Interview with Galip Gurel
I believe being a good clinician and being a good smile designer are two different things that require different skills and mindset. During all my years travelling around the world and working with many amazing professionals, I had the honor to meet a few great clinicians that were also very good smile designers. Galip Gurel was definitely one of them. I had the pleasure to work with him, treat many patients, design many smiles and lecture together. I remember, with affection, those nights sitting together discussing cases and ideas.
Galip was always very appreciative of and curious about the technical work. His vision and charisma were always inspiring to me. For all those reasons, it is a great pleasure for me to interview him in this first issue of our DSD Magazine.
Thanks so much Galip for sharing your precious time with us.
CHRISTIAN: First of all, can you tell us a little bit about your professional background and who your main mentors were?
GALIP: As you know, I also come from a family of dentists. It doesn't go as far back as yours but both my parents were dentists. I grew up in that atmosphere and my parents were always talking about dentistry so it was a natural choice for me. Dental school at that time was very traditional. In the restorative area it was basically drilling, filling and restoring. When I graduated, my biggest jump was to move to USA for my Prostho program.
The thing that gave me a lot was that on the same floor of the dental school there was the dental technician program as well. So every day, when I was done at around 4pm, I would run into the technicians' school and spend hours and hours doing my own learning and learning how to do things in what I call the "kitchen of dentistry", the dental lab. Even though my father was one of the first to have an in-house lab in his clinic, the things I learned there were very different.
When I came back, I started two things that were a big change for Turkey. One was stepping into multidisciplinary dentistry, that is completely different to today's interdisciplinary approach, and the second thing was that for four years I did all my lab work myself as a technician. I was doing my own wax-ups and baking my own porcelains which gave me a lot because even today I know what is going on in the "kitchen". I understand the difficulties that technicians go through and therefore, I have always had great respect for technicians that I worked with. That's why I admire their work. My two biggest concerns were: how to be the least harmful to the patient, and how to make the technician's life as easy as possible because these two things go hand in hand.
Because of my experience with the clinician/technician interaction, one of the main things I introduced to the dental world was to do the mock-up in advance, guided by the wax-up, discuss the smile design with the patient before starting the treatment, and finally prepping through the mock-up (APT).
In this way I was able to be minimally invasive and give the ideal clearance for the technician to build up the porcelain. This was a big jump in my practice and I know that many people are using this technique without any argument because it was a win-win situation.
CHRISTIAN: For sure the APT technique was a groundbreaking technique because it created, for the first time, a way to control a clinical procedure based on the initial smile design project. Nowadays, with the digital workflow, we are trying to bring the same principle to all clinical procedures.
I also totally agree that your APT technique is a way of demonstrating respect for the technician's work because it links the prep to the wax-up design, allowing the technician to translate this design to the final restorations.
GALIP: The technique helps everything. It was very beneficial for the patient, because it was minimally invasive, also beneficial to the technician as you mentioned, but also beneficial to the dentist because there was no guess work, everything was designed and performed following a proper strategy. It was almost like a mathematical outcome.
On top of that, when you think about making a smile design, things are a little bit different because, as you would very clearly remember, when we first started working together, there was no DSD. It was like team work and maybe I had some good eyes or good taste, some intuition that would help me to design something nice for the patient.
For me, the biggest step into smile design was doing the direct mock-up. A little different than drawing things or showing digital images to the patient because they were feeling it in 3D. As we both know, when we place a design, it is never 2D it is always 3D. It affects the lip position, it affects the posture, everything is combined. I can draw anything on the paper but functionally and esthetically I need to see it on the patient and the patient has to feel it before we start anything.
So this is what we used to do, actually, I still do direct mock-ups in my cases regardless of whether it is easy or not. But when we started working together, I always say, I learned many things from you as well, not only from the lab side, such as shaping teeth, etc, since you were amazing at that.
CHRISTIAN: Thanks Galip. Coming from you that means a lot and it's great to remember the amount of information we exchanged during that period.
GALIP: Yes, I do apply your techniques to my direct mock-up technique on how contour the tooth, how to work with the embrasures and dental contacts. Our interaction definitely boosted the direct smile designs that I was performing in an analogue way.
CHRISTIAN: There were many things that we were able to collaborate on and develop together. But there are 3 things that I think you really pioneered. Things that impacted my work when I was there with you. The first thing that caught my attention was the direct mock-up, but not direct mock-up as people usually talk about.
You were the first one I saw doing pre-op mock-ups in an initial consultation to people that didn't necessarily have the vision of how a new smile could impact their lives. You were the first one I saw doing "Emotional Dentistry" before I invented this name. For the first time, I saw a dentist emotionally linking the treatment and engaging the patient through the mock up that you were doing as a gift for the patient.
Of course the mock up was bringing you technical advantages because you were already test driving some aspects of the design but beyond that, you were engaging the patient, you were creating a relationship, you were sending a message that you were much more than just a very good clinician, you were also an artist. Your patients would really look at you with different eyes and admiration because of the mock up. So even before the patient could know how good you were clinically they were already appreciating your skills. So this is for me the beginning of what became known all over the world as "Emotional Dentistry", creating perceived value and improving patient interaction and experience through the smile design process.
The second concept that we developed together at that time with Livio Yoshinaga, and which became part of my workflow, was the Facial Dynamic Analysis. This is when we moved from photos to videos when analyzing faces. You actually had a specific space and setup in your office for the video recording and this brought a completely new dimension to our work, facial and lip dynamic analysis, smile integration and patient interaction.
The third concept was customizing smiles through morphopsychology principles, Visagism as we call. Inspired by the concept of my friend, Dr Braulio Paolucci, it brought these psychological factors into smile design and together with him and Dr Marcelo Calamita we were able to create a practical protocol of smile customization.
Matching smiles not only with the physical features of the patient but also with emotional features.
These are the 3 things that I believe we, as a team, can be very proud of developing and bringing to the dental world through practical workflows. I believe these ideas will be more and more utilized in dentistry and this moment will be remembered for many years.
GALIP: I completely agree with that. When we started working together I had this mock-up concept and you had a bunch of practical ideas about smile design and we were not only enjoying ourselves, we were working very hard, and more importantly, we were working often at a huge distance. You were flying all over and coming to my office from time to time. I believe the seeds of DSD were also sown at that time when you and Marcelo were thinking about all these ideas for how to improve team communication, smile design and treatment planning at a distance. When you started with those ideas it was great because it was making things easier for us. This was one of the biggest jumps in our collaboration.
Also, as you remember, you were working so much in Istanbul and we didn't have an extra room to place a bench for you and we ended up placing your bench inside my operatory clinical room. So many times you were doing a wax-up and I was doing a try-in almost shoulder to shoulder. Impossible to have more synergy between dentist, technician and patient. That definitely created a lot of quality time between us, speeding up our learning curve and evolving into many great ideas for how to work together as a team.
This brings me to an important finding, an important thing that was lacking there. Ok, we had the hands, the eyes, the vision, the thoughts between us to create the smile and treatment plan, but we couldn't really share it with the rest of the team, because these ideas were in our minds but hard to express. The visual communication protocol was key for that. For me it was super nice when you introduced me to Braulio Paolucci and to Visagism.
We then started working very hard on how to relate the designs that we were already producing with intuition to the patient's facial and emotional features. We started working backwards, first we were creating the great smile, and the patient was saying "WOW, I LOVE IT". We know that some of the cases we do, we feel they are OK, some are very good and some are really WOW!
We wanted more cases to be WOW.
More recently, we did research among 2000 random dentists that allowed us to create this new concept that we call Visagismile. We are now at a level that if someone follows this concept at least they will have a guide to start their smile design customization.
CHRISTIAN: So this will probably work as the shortcut to increase the percentage of WOW cases, because the patient will feel that the new smile is also fitting their character.
GALIP: Exactly. So we are at a very exciting moment with so many cool new concepts such as this one and DSD, SKYN Concept. All these concepts complete each other. If you use them properly it is hard to go wrong.
CHRISTIAN: If you had to train somebody to become the next smile designer at your clinic, how would you teach this person to become a bit like you? Of course we have Digital Smile Design (DSD) that gives you tools and a communication protocol, we have Visagism that gives you a process to select the best design, we have SKYN that allows us to copy natural morphology, we have the basic esthetic parameters that we can learn from articles and books, but we know that even though we have all these tools, becoming a good smile designer is very difficult and unique. So if you could highlight the main skills to become a smile designer and some suggestions for somebody that wants to become one, what would they be?
GALIP: Christian, if you want to become a good cook, you don't just watch the kitchen, you have to do your own shopping, maybe grow your own herbs, you have to try and create different things, you have to be active in the kitchen, you have to do things hands on! I can watch hundreds of videos about cooking but if I don't do it myself I will be very limited. Maybe I will be able to make some simple things, like making a nice egg, but I will not be able to make sophisticated dishes that can create a unique experience for others.
So bring this back to dentistry -- today what I see personally is that everybody should practice how to do a direct mock-up. Today I believe I'm doing OK dentistry in terms of the esthetic design. Today, even in the most simple cases. I still do a direct mock-up, whether they are asking for it or not. Just for me to practice and see the changes I can create -- and you will be amazed with the amount of things that we can feel and learn from every single case. Everybody is different. If you want to talk about the standard Hollywood smile, this is a different chapter, but if you want to go for natural and creative, getting into the emotions of the patient, you have to do this direct mock-up every single time.
This will generate great excitement for any dentist, as I still have today, and makes us realize the importance of details and the impact that small changes can have on the overall smile look. I'm very confident about it because even when I thought I was doing great smile designs, when I watched you making the wax-ups and how to counter the tooth, or when you were shaping the ceramics at a bisque bake, I realized that things could be very different under the same circumstances.
My first advice would be to definitely try to do the direct mock-up in the patient's mouth, and by the way, I still do it for free even though we charge a lot for the rest of the work, and I never think about it as a waste of time or as something that is pushing the patient into accepting a case, but it all happens automatically. Because this is something patients have zero idea about, they only see smiles in the media, which are usually big white porcelain teeth, but when they see it in their own mouth and they express their feelings like "l was like this 20 years ago" or "these are just like my mom's teeth", this is very exciting!
CHRISTIAN: Yeah, this is what we call morphological smile design research. Bringing genetic information from relatives that look similar to the project.
GALIP: Yes. So number one is practicing the direct mock-up and number two is, if you have chance, to learn and practice how to do the wax-up, because then comes the real world. If you practice these two things you will become a good esthetic dentist.
CHRISTIAN: But do you think that everybody can be trained in that or do you need some natural skills? If you had two different guys working for you, one is naturally gifted and the other is not, would you invest in both or would you suggest to the guy that is not naturally artistic to maybe focus on other clinic steps, surgery and other parts of dentistry?
GALIP: Natural talent is something different, it's maybe God given. But you see that many very talented football players don't become the best, they have to train over and over again.
Amazingly talented people will not succeed long term just because they are talented. Of course talent is an advantage but parallel to this we see many limited people that became very successful just because they were very persistent and trained very hard.
Maybe they will not become the superstars, but they can succeed. So we can make the parallel between an esthetic dentist and high performance athletes.
Of course the first tendency is to go for the talented guy but after a while I want to learn who is persistent and dedicated.
CHRISTIAN: So, perseverance can be as powerful as talent.
GALIP: Exactly. We had this conversation before when you used to tell me that from most dentists you would get bad quality information to perform the case and they would hope that you would perform a miracle and everything would be solved. Yes, sometimes dentists are lucky enough to work with amazing technicians like yourself and others, and then this miracle may happen. But most of the time if you don't give the correct information this will not happen.
(A parenthesis, I'm really impressed with this movement that started in Brazil and created so many amazing ceramists.) On the other hand, even a mediocre dentist should be doing nice composite work, and this work will get better and better the more you do it. The same with the mock-up. So if someone wants to perfect it, they should believe that repetition is never a waste of time. I see many dentists overthinking, "why should I spend time doing this mock-up, maybe the patient will not like it" or "what advantages do I get by doing it?". After doing several times, your hand will get used to it and you will be amazed with how case acceptance will happen.
The direct mock-up is also great to show what you cannot do, or explain limitations to the patients and motivate them to accept proper orthodontic or period treatment before doing veneers, for example.
CHRISTIAN: For sure! It's actually amazing because with the digital workflow, DSD concept, SKYN Concept and the evolution of CAD/CAM we can really perform amazing restorations with very little hand touch but at the same time we need the information coming from the dentist to show us where to place the teeth, exactly where the patient wants them. Actually, for me, the direct mock-up is becoming more and more important and trendy because as technology evolves, what will really matter is where to position things according to the face and bite. So when we get any kind of valid information from the direct mock-up we can move from there to the digital world and develop amazing rehabilitations.
GALIP: Another situation where we see an advantage of the pre-operative mock-up... You have seen me working on patients that were asking for veneers but the case was not favorable for veneers in the existing situation, either because teeth were extremely crowded, or because there were multiple big diastemas, midline shift, whatever, so in these situations mock-ups are important to show that whatever we do under these circumstances, it will not look nice if the case is not properly prepared with proper previous clinical procedures. And if the patient still asks for veneers without the ideal procedures we can show the best result possible. When you start this type of communication with the patient from scratch, things will change big time.
CHRISTIAN: It's a visual educational tool.
GALIP: Exactly, and you made it simple with your DSD workflow that helps the dentist to see good proportions, position, if ortho is needed, how much to move the tooth, this additional digital diagnostic help is very useful for the dentist.
CHRISTIAN: Digital is just tools because the principles need to be very well understood by the professional regardless of whether digital or analogue procedures are used.
Where do you think digital will take us?
GALIP: I'm waiting for my robot that will prep teeth. We had huge advances and hopefully in less than a year and a half we will have the first prototype but again, we don't believe only in artificial intelligence, we cannot leave everything to the robot and say "please do the smile design, do this and do that". As we already discussed, we have to follow our basic concepts and as an additional help we will be using the robots and using the software. So still, at the end, you will be your smile designer.
CHRISTIAN: The brain needs to still be in charge.
GALIP: Exactly, and if you lose your passion to be creative I think dentistry will be very boring.
CHRISTIAN: The human touch will always make the difference.
GALIP: Of course.
CHRISTIAN: Galip, I always say in my courses that being good clinician is not enough to guarantee a successful career. Having charisma and communication skills is just as important.
For me, you are an amazing clinician but also an excellent communicator with great charisma and because of this combination, you are so successful. What advice would you give to dentists when it comes to engaging the patient, making the patient trust you and like you and above all making the patient happy?
GALIP: First of all, you should always be very open and honest, never promise things that cannot be done. Secondly, I always try to put myself in the position of the patient and imagine how I would like to be treated. This is how I always approach the patient, mentioning the positive and the negative parts of the treatment. I always let them know the situation well in advance before we start the case.
Creating this trust relationship doesn't happen because you published two articles, it comes from many, many years of experience and patients talking positively about you and about your work.
CHRISTIAN: Yes, but what I mean is that I know dentists that are very ethical, very concerned, very correct, and people just don't engage or like them that much. Is there a way that we can become somebody that patients will actually enjoy and trust in a 15-minute conversation, like I saw happening with you many times?
GALIP: Christian, I never made an effort to be like that, maybe it was me, I mean, during my life I always loved people, I love my job, and we have this energy and enthusiastic way of approaching the patient. Maybe people can feel things, there are things that cannot be said, that cannot be written, that cannot be exercised. Everybody has an aura, maybe a charisma, bigger or smaller, and I really don't know where it comes from but it is part of your personality.
CHRISTIAN: So you do agree that this is an important skill for a dentist because our business runs on relationships and having people trust us before we can even show them our skills.
GALIP: For sure. It's actually a whole package. It's never only being a great dentist or never only being so charismatic, never only tempering the patients or only having a beautifully decorated office, never only the gadgets you have, but instead, it is the combination of it all. It's a whole package. And if you build it yourself and you have your finger on all aspects, your business will express who you are. Having acting classes, in my opinion, to act nicer to the patient will maybe not reflect your personality and will feel fake.
CHRISTIAN: I think you summarized it very well when you said: liking people naturally and being able to express your passion.
GALIP: I think so, this is simple. Be yourself. Be honest and truthful and things will come. And this is not only valid for your dentist/patient relationship; it's about your whole life.
I've always been very nice to people, honest with people, not gossiping about people, not talking bad about people. Just be positive. Unfortunately the world is going crazy right now. Economical problems all over, terrorism, etc. Everything is going negative and we have to do something positive as people, whatever it might be, through our dentistry or through our relationships with friends, to make a better world.
CHRISTIAN: I think this is a beautiful way to end this memorable interview for me, and I'm going to make sure I write this down because dentistry is small in relationship to everything that we have to experience during our whole life so it's nice to be inspired by people like you. For me it was a great honor to work with you for so many years and I thank you for being part of this new project, the DSD Magazine.
GALIP: Well, I wish you the best of luck in this project. There is definitely a space in the dental world for such communicative tools. I hope it will last long so that many people will know about what is going on and get in touch with so many new cool ideas through this magazine and be able to apply them in their daily work.