Dr. Christopher Cetta is a Board-Certified Orthodontist who practices with Blue Wave Orthodontics in Bradenton and Tampa, FL. Dr. Cetta grew up in New Jersey and is a third-generation doctor. He received his undergraduate degree from Wake Forest University in North Carolina and graduated from Rutgers School of Dental Medicine in New Jersey. Dr. Cetta practiced general and cosmetic dentistry for several years prior to specializing in orthodontics at Jacksonville University in Florida. He is the co-inventor of Precision Aligner Buttons™ by DynaFlex and has had several articles featured in the Journal of Clinical Orthodontics. Dr. Cetta also plays bass for two rock bands, including the all-orthodontist group “Relapse.” Dr. Cetta currently lives in St. Petersburg, FL with his beautiful wife Nicole and puppy Jagger.
VIDEO - DUwHF #1298 - Chris Cetta
AUDIO - DUwHF #1298 - Chris Cetta
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Howard: It's just a huge honor for me today to be podcast interviewing Dr. Christopher Cetta DMD he's a board-certified orthodontist who practices with Blue Wave orthodontics in Bradington and Tampa Florida. Dr. Cetta grew up in New Jersey and is a third generation doctor he received his undergraduate degree from Wake Forest University in North Carolina and graduated from Rutgers School of Dental Medicine in New Jersey Dr. Cetta practiced general and cosmetic dentistry for several years prior to specializing in orthodontics at Jacksonville University in Florida. He is the co-inventor of precision Aligner Buttons by DynaFlex and has had several articles featured in the journal of clinical orthodontics. Dr. Cetta also plays bass for two rock bands including the all orthodontic group relapse, you've got to send me a video that man I'm gonna I'll push that video out everywhere. Dr. Cetta it currently lives in st. Petersburg Florida with his beautiful wife Nicole and puppy, Jaggers that named after Mick Jagger?
Christopher: Allegedly yeah thanks for having me on the show.
Howard: Oh my gosh well you know this is called dentistry uncensored so I don't want to throw you under the bus with the first question but gosh you're an orthodontist and the biggest orthodontic story of the century is Smiles Direct Club going public did you did you have any thoughts on that or not really?
Christopher: Smile regret club is that well...
Howard: I haven't heard that one smiles regret Club what was your what was your take on that I mean I mean so the one side is okay some entrepreneurs try to do something faster easier better higher quality lower costs and give you more for less and then of course the story is oh well the good old boys are trying to keep their system, where did you see it was it is is that the orthodontist trying to protect their turf were they trying to block innovation or where did you fall in on this or did you not?
Christopher: You know I think most orthodontists probably think similarly most dentists in that you know it's not that we're against tele-dentistry per se but the biggest concern is that they're seeing patients they're not taking x-rays they're not checking for periodontal disease so you know what I learned in school is that was almost malpractice right yeah you know there's certain standards that we as dentists are held to you know such as coming up with a proper diagnosis proper treatment plan and I just don't see how you can do that remotely with just impressions that you're taking someone going to a scan center never properly seeing a patient in person.
Howard: You know when I got at a school in 87 the biggest brands in dentistry were made you know Colgate Christ you know Listerine all those big names and there they all ruled forever and the only big name that's came out in my 30 years and is even bigger than those three is Invisalign I mean when I go to when I lecture in Japan, Cambodia, Malaysia I mean you can't go anywhere and once the bartender are they the waitress figures out to me that we're dentist the first thing on their mouth is Invisalign it's like it's like how am i eating in Cambodia and they're asking us really good Invisalign questions did you ever even when that brand came out did you see it coming out like that?
Christopher: You know it's hard to say certainly they had a huge marketing push I started off as a general dentist as you mentioned in my bio so I actually was doing invisalign at that time and you know I think when it first came out the orthodontist weren't quite ready to adopt it the product really wasn't quite perfect so you know I think maybe dentists were more willing to give it a shot at that time but you know over time the product really has improved and you know certainly we all know what they've done in terms of marketing.
Howard: but all the patents pretty much expired right?
Christopher: Well not exactly so you know Invisalign has hundreds of patents really World wide certainly they have a huge US portfolio so you know really with the line they had one sort of key patent and that came out in 1997 I should qualify this I am certainly not a patent attorney but that key patent.
Howard: but his dog is named after Mick Jagger so you make your own decision.
Christopher: Please do but that keypad was called method and system for incrementally moving teeth and you know Invisalign did not invent clear aligners clear aligners have been around since the 1940s it was a gentleman by the name of Dr. Harold Kesling who came up with sort of moving teeth with rubber positioners and aligners it's probably like a Vulcan Knight material I'm guessing at that time and then from there a mentor of mine Dr. Jack Sheridan the late Dr. Sheridan who was at LSU he came up with the Essex material and so he really started moving teeth you know basically at the time what they're doing is taking impressions pouring it up into plaster using a little jigsaw to move the teeth or maybe some of the younger doctors that weren't familiar with it but it was sort of a time-consuming process you could really just make one aligner at a time having to take a new impression and invisaligns big innovation that they came out with was to do this in sort of CAD CAM that process so one of their initial patents was how to sort of computerize this process and that was the one patent that really sort of was holding a lot of the other players back from coming in so that one did expire utility patents are good in the u.s. for 20 years so in 2017 that particular patent expired but the majority of invisaligns patents are still active.
Howard: So you talk about Jack Sheridan did you know him well or did you...?
Christopher: I mean yeah actually I was quite lucky that towards the end of his career after Hurricane Katrina he relocated to the Jacksonville Florida area where I did my residency program so he was my faculty there and just a brilliant guy super humble too.
Howard: Yeah I saw him like, was he a board-certified orthodontist?
Christopher: He was a board-certified orthodontist.
Howard: I used to always I used to always see him lecture with a Brock Rondo.
Howard: Which is great but he's the Canadian I'm he's up there in Canada but anyway just just what an amazing I amazing guy Josh John Joseph Jack Sheridan of Trinity Florida died February 2nd 2018 at the age of 85 with his passing the orthodontist lost one of his true luminaries and most original characters and he went by Jack. So you really are making a move in clear aligners with your aligner buttons talk about your and I also think it's fair to say that of all the orthodontist we've had on the show they're all saying they're about 20% and visible our clear aligner an 80% fixed or is that where you are at Blue Wave ortho?
Christopher: You know Blue Wave Ortho it's a little bit of a different demographic so at this point I'd say in that particular practice which I just started with about a year ago closer to maybe 10% aligners but my previous practice I was with a gentleman named Dr. Jason Rothenberg who's a fantastic orthodontist up in New Jersey and I'd say we were around maybe 35 40 % aligners.
Howard: So what's the difference the demographic stream 35% New Jersey 10% Florida?
Christopher: It's a little bit more of a Medicaid based practice where I'm at now.
Howard: In Florida?
Christopher: Yeah so a lot of patients are coming in and you know they were just preferring the braces and you know they they feel quite happy to get braces to be able to straighten out their teeth.
Howard: Yeah and what's weird out here in Phoenix Arizona um I've had patients cry if the moms tries does Invisalign because they want the braces and the green rubber bands and they already had the whole concept of braces and the rubber bands and the school colors and which is...
Christopher: Really into colors
Howard: Oh yeah so when you start talking clear aligners you're completely destroying her whole bubble.
Christopher: Yeah but you know the colors just come down to being able to express yourself I think that's why the kids like it you know they get to choose their own colors and be able to express you know who they are, whether it's their favorite sports team or like you mentioned the school colors maybe some kids just want black on there but you know that's that's why it's cool that's why kids are into it.
Howard: So tell us your journey where why did tell us about your precision eyeliner buttons but first before you sell that you have to tell me the the st. Louis mafia orthodontic gunman st. Louis you got DynaFlex you got the American Association of orthodontists you got the mid-atlantic ortho meeting you got um I mean who the hell was born in st. Louis it was Engle born there or something or?
Christopher: You know to be honest I'm not even sure where Engle was born.
Howard: He's the father of Orthodontics, so what is the st. Louis orthodontics?
Christopher: I don't know it's just happenstance I've only been to st. Louis once in my life it seems like a beautiful city out there but it was to take my American Board of Orthodontics exam.
Howard: Yeah my god so pretty much where was he born he was born here it is Edward Engel he was born in Herricks New York he was the fifth of seven children yeah he's the father of Orthodontics but yeah I don't know I've never figured out what the st. Louis orthodontic connection is but basically in America if you're a power broker and orthodontics you're you're in st. Louis.
Christopher: Well there you go
Howard: Do you I agree I mean they all that but anyway so to talk about your journey you're doing clear liners and then you wanted a precision aligner button and you got Dyna flex and st. Louis to make it for you is that what's going on?
Christopher: More or less yeah so you know just to back up a little bit you know the genesis of this was really around I'd say 2015 2016 and I was practicing as an associate for a husband and wife orthodontist in southern New Jersey and his name is Dr. Richard K and his wife is Dr. Mary Beth Barone lovely couple and I would drive down there every Monday to practice and we were doing quite a bit of Invisalign and that practice probably about 50% and what we found is that we certainly had a lot of patients that were class 2 class 3 and we would use either the small lingual buttons to hook the elastics up or in other cases we use a second molar tube second well you know bracket basically I mean we were just bond that sort of in the cervical third of the tooth and we were having so many patients come back with either broken molar tubes or the lingual buttons were coming loose and you know the patients get annoyed they don't want to have to come back so you know to me I just looked at this and I and I turn to Dr. K and I said you know how come these buttons aren't shaped to just fit in and busy lines cut out like a puzzle piece and he said hmm you know it's an interesting idea you know maybe you should run with that maybe you should do something with that and you know at that time I was sort of doing the associate hustle right so I was working five six days a week trying to you know pay off my student loans and every week I'd come in and show up to their office and and basically Rich would turn to me and say you know what have you done with the idea and I said nothing I've just been busy you know running around seeing 100 patients a day and finally one day he turned to me and I said Rich let's do let's go 50-50 on this and so we we ultimately partnered on it and at that point we had no idea how to invent a dental or orthodontic product whatsoever I certainly knew of certain people in the orthodontic industry who were famous orthodontists inventors Dwight Daymond comes to mind with the Dayman bracket louisa carry a who invented Henry Schines carry a motion SLX brackets but at the time I wasn't on social media so I really had no way of sort of reaching out to these orthodontist inventors so we did basically what most people do is you know instead of go to YouTube we actually went to Amazon and we both got the same book it was really an incredible book that you should check out Howard it's called one simple idea by Mr. Steven key
Howard: One simple idea by Stephen key?
Christopher: Yes so basically what this book is about is you know not all inventions are these incredible big huge ideas that require 20 years of computer development sometimes ideas are very simple and they're just a slight twist or variation on an existing product so certainly Dr. K and I did not invent any kind of orthodontic button but buttons have been around for years and was almost like a sleeping dinosaur no one really paid attention to buttons and we sort of had an idea of how we can make these buttons better because the original Orthodox buttons were really made for braces and we want to make some buttons for aligners.
Howard: and so then you so I looked it up actually the Fourth International Congress of orthodontics was in st. Louis before Engle moved there. So ortho was in st. Louis but he did move to st. Louis and convinced the the whatever to build the angle school for that aren't you. So then your next move was to get a so you had this idea so what did the book teach oh um if you were on Shark Tank that's what everybody knows mr. wonderful The Canadian and say hey hey you got any intellectual property is that the next step did you go get a patent attorney or did you go make a prototype?
Christopher: You know not quite so basically what we did as a next step is you know after reading that book that book is really about the licensing process and I'm not sure how familiar you are Howard with licensing I certainly had heard of it I didn't really know a whole lot about it you know I've heard of music licensing but it's basically sort of explained the whole model of when do you license or intellectual property versus sort of venturing a business around it. So you know we found the book very intriguing Steven key has a business partner his name is Andrew Krause they have sort of an inventing consulting service and that's called invent right if you want to check out inventright.com and basically it's a one-year program that sort of mentors and teaches inventors on how to bring a product idea to market so rich and I signed up for that program and it was really fantastic so they sort of walked us through the steps.
Howard: and so did you get a patent before you went to Dyna flex that's what I'm wondering on the store I mean because a lot of dentists okay so I'll save you a lot of frustration when dealing with me I you know ever since you I started dentaltown magazine in 1994 in the web site in 98 I always get these dentists who send me a letter says hey I need you to sign a nondisclosure agreement and sign this because I want to talk to you about this idea and I'm like well I can't sign a nondisclosure I mean I'm a dentist you know what I do you read my columns I mean I've talked about everything in dentistry I don't you know I if you need this just don't I don't wanna meet you know I don't want sorry I certainly don't want to feed the lawyers and I learned this from Bob Ibsen and Bob Ibsen man he says oh these guys they'll say they'll sell you an on you'll sign in on consent Clause then basically every idea you've ever said about dentistry your whole life they think is covered in their non-compete clause and and Gibson told me said don't ever sign one of those damn things because he paid millions to get out of those things. So I'm just curious did you did you get the IP first before you talk to DynaFlex or did you go there and trust that they would listen to you without stealing your idea or how did that work?
Christopher: Well you know it's interesting you mentioned non-disclosure agreements because how you feel about them as how most companies feel about them so you know if you're a small inventor and you're approaching a line technology or Henry Schein or even the dental side DENTSPLY Sirona and you're asking them to sign your non-disclosure they're probably gonna laugh at your face to be honest so yes you do need to find a way to protect yourself but you know there's a better way if there's any listeners that are dentists at our inventors rather than running straight to the patent attorney patent attorneys are great but it does end up being quite expensive once you get into the process but a really great tool from the US Patent and Trademark Office or called the USPTO and it's called a provisional patent application or a PPA and basically what a PPA is a patent pending so it gives you protection for one year to be able to shop your idea and pitch it to different companies. So what we learned through this invent right program is you can actually write a pretty good provisional patent application yourself and file it with the USPTO for about 150 dollars so once that's on file your practice patent pending and you don't necessarily need a nondisclosure at that point because you have basically identified what your idea is with the Patent Office and if that gives you the time to go ahead and see if there's any kind of market out there for your invention.
Howard: So where you were yet now did you get the patent and you're certain dynaflux is making it and selling it and it's doing well or what's the status right now?
Christopher: Yeah so that you know the status right now is once we got the provisional patent we approached a number of different companies which I won't mention because I'm under NDA.
Howard: What percent of those companies are within an hour's drive a st. Louis?
Christopher: 99% no I'm just kidding. So basically we ended up licensing the product to a smaller orthodontic company out of New Jersey called mid-atlantic orthodontics or MAO and so we were with them for about a year we launched at the AAO meeting in 2018 and just recently I think it was around March or April of 2019 DynaFlez acquired MAO so then our product went on board with DynaFlex but to answer your question, yes the product is selling really well we've been quite fortunate that were that honest really have taken to it they seem to like the product is certainly reducing a lot of the emergency visits and saving orthodontist chair time.
Howard: So it's dentistry uncensored so let's go after the controversial stuff let's not talk about let's not share anything so um then it's our confused in dental schools today they say when they the dental school they we need help doing a molar root canal the endodontists are all on it pulling the tooth there's with the world surgeon everybody goes to help them but when they say I want to learn ortho they say well then you need to go to ortho school and then when you come out and you go to your state your state Dental Society and they put on continued education that the 50 state dental society put on a huge majority of the continued education you can't put on a c e course by an orthodontist for the general dentist are you it'd be easier just to go there and sell crack cocaine and well what way I mean endodontists could keep get approved all day long to teach general dentists how to do molar endo an oral surgeon could say I want to teach these guys how to lay flaps and pull wisdom teeth or everybody is that but when it comes to ortho they always gonna say no so are they just holding their ground or is it so my question you is like is DynaFlex is this all being sold to orthodontist I mean could a general do they even promote it to general dentists do you lecture to general dentists are you promoting this a general dentist?
Christopher: You know at this point I'm not promoting this to general dentists but just to back up a little bit in terms of sort of this adversarial relationship between general dentists and orthodontists to be honest I don't 100% know where this came from.
Howard: but you agree it's there?
Christopher: I think to some extent maybe it's more unspoken you know sometimes there could be a tension you know certainly since I was a general dentist I've been on both sides of this right so I you know I can see it from both perspectives you know obviously you know this is a tough question but I'm on dentistry uncensored so I would say that you know from an orthodontists perspective I don't think most of us have issues with general dentists doing orthodontics it's just a matter of sort of knowing your limits and sometimes if you maybe don't completely understand everything some of the cases that at least some general dentists send me are pretty complex cases that maybe they're looking at as simple cases if that makes sense. So I think maybe that's why some orthodontists buy get frustrated it's not that general dentists are doing bad ortho in fact I had a general dentist today transferred me a couple cases he does very nice ortho I think but you know it's just if general dentists maybe just get a little too aggressive with it perhaps maybe that's where it comes from but at the same time I think is orthodontist we need to all realize that we're all in the same team right there's there's other companies out there like smile regret Club like we talked about.
Howard: Yeah I and that's what that's what I love the most about smiles direct clubs I thought you know you know they hidden lining here it's gonna bring the orthodontist and the dentist together because those guys they figure that out in California the first day they were that I said well you know who's gonna save us is the CDA and getting all these dentists and the courts and so I think it's actually I love smiles regret club because I think it's gonna make the orthodontists and dentists know more than ever they're on the same damn team.
Christopher: We are, for sure.
Howard: So don't compete with the general dentists compete with the big screen TV I mean you wouldn't believe how much money these people spent on cruises and all that said they got money they just only want to spend it where they're spending it. So in Invisalign when when Invisalign ever does something that the orthodontist doesn't like like you know they bought an Invisalign owned by Align Technology they'll own they own a taro and then they they quit taking scans from bio you know Bio Lace out of Copenhagen Denmark or whatever I always say the and I say well you know what if you don't like them just quit using them you use another brand. So even the patents are up there's about 40 clear aligner companies every orthodontist I know they love they love the Invisalign system is that the polymers is it the system is it the what is it I mean because you can't piss them off enough to make them switch brands. I mean I know orthodontist I can't talk about Invisalign or Align with the rogon guy without profanity the man they sure use only their stuff so there's gotta be something amazing about the product compared to the generics and knock-offs.
Christopher: You know I think it depends on which were that honest you talk to in terms of how amazing the product is you know I would classify orthodontists relationships with Align technology as it's complicated right we've over the years you know certainly there's no love loss I think probably on either side but I think why orthodontists or maybe sticking with Invisalign is that you know a lot of the products that are coming out at least ones that I've seen whether it's you know Henry Schein SLX or 3M clarity or OrmCo has spark now some of these other aligners that are coming out they're sort of in their infancy stages and even just the software for treatment planning Align had a huge jump start with ClinCheck so it's much more advanced in terms of the features and attachment design and you know of course they have their smart track material so it was quite a learning curve for a lot of us north of us and dentists to learn this whole ClinCheck software learn the process so at this point we're comfortable with it we know what we need to do to make it work we know if we need to over engineer a ClinCheck or over correct things and so when you're switching to a different brand it's sort of like starting over again and a lot of these other companies I've come out with aligners they're lab fees aren't that significantly different to make a lot of people jump ship if anything they're maybe a couple hundred dollars less than Invisalign on a lot of the cases so I think a lot of doctors at this point are just sort of hanging tight.
Howard: Interesting so what is your what is your next goal and what are you trying to achieve now with your new product the precision aligner buttons?
Christopher: Well the the first precision aligner buttons we came out they're really designed for upper lower molar so it's a metal buy and and it just sort of again sort of fits perfectly in that precision-cut window so after talking to a lot of doctors we got demand for a clear button so just in a couple months here we'll be rolling out a nuclear precision aligner button which we're very excited about and it's universal upper lower left right it fits perfectly right in the cervical third of a crown for any canine or premolar tooth so that's the big news there big reveal a first-year Howard we're revealing it and then I have another product with Hu-Friedy that will be coming out soon too.
Howard: Now Hu-Friedy that's Premiere?
Christopher: It'll be in that clear collection.
Howard: The clear collection we'll talk about Hu-Friedy.
Christopher: So with Hu-Friedy I don't want to go into too many details but I can give a little teaser that we're developing and instruments that will punch within any align or the perfect shape of our precision aligner button so whether if you're using the Invisalign system you're probably ordering the prefabricated precision cut windows but some of the other systems don't necessarily have the cutout windows or a lot of worth it on us now or basically fabricating their own aligners in-house 3d printing so this instrument will be great for punching holes in that plastic.
Howard: and what do you what do you think of the 3d printing and all that are you gonna do you see yourself printing your aligner trays sometime soon?
Christopher: You know personally I've done a little bit with you lab systems and I know you had those guys on your podcast recently and I think it's a great software most of the cases I've done for in-house aligners and I used the formlabs printer most of the cases I would say or more relapse cases mild to moderate I know some doctors that are doing a lot of in-house aligners Dr. Ravi in Washington State, I also have a friend Dr. Brian Lockhart North Carolina he's doing a lot of in-house aligners they're getting great results but for me I don't have the team to sort of train and do all the manufacturing so to sort of outsource that just makes more sense for me at this point.
Howard: and why did you pick premier is because Patrick Bernardi you love Chicago what would was a Premier and you just thought they were the best making the instruments?
Christopher: You know I do love Hu-Friedy instruments probably this dates back to my days of being a general dentist I thought they had fantastic instruments and I just had a mutual connection Dr. Jay Bowman who put me in touch with them he had invented a couple instruments and you know they're a great company to work with.
Howard: Yeah and it's an old company yeah it's how old?
Christopher: A hundred years I believe
Howard: Yeah I mean guys I'm telling you that whenever I went on vacation I always stopped at the dental manufacturer or that area I mean I've done it my whole life because that might that's what my dad did when we went on vacation, we always went to the Six Flags over whatever and then we'd stop by you know it's the company and my god when you go into a dental company they're the most passionate about their products they show you how it's made it's that hands-on show touch feel you just can't remember that stuff I mean I remember what's an emperor gum being made in a gosh-darn Germany like in the 80s and yeah I can so remember climbing up the ladder and looking in you don't I mean I mean you just like yes you'd never forget that that says how I'm how humans learn. So I'm what else is um so what else are you passionate about what's got you excited these days?
Christopher: Well outside of aligners trying to think what other hot topics and orthodontics we have certainly outside of orthodontics I'm passionate about music if you'd like to talk about Relapse.
Howard: Well you know I think with or when I think it worth oh I think the dentist uh the general dentist the patient always look at the crowding the overbite the over jet whatever whatever whatever but when you think of orthodontics you're a board-certified or not what's more difficult straightening up those teeth are the retention.
Christohper: You know probably straightening the teeth is the easy part retention is always tough.
Howard: Yeah you me but you don't even know how bad you are at ortho till you've seen all your cases five ten years after they're done. I mean and in fact orthodontics is weird like I live in Phoenix and by the time I'm 57 I got four kids five grandkids everybody my age they've all done ortho at least twice.
Christopher: Yeah we're seeing a lot of patients come in and you know I think it's it's different than it used to be maybe 10, 20 years ago when orthodontics was maybe a once or if you had to face orthodontic twice in a lifetime type thing I almost think orthodontics has become similar to something like getting Botox injections that people sort of or at least patients sort of look at it like oh you know I didn't wear my retainer let me go get a touch-up or an orthodontic touch-up and that's really where certain direct-to-consumer companies are sort of stepping in because you know with that lower price point with the convenience people can sort of I just want to fix this one tooth and you know make this one rotated lateral incisor a little better.
Howard: You know getting a patent is a really rare thing I mean it's just a really weird thing in fact they even tell you 99% of all patents will never generate enough money to pay for this sure that statistic yeah and so and so and you've got several patents?
Christopher: I have one patent granted and I have several pending and not just provisional patents utility and design patents.
Howard: So you got to be wicked smart I mean you're like third generation doctor in your family - right?
Christopher: That is true I don't know if I'm wicked smart but thank you Howard.
Howard: No no you gotta be to get all these patents and patent pending I mean that that's no small feat I mean you could even predict you can just lay out the 220 countries how many patents they've issued in the last year decade century and it just perfectly lines up with GDP I mean you don't get any patents you're not gonna be you're not gonna have any money, so where does this come from though?
Christopher: You know it's hard to say where it comes from I don't know how much it has to do with being a third-generation doctor I think a lot of it just comes from being a creative person and I think a lot of dentists in general have that creativity it's just a matter of sort of unlocking it and then capitalizing on that creativity which is pretty cool about this patent process which I've gone through. So I think inherently you know in dentistry it's sort of that mix of art and science right so it's just sort of tapping into maybe that artistic side that allows us to sort of think of things maybe a little bit differently.
Howard: So what year did you get out of dental school first time?
Howard: Okay so 2005 try to go back to that place I know it's 2019 but try to roll your brain back out to 2005, she's coming out of school she's $285,000 in debt when she looks across the globe of seven point seven billion people going to two million dentists everything in dentistry is growing at about you know two to three and a half percent a year like clockwork the only two areas growing in double-digit are implants and clear aligners end of story it's not and a lot of diseases are going down right so she's got $285,000 she's only 25 and she's either so she's got her eyes on clear aligners or implants what would what would you do now what would you tell her to do now that you know in 2019 that you didn't know in 2005? I mean do you do I mean obviously you're gonna be attracted to the double-digit growth factors as opposed to the one and a half to three and a half right?
Christopher: No you are you know I don't think you should you know coming right out dental school I don't think you should necessarily go and try to do what everyone's doing or you know you mentioned you know implants clear aligners you know it's great to learn a little bit of that but as a dentist you have to sort of really find what you're particularly passionate about and then go ahead and go out and get some additional continuing education to really learn about those things. You know sometimes going into areas where you know not everyone is necessarily headed in that direction you're gonna be able to differentiate yourself better. So if all the dentists are coming out and everyone's trying to do clear aligners I think it makes sense to sort of head in a different direction and possibly offer some different services that other people aren't.
Howard: Like what anything come to your mind?
Christopher: You know from orthodontic perspective you know lingual braces would be an option so there's a really cool company out now called embrace I don't know if you've heard of it Dr. John Pham is the CEO of embrace and it's sort of like a reinvented lingual bracket system with these new CAD cam wires so you know sometimes we focus so much on clear aligners and you know again as we mentioned a lot of these direct consumer companies are coming out but you know people can't get lingual braces from a direct-to-consumer company. So that would just be you know one example.
Hward: Yeah and what is your what is your thoughts on that company I mean do you like legal I mean back in the day in 87 the promo lingual braces your tongue would chew it up I mean your tongue could leave it alone and it turn into raw hamburger what's it look like now?
Christopher: You know it's a self ligating system because of these CAD cam nickel titanium wires that doesn't require power chaining or things like that for space closure to be honest I haven't done any cases it looks super promising though I'm very intrigued by it but just to get to your point in terms of people coming out of school you know certainly dental implants certainly you're gonna want to learn about it certainly you're gonna want to learn about clear aligners and things like that but you know there's other things out there in dentistry you just don't want to do what everyone else is doing.
Howard: What about implants where does dent where does implantology meet orthodontics in your in the last 10 years, you see more implants being worked into ortho treatment you see less. What does the junction that look like?
Christopher: You know probably again I sort of came out of dental school 2005 and in implants were huge back then because that was sort of it correct me if I'm wrong Howard but that was sort of the time when people had the mindset I'm just gonna take the tooth out put an implant right swayed back a little bit maybe more towards the middle of you know trying to save that tooth a little bit more so I think I probably see fewer implants now. Certainly I know when I was doing my orthodontic residency anyone with with missing maxillary lateral incisors it was we're talking about implants and you know there's some cases that turn out really nice but I've seen other cases where there's sort of a latent vertical growth and then all of a sudden you know the top of the implant the collar is sort of exposed and it doesn't look very aesthetic.
Howard: Wow so I found that in brace is a new solid braces that hides behind the teeth so you would you'd recommend that they go learn embrace?
Christopher: For orthodontist yeah I think you know it's a cool product it's a way to differentiate yourself, you know it's hard to always try to propose yourself out there or posture yourself as the Invisalign or the aligned or expert because so many people are doing aligners.
Howard: Right so what is their website myembraces. com
Christopher: I believe that's correct
Howard: Yeah my embrace. com so that's interesting. I want to go back to um I'm gonna ask about board-certified orthodontics am I've noticed that orthodontists seem to be more motivated to go get board-certified than say prosthodontist or orthodontist explain your journey why did you want to be a board-certified orthodontist is that something for just dentists who refer to you or does the b2c consumer market like when you're driving around Brandon's in Florida do people know that some orthodontists are board-certified and others aren't?
Christopher: Absolutely not
Christopher: I don't I can't think of any situation where a patient you know asked if I was board-certified because I you know if you look at the model with physicians most physicians have to be board certified to practice so I don't think it's a big differentiator in terms of attracting patients.
Howard: Do most physicians have to be board certified to practice?
Christopher: From what I understand I could be off base on that but um you know I think most of the public doesn't at you know if you're a orthodontist periodontist an oral surgeon that you're probably board certify even probably general dentists the public would think our board certified by the dental board right which is true, we take what the dental boards but as far as you know why I particularly went for board certification that was something that was really sort of pushed by my program at Jacksonville University they really support it they thought it was a great thing for the specialty to go ahead and get board certified. So you know we take the first part which is the written exam before we actually graduate residency so then it was just a matter of presenting cases and at the time I took it it was six clinical cases that you had to present and then there was also an in-person sort of interview style exam that you did as well.
Howard: So you would you recommend the other orthodontists become board certified I mean do you think that would be worth their time I mean like I tell general dentists they should get their FAGD, MAGD I think it was the best decision I ever made do you think getting board certified is something that you wholeheartedly recommend all the other orthodontist or is it a case-by-case?
Christopher: No I certainly would recommend it I don't regret doing it I think it's a really good process in terms of so reflection looking at your own cases we don't always have time to do that private practice because it's always sort of looking forwards but it's nice to look back and and just really reflect and you learn a lot about yourself as a clinician in areas to improve so I thought was a fantastic process with the American Board of orthodontics you do have to renew every ten years and I believe mines up in 2023 and I definitely plan on renewing.
Howard: Interesting so what other advice would you give that 25 year old kid I mean III though is I've been telling her for 12 minutes that if I had to look back for 32 years and said what one behavior could you measure the track success closer to anything I would say it was number of hours to see a year the junkies the attics who took a hundred hours a year for 30 years they did whatever they want they had the money they bought all the toys they always seemed the happiest and the ones who are always mad that they had to take 12 hours to get their license renewed every three hours three years I would say the ones who did see that was the best decision and number two was the ones who made friends and camaraderie with their other colleagues instead of all looking at them as fear and scarcity you know they're the the other everyone in dentistry is not a predator you guys you know the you know they're your colleagues so I would say I would say mentors CE and colleagues what would what would you recommend?
Christopher: I think you nailed it right there Howard certainly in terms of my professional career I I didn't quite realize the value of continuing education probably until I became an orthodontist so those first three years that I was a general dentist I was just so excited to be done with school for in my own particular case I went straight through from college to dental school I did a general practice residency I couldn't wait to get out there apply the things I learned make money start paying back my loans the last thing on my mind was you know taking a Friday off to go to a continued education course but after I became an orthodontist I think I my mindset did change and the value of continuing education I'd like to tell maybe the young doctors listening is you really will learn to sort of differentiate yourself you need to find what you're passionate about and really focus in on that you know there's gonna be areas of Dentistry that you probably don't care that much about so don't worry you know learn the basics but you don't have to go crazy doing continuing education in that regard but I think in this past two years my florida board florida i'm Secutor me flora dental license is up for a new I think I did a 100 plus hours myself of CE.
Howard: So you know the natural selection of dinner with done Jack Dillonburg last this last weekend and he was the founding dean of the dental school in Mesa Arizona for 10 years and I always talked with him about this natural selection thing where you know if it's a given dental school you got a A's in math physics chemistry you're gonna be this introvert guy in the library I mean and every time you walk into a dental office you know that receptionist was only hired because she reminded doc of the perfect librarian I mean you know she's shy thing that doesn't talk and you know just smells like a library but you're in the of all the areas of Dentistry your area has the most marketing competition I mean all the average orthodontists markets advertises social media twice as much as a general dentists in fact when I have these practice management consultants in the room I mean they're trying to get general dentists to commit three percent of collections to marketing they've all got orthodontists clients that routinely do 6 7 8 % on marketing. So is there a disconnect between an introvert orthodontist who got A's in physics and chemistry and thought Sir Isaac Newton was Mick Jagger and now he has to be a social media Instagram influencer guy is that is that a disconnect?
Christopher: You know I don't necessarily think that's a disconnect I do think it certainly helps to get yourself out there and you know something I've learned later in my career that I've been out in practice for a while is that in the beginning I just as an associate I just thought my role was to sort of show up and see patients you know I figured I was hired because they had a lot of extra patients or maybe the the practice owner was doing more on the practice management side and it really was just to do dentistry and do it well but at the end of the day you got to go home but now that I've been out and practice a while and I'm still an associate at this point in my career you really do have to market dentistry has changed a lot as you mentioned on your podcast quite often and really we have to bring continue to bring those new patients in and you know I'm sure many of your young doctors are on social media already but you know it goes beyond social media to really build a practice and you know what I've learned in last year it's really just about making connections it's about meeting people having lunches with other dentists getting involved in the community you know whether that's through a church or possibly through your kids activities really I think that's the best way to meet people and attract new patients.
Howard: So I want to go back to back to st. Louis so are you a member of the American orthodontic Association?
Howard: Okay talk about that because tell me they would say well yeah I got to it any 285 thousand dollar student loans and the ADA I got asked this twice as weekend well why can't I just join Arizona I don't want to join the National why do I have to join the tripartite system I just want to be local cads I don't even want to be all Arizona and I'm always sitting there thinking you know when I hear that question I don't think they even know how America even works I mean it's just a political bribe machine you go raise a bunch of money you bribe all these people to for their campaign funds when they get there they pass laws to pay you back I mean they I think they still believe in truth, liberty and justice and they don't realize that if you're not up there wheeling and dealing in the corrupt bribery machine that they'll lose their profession.
Christopher: You know I I see we were coming from the on that I personally I'm a huge proponent of being a member of the American Association of orthodontics as an orthodontist and I'm an ADA member which you know some orthodontists feel I'm an orthodontist why do I need to be a part of the ADA just like you mentioned it's hugely important to be a part of organized dentistry there's a lot that goes on behind the scenes that we're not even aware of.
Howard: I mean do you think Delta wants more dentists or less dentists do you think they want to pay you more money or less money I mean was a smiles direct club they they wish all the orthodontists were removed Angola I mean I mean it's just the nature of humans they're there I mean look at a homo sapien I just asked of all time they say you think they would do that I'm like well where where are the Neanderthals were the denotes ovits where's Homo erectus where's home well I'm pretty sure you killed off every homo were the last remaining tribe of homos and you think were these innocent little children who all want to get along in the in a sandbox and sing Kumbaya it's a bloodbath and and I don't think smiles direct even I think smiles direct I think they're why I sense it I saw it where you know I was going along the words honest didn't like it they were inching the technology to tell identity but man when they start suing some dental boards in Canada for speaking out or asking questions the minute they slammed them that I said that this couldn't think about eight seconds and 200,000 dentists are gonna get out there or they're flyswatter and smack these guys around and that they did they absolutely did I mean. So anyway um if you're not paying dues and if the most part of that dues isn't going to Congress politicians remember if I print money I go to jail they call it the fractional reserve system I mean you know it's just the way it is but you if you lose the government side of your profession while you is open a history book and see how that worked out so going back to st. Louis DynaFlex um that's another orthodontic powerhouse so what are you a big do you use DynaFlex a lot there they are they the main maker of your two products?
Christopher: Yeah does the main maker of our two products to be honest with you I'm sort of new to DynaFlex so you know our product has just been with them for the past six months hugely impressed with their CEO Darren Buddemeyer starting to use more of their products but I wasn't as much of a user previously.
Howard: yYeah I've known those guys for 32 years I'm those Midwestern companies like st. Louis I mean it's like NDIC out of Iowa I mean those guys are DynaFlex they'll the only thing they know is how to work 12 hours a day five days a week for 25 75 I mean they don't even know any different but yeah that's a that's a a powerhouse country company. So we're I can't believe we're coming up on an hour but I want to go back to that 25 year-old who what I'm sensing they come in a school you can split the herd in half there's the pretty fluffy ones who don't like blood and guts and they like bleaching bonding and clear liners and then there's guys like me who mind they like blood and gods extract I mean when I when I wash my hands I want to see blood on my bald head and you know if it's not there's not blood and guts it's not even it's not even fun so if she's soft and pretty and fluffy and waging bonding veneers and photography and wanted to do clear aligners and during the AACD and be a cosmetic dentists what advice would you give her?
Christopher: Well you know certainly you want a diaper you know you if you just only want to do aesthetic dentistry I think you really need to be balanced right so you're gonna have to learn a little bit of everything I think to go extremely into one direction or another you're going to regret that a little bit later in your career.
Howard: Well put in well wise because the last you know I've lived through the economic meltdowns several times and I graduated high school in 1980 that was a worse 87 but every time there's a meltdown the blood-and-guts ones are the only ones who do just the same and people can put off bleaching bonding in veneers during the Lehman's day crisis but again I just want to read
Christopher: That is true that's a very good point.
Howard: The average oral surgeon makes 448 periodontist 330 endo 307 pediatric dentists 304 orthodontist are the first ones that drops below the 300 there 289 prosthodontist 219 general Dennis drop below the 200 there are 184 so when you look at that I mean it's just blood and guts pulling a tooth is and by the way when I find oral surgeons who only do accident you their overheads 40% when I find them that mostly it's an implant practice their overhead 60% so they're not pricing their overhead correctly but extracting a tooth doing simple endo doing fillings doing cleanings exams and x-rays I mean get to be what will you just said if it was Warren Buffett talking he'd say be diversified so you said I want to have all my money in Enron in one stock he'd say well that's a really bad idea. Pediatric dentist that there's a dentistry uncentered for the 32 years I've been out here there's been a couple of low-key to medium key beefs about a pediatric dentist in time doing all this phase one and then when the orthodontist across street gets this kid ten years later for Phase two you know the orthodontists the benefits have been dry in anyway there's been some rivalries there between phase one pediatric dentists and phase two orthodontist does that look any different to you today than it did than they used to?
Christopher: You know believe it or not where I practice which is New Jersey in Florida I haven't seen a ton of pediatric dentists doing phase one ortho in those areas so personally I just haven't really experienced that rivalry firsthand you know I've heard some of your other podcast with orthodontist where you've mentioned it but I don't know it's just one that I guess I'm just not feeling the pressure of the tension of that I seem to get along great with my pediatric dentists.
Howard: So you were born in New Jersey?
Christopher: That's correct
Howard: So but you're a make jagger fan and not a Bruce Springsteen?
Christopher: Oh I love the boss
Howard: Are you?
Christopher: Yeah you never got huge into Bon Jovi and Bon Jovi's the other prodigal son of New Jersey but I'm a huge Springsteen fan I have almost every album on vinyl.
Howard: Really and how would you like them a Bruce or Mick Jagger?
Christopher: Ooh that's a tough one probably a little bit more of a Stones fan yeah I'm a stones I love the Beatles to Led Zeppelin as well.
Howard: Yeah now there's a guy in Arizona and his whole office is in rock-and-roll Mobilia electric guitars I mean it's a hoot and a hit.
Christopher: I better get over there
Howard: Is your love for music are you are you working that into your personality your marketing your Instagram is that part of your stick?
Christopher: Yeah I mean why not I mean in today's day and age I think patients want to see what you do in your personal life when I came out of school that was sort of taboo is you just wanted to have your shirt and tie on and be very proper and sort of present that stereotypical image of what a dentist should look like but today's day in age of social media I think patients do like to see that you have other interests and hobbies and and sometimes that opens up conversation with patients right you know I might mention that I like music and I play bass and they might read my bio and say oh that's so cool you play bass I happen to play guitar or drums or cello so you know I think it's good to talk about your interest in hobbies.
Howard: You know I used to always have this conversation with Bob Ibsen so many times where I wanted to talk about something or in dental town or he had me come lecture to his group and I'd be trying to get him to come up on stage I said well Bob just come up here in 20 minutes and he'll I just want him to tell me what he told me in the car from the airport to the deal but that generation they just couldn't promote themselves and then they they know that'd that'd look like self-promotion like it's a great story they'll love it they'll let your engagement but they had so many mental blocks about self-promotion.
Christopher: Yeah yeah and I don't know when that sort of generational or thought process shift even really occurred but you're right I say I think the older generation they maybe looked at that like you said as promoting themselves and you know you sort of have to share your story so people can learn about you and you know you want people you want to inspire people you want them to connect with you so you know I it's important to reveal you know certain things you don't reveal everything obviously.
Howard: So staying on dentistry uncensored not talking about anything ever agrees on and I still keep hearing it a lot and it's just a huge intellectual mistake like like it's extremism I mean when you tell me that everything is a and there's nothing be I mean it just doesn't happen and I'm talking about four bicuspid extraction I know so many locals who if the general if the or they quit referring to an orthodontist because he'd recommend it for by custom extraction and they say I don't believe in that well I don't care what you believe in, I mean you know that universe doesn't care what you believe in do you think the Big Bang really thinks what you cares what you think about it, I mean the bottom line is if you think 8 billion people can all have their teeth straightened without any extractions you should tell a doctor I mean did you agree or disagree?
Christopher: You know I'm a non extraction but you're absolutely right Howard there's times when you have to extract and I don't believe that necessarily causes airway problems you know really you have to just sort of look at the size of the jaws the size of the alveolar bone relative to size you know I mentioned before in New Jersey I had a different patient population than I have now in Florida when I was in New Jersey I probably did 5% extraction 10% now I'm working on a slightly different you know ethnic populations and I'm finding that I'm extracting closer to 20% just because we're finishing a lot of cases and the teeth are flared way out so tomorrow and the patients notice that they may not be able to articulate because like in...
Howard: What ethnicity is this because class threes are all in Japan right?
Christopher: Not necessarily
Howard: I mean the highest proportion of any population with class threes Japanese right?
Christopher: I believe that's correct yes you know you know in my particular practice now we have a lot of Latino patients a lot from South America and you know there have been cases that I felt like I was the hero by finishing this non extraction doing IPR and the parents have come back I actually had one parent say my child looks like a horse which I thought was terrible but you know I think patient patients really do you know when those upper incisors are upright and they sort of understand they can't articulate smile arc but they sort of get it it sort of it resonates a smile can sort of pop I guess and so when the teeth are flared out and you have this you know super proclaimed incisors it just doesn't look right so by bringing them back in you're not necessarily you know impeding the airway space the tongue space it really just depends on the individual.
Howard: I had one patient you can't make this up the dad was six foot six and about 280 and the mom was like five foot and a hundred pounds and here comes in their little twelve-year-old with dads teeth and moms jaws and I'm sitting here showing this to my buddy I say are you still still non extraction because at this point we're looking at four wisdom teeth for bite customers and even like a central I mean like I mean we were I I would have pulled my hair out if I had any I mean and here's my crazy friend saying well I still wouldn't do extraction.
Christopher: Yeah you know it's funny as I get further into my career I'm probably starting to do more extraction believe it or not because I you know non extraction was sort of the hot thing for me coming right out of residency and you know you want to treat everybody not extraction if you could and what I was finding with my cases is that a lot of the second molars were completely soft tissue impacted and so there was yes we were resolving the - you're crowding but then you had this huge posterior crowding situation so you know it's something to consider - with extraction is you know, at least for me, I want to get those second molars completely and so the patient's able to clean the distal aspects.
Howard: Yeah I love it I would I'd love even more is you see all this I'm different views on pinions and I say it's because a lot of people live here think it's a really big country well it's not even four and a half percent of the population in the world I mean it's only 230 million at a seven point seven billion I love hearing the debates and all the other countries going on like like when you're in Scandinavia the big debate you know how we had the view of the wisdom teeth well no one chews on it throw it away just pull it you know don't put any money into it was it I mean a lot of Scandinavia feels that way about second molars I mean there are endodontists in Scandinavia to say well why would you save a second molar I mean I don't chew on it throw it away and they'll say I've been an endodontist for thirty years and I only have one person a decade that says I wish I would have saved that - you pull it and make the next thing you say oh no I don't miss it note you so the variance around the world is very interesting very fun to watch and and so then I start looking at numbers like well what percent of the endodontists revenue is just from second molars well it's huge because the general dentists are gonna do all the easy the easy layups so it's like if you implemented that in the United States of America I mean that four thousand endodontists would all take a significant hit but if you start getting tuned into things like this and start asking all the patients you see that are missing their lower second molar or a second molar anywhere and say you miss that tooth I mean if you went to a restaurant and gave you a menu suddenly wouldn't no one misses that tooth.
Christopher: Yeah but you know to be fair I think you could probably say that about you know if someone was congenitally missing their lower second premolars right they probably wouldn't miss that tooth or you know patients are only gonna miss the teeth that are showing if they have a jack-o-lantern smile right.
Howard: Yeah it's beauty first and then health comprise it's what's it look like Beauty trump's form and function.
Christopher: There you go.
Howard: Alright well hey I can't believe it's of an hour Christopher Cetta DMD board certified orthodontist at Blue Wave Orthodontics his websites bluewaveortho but put his name in YouTube are you are you to post those YouTube videos, on dentaltown when you make a post they have that YouTube button so when you go to your YouTube button and you can hit share and I'll give you a link but the next button over is embed you hate that you copy that you can drop the whole video on and whenever you do it on dentaltown your YouTube videos will explode because it's the YouTube video and a message board but I wish I wish you'd post those YouTube videos in there and because I think when dentists learn how to do ortho general dentists they actually don't do more ortho but they sure get better at diagnosing and treatment planning and working with orthodontist better but I'm Christopher thank you so much for coming on the show today
Christopher: Thank you so much Howard