Orthodontists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Orthotown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we visit Dr. Sandy Bigman, a Bay Area Townie who’s been practicing for 30 years and considers himself an experienced veteran, and for good reason: This dentist–turned–orthodontist has seen it all and knows what works and what doesn’t. He’s big on incorporating modern technology into his practice and was just selected to be a council member of the College of Diplomates of the American Board of Orthodontics. Read on to see how, and why, even after 30 years, he still enjoys coming to work every day.
Name and credentials:
Sandy Ira Allan Bigman, DDS, MSD
• University of the Pacific,
San Francisco (DDS)
• Fairleigh Dickinson School of Dental Medicine, Hackensack, New Jersey
(certificate and MSD in orthodontics)
Bigman Orthodontics, San Ramon, California
2,140 square feet
What was the path you took that led to you becoming an orthodontist?
In college, I took a winter-term dental practicum that let me visit different dental specialties, including orthodontics, and write about my experience. The orthodontist I visited, Dr. George Chingas, had a daughter I went to high school with. I thought his office was so cool, with an open bay concept and a sailfish hung over his treatment area with braces on it. Even his license plate on his car said “Wire Em.” It looked so fun and busy.
In dental school at the University of the Pacific, I spent quite a bit of my “extra” time in the orthodontic clinic observing. One day during lunch, Dr. Dugoni (our dean and an orthodontist) had a lunch-and-learn about a career in orthodontics and his enthusiasm was contagious. After graduating and practicing dentistry, I began to feel the calling to be an orthodontist. This got stronger every day. I continued to visit different orthodontists in my area and spend time in their offices even though I was a dentist.
You used to be a competitive
figure skater and practiced dentistry before switching to orthodontics. How (and why) did you make that transition from skating to dentistry and, ultimately, to orthodontics? Are there any similarities between figure skating and orthodontics?
As a teen, I trained with Olympic medalist Charlie Tickner in Squaw Valley, California, which hosted the 1960 Winter Olympics. My coach, Barbara Wagner, was an Olympic gold medalist, but when I saw the commitment in time and money that was required, I felt that I also needed an educational career path, because so few athletes achieve Olympic status.
While I was in high school, my family moved from San Francisco to Walnut Creek, and I went to a new dentist who was on the state board that tests dentists to get their licenses. He was very ethical and kind with his time and met with me about what dentistry was about. Figure skating is an art and a sport, and dentistry is an art and a science. I enjoyed the artistry in both—and actually, doing figures on the ice helped me focus in school by developing my concentration.
Dr. Bigman at age 14, left, and 52. COURTESY OF DR. Bigman.
You’ve been practicing for about 30? years and consider yourself an experienced veteran when it comes to orthodontics. What are some of the changes in treatment, and the practice as a whole, that you’ve seen over the decades, and how have you adapted to them?
I could write a book on what I’ve seen. In graduate school, I was pinching bands and welding brackets on my custom bands. In addition, 20% of my graduate cases were the Begg Technique. And I’m sure lots of older doctors remember the Concise Paste A and B: Be sure to mix for each bracket and place before it sets! Look at where we are today: Orthodontics is an amazing specialty. The future is here now! It is so exciting. I can treat patients more comfortably and predictably with greater aesthetics with the many “tools” in my tool chest. Who would ever have thought that you could move teeth with a clear plastic? Impressions? A thing of the past ... well, mostly. TAD screws for anchorage when we had cemented appliances supported by head and neck gear. The technology explosion has dramatically changed how I practice, with so many options available.
How do you set your practice apart from others and market to new patients?
It seems like the young families rely on social media quite a bit, so I invested in a great website (Dentalfone) and internal marketing, and hired a savvy office marketing team member. I believe internal marketing is the most important, because your patients are your ambassadors. Investing in staffing that is stable also is a marketing tool. I’m very fortunate to have long-term staff who become friends with our patients and really invest in getting to know them. There is a comfort level knowing you can see the same people year after year. “People won’t remember what you said, but they will remember how you made them feel.”
I’m also fortunate to have treated more than 10,000 patients in the community in more than 30 years, so I’m pretty well known and am even treating second generations. I think that newer practitioners have a taller ladder to climb with the increased competition. There are still many underserved areas that need orthodontics, so it’s unfortunate that urban areas have such a concentration of practitioners.
1. iTero Element 2/Invisalign.
I got the iTero Element 2 when it first came out. The screen is huge, and the unit stays on with the built-in battery while we wheel it from chair to chair. It has completely changed my practice. We can do open scans for lab work, including my sleep appliances, without impressions.
2. Planmeca ProMax 3D.
I had a ProMax 2D for many years—it’s a reliable machine. What’s nice about the 3D is that it has a pediatric setting for lower dose, and I can also use a 2D option for just a panorex and don’t have to always take a 3D. It’s compact and fits great in my imaging room.
3. Carriere Motion 3D appliance.
How great is it to eliminate headgears?
I think having the patients go 100% on elastics right away gets the sagittal correction done in a few months, which creates a simpler case for me to treat. Even works for Class IIIs.
4. SureSmile. The SureSmile aligner system offers multiple options to treat patients with aligners. You can do it yourself with no third party setting up the case and manipulate the software, or have SureSmile perform comprehensive treatment including producing the aligners. I use it for do-it-yourself cases where I manipulate the movement through their improved software and have SureSmile
send me printed models for each stage so we can use our Drufomat to make the aligners in house. For me, it is a nice affordable option for minor cases. I never have to heat up instruments to place dimples in aligners again.
5. Dolphin and Dolphin Aquarium.
The Dolphin 3D software is a tremendous value, and you can see so much on an initial exam. Before, I had to send patients out to an oral surgeon for a 3D and they’d be charged; now, I can take one as part of my initial exam. With one image, I can extrapolate the ceph and panorex and see the airway and TMJ. This offers better care for my patients. Aquarium is a great tool to explain treatment to patients, with high-quality videos.
What would you say makes your practice modern?
I always pride myself in sustaining a modern practice and learning new technology. Our iTero scanner and Planmeca Pro Max 3D imaging play an important part in keeping my practice modern and contribute to a great office design. My office was designed by Design for Health in Santa Cruz in 1994, and patients still can’t believe my office is more than 25 years old. Good design is timeless!
Educationally, I keep up to date with quite a bit of continuing education, and my occasional teaching keeps me connected to education. I try to attend as many AAO and CDABO meetings as possible to keep a “pulse” on the profession.
You also treat sleep apnea, and even treat TMJ with Botox. How did you end up providing these services?
About 20 years ago I had some parents come to me and ask if I could make them a sleep “retainer” they’d read about. I researched and found the NAPA appliance made by Great Lakes, so I tried it. The patients felt great and slept better, but then disappeared. I thought I needed to get more of an education, so I attended the dental sleep medicine residency at UCLA under Dr. Dennis Bailey for half a year. (Interestingly, I was the only orthodontist out of 25 participants.) A lightbulb went off in my head during this education, and I completely changed how I looked at patients and their treatment. I joined the Academy of Dental Sleep Medicine and haven’t stopped learning.
Interesting as that had been, I attended a joint sleep medicine/Botox class from the late Dr. Steve Tracey and began learning more about Botox helping TMD symptoms. I’d already attended Dr. Charles McNeill’s TMJ?residency for two years at UCSF, so I thought I had a good foundation on the subject. Further practical education on Botox and fillers was completed at the Academy of Dental Facial Esthetics, where I began feeling comfortable with the procedures. It was fun and I was helping patients with their discomfort as well as their appearance.
- Schwartz expanders
RPE and Haas RPE
Biteplates and Forsus
Retainers are either ACE clear
or Hawley’s with clear lip bumper
Reliance Ortho FlexTech for bonded lingual retainers
Nightguards/splints are made from a Facebow mounting, utilizing thermoplastic material
- Fuji glass ionomer
Reliance Pad Lock paste
Transbond Plus color-changing
adhesive for ceramic
Brackets and wires
Class II Appliances
- GAC/Dentsply OmniArch MBT
- Ovation S Ceramic Brackets 0.018 slot
- We utilize NiTi wire and get into square archwire as soon as possible. Our finishing wire is usually 16x22
- Resolve (TMA). If we need more slots filled, we’ll go up to 17x25. We also utilize steel wires. All are a broad archform.
- Implementing Pitts 21
Class III Appliances
- We utilize Twin Blocks in Phase I (similar to a sleep appliance); in full dentition, we use crossbows, Forsus springs and will still place a Herbst when we have a Class?II deep bite. We have also incorporated Carriere 3D Motion appliances and pretty much discontinued headgears.
- Phase I: RPE with a facemask
- Full dentition: Carriere 3D Motion appliance
- Platypus floss threaders
- Phos Flur by Colgate
- Plaque HD toothpaste
- I’m a client of Paul Zuelke (zuelke.com), who helped establish our protocols
for payment financing and management of delinquencies.
- Orthotrac Office in conjunction with Dolphin Imaging
- MME is our IT technology guru. I love working with our iTero and Planmeca and we are exploring utilizing Memotain computer-assisted lingual retainers. Dolphin Imaging is my go-to for imaging and ceph tracings; they have the quadrilateral analysis, which I was trained in at Fairleigh Dickinson. Aquarium is very beneficial to educate patients.
Walk us through an average
day at your practice.
I hope an average day is busy—I don’t like sitting around. We always start the day going over the schedule in a morning huddle. We typically have short appointments before school and longer appointments midday. After lunch is the usual rush, but we also try to fit in some longer appointments to mix it up.
The challenge is when we incorporate new technologies into the office. When you incorporate a new technique, like a Motion appliance, I assign one assistant to be the “expert” so when we do a few, he or she is teaching the others. Exams are throughout the day, but parents usually like after school.
I have my continuing education license with the state of California, so I give CE units when lecturing. I’ve enjoyed lunch-and-learns with not only my staff but also other dental offices whose staff wants to learn.
You’ve treated more than 10,000 patients. What would you say is your most memorable and unique patient story? What keeps practicing day-in and day-out fun and not mundane?
I had a patient who was a preteen with an 11-millimeter overjet who was withdrawn and so unhappy with her appearance. Her parents wanted us to do everything we could, short of orthognathic surgery, to correct the malocclusion. We utilized a crossbow appliance with Forsus springs, and I have to say I was very impressed with the nonsurgical correction. It changed her life. I’m also very proud to say that seven of my patients went on to dental school and said their experience with my office motivated them to go into the profession.
What are some of your favorite technological advances in orthodontics? What do you like using?
The iTero is awesome, and having 3D? imaging is a game-changer for me to see impactions, the airway and TMJ right away on the initial exam. For appliances, the Carriere 3D Motion appliance and its “sagittal-first” philosophy has helped my practice be more efficient.
What’s your patient
I think I’ll need a bigger sheet of paper for that! What’s awesome about orthodontics is that we learn from different teachers and go to continuing education on different topics. I follow a lot of blogs, including The Pragmatic Orthodontist, Orthodontic Pearls and Kevin O’Brien’s blog. My philosophy has changed over the years, but I always liked my time listening to and working with Dr. Norman Cetlin on his non-extraction therapy. He was influential during my early years in practice and I even helped him teach a class on lip bumper fabrication on the West Coast. I liked his treated cases and broad smile, and that leads me today to my education with Dr. Tom Pitts and the smile aesthetics. I don’t treat to the numbers 100% of the time but I look at the face, the airway, the smile and, of course, the biologic parameters.
I’ve always been a big believer in early treatment (Phase I) from my time in the mixed-dentition clinic in dental school at University of the Pacific. With my sleep education, I have young mixed-dentition patients who sleep better and feel better about themselves. I utilize leeway space if needed for non-extraction therapy. I have no problem with extractions, but I probably use the sagittal first philosophy on the Carriere more than I ever have. I can’t remember when I did a headgear last. (I’d like to thank all my mentors who contributed to the orthodontist I am today: Drs. Norm Cetlin, Vince Kokich, Arthur Dugoni, James Hilgers, Stephen Tracey, Jim McNamara, Robert Boyd, Terry Dischinger and Tom Pitts.)
What gives you the most
I have to say taking the braces or any appliance off and going into retention. It’s such a journey, and seeing the before and after with the patients is such a natural high. And in total, just coming to work and knowing I can do what I was trained to do always gives me a high. I love our profession.
Another satisfaction is connecting with my fellow orthodontists. I truly enjoy attending the College of Diplomates of the American Board of Orthodontics summer meetings. It’s an amazing group that strives for excellence. I enjoy this group so much that I recently agreed to be a member of the council.
Tell us about your life outside the practice. What are some of your hobbies? And do you still make time to strap on the ice skates?
Travel is on top of the list as a hobby and enjoyment. My daughter plays ice hockey at Adrian College in Michigan, so I enjoy watching her play. My stepson works for Google in Germany, so we’re visiting him and his wife this fall in Munich. My stepdaughter and her husband live in Carlsbad, New Mexico, along with our grandson. We’ll also explore that state and visit the Carlsbad Caverns.
My wife, Neleen, and I enjoy going to concerts and I’m a big of the San Jose Sharks, the San Francisco Giants and the Oakland Raiders (a team that I’ll be seeing in Las Vegas next year). One of my hobbies is teaching to share my 30 years of experience. I am currently spending time at UNLV’s orthodontic department under the direction of Dr. James Mah. The program is great, and the residents are awesome. I also recently guest-lectured at Montefiore Medical Center in the Bronx, New York.
I also enjoy classic cars and currently own a 1975 Bricklin (original owner) and a 1982 DeLorean that I drive to car shows. Everyone loves the Back to the Future car.
As far as skating goes ... over the years, I’ve had office skating parties for my patients. They enjoy watching me on the ice and performing my “tricks,” even at age 61. I’ve also played adult ice hockey. I’ll always have my blades and still keep in touch with my friends from the skating world.