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Would you learn about the oral biofilm if your health depended on it? Well it just might. On the Biofilm Factor, Dr. Ryan Nolan discusses the importance of diet, biofilm management and the oral systemic link with fellow dental professionals. Join us and learn how the state of your oral cavity can impact your overall health.

For more on The Biofilm Factor, follow on Instagram @biofilmfactor and @ryannolandmd or find me on Facebook at The Biofilm Factor Podcast.

Jul 17, 2018


Your teeth are one of your greatest assets. Don’t lose them or Dr. Donald Ross will be on your case. In this episode of the Biofilm Factor, Dr. Ryan Nolan talks with Dr. Donald Ross, prosthodontist and founder of Digital Ape Dental Labs. They discuss the All-on-4 procedure and the currently flawed attempt by the dental community to provide a successful “Teeth in a Day” experience for patients. Our current lack of dental research on the All-on-4 and poor communication with patients who need this procedure is the “Wild West” approach described by Dr. Ross. Instead, there needs to be a shift towards a cohesive method that ensures success, one supervised by a specialized restorative doctor. When teeth are on the line, we’re not keeping our mouths shut. For more on The Biofilm Factor, follow on Instagram @biofilmfactor and @ryannolandmd or find us on Facebook at The Biofilm Factor Podcast.


Bio for Dr. Don Ross

Dr. Donald Ross is a prosthodontist and the founder of Digital Ape Dental Labs. He is a graduate of the University of Iowa College of Dentistry where he also completed his residency program in Prosthodontics. This dental lab focuses on providing the optimal team for the All-on-4 procedure to assist dentists and surgeons in a smooth transition through the All-on-4 process. In addition, their vision is to improve the outcomes for patients in a standardized and successful way. Dr. Ross can be reached at the Digital Ape website or on instagram @digitalapelabs.

Show Notes:

  • What started Digital Ape Dental Labs and what is the vision behind it? [1:00]
  • What is an All-on-4 procedure? [4:05]
  • Dr. Nolan’s experience with an All-on-4 case. [5:18]
  • Dr. Ross shares his experience with a specific All-on-4 case. [6:35]
  • The difference between having everything under one roof and the “Wild West.” [8:40]
  • Digital Ape focuses on the restorative side of the All-on-4. [11:48]
  • An emphasis is not placed on the end goal of restoration. [13:55]
  • Explaining the idea behind the name “Teeth in a Day.”  [15:35]
  • Understanding the procedure behind an All-on-4 case. [17:00]
  • Discussing the need for education on the dental side and the possible consequences. [20:21]
  • Is it best to wait in certain cases because of immunocompromised situations? What aspects are considered for long term success in All-on-4 cases? [21:12]
  • Dr. Nolan shares his findings about pre ISQ values and post ISQ values in regard to loadings. [26:17]
  • All-on-4s can change the quality of a patient’s life. [29:40]
  • Three types of patients that would benefit from having an All-on-4: patients who are unsatisfied with their dentures, patients with permanent dentitions who don’t want dentures and patients who have heavily restored dentitions. [31:45]
  • Having teeth to chew allows an individual to eat wholesome food and get the right nutrition. [35:35]
  • The most common material used in All-on-4 is a titanium bar with an acrylic wrap-around, although acrylic is bound to break. [39:00]
  • Why is it important to have the right team for a dentist and the patient? [42:46]
  • Normally the team consists of a surgeon, lab and restorative doctor. [44:10]
  • Which population or age group goes the most unrecognized for this treatment and would benefit the most from it? [47:37]
  • The average population that needs an All-on-4 is getting younger and younger. [50:43]
  • Understanding when to extract and when to restore on a patient. [53:49]
  • Taking into account the biofilm and oral health of the patient when deciding a treatment plan. [57:00]
  • Discussing failed implants and why they fail. [59:40]
  • How do you explain to a patient that implants can fail and they need to be taken care of? [1:01:53]
  • Explaining the concept of platform switching and how it influences implant bone loss. [1:06:03]
  • Zirconium abutments versus titanium abutments and what factors determine success. [1:10:27]
  • Dr. Ross shares his experience about a patient and implant problems. [1:14:54]
  • Has Dr. Ross dealt with any high risk factors that influenced his decision to do an All-on-4? [1:19:30]
  • What is a big misconception that Dr. Ross was taught in dental school that he realized years later was not relevant? [1:21:59]
  • Closing thoughts and information about Dr. Donald Ross. [1:26:50]