Are you thinking it’s time to bring in an associate and start the process of planning a practice transition?  

Most dentists contemplate this matter at some point during their practice career but often struggle through the process and don’t know where to start. Taking the plunge is much easier once you feel more comfortable with your own perspective on dentistry.

As with all relationships, you have to work on you before you can offer something to another person. 

The Missing Link of Choosing an Associate

After many years of private practice and four associates who stayed an average of four years each (and left for “greener pastures”), I finally figured out the missing link.

This link is a clearly written and spoken practice philosophy. It is not your mission and/or vision statements (although they are important too). 

A Practice Philosophy

A practice philosophy is grounded in the 3-5 core values that describe the essence of WHO you are and WHAT you stand for. These crucial values also answer the question WHY? Why do you do what you do?  

My practice philosophy is rooted in the tenets of the Philosophy of Dentistry presented by Dr. LD Pankey. Living a life of success and happiness for Dr. Pankey meant being balanced in the areas: Work (Profession) – Love (Relationships) – Worship (Spirituality) – Play (Recreation).  

My philosophy is similar to Dr. Pankey’s, but also incorporates the values of Excellence, Integrity and Life-long learning. For me, being very clear in my principles and ideals made it much easier to evaluate and assess all potential candidates who considered joining me in my practice.   

Before embarking on the process to find the right associate/partner for your practice, ask yourself if you are clear on your core values and practice philosophy.  

Don’t miss Dr. Crete’s writing on 6-handed bonding restorations and his favorite dental material.

What does it mean to treatment plan your transition? It’s all about thinking strategically when it comes to the future of your career and the important relationships you will inevitably align with your goals.

Many dentists in the prime of their career decide it’s time for an associate to join the practice. Often it is because there is an overflow of patients or the senior doctor is interested in slowing down, taking more time off, and eventually planning for their retirement.   

Over the course of my career I’ve had four associates. One who took over a satellite practice I had purchased and three who moved on for various reasons. Even one who walked away from the “altar” when we had spent months planning to formalize the legal documents for a partnership.   

Lessons From a Professional Transition

What I’ve learned is that although the legal documents are important, it’s really the Core Values and Philosophy of the potential partner that form the glue capable of binding a solid long-term relationship.  

Once you have determined (usually with the help of a good practice management expert) that your business can financially support another dentist, it’s important to then reflect and put into writing the core values that are unique to you, your practice, and your philosophy of practice and life.

Share your core values with all potential associates and future partners. Make sure you are aligned in your principles and ideals. With a shared set of values you now have the blueprint for a successful future.  

I eventually found a partner to transition my practice to. It is our shared core values of Excellence, Relationships, and Balance that solidified our future and kept us on course for a successful transition.

What professional skills have you acquired over the years that have helped you throughout your career? 

This is part 2 in a series where Dr. Mike Crete describes an conservative esthetic case where he combined Invisalign and veneers.  Part one looks at helping the patient become aware of the possibilities. Read on for the conclusion.

A Smile Dialogue

… All of this conversation took place in about 5 minutes at the end of the patient’s initial hygiene examination. I then invited him to return for a ‘complimentary smile analysis’ appointment where I would take a series of digital photos and then sit down with him and talk about what we could do to improve his smile.   

I find I can build trust and credibility with a new patient by offering to see them for this complimentary appointment. It only takes about 20 minutes and I typically ‘convert’ the patient to a records appointment (comprehensive exam, X-rays, and mounted study models).

The records appointment was scheduled. More co-discovery revealed how significant Drew’s self-esteem was impacted by his smile and his ‘baby face and baby teeth.’ The records appointment was followed by a diagnostic wax up (or a “3D Design” as I like to call it when talking to patients).

Then a consultation was done to review treatment options. This was a formal case presentation using Powerpoint, photos, and mounted models. Drew’s mother sat in on the consultation appointment.

By having accurately mounted study models on a semi-adjustable articulator, I was able to determine I could give Drew an ideal occlusion AND a pleasing smile. This would involve some minor tooth movement using Invisalign for 6 months and then restoring his upper and lower anterior teeth with conservative porcelain veneers. His posterior teeth were equilibrated during the restorative process. Also, an upper bite guard was fabricated for nighttime wear and added protection of the restorations.  

Drew graduated from college approximately 18 months after I first met him. He completed an internship during his final semester and then was hired by the Fortune 500 company immediately following graduation. He recently got married and said to me, “After I had my teeth done everything in my life started to fall into place. I graduated, got a great job, and met the love of my life. Thanks, doc.”  

Changing a smile and changing a life. It’s being able to impact the lives of others in this way that makes it so rewarding to practice dentistry!  

Dr. Crete discusses an anterior esthetic case from the initial conversation to finished treatment plan for a patient who lacked smile confidence.

Patient Profile

Drew became a new patient at my practice as a 20-year-old junior in college. His reasoning was: “Just to get my teeth cleaned.” During his initial hygiene appointment, he mentioned the “spot” on his front tooth (#9 – small pit filled with composite 10 years prior).  

He asked: “Can you put some new bond on there and make it match better? Even when my dentist did it the first time, it was always obvious.”

I heard his question as a window to ask further questions and find out a little bit more about him. At Pankey, we call this, ‘knowing your patient.’ It can start with an introduction to a new patient during a hygiene examination.  

Asking the Right Questions for Case Acceptance

I began by asking, “Do you know why you had the bonding done?” and “Did you have a cavity?”  

His answer was, “No, I have been playing hockey since I was really little. I was not always good about wearing my mouth guard and I chipped my teeth a lot.”   

Further questioning revealed he was referring to the enhanced mamelons and pitted enamel areas of his anterior teeth as “chips.”

His parents had elected not to have the chips repaired because they were told it was cosmetic treatment and their insurance would likely not pay anything.  

The Value of Open Dialogue

I then asked a few more open-ended questions like, “Is there anything about your smile you would change?”  

His answer: “Well, I always feel like I have little teeth and it makes me look like a little kid. I wanted braces when I was in junior high but my dentist told me I had a good bite and braces wouldn’t fix all the spaces I have.”  

Further dialogue with Drew revealed a significant concern he had about graduating from business school in a year and having to go through interviews looking like a little kid. He said, ”I worry no one will want to hire me because I look so young.”

To be continued…

Have you ever recommended treatment to a patient and then gotten the “deer in the headlights” stare with the sound of silence in the room?

This is usually an indication the patient was listening to what you had to say … they just were not ready to HEAR what you said!

Knowing Your Patient and Learning When They Are Ready

One of the aspects of the Philosophy of Dentistry as taught by Dr. LD Pankey is the concept of “knowing” your patient. Do you really know what your patient’s circumstances, objectives, and temperament are?

When you really understand your patient, you are able to meet them where they are. You will then know when they might be ready to hear the recommendations you have to improve their dental health.

Knowing your patient starts with asking the right questions and using active listening skills while getting to know the patient. What are their values, fears, expectations, perceived needs? Do they have an appreciation of dentistry and value what it has to offer? A.K.A., what is their dental IQ?

Do they need more education about their current condition? Does their budget now include dental care? Are they ready to make an informed choice about their treatment options?

I oftentimes find myself initially putting out the “fire” for a patient (ie. repairing a broken cusp or chipped front tooth, getting the patient out of pain) and then easing the patient into care in our office in a way that makes them feel taken care of.

I may take several years to build trust with the patient, educate them about optimum oral health, and help them understand the root causes of their condition. Over time, the patient usually starts to ask more questions and dental health becomes a high value for them. They eventually say something like, “Hey doc, I’m READY … when can we get started?”

Developing your clinical skills is very important to providing excellent dental care. But I find it’s equally important to develop your communication skills such that you can really get to know your patient and know when they are READY to own their condition and get started with the necessary treatment.

How an Extra Dental Assistant Can Improve Your Protocol for Restorations

Restorations and adhesive dentistry have rapidly advanced over the past few decades. Changes in materials necessitate corresponding changes in protocol. Read on to learn the adjustment that drastically improved Dr. Mike Crete’s bonding process.

30 Years of Significant Advances in Clinical Dentistry

I have been practicing for a little over 30 years and often find myself looking back amazed at how many advances have occurred in clinical dentistry. Dental school requirements were focused on metal restorations that were either: (1) condensed into place (amalgam and gold foil) with “retention form” the key to success, or (2) cemented with the likes of zinc phosphate. Ah, the good ‘ol days of mixing on a cool glass slab!

My favorite general advancement over the years has been the concept of adhesive dentistry.  Not a day goes by in my practice where I don’t either bond a direct composite, bond a crown or two, or place an entire arch of bonded porcelain veneers.

Why 4-Handed Dentistry Fell Short for My Restorations

I must admit when I first started placing bonded restorations I was gun shy and felt like I would never be as adept as I was at carving amalgams or burnishing exquisite gold margins. I fumbled through bonded porcelain and composite like it was the same as metal restorations. I had mastered working with one chairside assistant. I could almost do dentistry blindfolded and 4-handed dentistry made me look great.

After about 3 years of really not liking treatment that involved bonding and finding myself justifying in my head how amalgam and gold were better, I finally had an aha moment when a mentor told me, ”You can’t do something new the old way.” I was a bit puzzled and asked, ”Why not?” My colleague then introduced me to the concept of 6-handed bonding.

6-Handed Dentistry Makes For a Better Bonding Protocol

Every time I do either a single unit or multiple indirect bonded restorations, I utilize both a chairside assistant and a “tray-side” or tertiary dental assistant. The tertiary assistant has the 5th and 6th hands.

The tertiary assistant helps by efficiently preparing the restorations for bonding (cleaning, silane, etch, prime, bond, resin adhesive, etc.) while the chairside assistant helps me keep the teeth isolated, etch the teeth, and place the restorations with precision and a very high level of accuracy. The chairside assistant can be totally focused on me and the patient, while the tertiary assistant prepares and hands me the indirect restorations.

Consider modifying your protocol to include a 3rd pair of hands and make 6-handed bonding part of your daily routine.

What is the most significant change in clinical dentistry you’ve noticed over the years? We’d love to hear from you in the comments!