Office Visit: Cali Orthodontist an Engineer of New Smiles by Kyle Patton, Associate Editor

Office Visit: Cali Orthodontist an Engineer of New Smiles

As an orthodontist, you spend most of your time at your practice. It's understandable that you might not get many opportunities to see what it's like in another doctor's office. That's why we bring you an "office visit." It's a chance for you to meet with your peers, see their practices and hear their stories.

This month we caught up with Dr. Brett Garrett of Garrett Orthodontics (GO), with offices in San Luis Obispo and Arroyo Grande, California. Read on to learn more about Dr. Garrett, who is also this year's Townie Choice $1,000 winner!

Office Highlights What was the path you took to becoming an orthodontist?
I've always been a hands-on tinkerer who likes to know how and why things work. To that end, I majored in mechanical engineering back in college. Since I also hoped to have my own company one day, I added a minor in business administration. The college had a great "learn by doing" philosophy that allowed me to work as an engineer for large corporations before I even graduated.

It's funny, but my first experience with nickel titanium was prior to dental school, when I helped design implantable medical stents used to treat aneurysms and save human lives. Unfortunately, there was something missing at each of these work experiences: the end result. I would design, manufacture and test the final product, but I never had the opportunity to interact with and actually see how it helped the person on the other end.

Luckily, a trip to my dentist changed everything. He told me about the dental field and urged me to visit all the specialties to see the possibilities. First stop was the oral and maxillofacial surgeon, where I semi-fainted during a third-molar extraction case and had to take a seat in the corner before my vision completely disappeared. No oral surgery for me! (Fast-forward 16 years: That surgeon and I work on a number of cases together.)

Next, I visited an orthodontist with a typical open-bay layout who was using indirect bonding at the time. I thought it was the greatest thing ever! I appreciated the detail and methodology used in meeting a new patient, designing a unique treatment sequence, using cool gadgets to advance the treatment, and witnessing the final product and how the person was positively affected.

I knew orthodontics would allow me to use my engineering mechanics during treatment, utilize my business background to run my office, and have a valuable impact on people's lives. I was hooked, and being an orthodontist was my goal! Regarding your practice, how is it laid out? What's the workflow like?

My team and I split time equally between two offices with a typical open-bay layout. We see 60 to 65 patients per day, utilizing four treatment chairs, one of which is semi-private for use with the diode laser or TAD placement, or for patients who request it.

My consultation room doubles as a retainer- or appliance-check and observation room, which really helps in the busy afternoons. A dedicated records room allows me to schedule photos, iTero Invisalign scans, or retainer and indirect bond model impressions—without taking up valuable treatment-chair space.

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You focus on keeping a small-town feel to your practice. How do you accomplish that and what are the benefits?
One of my offices is in a city (San Luis Obispo) that was branded as the "happiest city in America" a few years ago. One reason is the outdoor life and resulting social interactions it provides. I see my patients and families outside of the office every day … at the store, sporting events, church, etc. I actually just saw two patients while out surfing in a crowd of only 10 people a few weeks ago. These are people I will know and see for decades, and I want their smiles to shine, just as I want the satisfaction of knowing that I helped make that happen.

To that end, we try to promote a family feel in our offices. Some of my team members have been with the practice more than 30 years, while a few more recently retired. They have seen generations come through treatment and know the families on a personal level. To allow that connection, we have benches and chairs in the treatment area and encourage everyone to come back. I'll sit back and laugh when the patient in one chair is talking to one in another chair while the parents on the bench are exchanging recipes or book ideas.

I even have patients get back to the chair late because they stopped to talk to a few friends in the reception area. This local feel gets them promoting our practice in everyday conversations. Another thing I think is important that puts me in the minority is not having a dedicated treatment coordinator. Not that having one is negative, but I can't tell you how many times I've been told I spent the most time or gave the most thorough explanation of treatment options before the patient was handed off to someone else.

What is your practice philosophy?
GO for the smile of a lifetime. We want our patients to understand that having a great smile can benefit them in many ways throughout life, and that Garrett Orthodontics is the place to help achieve those goals. A healthy smile means different things to different people. Some of my patients want crowding corrected, spaces closed, more or less teeth showing, altered function restored, or jaw-joint disharmony improved.

Whatever the concerns, the GO Team and I engineer a plan that can help address their primary concerns, while aligning their occlusion with our learned orthodontic principles for years to come.

What do you do to help set the practice apart from others?
Since I was trained using 3D cone-beam imaging, I knew this would be an essential part of my treatment-planning process. As one of the few orthodontists in my area to have a unit, I'm still amazed at finding supernumerary teeth not shown on 2D images, or pathology. I have made alternate treatment decisions based on the 3D scan. Parents are impressed at how far technology has advanced with such a low-dose scan, since the time they were in braces.

What are your favorite marketing techniques? How do you get the word out about your practice?
I keep it simple. Living in a smaller town, word of mouth can be both a blessing and a curse, so my team and I make sure to treat our patients and families with professionalism, respect their time constraints, and really get to know them personally. We track and find that new patients usually hear about us through a current family of the practice. Our referring dentists are top-notch and go out of their way to tell us that our mutual patients feel at home and taken care of at Garrett Orthodontics. I think online reviews are a critical extension of that word-of-mouth mentality, so we started using a service that emails our patients every five appointments with a quick and easy survey.

After a response, they get a follow-up email with a link to post to one of the review sites. This has helped us grow our online presence and communicate what our practice has to offer.

What are the biggest problems orthodontists face today?
  1. Avoiding extinction of the solo-practitioner office.
  2. Direct marketing of corporations to the patient/consumer.
  3. Cost of technology.
What is your patient philosophy?
I feel honored when patients trust my recommendations enough to allow our office to make permanent, sometimes life-changing alterations to their body. Think about it: I just met them 10 minutes ago and I'm telling them they need to remove permanent teeth or I'm going to place this screw into their bone. That requires a high level of trust for them to say, "Sounds good—sign me up!"

So the question I always try to ask myself when making any treatment decision for my patients is, "Would I use this approach with my wife or children?" Without a resounding "Yes!" I wouldn't feel that I deserve their trust. I also don't discourage seeking a second opinion. If they are comfortable with my office, team and treatment technique, then they will end up choosing our office.

What is your technique philosophy?
I was trained under the Bioprogressive technique, so I like the versatility that Empower Self-Ligating dual activation brackets give me. I keep anterior torque and rotation control with interactive brackets, and use passive ligation in the posterior for sliding mechanics and a more settled occlusion.

To truly see the benefits and treat in the most efficient way possible, I converted entirely to indirect bonding three years ago. After a few iterations and technique changes, we have our system tuned and the reduced chair time, coupled with more accurate bracket placement, makes it one of the best choices I've implemented.

It's fun when my assistant and I look at the repositioning Panorex, then look at each other and shrug because there aren't any brackets that need to be moved.

What is the greatest advancement of change you have seen during your tenure as an orthodontist?
Having been in the orthodontic field for only a decade, I believe my residency at Loma Linda was ahead of the curve. We were routinely placing TADs for absolute anchorage, treatment planning with 3D cone-beam imaging and using self-ligating techniques. I thought this was how it always had been done.

Now, with digital scanning and the cost of 3D printers falling to acceptable levels, I feel we are on the cusp of a major change regarding in-house aligner fabrication, one-appointment replacement retainers/appliances and overall treatment efficiency.

What would you like to see orthodontics do in terms of the way it operates as a profession in the next five to 10 years?
I would like to see orthodontists continue to operate in whatever capacity they wish without fear of corporate or primary-care dental takeover. Many of us choose solo or partnership practices because we want to, but most magazines lately have an article about how the "golden age of orthodontics is over" and we will all have to convert to group-setting practices or risk corporate takeover. At the risk of offending people, I will say that I've worked in all of these settings and would never want to lose the autonomy and family feel that owning my own practice allows.

I hope the AAO and the dedicated minds of our profession can create a campaign that distinguishes the orthodontist and the stand-alone orthodontic office as a critical piece in the health-profession puzzle.

Describe your most successful or rewarding experience in your professional life.
I've had the opportunity to treat actors/actresses, athletes, and pageant winners, and to meet a lot of interesting people along the way.

It sounds cliché, but my most rewarding experience comes when I see a new patient who first sits quietly, lips closed, with a slumped demeanor in the consultation chair, and throughout treatment I see him or her transform to a confident, smiling individual.

Their chief concern changes from "never smiles" to "can't stop smiling."

You are an active Townie on Orthotown.com. How did you learn about Orthotown?
I think it was at an AAO convention about six years ago. They were handing out past magazine issues at the booth and I took as many as I could fit into my bag of goodies. I read them all cover to cover on the plane flight back home and thought it was a great magazine. As soon as I got home I signed up online and have been logging in almost every other day since.

What has Orthotown done for your professional life? For your social life? What is your favorite feature?
I have always enjoyed visiting orthodontic offices and seeing how others run their practices, so the Office Visit feature is my favorite. I usually learn something new that adds an extra tool to my orthodontic tool chest and makes me a better orthodontist.

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