Office Visit: Netherland Doc Combines European, American Treatments by Kyle Patton, Associate Editor

Office Visit: Netherland Doc

View of office

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. Guido Sampermans of Professionals in Pretty Mouths (PIMM), who has a beautiful, modern practice in Echt, Netherlands. Read on about this doc's unique experience working in orthodontics across the pond.

What path did you take to becoming an orthodontist?
I was 16 when the neighbor's son became the new dentist in our town in Belgium. After spending some time in his office, my interest for dentistry was born. Two years later I went to the University of Leuven in Belgium, from which I graduated in 1980 as a general dentist.

I opened my own dental office in Belgium soon after graduating. Orthodontics had fascinated me during my dental studies but in the mid-1970s, orthodontic treatment in Europe was mostly done via removable appliances; the American way, using fixed appliances, had been introduced but certainly wasn't the standard.

During the '80s and '90s, braces became popular and changed the European orthodontic treatment philosophy. Excited by this revolution, I decided in 1990 to become an orthodontist. This wasn't so easy in Europe! The official specialist title of orthodontist did not yet exist in most European countries, including Belgium, so I went to Germany, where orthodontics was progressing at a much faster rate.

I combined my studies in Germany with many visits to California to learn the straight-wire technique from the masters themselves, taking courses and in-office seminars from Drs. L. Andrews, R. McLaughlin, R. Roth, R. Williams, R. Roncone and oral facial surgeon W. Arnett. By 1997, a great year for me, the title of orthodontist was on the sign on my office wall in Germany.

In 2003, I moved my office to Holland and in 2010, I opened a new office in Echt, Holland.

Office Highlights

How is your practice laid out? What's the workflow like?
The demographic of my clientele has changed tremendously over the past 15 years— in 2000 only 5 percent of my patients were adults, but now they make up 38 percent. When I surveyed adult patients, one of their most common requests was to have more privacy; most German and Dutch orthodontic offices have an open-bay structure.

One of the main reasons I started a new office in 2010 was to be able to give patients more privacy, without losing efficiency. We developed a concept where five chairs sit parallel to each other, separated by curtains so no visual contact exists between patients. The curtains end right where the heads of the chairs do, so doctors and staff can work and still see other team members. Also, first consultations and treatment plan presentations are done in private rooms.

Another important feature that helps achieve an efficient, professional workflow is that patient routes and staff routes never cross. We also make use of an efficient tube and tray system, which allows for materials and instruments for a specific procedure to be present at the chair within seconds.

What's your practice philosophy?
It's based on two pillars: excellent treatment results and excellent service.

Staff Photo

What do you do to help set the practice apart from others?
I focus on a couple of key areas. The first is the technology I use: The office should have a cutting-edge image, using all state-of-the-art technology. Our waiting area looks more like a business lounge, and offers comfortable chairs, Wi-Fi, the latest magazines, coffee and cold drinks. We have two terminals where patients can check in or schedule appointments, just through using finger-recognition technology. All our computers have touch screens for quick and identical treatment chart registrations, making the keyboard use unnecessary. Digital models have been a part of our diagnosis and treatment planning for the past decade, and we introduced intraoral scanning a few months ago. Removable appliances like the twin block are made in a 3D printer. Herbst or rapid palatal expanders also are made of 3D-printed materials, giving patients an exceptional fit.

The other area I focus on is service. Most European doctors are still convinced that the success of their office is based on their medical skills. This is wrong—only if competency comes together with courtesy and compassion are great successes possible. We work every day on those three principles.

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What are your favorite marketing techniques? How do you get the word out about your practice?
My favorite marketing technique is simple: Try to get as many patient "wow" moments as possible. In other words, try to exceed patient expectations, from the first phone call to the last retention-control appointment. This creates more than satisfied patients; it creates loyal patients who spread the good news about your office every day. Fifty-five percent of my new patients are referred by former ones.

I also stay in contact with my referral doctors. I call often—to discuss patient issues, and also (instead of just sending a letter) to thank them for their referral. Every year we organize a scientific meeting for my referral doctors, inviting high-level speakers, and afterwards we host a big reception where I personally give presents as thank-yous for the cooperation over the past year. Every year, we have 35–40 doctors present.

It's a hard job to be a general dentist today, because every discipline in dentistry is developing so rapidly. If you want to be an excellent all-rounder, it takes a lot of study and courses to be at the top in every aspect of your office.

I see what I do just to stay current in the art of orthodontics, which gives me admiration for general dentists. For me, the future of dentistry is in specialization. But with specialization comes the added effort it takes to learn new things, master new techniques, and efficiently and effectively offer those services to patients.

What's your patient philosophy?
We have no patients; we only have guests. My team does not treat patients, we invite guests into our home. Treat your patients with the same respect and kindness you would do with your guests, and many mistakes in medical offices would be solved. When this is the rule, patients aren't left alone in the chair or see only the back of the assistants working on the computer. You greet your guests, help them whenever you can and never make them wait.

What's your technique philosophy?
Self-ligating active brackets, 0.022 slot. I use self-ligating brackets for chair time reasons, and the active brackets are for greater rotational control and torque control.

Normally, I use high-torque upper front brackets, extra derotation and torque values for the upper molars, while using less negative torque in the lower premolars and molars for more uprighting.

What's the greatest advancement of change you've seen during your tenure?
I have several in mind, but one that stands out is the digital possibilities available, starting with photography and X-ray machines. Then, of course, there are the advancements in practice management and imaging software, intraoral scanning with digital setups, digital 3D printing for models and appliances, and digital trays for indirect bonding.

Looking ahead, what would you like to see orthodontics do in terms of the way it operates as a profession in the next 5–10 years?
I see two threats for our profession in the next decade.

Medical care is getting more expensive, so several insurance companies and some governments are thinking of removing orthodontic coverage medical, arguing that it's just about aesthetics. Several European countries already offer refunds only on severe cases, based on the Index of Orthodontic Treatment Needed. For a lot of families, this means orthodontic care isn't financially accessible. I regret this very much.

But the biggest threat is that orthodontics will be delivered by the hand of big companies delivering "invisible" trays, digital setups, indirect bonding trays or jigs, or individual brackets and wires. This allows for the misguided idea that all a doctor has to do to offer orthodontic treatment to a patient is make an impression or do an intraoral scan. This misleads the general dentist and the patient that no further knowledge is required, and that straightening teeth can easily be done by any general dentist—or even by a hygienist.

Orthodontics is the science of occlusion, centric relation, joints, clinching, bruxism, muscles, airways, breathing, habits, chewing, impactions, rotations, crowding, missing teeth, jaw problems, growth and, yes, dental and facial esthetics. Not just straightening teeth.

Orthodontics is diagnosis and treatment planning, getting all factors in harmony, bringing teeth and jaws into an ideal position, and giving the patient improved health and aesthetics. In my region, I see far too many mistreated cases that had been performed by general dentists spurred on by companies offering orthodontic treatments.

Doctor with patients

What's your favorite procedure?
Finishing and detailing the case, making some small arch-wire corrections, minimal finishing steps, some interproximal stripping, getting that occlusion settled and, most of all, getting that unique, gorgeous smile.

What can you not live without?
This one is easy: My team. I'm surrounded by staff members who are so professional, flexible, competent and open to change, who pamper our patients with real courtesy and compassion. Most of them have been with me 15–25 years. I wouldn't have a chance to practice without them.

Doctor with patients

Describe the most successful or rewarding experience in your professional life.
As a clinician, those small but honest rewards of your patients thanking you and your team for good care are so valuable. That bottle of wine, those chocolates, a cake, a child's drawing, the thank-you card, the referral, the little things that patients do are daily rewards that have such a huge impact. As a lecturer, getting mail from colleagues thanking me for a great course always makes my day.

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What's your favorite feature of Orthotown or
I just discovered Orthotown a few months ago. I was reading for hours the first time, because every article is clinical and so helpful, giving practical tips and tricks with a nice mixture between clinical and management topics. I am already a big fan!

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