Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard:

It is a huge honor for me today to land this podcast interview with Brady Frank who’s a dentist. Let me read your bio. Dr. Frank has a multiple practice owner for 14 years and has been teaching phasing out and expansion strategy as a dentist for over 8 years. Dr. Frank is the Founder of OsteoReady Implant Solutions. Dr. Frank and his wife of 10 years live in Oregon with their three boys. That's the only thing I’ve bumped you at. I have four boys, you only have three. Are you going to do a fourth to catch up with the Farrans?

Brady:

Well, we are hoping for a girl so we stopped trying for that about five years ago, I’d say.

Howard:

Yeah, well, my first one was supposed to be a girl, Erica, and it turned out to be an Eric. Second one was going to be [Megan 00:00:51], turned out to be Greg. The third one, Ryan, he manages my podcast. He was supposed to be a girl. Zach was supposed to be a girl. I finally got a girl granddaughter, so I finally got my reward, little Taylor.

Brady:

Really? Excellent.

Howard:

I tell everyone that a granddaughter is a reward for not killing all four of your sons.

Brady:

That's so true.

Howard:

Dude, you are amazing. You’re the founder of OsteoReady out of Seattle. Two things I want to talk to you about. I want to talk to you about how the heck does a general dentist … Because you make your implants, right?

Brady:

Yeah. It didn’t start with manufacturing …

Howard:

Yeah, how did you go into that? Then I also wanted to talk to you because you’re an entrepreneurial satellite practice owner helping dentists transition out. Can I talk to you about both of those today?

Brady:

Yeah, of course, absolutely.

Howard:

Which one do you want to talk about first, bone or practices?

Brady:

Bone or practices, that's a tough one. Maybe since you brought …

Howard:

By the way, and your teeth are …

Brady:

… since you spliced the …

Howard:

… your teeth are perfect.

Brady:

Yeah. Since you spliced that OsteoReady piece into there, maybe I’ll talk about that one question you ask is how did I end up starting a company that manufactures implants.

Howard:

Yeah, let's do that first.

Brady:

Okay.

Howard:

Let's start with OsteoReady.

Brady:

We’ll do that and then I’ll go back and-

Howard:

I also want to say that a couple of my biggest role models on earth speak so highly. Steffany Mohan out of Iowa, I mean I think that woman has got to be one of the smartest dentists on earth, and from everything, from running a group practice to marketing. I mean if you go to Iowa she’s on the morning talk show all the time, Steffany Mohan. Erin Elliott in Idaho, I mean how do you get much smarter than that woman. You just have so many rock stars. Guy Gross in Kansas City, and then Tony Feck out of Lexington, Kentucky. These are all your friends and trainers of OsteoReady and it just speaks so highly of you that four of my … I mean Tony Feck is a legend. How did you get all these legends to train OsteoReady and to speak so highly of you? Are you just that great of a guy?

Brady:

Well, trust me, I’m not some amazing guy. Here’s how it happened. I was using five different implant systems. Nobel Biocare because I liked Replace Select with root form implant. I was using a solution for mini implants for narrow ridges, IMTEC minis. I was using a real narrow or a short wide implant like Bicon for areas with deficient maxilla. I was using Implant Direct due to the cost. I said, “There’s got to be a better way. I’m using five systems to achieve five different kind of [crosstalk 00:03:37]-

Howard:

Hey, I only counted four, Nobel Biocare, IMTEC, Bicon, Implant Direct, what was the fifth?

Brady:

The fifth was, what was I using? ANKYLOS because of the morse taper for a really good hermetic seal.

Howard:

That's by DENTSPLY?

Brady:

Yeah, by DENTSPLY.

Howard:

Okay, okay.

Brady:

I had all sorts of inventory, all sorts of parts, and I went to the engineers of the big companies that actually manufacture the implants for the retailers. What I didn’t realize was that these big companies oftentimes did not manufacture their own implants. I talked to about five engineers and I said, “Is there a way you could create all the positive attributes of all five of these systems that I’m using and put them in one system?” They said, “Yeah, we’ve been trying to tell the big companies to do this for years.” I ended up creating a system for myself because at that time I was placing over 200 implants a month and my account was in-

Howard:

Holy molly.

Brady:

Yeah. I was going to a lot of denture clinics, so up to 30 implants a day that's why I was [crosstalk 00:04:42].

Howard:

You were going into their offices.

Brady:

Yes, yes. I called 13 denturists and said, “Can I come into your office one day a week and just do your implants and extractions?” They said, “There’s no way you could do all that but we’ll stack you up with as many implant cases as you can handle.” I’d work a 12-hour day, it was tough, and I’d bring all the equipment in, mobile panoramic, mobile unit, everything, and work out of one room and do consults in the other, and do one implant case every hour about. I had to remove the Statim in there. That's why I was doing 30 implants a day many days and was doing over 200 implants a month.

Howard:

You’re speaking to dentists in every single country that iTunes has, gets a deal on every podcast. What is a denturist? Even within the United States, a denturist is only legal in some States.

Brady:

That's right. Denturism-

Howard:

I don't know if it's legal here in Arizona.

Brady:

Yeah, denturism is legal in Maine, Arizona, Colorado, Washington, Oregon, Montana, and Idaho. There’s the seven-

Howard:

Say it again, Maine, Arizona, Colorado.

Brady:

Maine, Arizona, Colorado, Oregon, Washington, Montano, and Idaho, they’re the seven States. Now other States have denturists, many people haven’t heard of them, but if you ever see something that just says denture clinic, in other States they are legal, they just have to have direct oversight of a dentist. That's how it is in Arizona.

Howard:

You were kind of doing, what it was, ClearChoice where they …

Brady:

Yeah.

Howard:

ClearChoice is the All-on-4, right?

Brady:

Yeah, yeah.

Howard:

Who was their chief oral surgeon, Dr. Ole Jensen out of Colorado?

Brady:

I know who you’re talking about but I forget his name.

Howard:

You were kind of that business model, you were going in there and what percent did you get of the fee? Do you know what percent the ClearChoice people … Because that's what they do, they set up the facility, say, “We’ll do all the marketing, location, facility …

Brady:

Yeah, yeah, yeah.

Howard:

… and then we’ll bring in a periodontist or an oral surgeon usually from another town and [knock a mile 00:06:45].” Do you know what ClearChoice pays their doctors?

Brady:

I do because when I was teaching phasing out seminars, transition seminars, a general dentist took my seminar from Colorado, and the CFO of ClearChoice was this guy’s patient, so he gave me all the numbers. When he talked to me he said I can’t tell anybody else. In light of that I will say I’ll give you the numbers of what I was doing in the denturist clinic so if anybody listening wants to do something similar. My overhead, get this, the average overhead today of a GP in the U.S. I think is 68.5% per the ADA’s most recent study. My overhead in the denturist clinics, because I didn’t have a lease, I didn’t have a bunch of staff, I didn’t have a big supply bill, I was using just the implants themselves basically, the denturists paid the minor supplies. I didn’t have utilities, I didn’t have a lot of the expenses you’d have as a general dentist, 17% was my overhead.

Some days at the end of the day my assistant would bring the cash checks and credit cards, and it was over $100,000 at 17% overhead. In that one day I was earning more than my private practice. I was like, “Wow, this is crazy.” That's when I realized …

Howard:

What did the denturists make of it because they’re providing the patients, the facility?

Brady:

Yes. I paid them a simple lease payment, that was it. They just viewed it as a big benefit to having their denture patients be seen in-house. I just paid them a lease payment, so I had part of the office and they had part, I just paid them a lease payment. It was a huge value add for them because when they give a denture patient over to a dentist to place implants it's because that denture patient’s a problem. They can’t fix him. They’re like, “You need implants.” Now they have a guy that comes into their office, gives them a better rate on the implants and does it right there where they trust going. It was easy. It was a huge advantage to them for me to come in there and do that. I’d be happy to give anybody information on that, just email me at bradyfrank74@gmail.com.

My wife said, “Brady, you either get to go around and lecture internationally or do the denturist thing, one of the two, but you can’t be traveling away from the three boys,” now that we had had three boys. I chose lecturing but it's a great thing for those of you that want to place more implants.

Howard:

I’ve got to tell you off the record, I have four boys, and you know how you do family vacations. What I did separately on the lectures is I would take one boy with me to [a lot of ones 00:09:21], especially London, Italy, wherever. Looking back, my boys now are 21, 23, 25, 27. Those one-on-one trips that I took a boy to Italy or London or Australia, those are some of the neatest trips and memories they ever had, and they still talk about them all the time. I’d divide those three boys up on some of those long haul trips, just do a one-on-one, I think that [crosstalk 00:09:42].

Brady:

I should do that.

Howard:

Yeah, they’re great. Man, you’re just a whiz kid, just a whiz kid.

Brady:

I’m not a whiz kid, but let me finish that thing about the five different implant systems, how I got them to manufacture it. I asked the engineers, I said, “Could you create a system that has all the positive attributes of all five of these systems?” like I’d gone over, and they said, “Absolutely.” They created a system for me with my guidance that basically did all the things of the systems that I had. I needed a narrow implant for skinny ridges, an OsteoHybrid that was still conventional, needed a short wide implant for areas by the sinus so I didn’t have to do sinus lifts with grafting. I wanted a root form implant like Nobel Biocare’s Replace Select.

Basically did that, created a system that basically took all five systems in one and made it all with the same platform so one abutment will fit either the most narrow implant or the widest implant. If you talk to your assistant, [Betsy 00:10:50], you say, “Betsy, I’d like an abutment, please.” Betsy passes you the abutment and it fits any of the implants. You just need a little bit of inventory rather than having a bunch of confusing inventory. That took off. What I didn’t realize was that what was easier and more efficient for the general dentist would also be easier and more efficient for specialists.

Now a lot of the top specialists in the U.S. and in Italy utilize this system because it's easier and you’ve got a more efficient drilling protocol with the 1-Drill implant procedure, which is really what has caused me to speak in China and be in Israel recently, in Germany, and I’d say it's the 1-Drill implant that's changed everything for a lot of general dentists and why I think OsteoReady is unique.

Howard:

Now when you said the 1-Drill Implant, explain that in more detail.

Brady:

I don't know if you’ve heard of DENTSPLY’s WaveOne Endo. WaveOne Endo basically has a custom fit gutta-percha cone to a file. The red file fits the red gutta-percha cone real easy, boom, boom, and they used to call it one file endo.

Howard:

You’re talking about Tulsa Dental Products owned by DENTSPLY.

Brady:

I think it is.

Howard:

Right, it is.

Brady:

I don’t want to get anything wrong, but anyway, it was WaveOne Endo. Aside from that, that became very popular. Right now the standard in implant dentistry is that you use about four of five different drills to drill the hole for one implant. I invented the Multi-Drill, it's about four and a half years ago now. The Multi-Drill has all four or five drills built into 1-Drill. Instead of using your pilot hole, then a 2.8, changing your drill, 3.2, changing your drill, 3.8, changing your drill, 4.2, changing your drill, the Multi-Drill has every drill built into it and so you just need 1-Drill. Zip, and then place your implant. That's why OsteoReady has become so popular, because it takes about 300% less time to place an implant and you generate less heat in the bone, less patient discomfort. Anyway, that's probably the biggest [crosstalk 00:13:12].

Howard:

Okay, now can I chew you out and spank you?

Brady:

Yes, you may.

Howard:

You are one of the most requested online CE courses on Dentaltown. We put up 350 courses, they’ve been viewed over half a million times, and I’ve gotten so many personal messages saying why don’t you … because you’re a dentist.

Brady:

Yes.

Howard:

You’re not a lawyer selling implants, you’re a dentist, you do this. They would love to have you explain all that, and it’d be massive marketing for you.

Brady:

Here’s my promise to you right now. I’m going to do it within the next 30 days. I told Howard Goldstein that I would do it. My problem is it took us 20 minutes to get this podcast going, [my son 00:13:56] couldn’t teach me fast enough. I’m not good with technology, but now that I’m [with this 00:14:00] right here, I’ll do it. I’ll-

Howard:

Well, what’s your sweet spot when you’re on Power Point to just show the slides and just do that?

Brady:

If I could have two hours I could go through five procedures that verifiably will increase a general dentist’s production by 26% within 12 months. My-

Howard:

Name those five procedures.

Brady:

The-

Howard:

Can we go through them all?

Brady:

Yeah, yeah, sure, we can. The first one’s the No-Drill implant procedure. That's using a specific tool called an OsteoConverter. An OsteoConverter takes a socket site, let's say you extract a premolar and you’ve got an oval. An OsteoConverter converts that socket site into something that accommodates an implant. You basically take the tooth out and screw in that OsteoConverter. That's called a No-Drill implant. Now a lot of general dentists who place 20, 40, 50 implants a month use that, probably three, four times a month. It's a lifesaver when the apex of the tooth is right against the sinus and you don’t want to drill beyond the apex of the tooth. You can literally extract the tooth, say, number 13, screw this OsteoConverter in there and you don’t invade the sinus. Otherwise you wouldn’t be able to place that implant, you’d have to graft it and wait.

The No-Drill implant, however, is probably the biggest benefit to a dentist who’s never placed implants before. If you’re listening to this and you’ve never placed implants, if you go to the OsteoReady site that Howard gave at the beginning, you can click on Procedures, click on No-Drill Implant, it’ll walk you through it. I like to say it's the gateway drug to implantology because you don’t need surgical tools. If a dentist has never placed an implant, it's a great first procedure. I would say over 700 dentists in the U.S. have gotten into implants with this procedure just over the last four years. Take a tooth out, screw in an implant just below the level of the bone and then graft as needed around it, just pack, graft around it, BaseBone, I prefer, around it, and boom, there you go. That [crosstalk 00:16:14].

Howard:

Now when you do your online course you can insert those videos right in there too. You’ve already got the content.

Brady:

Yeah, I could insert the videos [crosstalk 00:16:22].

Howard:

You could do the Power Point then you can insert, because I’m sure they’re on YouTube, right?

Brady:

Yeah, there’s a bunch of them on YouTube. Tony Feck has a bunch of them because he’s one of the educators. Just as long as I mention the word BaseBone, people say, “What's BaseBone?” BaseBone is actually a new product out there, it's only sold wholesale. I’ve been using it for eight years. It is irradiated with super critical carbon dioxide which is liquid carbon dioxide rather than heavy gamma ray sterilization, so it keeps more of its live proteins and collagen content, the fibroblasts, so you pack it like an amalgam. When you do that immediate you’ve always got some space around the implant and the socket site. You actually go to eBay, buy a sterile amalgam well and amalgam carrier, you put this bone in there hydrated, it's two particulate sizes, but because it is sterilized with carbon dioxide it's not desiccated and over irradiated. You only use 10% of the normal gamma ray sterilization.

When you pack that bone around the tooth you don’t need a collagen plug over the top, you just pack it right to the top of the soft tissue that acts as your collagen plug, you save a step. Anyway, the guy who loves that is a periodontist who is co-editor of the largest periodontal journal internationally, and he’s the one that created the particulate for BaseBone and-

Howard:

Who’s that?

Brady:

His name is Marc Nevins. You can look him up, M-A-R-C, Nevins, N-E-V-I-N-S. If anyone looks him up you’ll see that he’s got-

Howard:

Is he your friend?

Brady:

He is my friend.

Howard:

Will you score me a podcast with him?

Brady:

I will. He’s ultra-technical. I mean this guy lectures all over the world. He’s the guy that's the quality control guy for OsteoReady. Yeah-

Howard:

Where does he practice?

Brady:

He’s over in Boston, Massachusetts.

Howard:

Boston.

Brady:

Yeah.

Howard:

Tell  him to score me a Boston Marathon race ticket because I’ll never qualify … I’ll have to find some … how I got into Iron Man is I found a charity where the Iron Man gave them tickets to raise money.

Brady:

Yeah?

Howard:

This charity was auctioning it off for five grand. It was a great charity. I gave them five grand so I scored an Iron Man ticket for the Arizona Iron Man. The only way I’m going to run the Boston Marathon which is my dream is if I buy my way into it.

Brady:

Yeah.

Howard:

I’m too fat.

Brady:

I think he’s ran it before, this guy. He’ll correct me but he’s a runner and I think he may have either done that or one of the shorter versions. Yeah, I’ll get you in touch with him. Most of the general dentists listening to this have probably not heard of him. He’s ultra-researchy, phenomenal clinician, and yeah, so I’ll get you [crosstalk 00:19:08].

Howard:

Now when you’re screwing in that, you’re talking these are just maxilla, these are just upper maxilla, you can’t screw that into an anterior mandible.

Brady:

Yeah, you can if you’ve taken out tooth number 21, say, or 20, and you’ve got good facial bone, you don’t have any dehiscence in it, you can actually screw that puppy, that OsteoConverter right down there, put it below the crest of the bone in case you have any resorption, and then graft with BaseBone around it. BaseBone is that packable amalgam-like bone.

Howard:

Yeah, and I can’t wait to see this course. This is going to be amazing.

Brady:

Yeah. It’s-

Howard:

Because you talk about five. One was the No-Drill.

Brady:

Yeah, so one’s a No-Drill, great for a newbie because you don’t have to use surgical instruments. Simple, simple, takes about 30, 40 seconds to do it. One of them is the 1-Drill implant procedure. The 1-Drill is using the Multi-Drill. There’s a schematic on the website, but to explain it real quickly, you use 1-Drill that is custom fit to each diameter of implant. Let's say you’re using the 4.2 by 11.5 implant. You use the appropriate Multi-Drill for that 4.2, zip, goes down there, and then you place your implant. It decreases the implant placement time a lot. Decreased implant placement time reduces the potential for oral microbes to get in the osteotomy, it reduces heat generation. That drill is manufactured in France, and they actually use a diamond lathe with the strongest stainless steel.

Rather than being used for 8 to 10 implants, it's good for up to 80 implant procedures per Multi-Drill. You can do 80 implants per Multi-Drill because it keeps its edge longer. They actually have to use diamonds to lathe this drill.

Howard:

That is amazing.

Brady:

That's a Multi-Drill. That's for the 1-Drill implant procedure, a favorite amongst a lot of folks. The OsteoHybrid implant, they say the OsteoHybrid is as easy to place as a mini but has the lifetime success rate of a conventional implant. The OsteoHybrid it’s a mini at the apex-

Howard:

Say that again, it has the …

Brady:

It's as easy to place as a mini. Remember everyone that loved minis about eight years ago, they were talking about it all the time. Now the fad has gone because the FDA has called it a seven-year fix. This is a conventional implant, no doubt, it's not a mini, but it's called an OsteoHybrid because the apex of it is a mini. It's only 1.8 millimeters at the apex. That flares up to 3.75 at the occlusal. It is FDA-approved as a true conventional implant. As easy to place as a mini, as long-lasting and lifelong success rate like a conventional.

What you do is you do a single pilot hole in your bone, say you’re doing number four and it's a narrow ridge and you’re saying, “I don't know if I can do an implant up there. I might need to send it to my periodontist to do a ridge split,” which is episiotome, split the ridge, gain stability at the apical third of the implant, pack bone around it, do a membrane, two-hour procedure. This actually takes advantage of the 8% of bone that's fibroblastic. You put a pilot hole right in the middle of the ridge and then as you crank in your OsteoHybrid the bone expands, crank, crank, crank, crank, crank, crank. Then it's about a two to three-minute procedure. It expands, there’s a local ridge expansion, that's the OsteoHybrid.

Howard:

Now the FDA, the cut out’s 3.0, right?

Brady:

Yeah.

Howard:

Anything under a 3.0 diameter the FDA calls a mini implant?

Brady:

Yes, yes.

Howard:

Then anything 3.0 and above is it a root form implant?

Brady:

They actually call anything over 3.0, so if it's a 3.0 implant, period, they generally call it a narrow body. Now this is a 3.75 so it's actually classified as a normal conventional implant. Now even though the apex is 1.8 millimeters, it flares up mid body, it's about 2.6, and then at the top it's 3.75. If you take the average surface area on it, it qualifies as a true conventional implant, which is how the FDA ascertains whether it's a conventional or a mini. It has to go over a certain number of Newton centimeters. Don’t quote me, I think it's 104 Newton square millimeters of surface area and it qualifies for conventional. I can look that number up if you want. Anyway, so that's what makes it a conventional.

Howard:

Okay, so it's one’s the No-Drill implant procedure, two’s the 1-Drill, three’s the OsteoHybrid. What's four and five?

Brady:

Number four is the OsteoLift. The OsteoLift is really for general dentists that don’t want to do a bunch of big open sinus surgeries in their practice. It's for general dentists who already do a lot of crown and bridge work, a lot of composites, a lot of endo, and it leverages off the research from 1984 that Bicon has done. Bicon’s implants are amongst the most successful in the U.S. and Bicon’s average implant size is, I don't know what it is, but they’re generally between 5 millimeters long and 8 long. An 8-millimeter long Bicon is a very long implant. The OsteoLift, as it differs from Bicon, is it's got a spiral. Rather than Bicon where you tap it into place, you actually screw an OsteoLift into place gaining more primary stability at placement.

It's for areas where you don’t have much bone in the maxilla and you want to screw that implant up to the sinus floor but not do a sinus bump. It's for folks that want to be able to give their patients a solution without a major surgery while still having the same success rate as longer 10 and 13 millimeter implants.

Howard:

Let's stop here and talk about that a little bit because I want to focus on where the ball is during the game. There’s an oral surgeon in London who’s on Dentaltown showing all these cases, these short, fat implants. He shows like 5, 8, 10-year post-ofs, and yet everybody is like, they’re too short, they’re too short, they’re too … The mentality right now in 2016 is that you need a really long implant that goes out the back of your head and wraps around the moon three times, but what you’re saying is that's not true.

Brady:

Yeah.

Howard:

Go over that again because [we’re going to 00:25:54] thousands of dentists around the world and they believe length is everything, and it's really fat, right?

Brady:

Yeah, it's a wider, fatter, shorter implant. Here’s where the research comes in. Anyone who disagrees with the utilization of short wide implants, look up this research, I think it’ll help you. Go to PubMed, whatever it is. First, ClearChoice, the All-on-4 procedure puts a full arch of teeth on how many implants? Four, right? If you do the math on four implants and all those teeth you get a certain amount of surface area per implant. With the short wide implant, the reason it's a wider implant is because if it has to be shorter because of the sinus, if it has to be shorter then it's got to be wider to compensate for the surface area. You cannot do a short 3.0 implant. That's ridiculous.

You can do a short 6.0 wide implant, because the wider it is the more surface area, and a function of implant success is the surface area to crown ratio. In natural teeth they call it the crown to root ratio. In implants it's the crown to surface area ratio. If you go over a certain threshold of surface area per implant then it's all about the osseointegration. Now those folks that say, “We need a longer implant,” they are correct only from the standpoint that a longer implant will give you more primary stability pre-osseointegration, meaning the first 90 days, yes, a longer implant has more primary stability, but after 90 days after osseointegration then the short implants will perform just like the other implants per that ratio of surface area to crown.

Anyone that wants to research that go to Bicon’s research, they’ve been doing it since 1984. Phenomenal research, but here’s the key, you’ve got to wait until those short implants are fully osseointegrated or you could have a failure. Bicon recommends four to six months, OsteoReady recommends three to four months because the OsteoLift actually has a twisted threading so it gains a lot more primary stability when you place it initially.

Howard:

Bicon’s out of Boston, right?

Brady:

I believe they are. I believe they are.

Howard:

Was there some founder dentist that started all that or is that more of an engineering company?

Brady:

You know, I don’t even know. I would imagine it was some specialist that probably started it but I have no idea.

Howard:

What's your fifth? The OsteoLift was the fourth, what's the fifth?

Brady:

The fifth was born during the time I used to go to the denturist practices, and these denture patients, some of them wanted the Cadillac. They wanted full upper and lower arches of teeth. The fifth one is the three-appointment full arch implant solution with multi-unit abutments. It's similar to the All-on-4 procedure but you don’t require all this lab work ahead of time, you don’t require detailed CAT scan guides, it's built for the general dentist to take care of their patients in their practice without going through a ton of technological stuff that they might be up on. The first appointment involves placing all the implants, upper and lower, and then getting a bite relation using their current dentures. That's appointment one is placement and getting a vertical.

That appointment one utilizes no suture techniques, so no flaps. All the procedures that OsteoReady teaches involve no flaps, no sutures. I’m not saying for those listening that are saying, “Well, you’ve got to flap some of them.” I’m not saying that you can do every implant procedure without flapping. I’m saying OsteoReady teaches the 80% of the procedures that you can do flaplessly. I know there’s 20% of procedures that you need to have a flap. Nevertheless, you do it flaplessly with these denture patients, and you take your final impression with these abutments called OsteoReady multi-unit abutments. They’re gold-colored abutments, I should say, that are titanium, and you take an open tray impression. First one, implant placement final impression’s vertical.

Next appointment you put the frames in place and the lab gives you back wax rims on your bite. Then you screw them into place and do your VDO midline, get it just right. Then the lab sends back the frames with denture teeth that are flasked into place, screw them in, do a bite adjustment, you’re done. No denture adjustments. You can go to a fourth appointment if you want to do a wax try-in before flasking it to make sure that the patient loves the shade of the teeth, the midline’s on, all that stuff. Really easy appointments and I did a lot of those during the denturist thing.

Howard:

How long between appointment one and two, between placing the implants and screwing on?

Brady:

Between appointment one and two, two months, and that's when you try the frames in. Then the third appointment I usually seek that at the three-month mark. All the implants have had three full months to osseointegrate. It's not an immediate load procedure as opposed to the All-on-4 procedure which is immediate load. Instead of doing immediate load and prosthetics, I do immediate dentures that they’re wearing and I say, “That’s your band aid for now,” if they’re immediates. Or if they already have dentures you put the implants underneath, put cover screws on and [crosstalk 00:31:47].

Howard:

They’re doing those All-on-4 immediate load because those implants are so long they’re going in like zygomatic arch bone …

Brady:

Yeah.

Howard:

… mandible bone, they’re going clear through alveolar bone, right?

Brady:

Exactly. I will say many general dentists listening right now they’re not comfortable sticking a 16-millimeter right before the orbit, you know what I mean?

Howard:

Right.

Brady:

With this procedure instead of placing really long ones like All-on-4, you do six reasonable-sized ones, so you’re staying right in the alveolar crest.

Howard:

Where do those All-on-4 all go, upper and lower?

Brady:

The All-on-4 you get this one that angles right in front of the mesial portion of the sinus, and it goes right in-between where the canine ends and the sinus begins, right there.

Howard:

In the zygomatic arch?

Brady:

Well, not the zygomatic, they call it the, I don't know what they call that little piece right here. Zygomatics go way back here, and these ones go forward, these All-on-4, and then two right here, 7 and 10, and then basically 13 and number 4, but angled mesially right where that canine eminence is basically. You try and touch the canine eminence with those long ones. What I’m saying is most general dentists they don’t want to be doing that so you can [crosstalk 00:33:04].

Howard:

They shouldn’t be doing that. I mean you’ve got to be a surgeon to do that.

Brady:

Yeah, that's right. I’m not saying go out there and open them up and go right up here, I’m saying, use a 10, 11.5 or 13 implants, put them in there, and you can restore those, you just maybe want to do a 6 on top and 4 in the bottom because the bone’s hard. That's the fifth procedure, those are fun. Many of these procedures were built basically to help some dentists own multiple practices and increase in those practices. Maybe what I’ll do is, Howard, you asked me at the beginning, you said, “Hey, I want to talk about the entrepreneurial satellite practice ownership [crosstalk 00:33:49]-

Howard:

Well, wait, can I stay on OsteoReady for a while …

Brady:

Yes, you can.

Howard:

… first? I want to go back. My job is to ask the main questions. I know some listeners complain to me that I interrupt too much and all that stuff, but I get a lot of feedback that you should ask this, you should ask this. Whenever you’re talking implants, the first thing they’re going to ask, I mean this probably literally a couple of people asking this right now, do you need surgical guides?

Brady:

My answer about that [crosstalk 00:34:17]-

Howard:

The follow-up question is going to be do I need a CBCT tracing? Talk about the pre-op workup, do I need surgical guides? Do I need access to a CBCT? Do I need to do a tracing? Talk more about that.

Brady:

I’m going to answer it not with what little old Brady thinks because I don't think many people care about little old Brady thinks but I am going to …

Howard:

I do. I do.

Brady:

… but I am going to quote Gordon Christensen. Gordon Christensen believes that the majority of cases, based on what I’ve seen him write about and whatnot, can be done without a guide. Now you can do a guide as well but let me not take a side on this, but let me talk about the benefits of not using a guide and also the benefits of using a guide, because I know so many general dentists who don’t use a guide and say that they believe a guide is like a false sense of security, much like your anti-lock brakes on a Jeep. Some people have anti-lock brakes have got to fly down the snow in Oregon here, we have snow up here. They’re like, “Yeah, I got anti-lock brakes,” but then they’re in the trenches in a little bit. Here’s …

Howard:

I never thought I’d hear a four-wheel drive Jeep anti-lock analogy with dental implants but you …

Brady:

Yeah, I know. It's crazy.

Howard:

… you just delivered that straight from Pluto.

Brady:

Yeah, that's right. Many people who have used guides I’ve heard a lot of horror stories. They say, “I used the guide. I did it right like the guide. I stuck it in and the implant part was sticking out of the bone.” You’re reliant on several other people oftentimes when you have a guide made, the lab. Just like when dentists say, when a crown doesn’t fit they say, “There must have been distortion in the impression,” or, “maybe there was a void somewhere.” Well, you can say that as well with a guide but at the end of the day if the surgery didn’t go right, what do you do? A guide is only as good as the person who makes it. I believe you can control clinically in the mouth the situation better potentially without a guide, if I was going to argue for those who don’t use a guide.

I believe using about six techniques that I use that you can stay in the bone 100% of the time in the mouth and not deviate. With a guide oftentimes the lab will put the implant where they want the implant, and sometimes that's not correct. Now for those of you listening that say, “I’ve got a great lab, they know exactly where it should be.” Great, I don’t fault you whatsoever for it. You know what, sometimes when people come to the dental practice and they have a hurting tooth or they want to get an implant and they want to come in tomorrow, you don’t have three weeks of planning time with your lab and so there are some valid reasons to not use a guide. I’ve used a guide twice with over 12,000 implants.

Howard:

You’ve only used a guide twice?

Brady:

Twice with 12,000 implants. Now as a caveat to that, I don’t to ultra-complex cases. I own multiple practices, I’m fee for service, I wanted to sign up with PPOs for years but I just haven’t had any time to sign up with PPOs. A lot of people tell me not to but I still want to. I really believe that a general dentist should do the 80% of cases that they can do easily, efficiently, good, solid ridges where maybe they don’t feel like they need to use a guide, sure, your first 100 maybe do that but you don’t feel like you need to, take the 20% of cases where you say, “I need a guide for that,” maybe give it to your friendly oral surgeon because I believe if general dentists work with their specialists in the future like we currently work with our endodontists, that implants will be a lot stronger in the future. Give these tough cases to your-

Howard:

Okay, how many implants have you placed, you said 12,000?

Brady:

Yeah, currently a little over 12,000.

Howard:

Here’s my problem when I’m trying to lecture to a room of 300 people and they’re all different ages and experience and everything, whenever I talk to an implant legend that's placed 10,000, 20,000 implants, they never use a guide. Then every time we talk to someone who’s placed 20, they’re just preaching a guide and it’s …

Brady:

Yes.

Howard:

… so confusing. Most everyone I talk to that's placed 10,000 or 20,000 say they don’t like you getting used to a guide, they want you to learn how to place implants. Gordon Christensen even told a story that back in the day there were a lot of prosthodontists teaching using guides to prep teeth so they could be parallel and Gordon said it was a training crutch and what you need to do is get rid of that and learn how to properly. I want to go back to the CBCT though, what percent of these 12,000 did you get a CBCT on?

Brady:

The first 10,000 implants I placed with just a panoramic. I had like three CBCTs in the first 10,000 but the rest of them were just for the pan. Now mind you, I’m doing the 80% I think a general dentist can do without it, but [inaudible 00:39:07] that you need a CBC to do really well on. I’d recommend you give those to someone that has a CBCT or your specialist. The vast majority of them you can use techniques in the mouth to measure that bone. I’d also like to say if you have a CBCT and you measure it outside the mouth you still have to take measurements in the mouth, so it's more of a diagnostic tool than anything. Do I have a CBCT? Yes. The first 10,000 I placed without a CBCT, the last 2,000 that I placed I placed with a CBCT, because I’m almost given CBCTs because of what I do with teaching dentists, I get good deals on CBCTs, so I have them.

For those of you listening that just have a panoramic, help your patients out, learn how to do it without a CBCT, and once you’re placing 10 implants a month, sure, go out there and buy a CBCT. You can get them from anywhere from $70,000 to $120,000 right now. They’re a good value, they help with endo too, but don’t make getting a CBCT a barrier to you really getting active with implant placement.

Howard:

You said that you can teach people six techniques to place implants without, did you say techniques to place implants without a surgical guide …

Brady:

Yes, six techniques to place [crosstalk 00:40:25] CBCT, yes.

Howard:

… and without a surgical guide.

Brady:

Yes, without a surgical guide. I’ll go-

Howard:

Can I hear those?

Brady:

Okay, I’ll go over them briefly.

Howard:

You don’t have to be brief, this is Dentistry Uncensored.

Brady:

I really want to help folks out do what I did out of school which is own a bunch of practices because I believe in dentistry today if us general dentists networked together to own multiple practices, we’re going to even out what's happening with corporate dentistry. I have nothing-

Howard:

We’ll get to that in two minutes.

Brady:

Okay.

Howard:

These six techniques-

Brady:

Here we go. Okay, six techniques. If you are a general dentist and you’re wanting to make it easier to place implants, here’s a few tips. I elaborate on this at the courses that we teach around the nation. First of all, draw an imaginary line from central groove to central groove, so number 20 and number 19, draw an imaginary line through the central groove of both of them. That should be exactly where you place the implant because if you place the implant there your abutment’s going to come out right in the middle of where the tooth should be so you can take a direct impression in the mouth for the crown, saving you a bunch of lab fees on a custom abutment.

First one, draw an imaginary line between the central grooves of those two teeth, and look straight down to do it with your mirror or straight down. That's number one. Number two, let's say we’re doing number four and we’ve drawn a line through the central groove number three to number five. Right in the middle, that's where it should be. Then soft tissue access using your high speed hand piece, a special bur called the duo bur that OsteoReady can get you in touch with. This bur goes near high speed hand piece and it does a soft tissue access in keratinized tissue and bone. You use your high speed just for the soft tissue and a little in the bone.

For those of you listening saying, “Well, you’re going to burn the bone up with your high speed.” Not if you do it delicately, and remember, your implant drill is going to take out that bone if you burn it because you’re going to go in with your implant drill, your Multi-Drill after that. Anyway, but after you drill that initial hole you then put a kink in your anesthetic needle and you do bone sounding. Here’s your ridge, bone sound on the buccal, bone sound on the lingual. What happens is your mind is better than you think. As a dentist, your mind will create a 3D image in your head. Remember, everybody listening today passed the PAT, the perceptual abilities test. You had to visualize a trapezoid on the back side of a square. We can think in 3D.

If you don’t want to use your anesthetic needle, I like it the best because it goes right to the bone, you can feel it, you can use a Perio Probe or a explorer. Feel that bone. Now place your first pilot hole but look from the side, look from the side right here and go right parallel to the straightest tooth. Probably the straightest tooth is one of the premolars. Hold it up against that premolar if you’re doing upper and then drill your hole. Hold it up against the premolar, drill your hole. Just like if you’re doing a bridge preparation and you go to one of the bridge preps and you hold it against there to get parallelism or the right angle. Do that, hold it against that premolar, that gets it nice and straight.

Those are a few ways to get it straight, I believe straighter than if you had a guide, and to do it easily, share side, and of course if you want to double-check yourself, take a PA and whatnot, but we go over more in detail how to do that. If you want to do a guide, there’s nothing wrong with that. Make your guide yourself, do those same deals outside of the mouth and you can do that.

Howard:

You’re going to create a online course for us.

Brady:

Yeah, I promise you in the next 30 days I’ll work with Howard Goldstein to create, and I’ll go into more detail with how to do that as well.

Howard:

You’re a listener and you want to create a course for Dentaltown just email hogo, H-O-G-O@dentaltown.com and put a course up because they’re the future. You don’t have to shut down your office, you don’t have to travel across country. Now if someone wants to learn this, you have hands-on centers with all these amazing doctors, am I correct, they could go see Steffany Mohan in Iowa?

Brady:

Yeah. I used to just teach over the shoulder all around the nation, I flew all over the place. I actually taught Steffany Mohan originally over the shoulder, I flew out there to Des Moines. My fee was $22,000 a day because I had to take off a day in my clinical practice which I love. I ended up having too much demand for that over the shoulder training, so then I started training folks at my location here in Ashland, Oregon. I’d teach groups of 15 at a time, so instead of charging 22 grand for a day it’d end up being 4,500 bucks for two days. Full hands-on, breakfast, lunch, dinners, all that good stuff. Several of the students that I taught doubled their practice. Literally, I mean if they were doing 100 grand a month they ended up doing 200,000 a month, within about 120 days they would double their practice.

Those are the people that I said, “Hey, you’re having a good time. What do you think about teaching these techniques?” They happen to have a great success rate, over 98% success rate, all that good stuff, and they said, “Absolutely.” Tony Feck was one of those that doubled his practice, now he teaches 20 dentists a month there in Lexington, Kentucky. Steffany Mohan doubled her practice, but then she came out again and saw me in person on the two-day thing, doubled her practice again. She does extremely well out there. The folks that teach the courses were those that took the techniques, integrated them successfully, and then brought in more than 80 more new patients a month. Part of the course is really the not science but the art of bringing in a lot of implant patients to your practice.

Many people come to the course that already place 40 implants a month. Like a guy, Eric Compton, just south of Chicago in Indiana. He calls me up and says, “Brady, I want to come to your course but I already do 25 implants a month.” I said, “Eric, it's a lot more than just learning the efficiency of implants, new techniques, all that good stuff, it's about building your practice, and yes, using implants to build your practice.” He comes after the course. The next month he emails me, so not that first 30 days but the next 60 days. He said, “I placed 75 implants this month and I bought an ESP, an entrepreneurial satellite practice, a secondary practice, so really great guy. A lot of people come just to grow their practice so that they can buy an investment practice and do it debt-free which I know we’re going to talk about a little bit too.

Howard:

Now when they go to these courses do they get to surgically place them themselves?

Brady:

We do have one coming up where they actually are going to surgically place them themselves. In the average course right now I will usually place 20 implants. I have kind of a stadium seating, and everybody watches as I place.

Howard:

It's because they legally can’t, right?

Brady:

That's correct. We’re working on North Carolina where you legally can [crosstalk 00:47:53]-

Howard:

Okay, we fixed that in Phoenix, Arizona here.

Brady:

Really?

Howard:

Yeah. One of my best friends, he’s the sweetest guy in the world, Kris Volcheck, he runs the dental clinic for homeless Vets.

Brady:

Really?

Howard:

Phoenix is like the fifth largest city. It's like a four-million metro. There’s like a gazillion Vets down there. He went down to the Arizona State Board of Dental Examiners and said, if a licensed dentist who went to dental school in the United States, license, has a license, comes here and only places implants in this beautiful 15 operatory facility for no money just on Vets, and the Board said, “Hell yeah.” Kris-

Brady:

Here’s the deal here-

Howard:

Phoenix, they already love the Scottsdale Center. Everybody loves coming here. I mean this is the home of so many dental lectures, so dentists love Phoenix. You could set this up with Kris Volcheck. It's called the CASS Institute.

Brady:

Really? Okay, yeah. If you wanted to and you’d have to talk to Kris about this, I would make the offer, and pending just a week to chat with somebody else about it, but that we do a course to help these homeless folks where Dentaltown’s involved, OsteoReady is involved, he’s involved, and we help these guys out. We have so many-

Howard:

Let's do it. Let's put on a Dentaltown, Kris Volcheck, I mean how many dentists would love to come and fix up Vets who were serving this country while they were at the waffle house and …

Brady:

We’ve got a waiting list-

Howard:

… and learn how to place implants and learn your business?

Brady:

We’ve got a waiting list of 40 people that said if I can work on a real patient, I’m there if it's not in South America. They just don’t want to go to the South America one that teaches it. They said, “When you have that ready, let's do it.” We have a bunch of people that already wanted to do Arizona. They said, “When you start teaching in Arizona, count me in.” I’ve already got a bunch of people that want to learn. If you put it out on Dentaltown, we’ll do something that helps homeless Vets. OsteoReady will most likely donate all the implants for free for these homeless Vets and we could do something that’d be really great for these guys and we might even involve the Wounded Warrior Project too and invite the wounded warriors in Phoenix. There’s a lot of them there and a lot of them need some dental care. It would be neat to do that. Be fun.

Howard:

Well, let's do it. Are you promising right now?

Brady:

Let's do it. Okay, what did you say?

Howard:

Are you promising you’ll do that right now?

Brady:

I’ve got to talk to one guy first but I know I debated this guy before and I won on three debates, I think I’ll win this debate [crosstalk 00:50:27]-

Howard:

I want to do it just because I want to place the implant that you said looked just like me, the short, fat one.

Brady:

Come on.

Howard:

Can you name that the Howard Implant?

Brady:

I think we can do that [crosstalk 00:50:37].

Howard:

The short, fat one, is it bald too, is there no hair on it? We’ll call it the OsteoReady Howard short, fat, bald implant.

Brady:

My goodness.

Howard:

Now we’re going to switch gears 180% because you’re a legend in many ways. You really are, you’re a humble guy. I want to make one note on these guys that you’re placing, is the thing I don’t like about so many of the courses given, if they come from Beverly Hills and Key Biscayne, they think this stuff only happens in real rich cities. Isn’t it amazing how all these monster practices like Steffany in Iowa, Tony Feck in Lexington, one of the greatest cosmetic dentists I ever know, Michael Malone, he’s out there in Lafayette, Louisiana. Right up the street from him is Jerome Smith who’s placed literally 10,000 implants. So many dentists think, I can’t do that, I’m in Salina, Kansas. Baloney, dude, there’s people with 3, $4 million practices in areas where people only have enough money for Chevy and Ford pickup trucks.

Brady:

Yeah, yeah, [crosstalk 00:51:40].

Howard:

You cut your teeth in a denture clinic which …

Brady:

Yes.

Howard:

… most people think, well, there’s no money in dentures. I know a couple of dentists who actually learned how to place implants, went and bought a denture clinic that was like Denture World in their local State that was doing like $400,000 a year in dentures and now they do $3 million to $4 million a year because they upsell 20% of those dentures into …

Brady:

Yeah, yeah.

Howard:

… implant cases and they’re just making banking all they do is make dentures and place implant supported dentures and stuff, so kudos. Let's switch gears completely.

Brady:

Okay.

Howard:

Okay, so what is the state of building your dental practice? What would you say to someone?

Brady:

Did you say what is the state of your dental practice?

Howard:

Yes. Well, I mean switch to practice manager.

Brady:

Okay, let's do this-

Howard:

Take off your titanium implant hat and-

Brady:

Okay. Yeah, let me take [crosstalk 00:52:34]. All right, we’ve got it all off.

Howard:

Let's talk practice management. How can a dentist build their practice?

Brady:

In order for you to understand kind of what I’d like to talk about, I’d like to bring us back to 1999 when I was a …

Howard:

I wasn’t even born then.

Brady:

… when I was a junior in dental school. I had just done a research paper on the immediate placement of implants. I was looking around out in the job market, even as a junior, and most associateship positions you couldn’t place implants. They don’t have the equipment which meant somehow I’d have to talk these guys into getting implant equipment so I could place. I realized I would have to own my own thing right out of dental school, and I didn’t know how to do that. Only 2% of my class was thinking about owning their own practice out of school. I interviewed 72 dentists. I called up their practice, they gave me their home number, and I talked to them at night after their clinical day.

What I did is I figured I would do like in Stephen Covey’s book I had read at the time, begin with the end in mind, Seven Habits of a Highly Effective Person. I said, you know what, if I want to figure out how to own a practice let me first figure out and talk to these guys who are at the end of their career because they certainly know how they want to exit their career, and they certainly can help me get into if they’re toward the tail end. I call these guys and I asked them 12 questions about what their ideal transition would be to help find out what they desire in somebody coming into their practice. Through that process I realized one thing, and that was that the transitioning dentist was very similar to the guy in school. The guy in school didn’t really know what he wanted to do right out of school, so they’d take a default and work for one of the big groups usually.

The transition age dentist, well, only about 5% of them knew how they wanted to transition out. As I asked these detailed questions because I’d just read a book called Successful Practice Transitions by Dr. David Griggs, and asking these questions, 32 of the 72 offered to sell me their dental practice. Suddenly I’m a junior in dental school with 32 offers to buy a practice. I picked the two favorite ones, the two best values I felt [crosstalk 00:54:59]-

Howard:

You’re in school in Marquette which is …

Brady:

You have Marquette, Milwaukee, yup.

Howard:

In Milwaukee, and you’re talking to dentists in Oregon?

Brady:

I was talking to dentists in several States. I was talking to them in Western Washington, Montana, and also South Dakota at the time. I was thinking about South Dakota. I like to fish and hunt and do all that outdoor stuff. Ended up talking to these guys, ended up buying seven practices within five years out of school, and in the various States of Montana, Oregon, and Washington, and-

Howard:

You did?

Brady:

Yeah, I did. Basically what I would do is I’d buy them and I would have a dentist right out of school be an associate, and once the practice, you know, it was probably doing 300,000 when I bought it for 150 or whatever, and as we grew it and once that associate felt comfortable, he then would buy the practice from me. I would sell it for a discount because the sweat equity. I’d still make maybe 300% return on my money, he would get a value of a 30% discount on the practice and we were happy. Then I realized once I sold the practice to him I would say good bye to the staff because I had influence in that practice. I went around and I bought a company called Phasing Out Seminars in 2005. It was taught by Norm Culver for three years before me.

What it did is it was his experience of selling a part of his practice then selling another part and then retiring entirely, which is totally different from the typical brokerage sale where a dentist works, works, works, sells his practice, he’s done, and he’s gone. With this model I was teaching you’d work, work, work, sell a part of your practice, you’d cut back. If you cut from four days to two days a week, your income was actually the same, your profit was actually the same. You’ve had more time off, more profit, and you got to sell the second half of your practice. I taught that and the typical walkaway sale and the associate to buy in or buy out, and while I was teaching that I began to grow a group of my own and teach several other groups.

I ended up both helping guys that were 65 years old and wanted to transition out, but I also started helping group practices who were at 40 locations and I’d help them grow to 60, who were at 80 locations and I’d help them grow to 120 locations. I was a member of the American Academy of Dental Group Practice, the AADGP. I’d sit around the table with guys like Rick Workman and the founder of Dental One and I’d talk about what they were doing to grow their groups. Like I said, I have nothing against group practice, but my goal is to help private practitioners form their own groups in a financially friendly way without debt. That's what I’ve been doing the last seven years. What I did in my own practice was I said, “You know, what would be a good test case?”

Everyone would say to me, “Brady can do this because he’s been teaching dentists for years how to do it and he usually picks up practices that are really good deal.” What I did is five years ago I took over a practice that another dentist had left and taken all the patients. It was just a vacant space. Went into there and the first year it was just me working part-time, saw 80 new patients. The next year saw 150 new patients, I had to add a partner. The third year had to add another partner and was seeing 250 new patients. I wanted to sign up with PPOs, but I didn’t have time to sign up with PPOs because of these implant procedures I’m talking about. Patients love the minimally invasive nature of them so the practice was filling up based on those implant procedures.

This last year added two partners that still hasn’t taken care of the new patient flow. Added another location, 14 operatories, by the third month it was doing 250,000, scratch start, to 250 the third month and is totally packed. Now I’ve brought on four new partners that start the next four months, one a month, and I’m opening two more practices in the next three months, a 14 operatory, and a 5 operatory from a retiring guy. I do a hybrid, a mix of acquiring practices of folks that have, you know, there’s the growth phase, plateau, and regression. Where I like to buy the practices is when the dentist has pretty much gone into retirement and may have been worth 650 here, but now it's worth maybe 103,000 to 200,000. Here’s a list of the dollar amounts that I purchased practices for, 6,000, 8,000, 65,000, 103,000, 167,000.

One was 20,000 at his kitchen table. It was a guy that wasn’t able to sell his practice for three years. He calls me up, he says, “Brady, I know you have multiple locations. Would you buy my practice? If you took over my lease and I could go retire on the lake I would sell it to you for a really good deal.” I said, “Well, why don’t I meet you tonight? I actually bring a checkbook.” He said, “Okay.” I said, “If I took over your lease tonight what would you sell me your practice for?” He said, “Well, I’ve got a lot of patients.” I said, “Well, I’m really just looking for your equipment because I’ve got a lot of patients.” I wanted him to name the price or else he’d hold a grudge. He said, “Well, if you took over the lease, it's five operatory practice doing 550.”

He said, “If you wrote me a check tonight, you’re saying?” I said, “Yes, tonight.” He said, “If you wrote me a check for $20,000 you can have the practice.” I tell you what, I’ve never written a check so fast in my life. I wrote the check. He and his wife, [Sandy 01:00:51], were thrilled. There’s, believe it or not, practices out there that you can purchase because the dentist has enough money to retire, he just wants to get out of it. Here’s a secret I’m going to mention on the phone, once a practice goes below a certain threshold, there’s not enough net income to finance the debt of the practice and the living expenses of the dentist, and the banks right now won’t finance it. One guy I bought a practice for 103,000 from. He’d been trying to sell it for three years. He was doing 367,000.

He had eight buyers and the banks rejected it. He said, “I can’t sell my practice because I think I’ve got to hang it up.” It's because if you’re only doing 367,000 a year, your net’s about 58,000, your bank payments on that would be 20,000. The dentist can’t live on 36,000, a teacher’s income. I said, “Okay, what will you sell me your practice for?” He said, “Well, I’ve got a building for sale, a 9,000-square foot dental building.” I said, “Okay, what's that worth?” He said, “The tax assessed value is 1.1 million.” I said, “Okay, what would you sell it to me for?” He said, “Well, if you bought the practice and the building, I know you probably can’t afford this,” he said, “but I’d sell for $910,000.” Which means I got the building undervalued and the practice for free basically. Bought that, I’ve got a dentist in one half, the other half is a dental practice, and the second year did 1.8 million. That one’s up in Olympia, Washington.

There are deals out there, and I have seven ways to find deals you’ll never find through the brokers. These are the deals that I found right out of school while I was a junior in dental school in 1999. Deals that are right through the banks. When a dentist has a personal problem, bankrupts, deals where the dentist can’t sell his practice, deals where there’s a dental building involved and you can buy the building for a steal and get his practice for very, very little like the 20,000. Deals where it's a dental building that's now vacated like the first one I talked about. In dentistry today many dentists don’t understand how to create equity and then turn it into cash. Most dentists know plenty well how to get into debt, but I’m talking about how to take, you know what I mean?

Howard:

Yeah.

Brady:

You can take an asset, grow it, and that's increased equity. Like a house, like in Phoenix, I bought seven houses in Phoenix in 2001. Fortunately I sold almost all of them in 2005. Well, in 2001 you could buy the average house in Phoenix, I was buying them in Surprise, Goodyear, all these areas outside Phoenix when it was booming in Phoenix. What happened was there was appreciation, massive appreciation, and a mentor told me to sell them right here. I sold five of them and then the market tanked. Made almost double the money on those homes, converted that equity, right, positive equity into cash. What I’m talking about is taking a dental practice, buying it down here, finding value, and then increasing it, and that's called adding value. Then taking that equity and converting it to cash.

That's what us dentists have trouble with, we’re great at adding value. Everyone says, “I’ll do a startup and I’ll grow it.” Great, you still have 700,000 of debt. Well, now we’ve got to take that added value and convert it to cash. You can only convert it to cash in two ways, a refinance, which still keeps you in debt, or allowing another dentist in on the wealth of your practice to buy into the practice. Yes, you can still sell a part of your practice and control 100%, so don’t give me the excuse, “Well, I don’t want to sell it, I’d be giving up my baby.” No, you can add partners. Has Rick Kushner added partners with Comfort Dental? Yes, he has, and he claims it's a 97% success rate.

There are some wonderful things about Comfort Dental, there’s some wonderful things about other groups in the country. The equation that I use is a mix of the top three successful group practices in the country, but it's made to fit into a general dentist practice. The past model …

Howard:

Who are those three groups?

Brady:

… that's where I did the first two practices, we’re adding two more. I have been debt-free ever since the sixth month. As I add partners I continue to receive cash in return for the equity and the growth. Anyway, we could go for hours about that model, Howard, but basically here’s what I believe with multiple practice ownership. Do it, find value, and add value, and convert it to cash. Find value, add value, convert it to cash, and in your compensation formula create passive or residual streams of income.

A lot of dentists who own multiple locations own the multiple locations have a lot of debt and then sometimes they have one that has negative cash flow, one that has positive, and in the mix they end up just making the same or maybe a little more than they would have made being a solo dentist, because they’re taking their clinical time and converting it to administrative time and aren’t able to delegate so they’ve really gotten nowhere except a pile of debt. The model that I like to use is a mixture of the best groups where you grow debt-free, you have increasing passive income, and instead of taking on debt you continue to put away that cash that you converted your equity from and put it toward wealth building your retirement. That's basically the model that I like for multiple locations.

Howard:

You took a hybrid of the top three group practice models you like. You mentioned Comfort Dental with Rick Kushner out of Denver who owns about 350 Comfort Dentals. What were the other two business models?

Brady:

I don't know if I should say. I think I can, right, isn’t that reasonable to say it's nothing …

Howard:

Yeah, yeah.

Brady:

Yeah, so let me do it like this. I’m going to go over the compensation because a couple of them are similar. Many of you will know them. I don’t want to say the name for fear that maybe they wanted certain information confidential and I work with a lot of these groups. One popular group which most you know, they do a compensation form of 25% to the dentist and then they receive a percentage from 14% to 18% that they receive corporately.

Howard:

Is that Pacific Dental Services?

Brady:

Well …

Howard:

Thorne?

Brady:

… that one they utilize a dual entity structure, wherein there’s a clinical entity and a business entity, and generally Pacific Dental Services owns the majority of the business entity, therefore, they can own that, but the dentist all own 100% of the clinical entity. Through a management services agreement cash flow goes from the clinical entity to the non-clinical entity of its-

Howard:

That's Steve Thorne’s model.

Brady:

It is Steve Thorne’s model and this is different than that.

Howard:

Yeah. Okay, so this is a hybrid of these.

Brady:

Yeah, this is different. The model that I was describing has an equation where it's 25% to the doctor, a chunk that's passive or residual, and then a split of the profits. Basically let me describe this model that I utilize which is a hybrid of some of the best groups. Each partner in the practice receives 25% of their own collections. If you did 100,000 you get 25,000. Then a percentage of the gross revenue comes out of the practice which I consider the residual income or the founder’s fee. Now in Rick Kushner’s model Comfort Dental receives a 3% franchise fee, correct? That would be the equivalent of this 9%. Now Comfort Dental also receives a percentage for marketing fee, which is great, and Rick Kushner’s model is wonderful.

This is a little different, 9% comes out but it's split with the partners in the practice according to the risk that they took. If you listening right now are the founder of a dental practice or 2 practices or 10, this residual income you would receive the lion’s share of this. Let's say you receive 3% of this 9%, the difference is with some of the groups is the group normally receives 100% of this residual income, for instance, the 14% to 18% that some groups receive. In this model it's your own private practice group so you receive 3% for life. When you grow your practices to 2 million or when you grow them to 10 million, for instance. When you reach 10 million, say, with four locations which is very reasonable, you receive $300,000 every year for the rest of your life and that is the 3% of that 9%.

The profits can be split up in a variety of ways. Usually there’s business profit and clinical profit. The guy that started the practice may receive X percentage of the profit as business profit. I don’t want to get into a standard model because I think that's dangerous. I work with practices all over the U.S. to help them build their practice, and it's across the board. Basically the compensation formula needs to encompass three key elements, working profit, residual or passive income, and a split of the profits every month, and each of those has its own breakout.

If you put your model in the place, you simply don’t change it, you’ve got to have it right from the beginning because I don’t know, Howard, if you know much about network marketing companies, but the network marketing companies that change their formula eight years down the road automatically dip 30% in their revenue because nobody likes anything that changes and they just don’t trust it anymore. Talk to me, if you want to set up your group and grow debt-free while adding co-owners, while maintaining 100% control. I’d be happy to give you some things I’ve written on it or I’d talk to you on the phone, it's bradyfrank74@gmail.com.

I’d tell you even if you’re eligible for building a group of your own, most people are, don’t contact me unless you’re doing over 1.5 million because you at least have got to get to 1.5 million or else nobody wants to hop aboard your ship. If you are doing 1.5 million you’re in the top 5% of the nation which means you can add co-owners who want to hop aboard your ever-expanding group of practices. It's not that hard. I’ve gone over several examples. You don’t have to take on a bunch of debt, just look and find that perfect deal. I’ve done a lot of real estate in my lifetime, I own a lot of commercial dental buildings, and finding really good deals on dental practices is no more difficult than finding great commercial real estate deals like I find.

Talk to me, I’d put together a plan with you, and then I’d show you the six ways of finding really good deals on practices. Howard, you do some investing on your own, does a little bit of this you think makes sense for some of your dentists, because you know your dentists in Dentaltown better than I do.

Howard:

I do and what's amazing is how these business models that you’re talking about like Rick Kushner, I mean I can give you names of dentists who are doing this in Poland, in Australia, it's just taking place all over the world. Dentistry was $105 billion industry in the United States last year, is a half-trillion for the planet. It's huge. What is your implant course going to be called and it looks like you’re going to do two courses for me. You’ve got to do this course on Dentaltown and you know why you need to? You know why you need to? Because it's two separate markets. I look at the data who’s taking the online CE courses and who’s doing podcast and the overlap’s only like maybe 20%. There’s a lot of dentists who won’t learn anything unless they get AGD credit for it.

Brady:

Okay.

Howard:

You said you’ve got about a two-hour implant course you could do online with Howard Goldstein.

Brady:

Yeah, so-

Howard:

What were you going to call that?

Brady:

Let's call that The Top Five Minimally Invasive Efficient Implant Procedures for the GP and [crosstalk 01:13:11]-

Howard:

Then what's the business course, the [crosstalk 01:13:14] course?

Brady:

The business course, the name of that company, I just started that again because so many dentists want to buy an entrepreneurial satellite practice. We’re going to call that Transition Ready. That's the name of the seminars I’m doing in the company, Transition Ready, Build Your Own Portfolio of Multiple Investment Practices. Something like that.

Howard:

Back in the real estate deal, now you bought into where I live, Phoenix, in 2000, and you got out in 2005. What was your mentor telling you that was showing you that that market was over the top and overvalued?

Brady:

My mentor, I was doing a lot of commercial real estate courses at the time, investment courses. It's pretty clear when the residential markets go really high, those that invest in the broad range of real estate say, listen, they’re selling for a lot more than they cost to build right now. It's got to go down and meet the price of what it cost per square foot to build. Now’s a good time to take that money out of the residential side and do tax-free 1031 exchanges, and by the way, I did do those on those houses because I couldn’t find the properties in time, but you can do tax-free exchanges. Sell those basically, pay your long term capital gains rates which are the lowest tax rates, reinvest that money into commercial which gives you stable long term income.

Residential goes like this and commercial real estate goes like this. Commercial real estate is valued based on the income in the property, residential real estate is, it's more like the stock market, residential real estate, people don’t really know that much why the properties values go up so high. He said, get out of that, get into commercial, which I did. I put into dental buildings. I just sold my last three houses in Phoenix just about five months ago just because the market came up finally again a little bit. Anyway, that's what I’d done with real estate and-

Howard:

I went to the Scottsdale School of Real Estate right when I got out of dental school. I went there in ’87 …

Brady:

Really?

Howard:

… and I got my MBA. I like the two methods, so when you’re buying a house where it's cheaper to build it from scratch that's obviously a [good deal 01:15:35] obviously, and if you’re rent payment isn’t enough to pay the mortgage payment on a 30-year mortgage, it's overpriced too. I think it was so bizarre how so many people were shocked that the real estate bubble collapsed when the magazine the Economist had been calling it for three years. The rule about bubbles is bubbles always get bigger than … whenever you identify a bubble, rule number one is it's going to get bigger and rule number two is that it's always going to pop.

Brady:

Yeah.

Howard:

The Economist from 2005, ’06, ’07 were saying, “Hello, hello, hello.” Then it popped and so many dentists were like, “My God, I’m a victim. The real estate market collapsed.” It's like, “Dude.” You know what I mean, I mean The Economist, I mean when they’re telling you for three … Also you mentioned The Seven Habits of Highly Effective People, and you mentioned one of those habits. Can you name all seven?

Brady:

I cannot but one of them has to be to stay tuned to Dentaltown perhaps. I [crosstalk 01:16:42]-

Howard:

Poor guy. Poor guy, he’s a cyclist. He died, he fell off his mountain bike.

Brady:

Did he?

Howard:

Yeah, that's how he died in Utah. He fell off his mountain bike and got a head injury.

Brady:

Stephen Covey?

Howard:

Yeah.

Brady:

I didn’t realize it [crosstalk 01:16:53]-

Howard:

Now I sold my mountain bike and I just go to the IHOP and eat pancakes [crosstalk 01:16:56].

Brady:

Hey Howard, I want to bring this up with you because you’ve seen dentistry and been in it longer than I have, and from my perspective I’m looking at the field of dentistry right now and I believe that to own investment practices right now, getting them for good value, the equivalent of getting them well below replacement cost, correct?

Howard:

Right.

Brady:

I feel like with everything that you can add to a practice right now, the expanded services, the fact that government doesn’t cover dentistry, to include implants, sleep apnea, the aesthetics are still big, I mean everything that we’re doing in dentistry, I do buying these practices from a guy who’s just done, he’s ready to retire and you can get into it for about that much, I feel like we are the equivalent of Phoenix in the year 2000 before this boom, I mean do you believe in your heart of hearts that getting involved in investment practices right now in America is a good time in the investment practices in America for dentists?

Howard:

I actually do and I’ll say for these reasons why. It takes only a [Neanderthal 01:18:06] or Cro-Magnon to break up all the people in the planet into boys and girls. I mean that's just an anatomy issue. In the sixties and seventies people were trying to identify markets by Asians versus Filipinos or Hispanics or Irish, whatever. That's all [per se 01:18:22]. I think the elite minds are looking at how the difference in how people think of senior citizens versus baby boomers versus generation Xers and millennials, and all of my friends are telling me that when you go into dental school when I graduated everybody wanted to come out and own their own practice. I had mine up and running four months, I graduated May 11th and had it open September 21.

You go into these dental schools now and half those millennials will tell you, “I am never going to work like my parents did, I am never going to own my practice. I want a nice job, I want to be well…” They’re moderates, they’re having half the number of babies. 1950 the average woman pumped out 5.1 kids. Japan’s women are under 1. The replacement needed to maintain the herd is every girl has to have 2.3 babies to just keep the population flat. You back out immigration for the United States and Europe our populations are shrinking. Japan doesn’t have immigration. They have less people every year than the year before.

Setting up employment for these graduates who walk out and say, a third of them have a dentist in the family tree and they’re like, “My dad was crazy. I mean that's all he did, he went into his office every day at 7:00, got home 7:00 or 9:00 and then he died of a heart attack at 65. I want to be well-rounded.” They’re marrying smarter. A third of those women in the dental school class marry a male that's a dentist. They got double, that's why the most richest segment of the American population are same-sex marriages because two gay men get together, they’re both professional, they have no children. I mean when you’re double professional income, no kids, you’ve got a shitload of disposable income.

That's why Australia target market the homosexual crowd with their annual gay parade because those are the people most likely to be able to afford a round trip ticket from America to 14 hours to Australia. Yeah, when you set up these practices, you’ve got a plethora of dentists. You’ve got 5,000 graduates a year and half of them just want a job.

Brady:

Yeah. Let me make this one point, and I think you’ll understand this because you invest in real estate. It doesn’t have to be many practices, two, three, and when you do your first one and second one and maybe third one you’ll want to do more, but remember they made fun of Mitt Romney during the last election, and they said, you pay less taxes than X, Y, or Z. He was paying 15%. What you’re really doing, and this is what I teach, is when you add co-ownership to your practice, that means you’re paying not ordinary income but long term capital gains rates on that equity because you’ve owned the practice longer than 12 months. You in essence shift your income from being ordinary income, the highest tax bracket, to long term capital gains rates, the lowest tax bracket.

Most dentists are paying a ton in taxes. This way, by owning a portfolio of practices that you allow co-ownership in, you shift your tax bracket from the highest tax bracket to the lowest tax bracket. Since I started doing this I’ve paid a lot less taxes legally by paying long term capital gains rates which are much lower than ordinary income. Secondarily, if anybody wants just to get some references on the implant course that we were talking about, email me at bradyfrank74@gmail.com, I’d be happy to do that. Additionally, if you don’t own a practice or you own a practice and want to move, we’re opening a new location here. Our average partner income is $495,000 a year.

Our average partner income right out of school, this guy, I’d say averaging all our partners about a year, year and a half out of school, 495,000 in income including equity. If you’re interested, email me at bradyfrank74@gmail.com.

Howard:

Go to online CE course for this so you can show the math, show the graphs, go into more detail.

Brady:

Yeah. I’ll do that. Online CE course on implants, online CE on the transition ready or the business side entrepreneurial satellite practice ownership, and then what about our veterans? Are we going to help them out?

Howard:

Let's do it, man. Kris Volcheck …

Brady:

Don’t you think?

Howard:

… is the coolest damn dentist and he’s down there and he just wants a bunch of volunteer dentists to come down there and fix up all these patients [crosstalk 01:22:41] and hopefully earn some revenue for his clinic.

Brady:

Yeah.

Howard:

If you did a deal where you had the tuition and you split the tuition with him so he has operating income for his clinic and the other half would be for whatever.

Brady:

Yeah.

Howard:

Or hell, and how many dentists … dentists would much easier pay the tuition if they knew it was all going to support a homeless [shelter 01:23:00].

Brady:

Exactly, yeah. What I would say is we take the tuition, put it to him and to costs, and we dump in free implants so the dentists can place implants. Then the Vets get free implants and then we’ve just got to make sure that some of the guys are from Phoenix who don’t mind restoring the implants and then they get the full restoration. I can handle that, I’ve got a lot of friends in Phoenix and-

Howard:

Man, every time I go down there, I mean those vets are lined … I mean I’ve been there before where the line was the length of a football field.

Brady:

Really? This is-

Howard:

Of just Vets trying to get their teeth fixed.

Brady:

We could [crosstalk 01:23:33]. What's the guy’s name again?

Howard:

You said something that made me sad for my daddy, he died 16 years ago but when you talk about lower tax rate, he used to always say to me in the car we were driving [inaudible 01:23:41] he goes, he’d go, “The easiest dollar earned is a dollar in taxes saved, the second easiest dollar earned is a dollar in taxes delayed, but the hardest blankety blank blankety blank dollar you’ll ever earn is to sell another dollar in sales to your customer.” My dad went to mass every morning, so did my mom, but they cursed like sailors. It's part of being born in a barn in Kansas. Yeah, easiest dollar earned is a dollar in taxes saved, second easiest dollar earned is a dollar in taxes delayed, the hardest dollar you’ll ever earn is to go back to your work and sell another dollar.

Brady:

Yeah, that's true.

Howard:

Why not save a dollar in taxes?

Brady:

It's true.

Howard:

[crosstalk 01:24:19] do another dollar in dentistry?

Brady:

Yeah.

Howard:

All right, buddy, so we are at one hour and 25 minutes. I can’t believe I scored Brady Frank for an hour and a half and got him to commit to two online CE courses. Hey, if you can get Martin Evans, if you can send an email to  him …

Brady:

I’ll do it.

Howard:

… Tony Feck …

Brady:

I’ll do it.

Howard:

… my God, and who was the other guy, [Ryan Faser 01:24:42]?

Brady:

Ryan Faser, yeah, can get Ryan. He’s a key opinion leader-

Howard:

I’ve already got all the hot women you hang out with, Steffany Mohan and Erin Elliott, I’ve already got those two. Guy Gross.

Brady:

Yeah, Guy Gross, incredible guy, has four locations.

Howard:

Can you score me all those?

Brady:

Yeah, I can absolutely do that.

Howard:

Because the reason this podcast is amazing is because, number one, it's free, but it's because I keep getting awesome guests like you. Seriously, Brady, I think you’re a freak genius, you’re one of dentistry’s unicorns, and to sit here and share and hour and a half with me, thank you so much.

Brady:

Hey, it was great, Howard. Love talking to you, have a wonderful day down there in Phoenix.

Howard:

All right-