All-On-4 Revolution …a shotgun lecture in Tokyo

December 3, 2015 | by Dr Alex Fibishenko
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Meticulous, systematic, minimalist, and bullet-trains, …that’s Japan. So why would an invitation to speak be any different: fly-in Wednesday, do two lectures, visit a couple of clinics and fly out Thursday, …oh, and on 3 weeks notice, …plenty of time, right!?

When Mike Thompson, APAC manager for Nobel Biocare (NB), asked me to do a quick lecture on All-On-4 in Tokyo, I agreed on the condition that it would be the exact same lecture that I recently delivered in China for Geistlich biomaterials. I had surgical lists booked many weeks in advance, and would need to reshuffle my schedule to open up 3 days for this lecture. Reshuffling my patients meant working longer hours in the weeks leading up to the event, and this would not leave me any time to create a customised lecture. He agreed.

But just like in a typical family the man is the head, but the woman is the neck, and can turn the head any which way she likes, in the corporate world at NB APAC there is a similar model. She goes by the name of Ramya, NB Training & Education Manager. She emailed me ten days before the event, gently listing the agenda, demographic, …oh and the learning objectives for the attending clinicians. Lets just say it was a little different to what I originally thought I signed up for. Ok, it was a lot different!

I always tell my kids, if its worth doing, then its worth doing well, and I had to keep true to my own words. So I’m actually grateful Ramya contacted me. If I was going to deliver something that was not exactly what they wanted, this would be a waste of time for everyone, and who knows how this might affect my global reputation as a speaker. Anyway, I work best under pressure, so I spent the weekend writing up a new fully customised lecture, putting the final touches on my lecture right up until departure, pictured below at the airport.

Landing in Tokyo was a little weird. The last time I heard the captain’s announcement “we will shortly be landing in Tokyo” was less than 3 months ago. I was with my wife and 3 kids. We were en-route to Mexico on a Singapore Airlines Airbus A380, when one of the engines caught fire and was shut down. We were diverted to Narita airport for an emergency landing. Lets just say the kids took this a lot better than some of the flight attendants. It was like a scene from the show Air Crash Investigation. This time I was hoping to avoid fire trucks and ambulances along the runway.

I arrived in Tokyo at 5am. It was very early so I thought I’d go for jog. I mean, what else is there to do in a foreign country at that time of the morning, when there is not one soul on the streets, still dark and the weather is frosty. At least it wasn’t raining. The map that I was given by the concierge didn’t show any rivers, so you can imagine my surprise when I came across one. I got lost, to say the least, and was punished for this silly idea with a torturous 13km route.

Later I met with Melker Nilsson, NB Global Executive Vice President. I have met Melker a couple of times before, and always had a natural suspicion that a person in his position wears a corporate hat which is results-focused and sales-driven. This time around we talked a little more, and I got to learn about Melker’s leadership style, and vision for his company, which refreshingly shattered the misconceptions that I had.

I was surprised to learn that apart from the natural corporate aspirations, Melker’s vision is actually well attuned with ethical professional standards when it comes to training and education of Nobel Biocare’s users, for the ultimate benefit of the patients.

In one part of my lecture I talked about the 3 P’s that are essential to every business model: Product, Processes, and People, and I added the most important P, …a Point of difference. Apart from Nobel Biocare being the absolute leaders when it comes to their Products, especially with their Nobel Active and Nobel Parallel systems, the true asset of the company is the vision and dedication of people like Melker and Mike, and the relationships that they forge with clinicians at the coal face, which was clear from what I saw in terms of their interactions with their users at my lectures.

My first lecture was an address to the Nobel Biocare Japan team. I took them through my journey from a small suburban practice to an enterprise with associate clinics in 8 locations throughout Australia. I emphasised that their own growth in their roles can only be achieved if their users are growing, and for the users to grow, they must have a positive experience using the product, and to have a positive experience they must be working within their level of expertise, until they acquire more knowledge, skill and experience to progress to the next level.

I emphasised that for experienced mentors to be sufficiently motivated, the sales team can help by feeding their stream of patients in ways such as introducing them to less experienced dentists who would refer the more complex cases, and who can learn from those referrals as part of their mentored training. But as those dentists become more autonomous, the mentors lists may dry up, and eventhough there will be more implants sold in the short term because more people are doing them, the mentors will lose motivation to train or mentor others in their area. Eventually this will become a self-limiting model, unless the efforts of the sales team to support the mentors are perpetual.

One of the most important roles of the sales team is to match their users with appropriate mentors and training programs commensurate with each clinician’s individual level of experience, so that they can select their cases well in order to have a positive experience with the product and grow.

My second lecture was to clinicians. I am amazed how on such short notice Nobel Biocare Japan managed to fill up their Tokyo training center to capacity. I talked about clinical aspects of total rehabilitation on dental implants, and also about my journey and how to gradually acquire skills and experience to be able to treat a wider spectrum of patients with dental implants. I also talked about communication between dentists and patients.

As dentists we sometimes tend to focus too much on procedures. But our patients know that, as dentists, we are capable of performing dental treatment. What they want is a Solution!

The key to case acceptance and patient satisfaction is echoed in the late Professor Branemark’s remarks “Listen to your patient, instead of just looking into the computer”.

Below is the courtyard outside the offices of Nobel Biocare Japan.

The next day I was accompanied by Japan’s marketing manager Hideki Sakurada and APAC Marketing Manager Yu Fujita, and met with a couple of clinicians at their practices.

It was interesting to see Dr Hirohito Kikegawa stereoscopically retrieve implants lost in the sinus, a procedure pioneered by him. I also met with Professor Senichi Suzuki, who holds positions at Nihon University, University of Southern California, Yantai Stomatological Hospital, International Academy of Implantology, Columbia University and is on the board of directors and president of International Congress of Oral Implantologists (ICOI) Japan. Prof. Suzuki has 3 implant clinics in Japan and has published scientific articles as well as a book on All-On-4. He personally placed 10,000 implants, and his group of approximately 20 clinicians have documented close to 1,000 All-On-4 procedures. It was great to share views, but three things caught his special interest and undivided attention: the All-On-4 Clinic’s process of fitting FINAL teeth within 24 hours, the Sinus Impaction Graft (aks “Sinus Crush”) for restorative space management in the back of the upper jaw, and the new Zygoma Plus protocol. He personally doesn’t perform Zygoma surgery, and after watching a video of the procedure and rationale, he became eager to have his maxillofacial-surgical associate try to implement All-On-4 Clinic’s protocols for his patients.

Special thanks to Yu Fujita and Ramya Narayanaswamy, who organised all this in such a short time, and who made sure that my visit was enjoyable. Ramya was also responsible for organising my prior lectures in Mumbai and Delhi earlier in the year, which were organisationally flawless. Thank you also Riki for showing me around town in the very limited time we had.

Finally, Michael Glen Thompson (Mike), who apart from setting the wheels in motion for this event, managed to slip in a special tune he wrote, showing off his musical talents, a tune for me to use in my next surgical video, “Time for Feeling” …although I’m not sure how appropriate this title would be in a surgical video demonstrating Zygoma surgery. Great guitar work, kind of Pink Floydy, – worth a listen.

I enjoyed meeting the Japanese clinicians, and the Nobel Biocare team, and very much look forward to coming back soon. Hopefully next time I can stay for a little longer to experience more of this country and culture.

Dr. Alex Fibishenko


Oral Implantology & Reconstructive Dento-facial Surgery
Dental Surgeon in Self-Restricted Practice
Innovator of All-On-4 Plus ® & founder of All-On-4 Clinic

Dr Alex Fibishenko practices exclusively in Oral Implantology, Dento-Facial Surgery and Facial Aesthetics.

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