Office Visit: Dr. Ryan Pulfer by Kyle Patton

Orthodontists spend most of their working hours in their practices, so they don't get many opportunities to see what it's like inside another doctor's office. Orthotown's recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols. In this issue, we introduce Dr. Ryan Pulfer, a Townie who packed his small-town Montana practice full of new technology.

Why did you become an orthodontist?

I grew up in Indiana with an amazing mom and dad who are wonderful examples of good people. My dad is a dentist, so he got me thinking about dentistry from a young age. Then, Dr. Gene Dellinger was my orthodontist and I had such a wonderful experience at his office that I decided that I'd like to be an orthodontist.

I like how big of a change an orthodontist makes to a smile and the manner in which it's delivered. I like focusing on one thing: great smiles that make people feel good about themselves.

Bozeman has fewer than 50,000 residents and occasionally unforgiving weather, and it's 400 miles to the nearest major city, Salt Lake City. What's it like practicing there?

Yeah, it's an isolated place—it definitely doesn't have big-city amenities, but it does have great people who are genuinely kind and happy. I really appreciate that. Winters are long, cold and snowy, but we never close the office because of snow.

Bozeman also has a very supportive dental community. My friends always think that I'm the only orthodontist in town, but there are actually several here. I'm happy that they're all good and really kind.

In the Star Trek universe, the Bozeman area is where Earth has first contact with aliens in 2063. What do you hope orthodontics can accomplish by then—or at least in the next five to 10 years?

I did not know that! I'll do my best to fill Bozeman with pretty smiles, so we make a good first impression.

I don't think we need technological advancements as much as we need people advancements. I see too many professionals and companies making choices that benefit only themselves, not their patients—not being truthful about their skills and qualifications, to fool the public. It's just not right, and nobody is doing anything about it. I wish that integrity and ethics were more valued. We should treat every client and colleague like they were family.

Your practice seems to be on the "bleeding edge" when it comes to tech, and you've got a lot under one roof: digital X-rays, digital impressions, an in-house lab and a 3-D printer. A lot of docs hesitate to go all-digital or bring lab work into the practice. What has your experience been?

I like having the best for my patients, and we adopt the best technology and avoid the hype. We've eliminated impressions from our office in favor of digital scans and 3-D printing, for example, and the patient response was better than I anticipated. Nobody likes impressions, so digital scanning has been wonderful. It's much easier and gives extremely accurate data.

I used to make our expanders in-house but now we are too busy, and with our digital workflow it's better to send expanders to an outside lab, digitally. This allows me to focus on patients more instead of lab work. It also has eliminated a long and unpleasant appointment for our patients—fitting bands and taking impressions.

Our in-house 3-D printer has been wonderful; our retainers consistently fit so much better and are stronger. Having it in-house allows for a faster turnaround time. That's just good customer service.

Our digital X-rays allow for healthier, lower radiation and clearer images for diagnosis. We also avoid the harsh chemicals that traditional X-ray machines need. And we can instantly email the X-rays to their dentist. What would you want for your kids?

What's your typical day at the practice like?

We see patients from 7:30 a.m. to 4:30 p.m., and we enjoy all of the fun patients that come to see us each day. It's common to hear laughter in our office because we all enjoy what we do.

What aspect of your work are you most proud of?

How happy our patients are. There's a lot that goes into making a happy patient! Patients think that all orthodontists do the same thing, but that's not true; there are countless variables in how we can "do" orthodontics—materials, techniques, timing, scheduling, financing, interactions, facility, policies, etc. All of these affect the patient and their family's experience. I'm proud of my team for how good they are at turning nervous or resistant patients into happy patients.

You have a strong social media presence and some great online reviews. What is your strategy for cultivating your practice's online image?

Our great reviews are because we have great patients. We're honored that they take the time to share their experiences with others. We want our online image to reflect what it's like to be our patient. We aren't perfect, but we do everything we can to treat our patients right.

What's an aspect of orthodontics that never ceases to amaze you?

The lack of standardization in orthodontics—well, it used to, at least. Every orthodontist has a different way of doing things and usually that's OK. I used to think that there should be one agreed-upon approach to each type of case, but there's not. Nothing even close!

I've realized that's because orthodontics is 90 percent art and only 10 percent science. If it was all science, then it would be easy to identify a cookbook approach to orthodontics. But there is no cookbook.

Michelangelo didn't have a cookbook. It's art.Orthodontics is art. Yes, it's based on some science of course, but everything from the final goals you think are most important, to the techniques you use to get there, to the materials used to achieve that outcome, are all personalized by the orthodontist. It's a complex art form and that's what makes it great, because it all comes together to create a wonderful smile and a happy patient.

That's also why I'm not all that worried about do-it-yourself orthodontic products. Orthodontics isn't a simple cookbook that can be mass-produced by businessmen who are willing to deceive uninformed customers. Art is pure. Art is not an assembly line. Do-it-yourself teeth straightening techniques may survive but their customers will rarely be happy with their results because robots, computers and algorithms still can't create art.

What do you think is the biggest problem orthodontists face today?

Misunderstandings. These could be communication problems within your team, or between your team and patients. When patients don't understand the critical importance of brushing well and wearing their rubber bands, their results aren't as good as they could've been.

There are also misunderstandings among the public about what modern orthodontics is like—faster, more efficient, more affordable, with less discomfort than many people realize. I work every day on improving my communication, to try to minimize such misunderstandings so our patients can get excellent treatment.

What's the greatest advancement of change you've seen during your tenure?

The increase in the interconnection of orthodontists throughout the world, thanks to resources like Orthotown and online study groups. These groups allow for instant feedback on difficult cases and instant exposure to new concepts and products. Such immediate access to new information is very helpful at keeping participating orthodontists up to date and informed.

What do you find is the best way to market your practice? Were you always successful, or was it trial and error?

I'm not sure which marketing works best; I try a lot of things and it's impossible to track what really works. My approach is to enjoy the type of marketing that I do. It's just more genuine.

In the end, the best marketing is a great product and great service. Treating our patients right and always putting their best interests in mind is my favorite marketing.

What remains a challenge for you?

The hardest thing is making it all look easy. Most people don't see all of the work that's put in behind the scenes so that everything "just works." Patients and parents see staff doing the hands-on work, but they don't see the training, planning, refining, CE and thought that goes into every aspect of their care behind the scene. When a business is running smoothly and it all looks so easy, you can be sure that it took a ton of work and thousands of good decisions to get to that point.

What has been your most successful or proudest moment as a clinician?

One of my adult patients recently cried happy tears when she saw her new smile. Moments like that are priceless. Our motto is "Smile Like a Boss"; we want our patients to be so happy with their new smiles that they smile like a boss. With confidence like that, they're bound to change the world.

Give us a snapshot of your life outside of orthodontics.

My wife and I have an amazing 18-month-old son, Benjamin Wild, and another child due in June. My wife and I love to be active outdoors; we've run a few marathons and have competed in several triathlons.

If you could send one note back to yourself before you began practicing, what would it say?

"It's a lot harder than you think."

What advice would you give to a new orthodontist?

• Be patient, and consider being an associate for your first few years out in practice.
• There is a ton to learn, so keep studying after you graduate. There are tons of great continuing education courses and other resources on places like Orthotown, and it's up to you to take advantage of them and weed out the hype.
• And lastly, always treat your patients like family.?