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Office Visit: Dr. Brian Asbury

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Categories: Orthodontics; Practice Management, HR and Accounting;
Office Visit: Dr. Brian Asbury 

With salvaged materials and sheer determination, this Townie built his practice—literally

by Kyle Patton, editor
photography by Christina Gandolfo

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.
Out of all the readers who completed their ballots, we draw one at random to win a special prize: $1,000 and the chance to appear in an Office Visit cover profile. This year’s winner is Dr. Brian Asbury. Inspired by his early work providing dental care in underserved communities in Chile and Mexico, Asbury’s career path led him to orthodontics, where he found his passion for transforming smiles. When starting his San Diego practice, he and his father took a hands-on approach, tackling the entire office renovation themselves and repurposing materials to achieve a high-end look on a startup budget. Today, Asbury is particularly known for his focus on airway and early expansion cases, leveraging CBCT technology to deliver impactful clinical and behavioral results for his young patients.

 
OFFICE HIGHLIGHTS
NAME:
Dr. Brian Asbury

GRADUATED FROM:
UCLA Dental, Harvard Orthodontics

PRACTICE NAME:
Braces San Diego
San Diego, California


PRACTICE SIZE:
3,000 square feet; 7 ops

TEAM SIZE:
10

How did you find your way into orthodontics?
After my second year at West Point, I paused my education to serve as a missionary in Chile. I served in low-income, rural areas and witnessed the impact of poor oral health. Most homes I visited had never owned dental floss. It was common to see children with missing teeth and baby bottle decay. Organizations would come in to teach about oral health to improve the lives of the people who lived there. I loved the idea of helping others in this way. During dental school, I would go to Mexico with a service organization called Thousand Smiles as part of its oral surgery club. I loved oral surgery and the cleft work they did there, but when I saw what kind of work orthodontists could do, I knew it was for me. I was and still am amazed by how orthodontists could transform the lives of these children.


Tell us about your practice.
My office is very close to my house, and my community has a small-town feel, even though it’s in San Diego. I do tend to get a lot of very complex cases, including a lot of orthognathics. We are focused on the highest quality outcomes and making the process an easy and positive experience for our patients. Harvard was heavily focused on research and evidence, so I’m careful not to jump on every idea and invention I see at meetings. I keep the mechanics simple and stick with what works for my patients. The plan must work biomechanically, but also with their family’s lifestyle. I am a big believer in orthodontists affecting the airway. I treat early, a lot of Phase I, and I expand in most of my patients.


You did all of the renovations yourself—no help from contractors whatsoever! Walk us through what kind of work went into it.
Money was very tight at the time—a mountain of school debt, practice debt, house debt and now a building mortgage. My dad and I decided to do all the work ourselves. My dad found a cabinet factory that had flooded, and they sold us an entire truckload of damaged and partially finished cabinets and wood for less than $1,000. We salvaged, refinished and used as much as we could. I also had a friend who worked for a high-end custom cabinet manufacturer, so I could get custom CNC walnut wood to finish the cabinets. I bought remnants from a local stone yard. We came up with all sorts of ways to reuse and repurpose things in the office I had bought. Patterson sold us the floor models of the equipment. I ended up with very high-quality materials and finishes for budget pricing. I think I ended up putting around $70,000 into the buildout plus new equipment. Not bad for the entire interior and exterior of a 3,000-square-foot free-standing building in San Diego.

Those were long weeks, though. Seeing patients Monday through Thursday in the office, long days every Friday and Saturday building the new office and then long days on Sunday helping at church. Our fourth child was born the same month we closed on the new building and began construction. My dad was getting older, so he said he needed to cut back to only working half days while helping me. I thought this sounded pretty good until I learned that to him half days were literal—12 hours of work, then we got to rest!


What was the most surprising part of doing all your own renovations? What parts were easier or more difficult than you had expected?
I remember being pretty intimidated by the plumbing aspects of the buildout: suction, compressed air, etc. Changing the building from the needs of an accounting office to an orthodontic practice was significant. But it turned out to be surprisingly simple, not much different than doing plumbing in a house with all the same principles and materials. It probably also helped that my dad is great at brazing copper!

There were certainly a lot of parts that were more difficult than I thought. Trying to anticipate future needs, technology and space management was challenging. A full new build would have been ideal, but I had to keep costs down and use as much of the existing materials and layout as possible. Making everything ADA-compliant, especially the parking lot, was difficult. We had to have at least a one percent slope for drainage, but not more than two percent for a wheelchair. We spent lots of time with shovels and levels.
You have a healthy work-life balance. Why is it important to you that your profession does not define you?
In dental school, I remember when I would get together with my classmates, our wives would complain that all we would talk about was dentistry. It seemed to consume every aspect of our lives. I knew I shouldn’t keep that up long-term. When I got into practice, I remember going to a supermarket with a retired orthodontist. He knew so many people and still introduced himself as “doctor” to people at the supermarket. I felt like that had become who he was. That helped me cement my decision to not let my profession define who I was. I love this career and take pride in what I do, but it is such a small part of my identity and not what I want to be remembered for. There are so many other more important aspects of life, like family, caring for others and God.


If you could go back and give yourself advice before you began practicing, what would it be?
I would probably need to have a long sit down with myself. Roosevelt said, “People don’t care how much you know until they know how much you care.” Establishing trust is critical. Be very clear about what you can and cannot do. Underpromise, then overdeliver. If someone is expecting you to make them look like a movie star, they can get the most amazing results and still be disappointed with their outcome.

Keep the mechanics simple. Biomechanically, a double arch wire with auxiliary tubes, sectional mechanics, looped wires, and jigs ensures efficient and ideal mechanics, but it becomes a disaster when a water polo player takes a hit to the face. A patient would rather have a smooth 15-month experience than an uncomfortable 12-month experience. You’re not treating teeth. You’re treating people.


You mentioned going down to Mexico to treat cleft patients in dental school. Tell us about your involvement in charity cases and why you feel more doctors should try to participate.
Our specific skills are needed by many who don’t have the means or opportunity to seek treatment. I love that our profession provides us with the schedule flexibility to give back to the community and serve others. So many orthodontists across the country participate in free clinics, go on service trips and treat patients in need for free.

While I was in dental school at UCLA, I started going to Ensenada, Mexico. There is a clinic there owned by Thousand Smiles and sponsored by Rotary International to focus on patients with cleft palates. Over the years it has grown to be a sizeable operation. With much support, we have built a nice clinic. Every three months a large group of dentists, doctors, specialists and support teams travel to treat the people there. We are always looking for volunteers, and we especially need more orthodontists! There are very complex cases and many unusual syndromes. The people are so great, as are the tacos!


How’d you get involved in airway and early expansion cases? What have you seen since you started offering these options?
When I joined this practice, the founding orthodontist was a pioneer in myofunctional therapy and did a lot of early treatment and expansion. I didn’t do a lot of phase I treatment in residency. It was amazing that I could see a visual and behavioral change in my expansion treatments. Just a couple of visits with a hyrax expander and I frequently see many positive changes in their lives. The research is catching up and supporting what I have been seeing in practice. We were early adopters of iCAT, which helped me to see the changes in airway and allowed me to visualize what I was seeing clinically.


We’ve seen more and more of the specialty get taken away by general dentists and corporate offices. How do you think the profession should respond?
General dentists greatly outnumber orthodontists. In California, the majority of orthodontics is done by general dentists. As we treat more aligner patients and more data becomes available for AI and computer algorithms, treatment outcomes will only get better, more efficient and less reliant on the doctor.

When dentists bring orthodontists into their offices a couple of days a month, I don’t think the priority is to improve patient care and outcomes. When corporations purchase practices, I don’t think they are doing it so patients can get better, more affordable treatment. Private equity and insurance companies are there to make money.

When the internet started taking off, some libraries shut down, while others started offering computers and the digital lending of e-books and audiobooks. Similarly, we are going to have to adapt. I don’t have the answers here, but I think there are some things we can do:
  1. We need to clearly establish what the standard of care is for orthodontics, whether done by a GP or specialist, fixed or removable appliances. There should be a uniform standard of care established by the specialty.
  2. When looking to make practice decisions like how we practice, who we work for and who we sell our practices to, I think we need to ask what is not only best for us but what is best for patient care and our profession.
  3. We need to be very careful and selective about working in dentists’ offices. Often, they don’t have the imaging, emergency coverage or follow-up availability we have in private orthodontic offices.
  4. Many patients don’t realize there is a difference between a dentist and an orthodontist. They think it’s the same. I think as a specialty we could work to increase awareness.
TOP PRODUCTS
‘OV_Asbury_iCat
I-CAT FLX V17
I greatly appreciate the speed and convenience of the i-CAT, as it enables a precise and efficient visualization of the anatomy.

INVISALIGN DOCTOR SUBSCRIPTION PROGRAM
The dental service plan is an excellent solution for individuals who may not have consistently worn their retainer and are now looking to realign their teeth without committing to a more intensive treatment. You can easily order three or more trays and receive them promptly.

iTero
This is crucial to my practice. We currently have three iTeros.

SPRINTRAY PRINTERS
We use a Pro 95 for printing models and a Pro S for direct printing retainers. They are not as fast as our EnvisionTEC printers but are more user-friendly, and the support team seems eager to work out any issues.

VANIMAN SANDSTORM PROFESSIONAL
I feel like sandblasting increases bond strength for brackets and appliances. The Sandstorm is fast and powerful.
How do you imagine the profession will look ten years from now?
I think our profession is at a crossroads in many respects. Technology is leading to less specialization, with general dentists doing more. Corporations and private equity will likely dramatically change how care is delivered. We see this happening in most sectors of health care, including veterinarians, podiatrists, private clinics and hospitals. Imaging and understanding of bone biology and mechanics will continue to improve, which has great potential to improve patient care. However, the question remains whether corporate needs will overshadow the potential gains in patient care.


What was your most humbling experience in the profession? Likewise, what has been your proudest moment so far?
I came out of residency convinced that I knew everything and was the greatest orthodontist ever. I bought a practice during my residency and started working a couple of days after I graduated. My eyes were slowly opened to the realities of practice ownership, patient management and staff challenges.

My proudest moment—you mean besides being on the cover of Orthotown magazine? A couple of years ago there was a local competition with at least a dozen participants. I got a paper certificate with a golden seal sticker on it for throwing a frisbee the farthest. I stuck that up right next to my Harvard diploma in the consultation room. Patients always get a laugh when they see that monumental accomplishment.


Do you have a favorite patient story?
I had a patient in Mexico named Jose who presented with microcephaly, cleft palate and severe crowding. We followed and treated him for years. We only go every three months, and often patients miss visits. We worked hard and had nice results considering distraction osteogenesis and orthognathic surgery wasn’t a possibility because of the limited follow-up. When it came time to pick up his retainers, he didn’t show up. We knew we wouldn’t be back for three months so we were very worried things would quickly shift and our years of hard work would be lost. His chart had an address that only listed a community. We decided to go find him on the way home. We found the area and asked for him by name and tried to politely describe him to a group of locals, but nobody knew who we were talking about. Finally, somebody said, “Oh, do you mean the kid with the small head? He lives at the end of that street.” We found him, he got his retainers and things stayed stable. Even though there are many limitations and challenges in providing quality ongoing orthodontic care in another country, it was great to provide care in a way that affected his quality of life in almost every aspect, from aesthetics and personal confidence to health and function.


What’s an inexpensive (under $500) investment or purchase you’ve made that has made the best impact? What high-dollar investment has given you the best ROI?
The iPads and TVs throughout the office are so inexpensive and easy to maintain. The kids love them. A few years back Nintendo came out with small versions of the original NES and SNES systems. I paid about $80 each for them. Kids and parents play them every day in our office.

The i-CAT FLX V17 was a big purchase, but definitely worth it. At the time there was a debate on whether we should stick with 2D imaging or move to 3D. It has really helped with diagnosis and treatment evaluation. Low-dose scans are so fast and clear. Hands down it has been the best equipment purchase I have made.


Give us a snapshot of your life.
I have a busy life. I have been out of residency for 12 years now. My wife and I have four kids: three teenagers and one preteen. They keep us very busy. I probably spend just as much time at work as I do as a leader in my local church. I feel like my efforts there have a bigger impact on people’s lives than anything else I do outside of the home. If I can find any spare time, I enjoy target shooting and tending my garden of fruit trees. I also do all my home improvement work, which has become kind of a hobby. I have done some extensive additions and renovations to make my house ideal for the needs of my family.

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