Behind the Curtain: 5 Failures That Forged Me by Dr. Kyle Fagala

Behind the Curtain: 5 Failures That Forged Me 

by Dr. Kyle Fagala

[Editor’s note: In this recurring column, in their own words, some of the most well-known orthodontists share stories of personal or professional struggles they have managed, or continue to manage, during their journey in orthodontics. If you’re interested in participating, email Orthotown’s editorial director, Dr. Chad Foster, at]

I entered my eighth year of orthodontic practice last July. Saddle Creek Orthodontics could not be more different from when I started from scratch as a wide-eyed and recently graduated 29-year-old back in 2013. I was drowning in debt, had zero experience in business and was opening a practice only because I was out of options. Fortunately, my wife, Anna, had six years of experience in orthodontics as a scheduling and treatment coordinator. Beyond that, we were pretty clueless, albeit hopeful.

Today I feel lucky that when I look back on all the decisions that we made—and they are countless—there are really only a handful of decisions that I count as true failures. Chalk that up to dumb luck, God’s good favor or maybe that my personality compels me to consider the advice and wisdom of dozens before moving forward with any major decision, but whatever the case, we’ve skated through relatively unscathed.

How can this help you? If you’re a resident considering practice ownership, a new practice owner or even a veteran practice owner who has grown tired of hearing orthodontists preach unmitigated success at meetings or on podcasts, this column is for you. I believe there is great wisdom to be gleaned from considering the perspectives of others, and I trust that my mistakes can help inform your success.

Failure #1: When I made an 86 on boards

I decided that I wanted to do orthodontics somewhere around my second year of dental school. Obviously, a lot of that hinged on my board score. My class rank was always in the top 10, and I was active in extracurriculars, but I really struggled with studying for my Part I boards. I could have worked harder and the pressure of the moment definitely got the best of me.

In short, I didn’t deliver on my potential, and I knew it. An 86 was far less than what I was capable of, and certainly wasn’t the sort of score that guaranteed entry into orthodontics. I considered retaking the test but ultimately I decided to press on.

This experience instilled a feeling of inferiority that I battled for the next couple of years of dental school, and into my early career in orthodontics. On the bright side, it also taught me humility, and much like unranked basketball prospects, it gave me a chip on my shoulder that helped drive me.

Failure #2: When a sure thing fell through

Despite my average board score, I thankfully was accepted into my first choice for orthodontics, the University of Tennessee. My wife was working for an excellent three-location father-and-son practice in Memphis. They were high-quality people and it was a great opportunity. The son and I discussed practicing together—even to the point that he had me stand up at his office Christmas party to announce that I would soon be entering his practice. It felt like a done deal.

However, a few months later, he invited me to lunch to let me know he had changed his mind and was no longer looking for a partner. Naturally, I was crushed. I wondered if I wasn’t good enough and worried about what I would do after graduation. I began reaching out to other orthodontists to see if anyone was interested, but no one in Memphis was hiring.

In hindsight, losing this opportunity was the best thing that could have happened. Practice ownership was a natural fi t for my strengths (and weaknesses), and without this failure, we would have never taken the risks necessary to start our own practice.

Failure #3: When my assistant used the wrong etch (Or: That time I had a panic attack)

This story still makes me cringe. When I was an orthodontic resident, I would use multiple bonding systems, mixing and matching as needed to accomplish my clinical goals. When we opened our practice from scratch, we had no clinical assistants, so this pattern continued. Further, because we had opened from scratch, we didn’t inherit any clinical systems. Naturally, once we started adding assistants, this lack of structure was difficult for everyone. After all, assistants can’t read the doctor’s mind.

Most mistakes were minor, but I still remember an assistant accidentally applying hydrofluoric acid etch—a very strong etch that is supposed to be used only on crowns—to all 26 teeth of a teenage girl. When I found out, I freaked. The patient experienced some sensitivity for a few days, and when I received a call to inform me, I had a panic attack. I thought I was going to have my dental license revoked and lose everything I had worked so hard to achieve. Fortunately, the effects of the incorrectly used etch were short-term, and there was no damage to the enamel.

The silver lining was that it forced me to rethink the systems in my practice. It showed me the importance of delegation and of having turnkey systems like you might see at a McDonald’s or Starbucks. Each clinical chair was standardized and things such as hydrofluoric acid were clearly labeled. We also trained more regularly to ensure consistency from assistant to assistant.

Failure #4: When I almost lost my team

The worst moment in our eight years as a practice involved a major hiring decision that did not pan out. In one day, we were approached by every member of our team except one to tell us that we needed to let this person go. Worst of all, we chose not to heed their advice. It wasn’t that we didn’t believe our team, but we thought we could fix it. It turned out that we were wrong. We did eventually part ways with that employee, but not before a lot of additional damage was done.

As with most things, the fault did not lie with just one person—certainly not solely the employee in question. This situation was the cumulative effect of several missteps, most of which I gladly own. While it took around six to 12 months to regain the trust of the team, I’m happy to say that our team culture today is as good as it’s ever been. The adage “Hire slow and fire fast” is so true. I just wish that it were easier to live out.

Failure #5: When we closed a location

In 2018 we were offered a “no-brainer” opportunity to work inside the space of a pediatric dentist in a great area with no surrounding orthodontic practices. It required minimal investment to get started and we inherited a steady flow of new patients on day one. The main problem was, three locations ended up being one too many for our team. Also, because we were sharing the space with another practice, it meant that we had to set everything up from scratch each day we arrived. Further, we saw patients only two days a month, which was not enough for us to provide the level of care that we were accustomed to.

Even though we were profitable, the location quickly became every team member’s least favorite, so we decided to close it after one year. The decision naturally upset several patients and it was definitely a failure, but we did learn our limitations and strengths as a practice.


The main thing I want to share is that every orthodontist makes mistakes. I fail every single day in some way. If I were able, would I go back in time and do things differently? Of course! But I gladly embrace my past and deeply appreciate the ways in which it has made me a better person, practice owner and orthodontist.

Ultimately, I hope this column grants you the perspective that failures, both big and small, are an opportunity to learn and to improve. We cannot lose ourselves in the midst of struggle and storm. We must always remain humble, willing to learn, and true to who we are at our core. If we do, it will always serve us well.

Author Bio
Kyle_Fagala Dr. Kyle Fagala is the owner and orthodontist at Saddle Creek Orthodontics, with locations in Germantown and Collierville, Tennessee. Fagala is also the co-founder of digital marketing agency Neon Canvas and host of the podcast The Digital Orthodontist: Live!.
He is the course director of and lecturer for an occlusion class for first-year dental students at the University of Tennessee Health Science Center, and a key opinion leader for 3M Oral Care.

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