Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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958 Systemizing Your Clinical Practice with Dr. John Hagiliassis : Dentistry Uncensored with Howard Farran

958 Systemizing Your Clinical Practice with Dr. John Hagiliassis : Dentistry Uncensored with Howard Farran

2/27/2018 8:34:51 AM   |   Comments: 0   |   Views: 478

958 Systemizing Your Clinical Practice with Dr. John Hagiliassis : Dentistry Uncensored with Howard Farran

Dr John founded Freedom Dental, a South Melbourne-based dental clinic in 2011, which quickly listed on BRW’S Fast 100 businesses in Australia for the years 2011 and 2012.

With a true passion and commitment to customer service and cosmetic dentistry, Dr John and his team of over 50 staff treat thousands of patients every year, providing them with straighter, whiter smiles in a spa-like environment and providing personalised care and six-star service.

Dr John is the largest provider of Phillips Zoom! whitening treatment in Australasia since 2012.

Dr John absolutely loves technology and loves finding ways to incorporate it into his practice to make him more accurate and efficient. 

Many years ago, John was one of the first people to have an iTero scanner in the world and has continued this trend by updating his technology constantly.

Dr John has treated over 3000 Invisalign® cases to date, is an Invisalign® International Mentor and the 4th largest provider of Invisalign® in Asia and largest dentist provider in Australasia. 

His passion for cosmetic dentistry saw him further his education in 2017, completing a Graduate Diploma in Aesthetic Orthodontics at the Postgraduate School of Dentistry. 

Committed to advancing the professional development of his team, Dr John runs ongoing study group sessions for all staff at Freedom Dental, including the leadership team, dentists, oral health therapists, administrative assistants and treatment coordinators. 

Freedom Dental host professional development seminars for the wider dental industry, inviting clinicians from across all specialist fields to speak and share their knowledge and expertise with the audience.

John regularly speaks and mentors at the Postgraduate School of Dentistry, as well as for Ivoclar (Trios Intraoral scanning) and 3D Meditech. 

John is also the founder of Aesthetic Orthodontic and Restorative Training Academy (AORTA) which aims to promote the further education of dental clinicians in the new field of digital dentistry and aesthetic orthodontics.

Outside of dentistry, John keeps a busy life in fitness with particular love for running. John is a busy father of two amazing boys (Andy and Dean) and husband to the gorgeous Joanne. With one of his boys being diagnosed with Anaphylaxis to nuts, John and Joanne have been strong and continued supporters of various organisations and charities to improve understanding and treatment of such conditions. 

VIDEO - DUwHF #958 - John Hagiliassis

AUDIO - DUwHF #958 - John Hagiliassis

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958 Systemizing Your Clinical Practice with Dr. John Hagiliassis : Dentistry Uncensored with Howard Farran

Howard: It is such a huge honor for me today to be podcast interviewing Dr. John Hagiliassis. It's 12:30 in the afternoon on a Friday here and it's already 6:30 in the morning Saturday where he is at. So you're already a step ahead of everyone listening to you. John graduated from the University of Melbourne with a bachelor of dentistry in 1998. He founded Freedom Dental, a South Melbourne-based dental clinic in 2011, which quickly listed on the BRW's Fast 100 Businesses in Australia for years 2011 and ‘12 with a true passion and commitment to customer service and cosmetic dentistry. Dr John and his team of over fifty staff treat thousands of patients every year, providing them with straighter, wider smiles and a spa-like environment and providing personalized care and six star service. I love that six star service, I've never even heard of that. Five stars is as high as it gets over here.

Howard: Dr John is the largest provider of Philips Zoom Whitening Treatment Australia since 2012. He absolutely loves technology and loves finding ways to incorporate it into his practice to make it more accurate and efficient. Many years ago, John was one of the first people to have an iTero scanner in the world and has continued this trend by updating his technology constantly. He's treated over three thousand Invisalign cases up to today, is an Invisalign international mentor and the fourth largest provider of Invisalign in Asia and the largest dentist provider in Australia. His passion for cosmetic dentistry saw him further his education in 2017, completing a graduate diploma and aesthetic orthodontics at the postgraduate school of dentistry. Committed to advancing the professional development's team, Dr. John runs ongoing study group sessions for all staff of Freedom Dental, including the leadership team, dentist, oral health therapists, administrative assistants and treatment coordinators. Freedom Dental hosts professional development seminars for the wider dental industry, inviting clinicians from across all specialist fields to speak and share their knowledge and expertise with the audience.

Howard: John regularly speaks and mentors at the postgraduate school of dentistry as well as for Ivoclar, Trios, intraoral scanning and 3D MediTech. John is the founder of Aesthetic Orthodontic and Restorative Training, AORTA, which aims to promote the further education of and dental clinicians in the new field of digital dentistry and aesthetic orthodontics. Outside of dentistry, John keeps a busy life and fitness with particular love for running. John is a busy father of two amazing boys, Andy and Dean, and husband to the gorgeous Joanne. With one of his boys being diagnosed with anaphylaxis to nuts, John and Joanne have been strong and continued supporters of various organizations, charities to improve understanding and treatment of such conditions. So how old are Andy and Dean?

John: They're eleven and nine.

Howard: Oh, those are fun years. Those are very funny. My oldest grandson's ten so that explains why you look so handsome on Youtube and I only want my people to see me on iTunes. Where do you think your passion for technology comes from? Was it video games when you were a kid?

John: No, definitely not. I think I have surrounded myself with people who know how to use technology. I just see it as a way of improving the experience with the patient. So I think that's my drive, that's my passion and seeing dentistry advance and at the end of the day, we sometimes forget we're treating patients and it's making their experience, especially in the world we live in now, better and the technologies [inaudible 03:38] I think our profession is generally slow on the uptake. We often forget what's in their best interest. It's not just the oral care and the health, but it's also how they feel at the end of the day after the procedures.

Howard: I've lectured in Auckland, New Zealand, Sydney, Melbourne, Perth, Adelaide, Gold Coast, probably every five years for thirty years. And my God, Australia has become so competitive. Since I started going down there, they doubled the number of dental schools, the government let in a thousand dentists from around the world, my gosh, and there's only three publicly dental traded DSO's in the world, two of them are Australia, one's in Singapore. It's 1300SMILES and what is the other one? Pacific smiles. The Australian dental market is twice as competitive as it was a decade ago. Can a new kid coming out of dental school in Australia still grow up and be like you one day?

John: I think it's tough. I think dentistry in Australia has definitely changed and it's a corporate landscape, but I think if the new graduate is true to themselves and true to how they want to feel as the patient, I think there's always room. There's always going to be a need for dentists who care about their patients, who want to communicate with the patient. I think that's where my success has been really tapping into a new generation of consumer, not just patient, who wants a say in what they're going to have done to their mouth, whether it's for health or aesthetics. I think there's hope as long as they're willing to embrace technology. Now, I know technology comes at a price, but I think it all comes down to where we see ourselves in twenty years in terms of dentistry. If you think about when you started, what you were doing compared to what you're doing now?

It's changed significantly and it’s going to continue to exponentially. But thinking about new graduates, they have an advantage over us older dentists. They can embrace this technology a lot better than we can. I had to get my associate to just make sure Skype is still working for me. If they're going to embrace technology to better service their patients, I think they're going to have a bright, optimistic future, but I can appreciate them feeling a bit of doom and gloom, with the debts, the [inaudible 06:17] . The history of education debts, they continue to increase. It's a bit overwhelming for them. But I think if they stay true to why they got into the profession, have that passion for it, I think anything is possible. I think innovation is what we need to develop in dentistry and in any profession.

Howard: The first three technologies that were a must-have was a bullwhip, hammer and chisel. And now thirty-years later, what do you think is the must-have technology? 

John: I think an intraoral scanner. I got the iTero in 2010, and then I got the Trios. I've tried them all three and all those scanners are Carestream. The intraoral scanner to me has completely rejuvenated our practice from 2010 and giving us that ability to tap into ortho software and crown and bridge and implant, so the scanner to me is a must. The intraoral scanner integrated into your practice not just for speed, efficiency, but also the comfort for the patient. And then you've got this record of their teeth that I foresee in the future we'll be able to replicate and use and really [inaudible 07:28] restoration and fillings based on natural anatomy, so i think the intraoral scanner, we haven't really tapped into that potential as to what it's going to provide us in the future.

Howard: We'll go through all three of those. You started with an iTero and then you talk about an Ivoclar or Trios intraoral scanner, then a 3D MedTech. Talk about the iTero, do you still love that? Do you still use that?

John: The iTero is more [inaudible 07:74] to Invisalign cases that we do, but I found, unfortunately, I mean that was a drug product when it first came out, it was bulky, yes, but its ability to scan efficiently [inaudible 08:04] fantastic and the accuracy of the [inaudible 08:06] in 2010 were fantastic and then we ended up getting two, three within a couple of years because we grew so quickly. We were scanning and getting software back within twenty four hours rather than waiting two weeks especially in Australia [inaudible 08:20] these impressions. It completely transformed systems and the workflow of our practice. The problem was when Invisalign didn't board iTero out. I didn't focus or invest in the crown and bridge aspect of the workflow. Trios then came on board. It's like a smartphone. It's the software that you can use and I think Trios had done that very well with the software. The ability to make in-house [inaudible 08:52] and restorations and smile design as well was a big buzzword [inaudible 08:56] smile design, but the ability to use the software to design smiles and show that patient and communicate with that patient transparently what we're trying to achieve [inaudible 09:06] giving them the edge are really competitive.

Howard: You're calling it the Ivoclar Trios intraoral scanner, but Trios is made

John: Ivoclar is just the reseller.

Howard: You're talking about the Trios. They're out of Denmark, right?

John: Yeah.

Howard: Align technology, you're saying, who owns Invisalign also bought iTero but you're saying that

John: In 2011 but I got the iTero before that happened and we're using the crown and bridging [inaudible 09:45] back but once Align bought them out and we were able to scan directly at that time, we were the first in the world scanning. We had two scan scanners and I remember the IT department at Align at the time, iTero at that time, we couldn't send two cases simultaneously so my IT guy had to speak to Israel who were the creators of iTero at that time to work it out.

Howard: iTero was originally out of Israel?

John: Israeli military is what my understanding was. They created the technology back in, I think it was 2009, but I saw a demo of it in 2010 and then within a month I had to have. I saw the future and I didn't look back.

Howard: That is amazing. I never knew so that. So the I in iTero stands for Israeli, huh? Israeli.

John: Possibly. I'm not actually sure.

Howard: You're saying that when Align who owns Invisalign bought iTero from Israel that they really just focused on the orthodontic and quit focusing on the crown and bridge? They have gone back to it but they haven't invested. They're way behind.

John: They have gone back to it but they haven't invested. They're way behind.

Howard: So that's you went to the 3Shape. So my question is, can you scan with the 3Shape Trios for clear aligners and that's Invisalign?

John: Yes you can and I know in the US recently, you can, but in Australia we're still allowed to send it to the Trios to align and they'll accept it.

Howard: When you're doing Invisalign, which should you go to, 3Shape Trios or iTero?

John: Whichever ones available. We have four running.

Howard: It doesn't matter to you?

John: lt doesn't matter. We have our assistants, our nurses who are scanning for us as well as taking the photo so it's a whole workflow where wherever the machine is available. Often we'll have four people needing the machine at any amount of time, there's a waiting list for it and there are surgeries that we run, so whichever one's available. It's not much of a difference from that point of view.

Howard: What about overhead costs, what do you think is the difference between the cost of taking vinyl polysiloxane impressions versus a scanner?

John: It's a no-brainer from my perspective and [inaudible 12:18] show that in terms of the remakes of crowns. Let's talk about crown and bridge first. The remake of crowns, I hardly need to adjust, modify and often when it is, it's because I didn't scan properly the equation or the bite, so remakes, we'll probably send one in twenty crowns back or have to adjust one in twenty, insert it for maybe ten or fifteen minutes at most for an individual crown, so it's saving you time from that point of view, but the focus has always been the patient. How many dental practices do you see advertising the gag? I want to gag on that polyvinyl siloxane material. No one wants it. Patients don't want it. Patients want comfort and to be able to show them on the screen those amalgam fillings that are still in their mouth, not to mention how easy it is for them to have it done. It's a no-brainer.

John: If the patient is our focus, the rest of it wasn't a fight. It's a more efficient way, so it saves me time, allows me to communicate to my patient what I'm doing and what I need to do for them in the future. It creates a medicolegal record. It's saved in the cloud and can be accessed anytime. When you look at it from that point of view, yes, it might be a cost if you've been doing PVS impressions for twenty years, but it just takes time. You have to invest in that technology and know in twenty years' time, impressions will be something in the museum, that won't be something that will be rare. [inaudible 13:49] scanning will be the way that we communicate through our technicians, through our third-party orthodontic labs and also as well as recording data and records of the patient. To me, it's a no-brainer. Economically, it's made sense [inaudible 14:05] You've seen the growth of our figures. It allowed us to explode and gave us an edge in patient service and chair time.

Howard: Whenever I meet someone like you who's done 3000 Invisalign cases. I know you're a passionate dentist, you love technology, your a great dentist. My homies down in Australia were so excited I was going to podcast you, but you've got to present this treatment and dentists always tell me they don't like selling. that they say, I didn't go to school eight years to learn how to sell and they just don't want to. It'd be like me going in to the doctor and he's saying, you should get a cosmetic surgery, or you should wear a wig or you need a tummy tuck or whatever. Do you think any of this technology helps you with presenting the cases? How do you close 3000 Invisalign cases?

John: It has been the key to success. The key has been using the technology to communicate to the patient. I'm still surprised. We get cases from all over the world that are continuing Invisalign and not living in Melbourne, for example, or cases [inaudible 15:19]. I cannot believe how many times these patients come in and I review the software with them and it's the first time they are seeing the software. It's mindblowing. Why do we fear showing the patient what we hope to tell you? Rather than using it to inspire them to see this is what we hope to achieve, this is what you're working towards, becomes a way of motivating them to wear the aligners because it's a collaborative effort. We can set the software up anywhere we like, unless they wear it, it's not gonna work. So closing those cases becomes easy. We bring the patient, we're not talking down to them, we're talking with them and working on a solution.

John: Are you using the technology to show them what we can do, where the problems may occur, what I have to focus on, that's been the secret of success is communicating using technologies. The technology is two things. It's the clinical advantage of diagnostics and treatment planning, but it's also the communication with your patient. To begin with the treatment, but every time that patient comes in for their aligners, by us seeing the software, they're seeing their progress, they are communicated what the next step is going to be and where the focus has to be becomes a win-win. It's the technology. It's empowering the patient to see and support them on their journey rather than telling what we're doing or trust me, I'm going to put braces on you and you'll have a straight smile. They're getting to see and interact with that process. That's been the key to success.

Howard: If you want to follow this young man, he's on Twitter. He is at freedom_dental. I just retweeted his last tweet, we aim to bridge the gap between dentistry, artistry and hospitality, so you can experience a day spa for your smile. Call 1-300-freedom to release your smile. I love it. Is that why you named it freedom? The freedom to release your smile?

John: I think that's where it evolved. We had a pretty [inaudible 17:21] huge for us. We were focusing on patient-focus philosophy. The wants versus needs mentality where patients coming, wanting something and they've got a missing tooth. And the mentality of dentists in general is to focus on what they need, the caries on that upper molar or something that's not visible. That's where it evolved from. I didn't like the way dentistry was presented. I was in undergraduate and I could see this disconnect between patients, how do I want to feel and what we're telling them. That's where it evolved. The freedom then evolved from there because we were Albert Square, which was a locality name, Albert Square Dental from the early 80s and as this evolved and exploded for us, we thought Freedom was a perfect fit as [inaudible 18:15] and philosophy.

Howard: Can you schedule an appointment on your website or you just leave contact information?

John: No, there should be appointments available. I'm writing that shortly to a new platform as all our forms. We usually focus on appointments, the therapist as initial contact, but we're now opening that up with a new interface.

Howard: That's a new deal in dentistry. How long have you been doing scheduling your own appointment online without talking to a receptionist?

John: About eighteen months and live chat too so if patients have an inquiry, they can just go online and chat to our receptors and we have a call center actually at our practice where we have reception/admin staff that are in that area dealing with all inquiries, not just phone because the reality is the new generation doesn't want to pick the phone, they want to text. on the barn.

Howard: Eighteen months you've been doing live chat, you have your own call center, schedule online, this is an amazing stuff. As far as scheduling online, how has that been? Has that been significant? And what about live chat, has that been significant?

John: Live chat has definitely been significant whether it's Facebook or Instagram interactions, that's been significant. The online booking, we've done it quarterly so my book, for example, isn't online yet because we haven't quite worked that out. We're looking at a new software that will help assist that. The appointment books has been a steady increase for our like I said junior dentists and therapists when they book [inaudible 20:08] That's making progress and I could see that really taking off. But the live chat has really been significant.

Howard: Do you think the live, the live chat is more significant than the schedule online

John: Yeah without having to speak to someone.

Howard: The person chatting is actually your own receptionist in your own office.

John: Of course, yes.

New Speaker: Where are you using for that?

John: We use a program called Dental 4 Windows and it's linked off that. Dental 4 Windows is the appointment book software. It's Australian. We're about to change that. We're looking at changing that to a new group that are cloud based, also Sydney based, Core Practice, a fantastic software where it's a lot more interactive with appointment booking and scheduling.

Howard: They do just for dentistry?

John: It's dentistry.

Howard: What's the name of that company?

John: The new one is called Core Practice, I think. 

Howard: Core Practice. And what was the last one, the one you're using now?

John: Dental 4 Windows.

Howard: Dental 4 windows. Is it the numeral four or spell out four?

John: Numeral.

Howard: Dental 4 Windows. Yeah. What we see in the United States is that for every one hundred people that land on a dentist's website, only three are going to call. But if you add live chat, maybe that turns into six. If you add online scheduling, maybe that turns into nine. On your call center, is that a twenty four hour seven day a week call center or is it just business hours?

John: Only the operating hours so seven until six, Monday to Friday and Saturdays.

Howard: Your hours are seven am to six pm, Monday through Saturday?

John: Friday and Saturdays, eight until three.

Howard: Eight to three.

John: We have staff committed, dedicated staff that will take inquiries. If someone's on Facebook [inaudible 22:18] midnight on a Saturday, usually someone will get back to them first thing Sunday morning. The beauty of technology is everyone's got a smartphone. The ability to communicate to a patient or a customer who has an issue [inaudible 22:34] as well as anew inquiry is at our fingertips.

Howard: I asked my staff if they wanted a smartphone and they said no, they wanted a smart dentist.

John: [inaudible 22:46] smart team around their dentist.

Howard: For a person to do 3000 Invisalign cases, that's impressive. Asia is what, 3/5 of the world's. There's only a billion people in the Americas, north and south. There's a billion in Africa, there's a billion two in India, there's a billion three in China. So for you to be the fourth largest for provider of Invisalign in Asia, I was so excited to get you on here. And it sounds like that these technology, the iTero, the 3Shape Trios intraoral scanner is a big part of presenting and communicating to the patient while you're selling these. And it sounds like in order to get this volume of patients, you're just highly sophisticated. Your website has live chat.

John: And what's amazing about that, it's the approach. It's not just setting up a dental practice saying, come here and I'll help clean your teeth, fix your teeth and i'll tell you what you need. Patients search for what they want. They search what teeth, what smile, better smile. We've just tapped into that. And what we have found amazingly with the growth, it's not that they're coming for aligners, they come from aligners and then they want whiter teeth. They need it cleaned, they have carie issues, they have endo issues, they have wisdome teeth that are going to be removed. Then there's aesthetic augmentation. There's bonding to the teeth because we're not only going to align the teeth, then we can improve the [inaudible 24:15] By using the software constantly, they're saying, I think that tooth doesn't look [inaudible 24:19] It's not as symmetrical to that lateral tooth. The lateral tooth has a different width. Then all of a sudden, the technology's helping them see what they want. We're not pushing, we're not selling, we're just showing them what's possible. It's the whole package. It's provided a way of helping patients improve their smile and then it brings in all the other dentistry involved and telling the patient what they need. It's doing a back to back [inaudible 24:49] from the patient's perspective part and then the dentist's perspective. We practice on how to improve stability and inclusion, that's all well and good and it's all necessarily but from the patient, they see it the other way around and that's how it's been successful for us.

Howard: That's amazing because so many dentists tell me, I asked them, are you dentist focused, is it all about you or are you patient focused? And they all say patient focused. And I say okay, what are your hours? And they say Monday through Thursday, eight to four. And look at you, your Monday through Friday, seven am to six pm. You're open eleven hours a day for five days and Saturday you're open eight to three. The only dentists that I know that are open on Saturdays is maybe one Saturday a month and that's only if they have several hundred thousand dollars in student loans, a stay-at-home wife and three kids running around. But if they're single, no kids, not a chance they're open Saturday or Sunday. What practice management software do you use to run your office?

John: It's the Dental 4 Windows. It's an all-inclusive software. It's the same softwares that we spoke about for the dental book all have the accounts and the charting and patient record and we're actually transferring that to this new one called Core.

Howard: Did you find that one, the next one? Core Practice. Are you holding your software in your office on servers or do you switch all that off to the cloud?

John: We've got servers. I never thought when I started really expanding, I'd have an IT room. We have an IT room. There's a server for the radiology and the CBCT, there's a server for the patient records and photos. We have photo studio as well, so there's a lot of data that's been collected. We're transitioning to the cloud, but we're going to always have a server as a backup. As these records transfer to the new software, it's really important. It's called Core Practice by the way.

Howard: Yeah we found it. Is your servers more a backup or is the issue that when you're starting to use scanners, iTero, 3Shape Trios, that these data files are so huge that they don't really make to backup on the cloud. Some dentists say that the files are too big. Is that the issue in Melbourne or not really?

John: Yeah, definitely, it's still an issue. I think when we want to tap into it, there's a site that's in cloud through the provider, so whether it's iTero, whether it's Trios, they have a cloud based system where the scans condense it. I don't think anyone really found a solution for that yet, but I foresee us all having the scan accessible through our dental records, like x-rays or photos. But you're right, the file is too large for that to be something that you can now have on your computer, but we're going need to use it. It's amazing data. You mentioned an eight-year-old scan and then [inaudible 27:59] the central incisor. In the future, no matter how good our dentistry is, we don't to have to try and copy nature. Imagine the ability to go back to that original tooth and emulate nature by 3D printing or milling restorations to replace what was already there.

John: These scans have got huge potential, we just haven't tapped into it yet. The technology hasn't caught up yet, so those scans will be something. I suppose every new patient will be scanned with an intraoral scanner. [inaudible 28:29] for future reference, whether it's the replicate a tooth that needs repair or for just collation of records for orthodontic needs. There is a whole host of reasons why this scan becomes important, but we haven't worked out how to say that effectively. It's pretty much a cloud based of a server or third party server rather than a practice having to worry about saving it at the moment.

Howard: Another , you're the largest Invisalign. Are you still staying loyal to Invisalign? Because now that the patents have ran off, we keep hearing that there's a lot of other clear aligner companies that are

John: Of course, I'm actually working with one in Australia at the moment called SmileStyler. You might want to look that up. They're launching in March. I think it's going to be an [inaudible 29:19] It's a 3DMEDiTech company. I'm already beta testing it. The reality is Invisalign made a choice and I think the dentists are part of that long-term plan. We know what's happening in Canada and the US where they're setting up dental practices, employing orthodontists and probably going alone, they're boarding the SmileDirectClub. There is a massive change that's going on. I think we all foresee this. The corporates see this as a huge growth potential. People want straighter and even in the era of selfies, people want straight teeth, white teeth, so the aligner's become a very effective way of doing that. I think Invisalign has made a shift i've seen in the last couple of years where they openly tried to undermine our success.

Howard: Did you switch to SmileStyler?

John: Yes. I have been using ClearCorrect, I've been using SmileStyler, I've been using Invisalign. It's each case has a different situation. That could be a patient choice. Invisalign is an established brand and it's great product, but it comes at a significant cost. There's no question about that. It's about choice. If it's a case where there's an alternative, then it's offered.

Howard: I'm going to go back a couple of questions. Did you switch to ClearCorrect and looking into SmileStyler because it was less cost or because you found it troubling that align technology with owns Invisalign and iTero bought a significant chunk aT SmileDirectClub and are basically waiting.

John: I think it's both. I think the reality is I've been interacting with Invisalign for a long time to look at assisting with the software to show tooth augmentation, so we're not just showing an alignment, we can also show augmentation of teeth with the software and that [inaudible 31:24] . I've been approached by other clear aligners to look at, with my expertise, what we can do to help in that area. I've been beta testing a number of products and usually I'll test it on myself, I will wear the aligners on myself. The ClearCorrect, unfortunately, is limited in what it can provide, that's our concern. But SmileStyler does show potential. I will finish a few cases now within six months of beta testing with amazing results that I wouldn't have even thought about using with ClearCorrect but will be comparable with Invisalign. And I think all those factors and you said costs as well as the shift that's happening globally with Invisalign means that we need to look at [inaudible 32:13] for the consumer and for ourselves as a profession. 

Howard: What's the population in Australia? What is it? Twenty six million?

John: Pretty much, twenty five, twenty six mill.

Howard: Of that twenty five, twenty six million, when they come in and they want clear aligners, what percent of them say no, it's brand specific. I want chanel number five, I want Invisalign versus you can talk them into just to clear aligners and it doesn't matter if it's ClearCorrect or SmileStyler?

John: I think what we're seeing is patients who come in already informed, they've done their research. For us, the patients come in because the orthodontist down the road told them they needs braces but they've heard about clear aligners whether it's Invisalign or not. I think for us, it's hard to give you that assessment because of the exposure and the marketing is really Invisalign based despite the orthodontist telling the patients otherwise that it's only [inaudible 33:20] . It's a hard one to answer. I think it's only going to grow as social media taps into this. I think for the under thirties, this will exponentially grow. I think it's untapped potential. So to give you that figure, when a patient comes in, I'd say that probably a third that are brand based on their research, I think the rest would be open to a cost-based product, if they can see comparable results.

Howard: So you're saying one third of the market is brand specific and wants Invisalign and two thirds...

John: In wanting aligners, I say would be open based on cost [inaudible 34:02] Patients come in, they shop around. The pretty obvious fact, especially with the aligners in orthodontics, patients will come and say yes I've gone to three or four other places at minimum and that's by online shopping. They'll go on, they'll search, they'll inquire by price without even [inaudible 34:20] their teeth but that's the perception.

Howard: You say a third specifically wants Invisalign but two thirds can be talked for price to go to generics?

John: Of course, based on what's happening at the moment. They go online and Invisalign has a huge online presence. So a third are sold on that. It's a tough one because these are people who are already shopping but what we've seen is those that come in, price is always an issue. Two thirds have to be convinced that Invisalign may be the only option rather than fixed orthodontics which is more affordable and some even go with fixed orthodontics based on price. There's a huge potential demand for an alternative product that can be used effectively because of price, no question, and that's my direct to consumer concept. It just started in Australia that there's talk about a [inaudible 35:22] up north in Queensland. So it has potential. These patients want affordability, they want predictable treatment and they want it now, they want it quickly and they want it now. That's our challenge as dentists, to be able to provide choice and option and balancing all those health and needs that are required.

Howard: My dental office just turned 30 years old last September, so I've seen this rodeo before. I remember when bleaching could only be done at the dental office and then Crest white strips came out with a $50 box and in-office bleaching is still here and over-the-counter bleaching is still here. Another thing you mentioned in your bio that when you teach, speak and mentor at the postgraduate school dentistry, not only do you talk about 3Shape Trios intraoral scanning, but also 3D printing with MEDiTech. Are you printing your aligners?

John: No. 3D MEDiTech is related to SmileStyler. SmileStyler is a Melbourne group that are now printing their own aligners. They've got a high-tech facility where they're printing the aligners. The 3D MEDiTech is related to the SmileStyler group where I've been beta testing their product.

Howard: Are you doing any 3D printing in your office?

John: Not yet, but I foresee it will be a matter of time. We got a Roland milling unit for our porcelain restorations. We've set up a lab at our practice for retainers, so we make our retainers inhouse, with Zendura retainers or whitening trays, and splints and so forth. We have a full-time technician on site so we've got a milling unit for that, but I foresee that will be replaced in time at some point with a 3D printer. Now whether that means printing in-house aligners, I think that's potentially where it's headed. If the software is able to be done like the 3Shape software, you could technically do that manually yourself if you had an accurate enough printer. The basic printers, they are currently big, pretty expensive and that's why it's a centralized printing process at the moment whether it's align or 3D MEDiTech or otherwise.

Howard: What do you mean when you talk about systemizing your clinical practice?

John: It's about the efficiency. We talked about communication, technology which were parts of what's been successful for us, but the systematization is every team member plays a role in the administering of these aligners whether it's the nurse taking the photos and scans, it's the admin staff assisting me, uploading the data. It's a systemized process because all I'm focusing on is meeting the patient, diagnosing the situation, ensuring they understand their options, using the software at the treatment plant and then it's a team of providers, nurses, receptionists that ensure that it flows well. So that's the systematization of aligners at our practice.

Howard: When I survey dentists on Dentaltown, first of all, when you're on Dentaltown, quarter-million dentists on Dentaltown, when you start a thread, you can actually start a poll so you could sit there and start a question and say, “do you prefer ClearCorrect or Invisalign?” and then you vote, and then you're going to see all the replies after and all that stuff. But whenever we poll them and say, what stresses you out the most, it's never figuring out whether you should use Invisalign or ClearCorrect. It's never about what bonding agent. It's always staff. They say the staff drive them crazy, it's so stressful. After they get done doing a root canal, they just run in their office and lock the door. How do you coach dentists to be better leaders with their staff? Did you just naturally love it? Were you like that guy in school, Mr. Personality, or did you formally teach yourself?

John: It was out of necessity. This growth that we had was based on this, we started to see this untapped potential. It became an afterthought. It's been ten, fifteen years with the growth that we had. How was I going to do with this? I got [inaudible 39:35] about 20 cases, so I've had to deal with the problem we've had, the growth that we've had. The staff who were there to assist became a necessity. I was sort of forced into a situation where we had to find a way to manage our success and it was with the people. That's how it came because I agree, with every dentist that you survey, dealing with a team and with the turnover of nurses that you get especially with this generation, it's a constant issue, so the training had to be there..

John: And you do understand, when I was doing what I was doing, the dental profession didn't believe in Invisalign work. I had to convince my own team of what we were doing, the system we're doing. Until they saw the results, they believed. The hardest people that's part of this team and the systematization of what we do is actually the dentist. The nurses, the receptionists, they have checklists, they have a drug prescription they know and they are empowered because they're part of that process and not just sitting there using suction. They're there helping that patient on their journey, coaching, motivating the patient. It's the dentist that had been the most difficult part to help them be part of a team approach to dentistry rather than individual with their own book. It's not been easy. I'm not saying I have all the answers, but I've had to work hard at creating a process that everyone feels part of that team and helps the dentist grow and develop as well.

Howard: I talked to several dental school deans with this. Jack Dillenberg was a leader in this so was Art Dugoni at UOP where in all the dental schools only accept you on whether or not you got straight A's in Chemistry and Physics and Geometry, you really end up with a really freakish oddball. And when look at someone in undergrad who was well rounded, maybe spent a lot of time volunteering, or maybe they had a girlfriend or maybe they had a sick parent that lived in the same town and they start making just average or above-average grades, well they don't have a chance of getting into dental school, med school or law school, so you just come up with these weird freaks. Your average dentist, physician, lawyer is totally different than your average business, communications major at a college so they're hard to manage.

Howard: And also, you spoke about this generation with turnover. My mom's brother got a job at Mobil oil when he was 16 and retired at 65. And almost all of my friends that are my age, their dad did the same thing. They got a job at GM, Chrysler, ford. They stay their whole life. The millennials, they think their whole life is about two years. Their turnover is crazy.

John: Exactly right. There is no loyalty.

Howard: 1-300-smiles and Pacific Smiles, they're publicly traded so you can see what their staff turnover is and it's 20% a year. You're saying the dentists are harder to manage and staff turnover is tough.

Howard: How do you deal with managing dentists? How do you deal with staff turnover? I know what we do. I probably can't say it because it's going to used against me in court, but if I get five applications and four of them are millennials and one of them is a baby boomer, I guarantee you where I'm going. If I hire a dentist, forty years old, they'll stay with me ten years. I hire a twenty five year old, they'll stay with the one to two. Same thing with dental assistance, older people, the baby boomer generation, they stay put. The millennials, they're just off to the horse races.

John: That's where the systemization approach is effective. I would take the millennial because they can embrace that technology far better than I can or you and I can. It's about the technology. If I get a millenial for three or four years [inaudible 43:57] five years plus, [inaudible 44:01] I believe in what we do and embody the [inaudible 44:03] and philosophy, it's gold. It's about the systems, right. Patients come in for an expected customer service experience, does not matter who the dentist is. It's not about me, I dont want dentists replicating me in the surgeries, but they have to have that ability to embrace technology, embrace the communication and transparency. It's about the training and setting the philosophy and the culture of our practice. That's the key. It's about attitude. I don't look at the skill level and one thing I do, I do not get involved in recruiting a dentist. I gave that up a long time ago because I don't have a clue in that process.

John: Our best dentists at our practice have nothing to do with me. It's about recruiting for culture and attitude and that's been the key to our success. We have a training plan in place. We have an internal training and that's where it's evolved with this growth. We have to have certain standards in place of customer service protocols and checklists, so dentists don't have to abide and follow protocol, whether it's a clinical treatment. We have what we call a SAC protocol, simple, advance, complex, [inaudible 45:14] where dentists or oral surgeons look at a new plan and say what are the factors that are going to make this simple, advance, complex? We use that for every aspect of each dentist ability to do treatment. They have the ability to [inaudible 45:31] to grow based on knowing what they can and can't do and learning and evolving. That's the training and development that we put into our team. That's the answer to the turnover whether it's a millennial dentist or a millennial nurse or therapist, all health therapists. That's the key to long-term viability for us is putting the training back into them.

Howard: Is this what you call your AORTA,?

John: Aesthetic Orthodontic and Restorative Training Academy.

Howard: Is that just for your staff or is that a website for other dentists?

John: We've been open and had been training other practices based on lectures and also hands-on training where they come and spend a day with us and observe our protocols and for the team. It's a team approach. We have sessions for dentists, therapists, but we also have the ability to train up teams with their nurses and receptionists because that's the key to us. It's not about the dentist, it's not about [inaudible 43:33] is a team approach, so that's how we train them up.

Howard: Do you have a bunch of online courses on there?

John: No, not online courses yet but but there's an interactive dialogue where we bring up cases and discuss scenarios and incorporate chat and have videos of procedures being done in cases, before and after cases, where we engage conversation and try and give confidence to the dentist to be able to perform and troubleshoot scenarios they'll come up with.

Howard: What procedures do you do? Obviously you do ortho, cosmetics, bleaching, bonding, veneers. Do you implants, root canals, extractions, kids. What else do you do?

John: We do the works here at our practice, but I don't do any surgery, implants. My practice is on the restoratives and prosthodontics. I have a team of providers that can place implants in. We have a CBCT unit at our practice. We treat and plan together. I'll do the restorative, they'll do the surgery or we all do both. We have dental practitioners that will do wisdom teeth extractions, pediatrics, we do. We try and cover all bases likea sleep apnea devices, we also do. It's a comprehensive team, but we all have our strengths and that's what we work together to bypass. I don't do everything. I have a team that can do things better than I can and so I will refer my patients to my associates whether it's wisdom teeth or [inaudible 48:10] can do. And I think that's been the key, having a team approach and providing services for the patient at one place.

Howard: When you say you have a dental office spa, what percent of the market understands that or what does that mean to the market when you say you're a spa dental office?

John: I think it's how it feels. I think it's the key. It's the ambiance, it's how it feels. When a patient walks in, it's the smell, it's the sound and I think that spa is that connotation. We have our own brand of candles with our own scent that we're proud of so when our patient comes in, they know they're at Freedom based on how it smells and these candles are gifts that we give to all our new patients. We're renowned for our candles and that's been something that's evolved and I can't tell you [inaudible 49:07] where a rep will come up and say where you're from, Freedom Dental. That's where the candles are. It's the ambiance that we create. That's what the spa-like environment is about. All our equipment is built behind so the patient comes in, it's a stand-alone chair, and we have TV's on the ceiling that have netflix or movies or TED Talk, whatever it might be. It's all about the patient. There's built-in laughing gas RI. It's about that spa so they don't feel like they're at the dentist. That's our goal.

Howard: When you work on children, do you put the laughing gas on the child or yourself?

John: I'm sure there's days where we all feel like putting it on ourselves first but no, of course not.

Howard: What is your go-to marketing? When you're marketing and advertising in this dental industry, do you do in print, is it location, is it billboard, is it Facebook, is it google ad-words? What are you doing for marketing?

John: It's a combination of all of the above. I mean it's constantly changing. I think the effectiveness of Facebook for us was three to four years ago when no one was using it in Australia five years ago. Now, everyone who puts dentist as the profession, you have an ad every five minutes from a dental practice all over Melbourne. I think it's constantly changing. But I think it's word of mouth. The social media is in essence a word-of-mouth platform. It's tapping into that and it's online communities that you want to be embracing. Nothing works better than a happy patient giving you five star service. Simple as that. And there's forums. I know of a forum that I've never seen, but it's apparently in Australia, the IT professionals forum called Whirlpool and any [inaudible 51:08] they get from this site is incredible.

John: These are always these IT, geeks, the analytical who have searched based on what their peers have done. It's not about going out there and just spending money on google ad words or what not. You have to do that. It's the next generation of yellow pages. Google ad words is something you need to have a presidency, but it's the word of mouth, simple as that, but online word of mouth. And what does that mean? That means a bit of Facebook, that means a bit of Instagram, that means a whole thinge. There's no right combination. It's up to the practitioner to look at their strengths and work out what kind of patients do they want to see. And it's often word of mouth. The patients that refer the patients want to see you because they want you and it's like birds of a feather flock together. And that's in essence the concept. But you got to be active and want to promote a certain procedure. How you do that is really targeting your audience. What are their age? What do they like? What did I do? That's the focus. Social media is redefining marketing for every aspect in the world but dentistry especially, so word of mouth has been the most successful.

Howard: What percent of your orthodontic cases are clear aligners versus banding on wires and brackets?

John: Yeah, good question. I only started introducing fixed orthodontics at our practice because I was tired of having to justify to patients that aligners work. We provided fixed and I'm amazed. I think it's about 5%, 10% [inaudibl 52:53]. It's not even in the last three or four years that we've had a dentist who does fixed orthodontics and who now does more aligners himself because he's now been there about three years and starts to see it. He didn't believe it when he first saw it when I was showing him the cases that we've done until he saw the results. And now he's doing probably as many aligners as [inaudible 53:15] so it's about 5% of our practice.

Howard: Are those 5% because those cases you can't use clear aligners, you just need to band and bracket it up?

John: No, patient choice.

Howard: Patient choice.

John: And they're provider's perception so if their provider was saying it. We provide them both, we'll offer them both the aligner and the fixed orthodontic with the pros and cons. and I'm not saying Invisalign is all encompassing, but it's getting pretty close. There's not much [inaudible 53:42] with aligners as long as the patient expectation is there, you know, it's all part of that. If they need jaw surgery and I want surgery, that's the oral surgeon and the orthodontist to deal with. But if they want an aesthetic alternative without having to break the jaw, we'll show them what we can do in moving their teeth, not trying to change the jaw posture. Fixed becomes an alternative for some patients and I can be compliant. We have that frank conversation. They're not going to where the aligners, maybe braces are for them. If they're teenage males or someone who has poor oral hygiene or poor compliance could it, or fixed orthodontics is still a viable option. That's where we see that sort of numbers or patient belief. Any day, patients have a belief system, what they read online and what they hear from an orthodontist they spoke to five years ago, five months ago. Those patients believe fixed is better and I want fixed, we provide it for them but i's patient choice. Either B, what car is going to get you there better. It doesn't matter, does it? Can you get there? Whether it's fixed or aligners, it's about the patient's want.

Howard: A lot of dentists, they're afraid to get into Invisalign because they think the orthodontist up the street is going to get mad or not like him anymore. Do you feel any negative vibes or attention or energy from orthodontists when you're doing 3000 Invisalign cases instead of giving it to them?

John: Of course [inaudible 55:14] y back,, there's gunshot wounds and stab wounds. I got orthodontists who also respect what a dentists say in my cases and have an utmost respect. I don't blame them. They spent three extra years in Australia doing the postgraduate studies and basically learning how to bend a piece of wire and the effectiveness of bending this wire. And all comes along this third party provider taking away from them. They're angry at aligner companies and they're also annoyed at the dentist doing it, but the reality is how can I get any better and for dentists to be fearful of our colleagues or our specialist colleagues, it's sad, but that's the reality. But at the end of the day, if you're quite happy doing checkup and claims then that's fine.

John: If you want to provide patient service and choice and have that feeling of feeling good about helping a patient and you wanted [inaudible 56:08] oral surgeon being annoyed that a general dentist is doing an implant. We have a license to practice and to their patients, as long as we abide by those guidelines, I think there's always going to be a part of the profession you don't want to change and like things just the way they are and there's going to be the other part that want to grow and development and how ultimately the patient looks, it's very easy to forget. We're sort of always compartmentalized as dentists, always fixed to the small area of the mouth. We don't look at the bigger picture. The bigger picture is we're serving patients and costs need to come down and we need to find better ways, innovative ways to help service patients and the technology is there, ready to be taken.

Howard: Final question. Basically dentistry is going through a disruption. Would you agree?

John: Massive. Exciting disruption, no question. Robotics, it's all about to happen. That's why those new graduates that are sitting in their car listening to this or wondering whether they have regrets in getting into the profession. It's about to turn on its head and they are the ones that are going to drive it, not us. It's gonna pass us by very quickly. They have the ability and potential to embrace this and turn dentistry on it’s head.

Howard: What technology is going to turn it on its head. What big disruption do you see down the road?

John: This to begin with. The ability to take photos. There things called dental monitoring where you to take photos and upload it to a database and see whether your treatment is progressing, orthodontic progression. It won't be long before there will be apps assisting our health monitoring. The technology in integrating CBCT's for implant placement with the orthodontic software and be able to show a patient the end result and plan from there. We will be using more and more computers, lots of technicians. We will be using more and more technology to treat and plan, and then it becomes a more systemized process of treatment, more efficient, more effecive. Yes, we got great dentists and surgeons that can place implants in freehand without needing a guided process but patients want reliable, predictable treatment, so the technology is going to provide that. We haven't found it yet. This hasn't been invented yet and it will. That's exciting times, but it's going to turn everything we do on its head.

Howard: And let us not forget that China just had the first robot place an implant.

John: Yes I was talking about it last year and the jaw dropped of the people in the audience. They didn't want to believe it. That's right, it's fun. It's an amazing fact to be that first person to have an implant placed in by a robot. It would be a great interview for that person sitting in the chair, how they felt having a robot put an implant in them so it's a great story and will only grow from there.

Howard: I'm mostly mostly excited about robots because I know I will only get married again if it is a robot. I would never, never go with a human again. I'm just kidding.

John: It might even deal with [inaudible 59:20].

Howard: I know. I know. When 3M and those companies always asks me, what piece of technology, like dental supply, Serona, they'll say, what would be the most exciting pieces of equipment? I'd say R2D2 or C3PO, that's what I want. I want to replace all my staff with droids, either the short squatty one… What’s the short, squatty one?

Ryan: R2D2.

Howard: R2D2. And the tall gold gay one is?

Ryan: C3PO.

Howard: C3PO, but yeah, that would be amazing. But on that note, it was just an honor to have you come on this show. Thanks for getting up so early morning on your day off on a saturday to come talk to my homies. I hope someday you make us an online CE course or write us an article, and the reason I love it so much is because when you travel around the world, so many countries just sit in their own country and drink their own kool-aid and I have always found the most outside the box thinking when I leave the United States.

Howard: I have had the most refreshing ideas in Australia and Taiwan and Poland and Brazil and a lot of times when you're lecturing within those countries, I was in Tokyo and a dentist said to me, he goes, “these Japanese dentists, they don't see what's going on in the rest of the world. They don't pay enough attention to even their neighbor, Taiwan or South Korea or Australia.” And on Dentaltown, I see the most outside of the box thinking when it's from another country. And that's what I love the most about the internet. When we put this podcast on Youtube or Facebook or Dentaltown or Orthotown, the internet doesn't know nationalism. They don't know where the boundary stops and listening to you down there is great. I just want to say one last thing to the Americans, my brother lives in Sydney and I've been to Sydney so much, even more so now that my brother lives in Sydney, but I think it's probably the only country where I could leave the United States and go and come back.

Howard: Everytime I visit my brother, my brother always says, “Howie, why do you want to go back?” And I go, “I know, I know. I know, but I got four kids and four grandchildren, two walking, two in the oven.” But you know what, if I was a bachelor and I had no ties to the United States of America, there's no way I wouldn't leave Australia. And on to that point, I know how competitive it is down there. I think it's more competitive than any place in America. I don't know any place in the United States of America, just out of nowhere, double the schools, letting in a thousand dentists from South Africa and all around the world. And then DSO's and corporate landscape, yet there's still guys like you just crushing it, so anything's possible if you're willing to do the work, put in the hours, have the passion, and most importantly, what you said, a commitment to the customer, the patient, a patient-centered practice. John, thank you so much for getting up early and coming on my show today. It was an honor to podcast you.

John: Thank you. Thank you for having me.

Howard: Next time I came to Melbourne, you'll have to have a beer with me and my brother.

John: For sure, I will come up to Sydney, definitely.

Howard: Okay, have a rocking hot day.

John: Will do. Thank you. Thanks very much.

Category: Marketing, Orthodontics
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