, not a specialist.
Yeah, no, that, that makes sense and of course the, the importance of radiography within that, so you've got a, an idea of what actually is going on, you know, not only above the, the gum line but below the gum line as well. It can save you a vast amount of time. If anyone's listening and they don't do dental radiography in cats, you are wasting your time.
If there's a resorptive lesion and there's no peridontal ligament space and the bone's just going into that root, you can row amputate that root, you can smooth it off. It'll take you minutes and you've done a good job. So dental radiography is a time saver, not a time waster.
Yeah, it's super important. And not as hard as you think. No, exactly, and that's a great point maybe to, to finish with, you know, we were speaking to Norman Johnson on the podcast as well.
It's a great, you know, one of the, the founding fathers certainly in the UK of dentistry and and a similar thing, you know, dental radiography is really essential. Obviously we do it in humans, we should be doing it on our cats and dogs. I think don't be put off by thinking that radiography is complicated and dentistry is complicated, it's not.
You are going 0.5 millimetre into the bone and taking out a very simple structure. So dental radiography.
If you're trying to get textbook perfect pictures, then yes, I agree it's complex, but we're not. We're just trying to get a diagnostic radiograph, just start doing it. The SAVA manual of dentistry's got some fantastic stuff in there.
I have that. I have a couple of other books, but that's the one I go back to. Cecilia Gorr's dental book is also very good.
It's much smaller. And that's what you can flick through and you just find the location, you eyeball the angle, take a picture. And then you get better at it over time.
So stop trying to be perfect with it, just, just do it. I think this is the key, that's, we know a lot can be perfectionists and actually the only way you get good at something is to do more of it. So if you don't, if you're not able to walk, you know, as a child, you just practise, practise, practise, and you get better at it.
Well, similarly, you know, any sort of exercise, riding a bike. Swimming, running, you know, the more you do, the better you become, similarly with our, our clinical things I, as a dermatologist just wanted to use my microscope all the time, the more I did, the better I became, it's the same with radiography, isn't it? Yeah.
Absolutely. Ivan, thank you so much for agreeing to spend some time on the podcast. It's dentistry is so important, again speaking to Norman recently, amazing that 30 years on from myself graduating, we're not doing more of it at university, it is something that seems to come on.
We seem to educate ourselves on a postgraduate level, but of course, Dental problems in, you know, in many of our species in cats, dogs, horses, rabbits can be a a a massive issue for welfare of the animal. So it's great to see people like you, spending time thinking about it, creating and developing these lovely instruments that you've developed, but making sure that as a GP it's something that we should feel comfortable. Doing the, the, the easy stuff and then obviously the more complex stuff, sending on to our specialist friends.
Yeah. Anyone that wants to access that training, Dentonomic.com, go there, there's a link through and you can come onto one of our Thursday sessions free of charge whenever you like.
We'll, we'll put that underneath on the podcast so people can actually see what the link is, and obviously your email address if people want to perhaps email you and and chat further about anything. Lovely. Thanks again, Ivan, thank you everyone for listening.
Hopefully we'll see you on a podcast or webinar very soon. This has been Anthony Chadwick from the webinar vet and Vet Chat, the number one UK veterinary podcast. Take care, have a great day.
