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Office Visit: Dr. Christopher Cetta by Kyle Patton, associate editor

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Categories: Practice Management, HR and Accounting;
Office Visit: Dr. Christopher Cetta 

This Townie moves the profession forward through invention, content creation and leveraging large partnerships

by Kyle Patton, associate editor
photography by Gabriel Burgos

Orthodontists spend most of their working hours inside their own 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 how they practice.
Those in the orthodontic profession understand better than most the positive outcomes of combining art and science. Dr. Christopher Cetta is the product of such a marriage, literally: a world of medicine and surgery from his father and a world of art and crafting from his mother. This Florida Townie would go on to spend his first few years practicing dentistry, even dabbling in the cosmetic side of the industry, before setting his aim on orthodontics after one of the country’s greatest economic lows.

Cetta has been now practicing orthodontics for a solid decade and is part of a family-owned chain of practices in the Tampa area that consists of five offices and more than 75 team members. As a non-owner, Cetta enjoys the freedom to focus on the clinical and aesthetic elements without getting bogged down in the weeds of practice management. He has used that freedom to further himself and the profession, turning himself into an orthodontic product inventor and starting a podcast that shines a spotlight on other doctors.

In our exclusive Q&A, we head to one of the offices of Blue Wave Orthodontics and Kids Smiles Pediatric Dentistry, and chat with Cetta about the emergence of the “broad smile” design, the importance of Phase I considerations, what it takes to bring a product from idea to reality and more.
OFFICE HIGHLIGHTS
NAME:
Dr. Christopher Cetta

GRADUATED FROM:
Jacksonville University, Orthodontics and
Dentofacial Orthopedics (2012)

PRACTICE NAME:
Blue Wave Orthodontics and
Kids Smiles Pediatric Dentistry

PRACTICE SIZE:
4,017 square feet; 7 chairs,
2 private ops

TEAM SIZE:
76 total (30 ortho)
How’d you find your way into orthodontics?

I grew up as the son of an ophthalmologist and a grandson of an anesthesiologist. Health care was “in my blood,” I suppose. (Though, frankly, I was a squeamish kid who could barely stand the sight of blood!) I always excelled in science yet was a creative and curious child. My mom is quite artistic and had a small business teaching craft lessons out of our home. So, I was exposed to science through my father and art from my mother.

As a child, I had positive experiences at both the dentist and orthodontist. Orthodontics seemed particularly appealing to me by the time I reached high school. While we didn’t have any dentists in the family, my parents steered me in that direction as opposed to medicine.

I attended college in North Carolina at Wake Forest University and returned for dental school at the University of Medicine of Dentistry of New Jersey, which is now Rutgers. I then completed a general practice residency before practicing general and cosmetic dentistry for three years in northern New Jersey. After the financial crisis of 2008, I decided to pursue my dream of becoming an orthodontist and was accepted into the residency program at Jacksonville University in Florida.


Tell us about your role within the practice.

I joined Blue Wave Orthodontics and Kids Smiles Pediatric Dentistry as an associate orthodontist in 2018 when my wife, Nicole, and I relocated to Florida. I had the pleasure of learning from Dr. Randy Feldman, who was a beloved orthodontist in the Tampa Bay area and had a largerthan- life personality. Sadly, Dr. Feldman passed away unexpectedly in 2021; we now carry on his legacy with our pediatric dentist, Dr. Frank Sierra, at the helm.

I’m fortunate to practice alongside orthodontist Dr. Robertzon Guloy and pediatric dentists Drs. Mia Kwon and Khusbu Patel. We are blessed to have a loyal and dedicated team, many of whom have been with the practice for 20-plus years. We currently have five locations, four of which practice orthodontics. I see patients in the South Tampa and Bradenton offices.


What are some benefits you’ve found working within a network of practices, compared with working as a solo practitioner?

One of the biggest benefits is the collaborative treatment approach. In today’s busy world, it can be difficult to connect with other dental professionals about a patient’s care in a timely fashion. The ability to bounce treatment plans off each other and to understand a patient’s dental needs beyond orthodontics is super helpful.
 
What’s your take on Phase I treatments?

My orthodontic residency program at Jacksonville, at least at the time, encouraged Phase I treatment only when deemed absolutely necessary. Those cases were typically limited to anterior or posterior crossbites, habit cessation, etc.; we didn’t necessarily address crowding, except for extracting primary teeth to temporarily create space in the arch. Consequently, we mostly treated patients 12 and older and I didn’t have much exposure to mixed-dentition cases, so I had that mindset early on in practice—to hold off for comprehensive or one-phase treatment if possible.

Today, after having practiced in several orthodontic-pediatric settings in Florida and New Jersey, I’ve seen the benefits of early treatment in developing the arches and avoiding unnecessary dental impactions or protentional extractions. I have to credit Dr. Feldman, because I learned a fair amount about Phase I treatment from him. The parents often appreciate this approach as well, instead of just waiting until the child is in middle or high school for treatment.


How do you think clear aligner therapy will look in a decade?

I’ve had a keen interest in aligners over the years and also try to keep my finger on the pulse of innovation. If I had to make a prediction, I envision a combination of direct aligner printing (as opposed to 3D-printing the models first) and shape-memory polymers. The treatment planning will largely be driven by artificial intelligence, though I still believe in the role of human oversight or supervision.

I predict a consolidation of the aligner manufacturers, because there are currently too many product offerings. I anticipate that aligner cases will continue to grow in expanding markets, but the American market will begin to level off with the advent of digital custom braces options.


You’ve invented a companion product used with clear aligners. How did that start and where are you now with the product?

I came up with the idea for the Precision Aligner Buttons a few years after graduating. At the time, orthodontists were taking components intended for braces and adapting them for wearing elastic bands with Invisalign to correct malocclusions. I was working for several different practices in New Jersey and I recognized they were all encountering the same problem of frequent emergency visits for broken attachments, whether they were using lingual buttons, molar tubes or Caplin hooks. I thought there had to be a better solution!

One day I asked Dr. Richard Kaye of Morrone and Kaye Orthodontics in Moorestown, New Jersey, a question: “What if there were an orthodontic button that would fit inside the cutout windows from Invisalign just like a puzzle piece?”

The button would have a larger bonding pad for a stronger bond strength to the tooth and would be properly contoured to be attached at the gum line. Dr. Kaye and I agreed to partner on the idea and began working with a coaching/consulting company called inventRight to make the product a reality.

Precision Aligner Buttons were launched by MidAtlantic Ortho (MAO) at the AAO meeting in 2018. DynaFlex acquired MAO a year later and worked with us to expand the product line to include a clear version for canines and premolars. DynaFlex released our next-generation product at AAO in Chicago this year, which includes new design improvements as well as a Mini version that we are super excited about.

Dr. Kaye and I also recently created an instrument with HuFriedyGroup that has been included in its special line of aligner instrumentation called The Clear Collection. These are some handy aligner-modification instruments to have in the office developed by Dr. Jay Bowman. Our Precision Aligner Punch will create the exact shape of a metal Precision Aligner Button in any clear plastic aligner, and is particularly useful for in-house aligner fabrication.


When it comes to facial aesthetics, what are some considerations you—and other docs should—keep in mind?

I was recently introduced to the concept of a broad smile, with upright buccal segments instead of lingually inclined crowns. I suppose some might refer to this as a “Damon smile,” but it is a look that many patients seem to be requesting.

We have been incorporating Norris Extra Broad archwires from DynaFlex into our LightForce and KLOwen Stride custom braces cases with beautiful results. Patients seem to love a fuller smile with minimal buccal corridors. Of course, it goes without saying that it’s imperative to assess whether the patient has the periodontal support for this lateral expansion.


You love digital workflows. What are some digital adjustments you’ve made that led to positive outcomes? Any tips for those still living in an analog world?

When digitally planning orthodontic treatment, whether for aligners or custom braces, it’s important to pay attention to smile gradation.

While most orthodontists are now quite attuned to smile arc, smile gradation refers to the concept of seeing each progressive tooth from the canine back to the second premolar or first molar. Essentially, the smile arc pertains to the vertical dimension, while smile gradation is a transverse consideration. These are smile design concepts that many cosmetic dentists pay attention to and have been popularized in orthodontics by Dr. David Sarver.

If a canine or first premolar is inadvertently positioned too prominently to the buccal, it won’t be possible to see each successive tooth when smiling. This is particularly important with aligners and custom braces, because the thickness of the bracket base was a standardized dimension with analog systems. This isn’t something orthodontists had to pay as close attention to with traditional braces.
Top products
Invisalign clear aligners.
From the advanced functionality of the ClinCheck software to the predictability of the SmartTrack plastic and optimized attachments, Invisalign is still my No. 1 choice for clear plastic aligners. Invisalign also has widespread consumer brand recognition.

LightForce custom braces. 
I love the digital workflow of LightForce custom braces. We’re able to offer patients 10-week appointment intervals instead of 6-week appointments, and are seeing better results than with traditional braces. Plus, I’m able to delegate bracket rebonds!

Isoglide eruption springs. 
These springs created by Dr. Grant Coleman are game-changers for bringing in impacted teeth. They work much more efficiently than traditional gold chains.

KLOwen Stride custom braces. Stride custom braces also use a digital workflow and are appealing to patients who prefer metal braces. We’re doing little to no wire bending or bracket repositions because of the accuracy of the indirect bonding combined with their custom brackets. They’re truly revolutionary!

Norris extra broad archwires by DynaFlex. 
These nickel titanium wires designed by Dr. Tito Norris are my go-to archwires for creating beautiful broad smiles or for borderline non-extraction cases.

Precision Aligner Buttons from Dynaflex. 
These make it easy for patients to attach their elastics to the aligners. Often, ease of use equals better compliance. (Also, we rarely have emergency visits anymore.)



Give us an overview of your podcast.

During a period when I had a long commute to work, I would listen to orthodontic podcasts while driving. I found inspiration in Dr. Lance Miller’s Elevate Orthodontics Podcast, Dr. Kyle Fagala’s The Digital Orthodontist: Live! and Dr. Glenn Krieger’s Orthopreneurs Podcast.

I didn’t want to replicate any of these podcasts, so I thought about one with a different spin—specifically, one that told the stories of innovators and inventors within the orthodontic profession. I hoped to conduct in-person conversations, instead of chatting through a computer screen, to produce a more personal and compelling interview, and I wanted studio-level sound quality and production.

I started The Illuminate Orthodontic Podcast in March 2020—a week before the COVID-19 shutdown. This presented a significant hurdle, because in-person meetings and travel options were limited or nonexistent.

Although many suggested that I pivot and record the podcast through Zoom, I stuck to my original plan. For many early episodes, my wife and I road-tripped to the interviews and I recorded the podcasts outdoors while sitting 6 feet away from the guests. Looking back, that experience is a story in and of itself.

Perhaps it was the human connection that resonated with people early on. Honestly, I never could have imagined the podcast would become as popular as it has, and I’m still a bit bewildered by how many people tune in each month to listen!


What are a few things you’ve learned from your guests?

That’s a great question, because it was my curiosity that led me to have conversations with all of these innovative minds. I’d love to connect what has made all of these individuals successful— perhaps one day I’ll give a talk on this subject.

I’ve been fortunate to interview some true orthodontic luminaries and one thing that has impressed me is how prepared they are, even for something as silly as a podcast. I’ll never forget when I recorded my podcast with Dr. Sarver, who came to the interview with a list of notes and speaking points prepared. Very few successful people “just wing it”—they’re usually so prepared that it comes off as effortless or casual.


Tell us the tale of the band you’re in, Mash Bill.

I’ve been playing music since high school, starting on electric guitar and migrating over to bass guitar in college. I played in a couple different bands in college, and one called Elëktrösurge while I was in dental school.

After graduating, I got together with friends from Wake Forest and a few from Rutgers to periodically jam and record music. Because we lived in different states, we often rented a house to record music for a long weekend.

Around 2009, we started collaborating with Skylar Adler (who incidentally is the audio engineer for The Illuminate Orthodontic Podcast). I met Skylar when I was practicing as a general dentist in New Jersey—Skylar was my patient while he was going to school to study audio engineering. He has recorded Mash Bill and also sat in for us on drums. We have a couple of EPs out on Spotify and Apple Music. We are overdue to get Mash Bill back together, actually!


What kinds of cases excite you the most?

I’ve been excited to tackle some impacted canine cases with aligners. Because there are no fixed anchorage appliances, this forces you to think creatively!

If an open-exposure technique is warranted, I’ll ask the surgeon to attach a clear button instead of a gold chain. I’ll then ask the patient to attach an elastic in a bootstrap fashion from the button to the aligner.

When a closed-exposure technique is necessary, I’ve incorporated transpalatal arches or cantilever arms until the forced eruption of the tooth is complete. Then I’ll bond the button to the tooth and continue with bootstrap elastics until the tooth has erupted enough for a regular Invisalign attachment. These patients really appreciate that you’re offering them aligners, because they’re often steered toward braces because of the impaction.


What’s a trend that you love in the profession?

I absolutely love seeing more doctorled and doctor-directed product innovation— for orthodontics, by orthodontists! There was a period when much of the innovation seemed to come from corporations, which even led to some brazen companies trying to eliminate the orthodontist entirely. But I love seeing innovators—Dr. Alfred Griffin III of LightForce, Dr. John Pham of InBrace, Dr. Brandon Owen of KLOwen Orthodontics and Dr. Adam Schulhof of Grin, to name a few—leading the charge of this latest movement. I’ve had many residents ask about the future of our profession, and I believe it is bright.


What’s your stance on more and more dentists offering orthodontic treatments?

This is always a sticky subject. I was trained in Invisalign back in 2007 as a general dentist, and I certainly didn’t understand or appreciate growth and development, orthodontic biomechanics or malocclusions as I do now as an orthodontist.

Unfortunately, sometimes you just don’t know what you don’t know, as the saying goes. I think that’s where general dentists can potentially get in over their heads, because the boundaries between simple and complex are not clear-cut in orthodontics. Orthodontics can be a humbling profession, even for specialists!


Give us a snapshot of your life outside of orthodontics.

My wife and I recently purchased our first home in St. Petersburg, Florida. We don’t have children yet, but we do have a Maltipoo pup named Jagger (after Mick Jagger). Last fall, we were able to take a 10-day tour of Italy, which was spectacular—we visited Lake Como, Venice, Florence and Rome. This summer, we’re looking forward to spending some time with family in the Outer Banks, North Carolina, to celebrate my parents’ 50th wedding anniversary.
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