Dentistry Uncensored with Howard Farran
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364 PROPEL Orthodontics with Wayne Hickory : Dentistry Uncensored with Howard Farran

364 PROPEL Orthodontics with Wayne Hickory : Dentistry Uncensored with Howard Farran

4/14/2016 5:21:35 AM   |   Comments: 0   |   Views: 464

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VIDEO - DUwHF #364 - Wayne Hickory



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AUDIO - DUwHF #364 - Wayne Hickory



Dr. Wayne Hickory has been an authority in the orthodontics field for over 25 years.

As an early adopter of many innovative technologies used throughout the industry today, and with a background in orthodontic research and instruction, Dr. Hickory is an expert in both traditional and modern orthodontic methods. His unique fusion of highly personalized care, leading-edge technology, and authentic, transparent patient relationships creates beautiful, straight, healthy smiles that patients can’t wait to rave about to their friends and family.

Teaching & Consulting:

Both patients and colleagues pursue Dr. Hickory’s expertise. As a former full-time professor at the Orthodontic Departments of both the University of Amsterdam and the University of Maryland, Dr. Hickory regularly consults in orthodontic practices and teaches courses to dentists and orthodontists throughout the world. Dr. Hickory also has a special interest in teaching abroad along with hosting orthodontists from Europe and Asia for advanced courses stateside.

Education:

Trinity College: (BS)

Boston University, School of Graduate Dentistry: Master’s Degree in Nutritional Science

University of Connecticut, School of Dental Medicine: Doctorate of Dental Medicine (DMD.)

University of Connecticut, School of Dental Medicine: Three-year postdoctoral orthodontics certification

University of Connecticut, School of Dental Medicine: Master’s of Dental Science (MDS)

www.EmbassyRowOrtho.com 

Howard:

This is a real honor and treat for everyone. I'm down here with two of my boys lecturing in Singapore and I run into this American, Wayne Hickory, who's down here lecturing in the same city and I said, "Let's go grab a cup of coffee and talk Propel." You're just a really rare unicorn, is what I call it. You graduated dental school in Connecticut in '79, then you became an orthodontist, then you went all the way to Amsterdam, or the Netherlands, also known as Holland, and you taught there for three years. Holland, the Dutch, were founders of South Africa, Indonesia, other countries, so that gave you some contacts in other countries around the world. Now, you started a dental practice management journal back in the day. How long ago was that?

 

Wayne:

That was more than 15 years ago.

 

Howard:

I wanted to get ahold of you and talk to you because now you're talking about something- Obviously, no one wants to wait two years to have their ortho done and there's a couple of new technologies - you're with Propel - that might make braces go faster?

 

Wayne:

There's a lot of excitement in the orthodontic industry now about changing the biology. Up until now, everything in orthodontics has been about how we put forces on teeth. Invisalign, self-ligating brackets, had amazing technology.

 

Howard:

What's new in orthodontics?

 

Wayne:

What's especially new now is technologies for changing the biological response. This last decade or so, we've had amazing technology for how we put forces on teeth. We've got two different technologies now. We've got how we put forces on teeth. That's Invisalign, amazing, SureSmile, robotic bending of wires, that's amazing, but the action is at the bone, that's where we have the biological response to the orthodontic forces. We've always thought that the future of orthodontics would be changing the biological response. Propel does that with a microperforation. You make a micro injury to the bone- This is not a new concept, we did that more than a decade ago with wilckodontics surgical procedure-

 

Howard:

Wilckodontics, the two brothers.

 

Wayne:

Exactly.

 

Howard:

One was an orthodontist, one was a periodontist.

 

Wayne:

Periodontist, right. That was a fabulous technique, but quite a major procedure, to say the least.

 

Howard:

That's quite an understatement.

 

Wayne:

Now, Propel accomplishes essentially the same thing in a very non-invasive way, just going right through the gum. You only have to make the soft tissue numb. You can do that with a profound topical. You don't even need to give it a needle. You put that profound topical and you use the Propel and the patient doesn't feel anything. What's amazing about this technique is that it's been proven in a highly controlled clinical study, which you don't see very much in products in our industry. This was developed at NYU dental school. The teeth were proven to move 2.3 times as fast. I don't know of any orthodontic product that could be proven to move teeth 2.3 times as fast.

 

Howard:

Is that one specific study?

 

Wayne:

I'm referring to one specific study?

 

Howard:

Do you have that on a PDF?

 

Wayne:

It was published in the American Journal of Orthodontics and that was about two years ago.

 

Howard:

But do you have that on a PDF?

 

Wayne:

Yeah. Oh, yeah.

 

Howard:

Can you email it to me.

 

Wayne:

Of course.

 

Howard:

Howard@dentaltown.com.

 

Wayne:

Absolutely, absolutely. Very simply, they took extraction cases and put calibrated springs to close the space. It was highly controlled. They did Propel on one side and not on the other and the side with the Propel moved more than twice as fast. This is a technique that any doctor has to feel, "Well, it's just a lot of anecdotal stories about 'this is what happened in my patients,'" this is based on real research. The way I use it, is I target the rate limiting tooth. I do mostly Invisalign and Invisalign for me is outperforming braces now.

 

Howard:

What do you mean "outperforming braces"? You mean that more of your patients get it or that it works faster or what do you mean by "outperforming"?

 

Wayne:

It works faster, more efficiently.

 

Howard:

Than-?

 

Wayne:

Than braces.

 

Howard:

And by braces you mean traditional brackets?

 

Wayne:

Any kind of brackets or wires.

 

Howard:

Brackets and wires.

 

Wayne:

It's hard to compete with computer modeling of treatment. I think SureSmile is also very efficient.

 

Howard:

Okay, what is SureSmile? Is that one word or two?

 

Wayne:

That's one word.

 

Howard:

SureSmile.com?

 

Wayne:

Yeah. Yeah, with a capital S, "Sure", capital S, "Smile."

 

Howard:

Okay. What is SureSmile.com? Is that an Invisalign knockoff?

 

Wayne:

No, no, no. SureSmile preceded Invisalign. They've been around quite awhile. Actually, it was developed by one of my classmates, Rohit Sachdeva.

 

Howard:

How do you spell his name?

 

Wayne:

I can't- (laughs)

 

Howard:

How do you say it?

 

Wayne:

Rohit Sachdeva.

 

Howard:

Roit? R-O-I-T?

 

Wayne:

If you Google "SureSmile," he's published a lot of cases and he developed that system.

 

Howard:

Is he your friend?

 

Wayne:

Yes, yeah, he's-

 

Howard:

Well, then you got to refer to a podcast.

 

Wayne:

Yeah.

 

Howard:

You got to email him and me and get this is going to be another podcast.

 

Wayne:

It would be very enlightening to talk to him, I can guarantee you that. He was doing 3D computer modeling before anybody and it was based on all the principles of treatment planning and biomechanics that we learned with Charlie Burstone. After doing the treatment on the computer model, they do 3D robotic bending of the orthodontic wire.

 

Howard:

You're talking about SureSmile right now.

 

Wayne:

You only need a few wires. They're super elastic wires. You can't bend them, their robots bend them by super heating small sections. That's really a great technique. In my practice, I'm downtown Washington, DC, mostly adults, and I also have a pediatric practice in Bethesda, Maryland. Even for the kids, most people today would prefer to have Invisalign over braces. Invisalign-

 

Howard:

What is your definition of kids?

 

Wayne:

Any age. I do a lot of early phase. I use Invisalign for that, too.

 

Howard:

Like how early?

 

Wayne:

Seven to nine.

 

Howard:

A seven to nine year old?

 

Wayne:

Yeah.

 

Howard:

It just seems counter-intuitive. It seems like if I gave a seven year old a retainer, it would be in the sandbox. But you're not seeing that?

 

Wayne:

This is a concern parents have: "How can you use Invisalign with kids? Because they're not going to be cooperative." My answer would be, "How can you use braces with kids?" Braces require a lot more compliance than Invisalign. If you have a non-compliant child and they're wearing braces, you're risking permanent damage. Decalcification of teeth, not to mention broken brackets, broken wires, a lot of extra visits. If I do Invisalign, if the kids don't wear it quite enough. It's going to take me a little longer. I can deal with that better.

 

Howard:

That's a good point. Can the Invisalign trays also kind of be like a fluoride tray, too?

 

Wayne:

They can. We haven't done that, but that's a thought.

 

Howard:

Just like the little foam? Because one of the absolute worst things about wires and brackets is you pull them off and see the demineralization around every bracket in the whole mouth.

 

Wayne:

That's one of the benefits of Invisalign.

 

Howard:

Let me get this right. My job is to ask every question that some listener might be thinking. You put the Propel topical, the gum's numb, so you're just poking through the gum and making bone trauma? Is it like a needle? What is it?

 

Wayne:

It's a mini-screw.

 

Howard:

It's a mini-screw?

 

Wayne:

It's a tiny screw. We tell the patients it's kind of like acupuncture for the teeth. They're not going to feel anything. That's true, they feel essentially nothing. It softens the bone, which is, in their terms, something they can understand, and it's a fairly accurate way of speaking of it because when you make a micro-injury in the bone, you are stimulating the same cascade of biological events as when you put a force on a tooth. You put a force on a tooth, you stimulate a release of chemical messengers that recruit precursors to osteoclast and that's what causes the bone remodeling which is the basis of tooth movement. If you put an orthodontic force - and you can do this in animal studies or in clinical trials - you put a force on a tooth, you get a certain amount of movement in a given period of time. If you add a micro-injury, such as Propel, you more than double that response.

 

Howard:

You put Propel topical and then you're going to place a little mini-screw into the bone.

 

Wayne:

You're just going to come in and come out. You just barely need to get through the cortical plate. You set the device-

 

Howard:

Just to make trauma?

 

Wayne:

Just to make a micro-injury.

 

Howard:

Just to make a micro-injury.

 

Wayne:

To stimulate that biological response that's going to make the teeth move faster in that area. You need to do two or three perforations between the roots of each tooth that you want to activate. You can be strategic, you can be selective. If you have a tooth like- Every appliance has its strengths and weaknesses. I think, again, Invisalign outperforms braces for most things, but there's still some things where it's challenging for Invisalign, like bringing maxillary lateral, extruding it. We know that is challenging, so sometimes we'll just target that tooth or a larger rotation of a premolar or a large space closure.

 

 

We can use it to target a rate limiting tooth-

 

Howard:

And what do you mean by a rate limiting tooth?

 

Wayne:

In many orthodontic cases, there's going to be one or two teeth that are going to require the most movement. If you can speed up the movement of those few teeth, you're going to decrease the total treatment time. For example, with Invisalign, they're going to take that rate limiting tooth, they're going to draw the timeline for how many aligners you're going to need to move that tooth. Their software is very precise in not allowing more than a certain amount per aligner. That's why the treatment is so predictable. Now, that tooth, let's say it's retracting a canine into a space, that's going to take a year. That means all the other movements will be spread out over that time frame in many cases. If we can shorten the time for the rate limiting tooth, then we shorten the whole treatment time.

 

Howard:

You moved away in the last 30 years from brackets and wires. You're mostly doing- What would the genre be called? Clear trays or would you call it removeable? What do you call the genre?

 

Wayne:

I would say-

 

Howard:

From a fixed bracket to-

 

Wayne:

Aligner.

 

Howard:

Aligners?

 

Wayne:

Clear aligner. The general term would be clear aligner therapy.

 

Howard:

You're favorite clear aligner therapies are Invisalign and SureSmile?

 

Wayne:

Well, SureSmile is braces. SureSmile is braces.

 

Howard:

SureSmile is braces and that's fixed brackets.

 

Wayne:

They don't have a bracket. You use any bracket, but they provide the wire. You scan the teeth with the brackets, you do the treatment using their software and then they provide wires that predictively give you the 3-dimensional forces to accomplish that tooth movement. Invisalign does the same thing, they're just using aligners instead of wires.

 

 

That's why I'm saying we've got two technologies now in orthodontics. We've got the technologies for how we put forces on teeth, and they've come a long way, thanks to computer modeling and now we are looking at having some control of the biology. You put the two together and you have a very powerful control of doing orthodontics.

 

Howard:

That's interesting. So basically the big two ortho breakthroughs in your 30 year career has been these of computer modeling and biology?

 

Wayne:

Right, right.

 

Howard:

You're using both of these together. If you're going fixed bracket, you're using SureSmile computer modeling-

 

Wayne:

I'm not using braces much at all at this point because in the part of the country I'm in, most patients really prefer aligners and because over the last decade or so I've done a lot of teaching for Invisalign, it kind of forced me to know how good it was. When I came back to my practice, I asked myself, "Why am I using braces?"

 

Howard:

Let me ask you. We call this Dentistry Uncensored because I like to talk about the most politically incorrect stuff.

 

Wayne:

Good. I'm from Washington, DC, so be careful (laughs).

 

Howard:

Okay, you're from Washington, DC, so you can spin your answer any which way. It seems like we kind of have- Probably the biggest controversy in orthodontics is a patient wants it in the shortest treatment and the orthodontist wanted everything lined up, torqued, tilted. I hear orthodontists say things when they hear that there's general dentists that teach short-term ortho and they'll do everything in a round wire. I'll hear orthodontist saying, "Are you kidding me? They didn't even use a square wire for bracket torque, [gropuing 00:14:38]. It's just too sloppy." Where do you ethically, morally draw the line between a woman who just wants whiter, brighter, straighter, sexier teeth versus you, being an orthodontist, who wants every single molar torqued and titled perfectly. Do you kind of know what I'm asking?

 

Wayne:

I know what you're asking and I think it's a very good question. I think the answer really should be patient-based. In other words, we should listen to what the patient wants and we should also tell the patient the benefits of giving more than-

 

Howard:

Isn't that a slippery slope if you start listening to the patients, then you'll be asked to listen to your assistant and then your kids and then your wife- No, I'm just kidding (laughs).

 

Wayne:

(laughs) I thought you were serious.

 

Howard:

No, I'm just kidding.

 

Wayne:

No, but it's true, as an orthodontist, by training, you're looking at doing perfection. You really want Class I canines and you want everything as ideal as possible. Thankfully, the new technology we have today makes it easier for us to accomplish that within the time frame that's good for our patient. Faster treatment's not only better for patients, it's better for orthodontic practices, too, because more efficient treatment means a more profitable case. If you're seeing patients for three years, you're probably losing money treating that patient.

 

Howard:

How much are these technologies? If Propel can make you go 2.3 times faster- How much is a Propel- Is there like a Propel kit for each patient?

 

Wayne:

You buy individual devices. You use each one- Well, they have several types of formats now. The original device was a disposable piece. It was just a nicely contained screw within a plastic handle and you could dial the depth three, five, or seven millimeters, depending on the region of the mouth. Three millimeters anterior, five millimeters typically in the premolar area, and perhaps seven toward the posterior. As you go in, it's easy to read that on the retractable sleeve but also an LED light goes off when you hit the depth that you've dialed. It makes it very nice. It's a nice little tool. It's not expensive and naturally the price depends on the quantity that you buy. If you're doing a lot, you buy them by the dozen. Per visit, it might be a couple hundred dollars.

 

 

For a doctor, if you can make- It's not just faster treatment, it's more predictable treatment. If you can have faster, more predictable treatment, a lot of doctors, "I don't need to charge the patient extra for this because it's adding to the efficiency of the treatment."

 

Howard:

So you're saying it's a couple hundred dollars per visit?

 

Wayne:

That you use Propel. Now, you're only going to use it once, twice, three times in a treatment, because the effect lasts for two or three months. Many times, once you release a movement, you're just fine.

 

Howard:

So you're putting these screws into the cortical plate of the mandible and the maxilla-

 

Wayne:

You go in and come out. You just-

 

Howard:

You go in and come out.

 

Wayne:

It's like acupuncture.

 

Howard:

And that micro-trauma is causing the osteoclast to [absorb 00:17:56] or the osteoblast to lay down and just get everything moving faster?

 

Wayne:

It's stimulating more bone remodeling. There's a baseline level of bone remodeling all the time. Our bone is dynamic.

 

Howard:

You know, we came out with the Dentaltown app and there's 210 thousand members. We started an online CE so you can watch the CE courses on your iPhone, your smartphone. This seems like something they'd really love to see. Do you think there's any chance you could put up a online lecture on this?

 

Wayne:

Of course.

 

Howard:

That would be- Because I'm sure you have slides on this.

 

Wayne:

Yeah, Propel has several speakers in the United States that are speaking all the time. I speak mostly over here. I'd be glad to do it. Propel would be glad to also refer you- There's several that would have really amazing cases to show.

 

Howard:

We put up 350 courses and they've been viewed over a half a million times. They love sitting on- Not everyone's on their phone on Facebook (laughs).

 

Wayne:

There's a Dr. Shipley. He's changing aligners every three days with Propel instead of two weeks. John [Nicocisus 00:19:17]-

 

Howard:

What's his total case time?

 

Wayne:

Well, depending on the case, it could be just two or three months.

 

Howard:

Your answer to short-term ortho is that you can do complete, quality ortho in short term.

 

Wayne:

Absolutely.

 

Howard:

Without cutting a bunch of corners.

 

Wayne:

Absolutely.

 

Howard:

What would the corners being cut on short term ortho versus regular ortho? The first thing comes to my mind is that if you only use a round wire, you're just [level 00:19:46] aligning the teeth. If you're not engaging the bracket with a square wire, you're not torquing the root, the tip.

 

Wayne:

A lot of cases could be finished in a round wire and be okay. You don't necessarily have to go to a thicker diameter wire to get a good result.

 

Howard:

You don't necessarily need a square wire?

 

Wayne:

The way I do it, I evaluate the case. How does it look, how does the occlusion look? If it's done, it's done. I'm not going to put in another wire just to follow a program. I don't know that I've seen that much short cutting where I am in Washington, DC. I think most dentists today that do orthodontics are using Invisalign and I think they're selecting cases that are within what they can manage.

 

Howard:

Are you kind of predicting clear aligners basically replacing fixed braces?

 

Wayne:

Well, they have in my practice.

 

Howard:

What percent of ortho was clear aligners when you got out of school in '79?

 

Wayne:

Zero.

 

Howard:

And what percent of ortho around the world today would you say is clear aligners?

 

Wayne:

In my practice, it's 98 percent. In the United States it would be high, but it's not as high as you'd think it might be.

 

Howard:

Whatever happened to the mythical lingual braces? If the big problem with fixed is "I don't want to see them," and we can easily put them on the inside, but it's never really taken off. Did the market kind of speak on that, that for various reasons-

 

Wayne:

Yeah. I was in downtown DC, I have a lot of adults, we did a lot of lingual and we used Lingualcare, which is great product. Also used robotic wire bending, which is very valuable on the lingual. Now SureSmile has a lingual system, which I think is very powerful.

 

 

Lingual is a great technique. However, the problem is for the patient, the comfort on the tongue side. You've got an adaptation of the tongue for comfort and for speech. It's also going to be more expensive. The cost to do orthodontics is the appliance and chair time, orthodontist time, doctor time. With Invisalign, you have an appliance cost that's significant, but you have very little chair time. With lingual orthodontics, you have a high appliance cost, more than Invisalign, I would say if you're using a high-tech product, and you have the chair time. Lingual, I think, a lot of doctors find they charge 10 thousand plus and it may not even be that profitable.

 

Howard:

I love the way your mind works. You started a practice management journal for orthodontics twenty years ago, didn't you?

 

Wayne:

Fifteen to 20 years ago we started-

 

Howard:

Talk about that, because what you just said, dentists' minds don't even think that way. They think they're saving money if they use a 90 dollar lab for a crown and then they spend half an hour adjusting it.

 

Wayne:

Right, right.

 

Howard:

Then there's a lab across the street that charges 140 and the seat time is zero.

 

Wayne:

I think orthodontists are more focused on management things. Just by nature, an orthodontic practice tends to see more patients per hour, tends to have a larger staff. A case is a year or two year management project of itself. An orthodontist becomes a manager, whether they want to or not. The success of their practice and even the quality of the work depends as much on how well you manage the practice as much as how good of a wire bender you are.

 

 

Back 15, 20 years ago, a friend of mine who was in the publishing business asked me if I'd be interested in doing an orthodontic journal. I said, "Well, no," I didn't really see a place for that. We had the JCO and the American Journal of Orthodontics. I didn't see how we were going to do another journal on orthodontics. Then I thought, "Well, wait a minute. There is an area that is not really addressed and that is practice management." We started a journal, called it Praxis. I think it was bi-monthly.

 

Howard:

It was called Praxis?

 

Wayne:

Praxis.

 

Howard:

P-R-A-X-

 

Wayne:

I-S.

 

Howard:

That was a play on practice management? Praxis?

 

Wayne:

It was just a word. I think a friend of ours just picked it out from [crosstalk 00:24:41] or something. It was nice. We got various people to contribute articles on practice management. I contributed a few on things that we were doing in our practice like the care coordinator program, things like this, case manager program, where we're sharing things about what we were doing in practice management along with other doctors. That was quite good. We were breaking even on having some advertising, but my key man, his wife's business took off and he had to leave. I didn't have time to follow up. We retired that project. But I thought it was a very worthwhile adventure.

 

Howard:

You got out in '79, now it's 2016. Are the orthodontists coming out of school today with more training in practice management than when you came out of school? Do you see them coming out with a more business mind? Because that was a huge void when you and I got out school.

 

Wayne:

I think a lot of departments are putting something in to that area. I think most orthodontists learn about practice management when they join a practice when they graduate. That's one of the benefits of joining a practice is there's a lot to learn about how to manage a practice and how to work within a busy environment like that. It's quite different from what you do in a residency.

 

Howard:

I want to talk about another historical thing. A lot of the kids got out of school today, they see corporate dentistry, they think it's always has been, always will be, whatever. But you and I lived through Orthodontic Centers of America, where all the orthodontists practice by themselves. Corporate came out, they started rolling up a huge number of orthodontics practices. They did an initial public offering on the New York Stock Exchange, the only dental service organization that's ever achieved that goal. Then it went spectacularly out of business. Do you see any of today's modern corporate dentistry following the same- Well, first of all, do you remember the Orthodontic Centers of America?

 

Wayne:

I sure do.

 

Howard:

What is your take of that?

 

Wayne:

I like the concept in this way. Every doctor has to reinvent and go through all the decision making and problem solving of hiring, budgeting, marketing, all these different areas of service. Wouldn't it make sense to have a franchise concept where you have a central place where you have experts in various departments that are resourced to your practice?

 

 

Now, Ortho Centers of America, my Bethesda practice was involved for awhile.

 

Howard:

Seriously?

 

Wayne:

By default. Originally we joined OrthAlliance [Pedialliance 00:27:49]. We liked that concept that they were going to provide practice management input. Then they went under, Ortho Centers of America bought them out. So we were by default with them. We got separated from that, it was a little bit of a legal thing going on there. We got out of that. Now, I have just joined OrthoSynetics, which is actually a lot of people from Ortho Centers of America. They have their experience from being in that organization. Now, OrthoSynetics provides 17 departments of management. You give them a fixed percentage of your gross.

 

Howard:

And what percentage is that?

 

Wayne:

It varies by the size of your practice and things like this. My experience so far is that I don't know how they do it. For the service that I'm getting-

 

Howard:

Where is OrthoSynetics out of?

 

Wayne:

They're out of Louisiana.

 

Howard:

Well, that's where [Lazarus 00:28:44] was out of. Is it [Lazarus 00:28:48] again?

 

Wayne:

I believe so.

 

Howard:

He's reemerged?

 

Wayne:

Yeah. You have these people there that have decades of experience. I'm benefiting from- They're representing over 200 orthodontic practices.

 

Howard:

And it's called OrthoSynetics?

 

Wayne:

OrthoSynetics.

 

Howard:

Can you score me a podcast with [Lazarus 00:29:12]?

 

Wayne:

Oh, sure. Yeah.

 

Howard:

Is that right? OrthoSyn-

 

Wayne:

OrthoSynetics.

 

Howard:

S-Y-

 

Wayne:

N

 

Howard:

N-E-T-I-C-S.

 

Wayne:

Right. OrthoSynetics.

 

Howard:

OrthoSynetics, okay.

 

Wayne:

They provide buying services, a page where all of our products would be, and just click and it's- So that's very efficient.

 

Howard:

Let's go back, history-speaking. Why did Orthodontic Centers of America fail the first time around?

 

Wayne:

You know, I'm not sure. I'm not sure. Well, there was something different about that model. They owned the practice. They would give you- If your practice was worth a million dollars, you'd get a million dollars, and then you'd pay a service fee.

 

Howard:

Then you became an employee.

 

Wayne:

Not really, but they owned the practice on paper. In some states, that's not allowed. You have to be a licensed dentist to own a practice. OrthoSynetics provides, again, about 17 departments of practice management service. Marketing, purchasing, you don't have to negotiate prices of things. They've negotiated all the best prices. Insurance submission, billing, all of these things you get to have an experienced team take control of that. I think that frees the orthodontics and their staff to focus more on the patient care.

 

Howard:

It is my opinion of just humans that some dentists love the business side of it. Some can't stand it. Others are being pulled different ways, like a lot of young dentists with young families, they want to leave at 5 o'clock and go home and take care of babies. They don't want to stay up late and do SEO on their website and buy supplies. It just really depends on the person.

 

Wayne:

I enjoy the management side, so my joining OrthoSynetics was not to evade being involved in the management, but it was to do it better. It was to have the expertise.

 

Howard:

It is 11:22. What time do you need to get out of here?

 

Wayne:

11:30.

 

Howard:

11:30. So I got eight more minutes with the man? I want to go back all the way to Amsterdam. I just think that's so cool. I don't even think one out of 1,000 kids will ever graduate from college and just pick up and go to another country and you go to Amsterdam. And Amsterdam has long, deep, historical connections with other countries.

 

Wayne:

Indonesia, in particular

 

Howard:

Indonesia. So you're lecturing in Indonesia and Vietnam. Are those the main two countries?

 

Wayne:

Yes. When I was teaching in Amsterdam, that was my first academic appointment. Just our research interest aligned, so I was there. It was also very broadening place to go, be in Europe for a few years. It was a great experience. By chance, because of the relations of Holland with Indonesia - the Dutch ruled Indonesia for 350 years, so it's a long history - and they still have a lot of exchange, cultural exchange, scientific exchange so they funded some dentists to do research with me. Over the years, I've kept in touch with them. I think one was like Minister of Health, another is Dean of a dental school.

 

 

I would give lectures over there over the years and I had a second home in Bali. I was looking to-

 

Howard:

You still have that home?

 

Wayne:

Yes, yes.

 

Howard:

Well, now you're my new best friend.

 

Wayne:

It's for sale. I don't tend to get there enough.

 

Howard:

And what is the price of something like that in Indonesia? Can you see the ocean?

 

Wayne:

Yeah, you can get a nice house for maybe 500 thousand or so.

 

Howard:

Near the ocean?

 

Wayne:

Yeah.

 

Howard:

See it looking out over the ocean?

 

Wayne:

Yeah.

 

Howard:

Would you have your beach on the ocean?

 

Wayne:

Well, that's a bit more. There's not a lot of that kind of land, just like everywhere.

 

Howard:

You lecture mainly today in the United States, Indonesia, and Vietnam?

 

Wayne:

Right. I was lecturing mostly for Invisalign for about six years in Indonesia, Vietnam. I helped with the product development there.

 

Howard:

In our show, 83 percent are from the United States and 17 percent are from 139, 140 countries. Tell my homies back in America, any difference in- What's it like being a dentist in Vietnam or Indonesia if you're right now living in Oklahoma and you've never left the country?

 

Wayne:

Well, I think what maybe different in some of the countries in Asia is that there's a wider range of the level of practice. You'll have some practices that are very, very basic. That's for the common people, the fees might be very low and it's very, very fundamental. But then you do also have some very high-end practices in the fashion malls and all this type of thing.

 

 

It's of course a different economy. The challenge to those dentists is they're buying orthodontic products on the international market with their local economy money. For example, an orthodontic case in Indonesia, Vietnam, the patient might pay about a thousand dollars or less. Then, that doctor, if they want to do Invisalign, they're going to pay a few thousand dollars lab fee for that product. Naturally, you've got different levels of practice here. Some people can easily afford high-end dentistry.

 

 

There's even dental tourism. A lot of Americans can't afford dental care. They need a lot of implants and things like this, so many patients from countries with expensive dental care will go to places like Vietnam or Thailand just as they go for plastic surgery, they'll go for dental care. In many cases, the care is of a very high standard. Naturally, you have to do your research, because in these countries, again, there's that wide range. If you go to a dentist, you're not guaranteed that it's going to be a quality service. It could be, it could be extremely high quality, or it could be substandard. There are hospitals that have dental centers that give people and added level of confidence in where they're going.

 

 

Generally speaking, in the countries in Southeast Asia, you have this wide range of levels. What's different is the cost to the dentist of products is very high relative to their fees. However, labor costs are very low. That's kind of the trade-off.

 

Howard:

Then I just want to end on one question because I know you're a busy man. It was so awesome to get a- I just want you to comment on something I find hilarious. Back in the United States, you see scads of women wanting Botox, to puff out their lip, dermal fillers, they'll do anything to push their lip out. Then you come to Southeast Asia and these women have these beautiful upper lips, but they'll draw a line from their nose to their chin and if their lip goes forward, they want to pull that back. It's so funny. My question to you is that it just shows you that beauty is just in the eye of the beholder. You got the girls in Oklahoma pushing it forward and the girls in Vietnam pulling it back. What do you call that, the incisal lip line? Or what do you call that?

 

Wayne:

The aesthetic e-line, the aesthetic line or something like that.

 

Howard:

What do you think of the aesthetic? Is that just the Southeast Asia cultural thing?

 

Wayne:

Well, what it is, orthodontic problems do have a genetic base, so in different parts of the world, you do see different proportions of different orthodontic problems. For example, you see more Class IIIs in Asia, you see more maxillary deficiency in Asia than you do in the states. Our European-based population has more Class II, more mandibular deficiency. In Asia, you see more protrusion, and that's why that's something they want to reduce. They're never satisfied, you're absolutely right.

 

Howard:

But as a man, do you see that as a beauty error that needs to be corrected?

 

Wayne:

No, I don't. I don't.

 

Howard:

Or is that all inside their mind?

 

Wayne:

It's an individual thing. We have a course in Washington, DC, being a very multicultural area, we have patients of all ethnic backgrounds, and we're very sensitive to their individual needs. Even within a particular racial group, you'll find some people that have no problem with a fuller lip and others who just want to reduce. So you really just need to talk to patients and find out what their goal is and do your best to satisfy them.

 

Howard:

That is my- Today's little mission statement at the end of the day is just keep it simple. I want to create a dental office where me and all the employees want to be a patient at. You can sum up every major religion with just "treat other people like you want to be treated."

 

Wayne:

There you go.

 

Howard:

At the end of the day, whether your question is short-term ortho, Invisalign, Propel, it just- What does the patient want? We only exist for the patient. They're not there for us, we're here for them.

 

 

Hey, it's been just an honor that you came by.

 

Wayne:

It's been a pleasure.

 

Howard:

I just think you're an amazing man. What a dental unicorn. I hope I get an online CE course from you because I know all my homies listen to this would want to see these cases. Plus then they also get AGD credit and ADA credit and all that.

 

Wayne:

Nice. Very good.

 

Howard:

And if you could score me a [Lazarus 00:39:44] or any other people from Propel or-

 

Wayne:

Oh, yeah, they'd be glad to talk to you.

 

Howard:

Email me that NYU study. I'll start a thread, too, on that, that's profound.

 

Wayne:

It's great stuff.

 

Howard:

Thanks for your time.

 

Wayne:

It's been a pleasure.

 

Howard:

Okay.

 

 

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