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Exponential by

The Teledentistry
Growth Guide
How to integrate Teledentistry to transform into a unique digital practice.
Deliver state of the art patient care, raise the oral health of your community
and drive the growth of your practice.
We live in a 24/7 fully digital connected world. Everyone is connected through their
mobiles and focused on digital solutions and time is increasingly under pressure,
no one wants to wait and in addition to this recent public health situations have
meant that people have to maintain limited physical contact.

And those that do visit


often wait until they
have a real problem
which then requires more Dentists are highly trained
complex solutions. in comprehensive dentistry
but they don’t always have
the time to educate and
explain all that they could
do for a patient to help
them protect and improve
their smiles.
<50% of adults visit
a dentist regularly

Prevention is very difficult to do in a practice as time is


under pressure and procedures must be delivered meaning
it’s left to a few sentences on how to clean or use
interproximal brushes.

This is still a reactive system - based on drilling and filling.


This is not the best that can be done for patients

The best we can do is a predictive preventive


system where all patients are able to
digitally check and measure their oral
health status through a digital plan at your
practice. Where they already understand
what cracks,gum issues or decay they may
have and they are the ones asking you to
help them treat it.
To do this you would need a type of diagnostic, preventive digital health layer that
you could offer to your patients to deliver preventive advice at home, measured
tracking of conditions throughout the year, enable them to digitally pre-approve for
finance and then schedule appointments which are for multiple procedures as part
of their comprehensive plan.

Exponential is that and even more enabling you to:

Expand your practice Deliver a differentiated Deliver state of the art


experience prevention beyond what other
practices provide

Have more engaged & Do more comprehensive


grateful patients dentistry

This means you:


Do more implants Do more aligners

Have an expanding and


successful practice
THE EXPONENTIAL SYSTEM
There are two parts to your teledentistry engine - inside the practice, and outside

OPTIMISE: INSIDE PRACTICE


Increase engagement, prevention and case
acceptance

- Digital Patient Reactivation

- Data Driven Digital Dental Assessments

- Digital Pre-Hygiene Assessments

- Enhanced Hygiene Oral Health E-commerce

- Digital Referrals

- Digital Practice Dental Plan

- 1hr Digital Aligners

EXPAND: OUTSIDE PRACTICE


attract new patients, help new audiences and
impact your community

- New Patients - Emergency patients

- New Patients - Pharmacy patients

- New Patients - Corporate employee patients

- New Patients - Domiciliary / Care Home patients

- New Patients - Dental Phobics

The objective of the modern digital practice is to:

Deliver high Retain patients Improve the Improve the Continually


quality, for life oral health of oral health of expand
accessible care. your patients your community
THE EXPONENTIAL ZONES
Once you become an exponential practice whole new zones become open to you.

OUTSIDE

OUTSIDE

OUTSIDE

OUTSIDE

OUTSIDE

INSIDE

INSIDE

YOUR PRACTICE

Physical Active
Patients

Physical Inactive Patients

Digital Referral

Pharmacy / Emergency Zone

Corporate Employee / Workplace zone

Care Home / Community Zone

Dental Phobic Zone

Online Engagement Zone


REDUCE CHAIRTIME, INCREASE PRODUCTION
AND ENHANCE RELATIONSHIPS

Comprehensive Digital Digital Reviews /


Assessments Remote Monitoring
Evaluating Risk and health Ability to securely review and
across 22 Dimensions with a document patient condition and
personalised report message securely

Specific Concern Digital Enhanced Oral Hygiene


Assessments Packs & Regimes
Advice on specific problem / Specialist preventive at home
emergency / situation with a regimes to supplement in
personalised report clinic care

Digital Dental Plans


Convenient practice subscription covering
2 Digital Assessments per year and a saving on clinic procedures.

When you enhance these with

Digital Enhancers:

DSD/Cosmetic Comprehensive Visually Engaging


In Clinic Simulation Treatment Planning
Imaging Treatment Plans

You Get these outcomes

Greater treatment
Healthier patients plan acceptance More production per
More patients and
through enhanced through enhanced appointment through
revenue per practice
prevention understanding in a efficient scheduling
fee based practice
HOW IT WORKS

Digital Assessment
Patient can do a digital assessment
anytime, anywhere 24/7

Dental History Captured

Photos & Video


Can also upload x-rays or treatment
plan for 2nd opinion

Comprehensive Report
Evaluating Risk and health across 22
Dimensions OR Advice on specific
problem / emergency / situation

Discussion With Patient


Email / Video Call / Phone to clarify
objectives and plan

Finance Approve
Credit application link can
be provided

Schedule Treatment
Have more productive appointments
with more procedures in less time
EXPONENTIAL PRACTICE SCORECARD
Identify your practice growth potential

2018 2019 2020

NUMBER OF NEW
PATIENTS

NUMBER OF ACTIVE
PATIENTS

NUMBER OF INACTIVE
PATIENTS
(No visit for >12months)

EMAIL LIST SIZE ON CRM


(include all email / website /
social media enquiries that never
scheduled)

NUMBER OF PATIENT
REFERRALS

NUMBER OF ALIGNER
CASES STARTED

NUMBER OF IMPLANTS
PLACED

NUMBER OF
UNCONVERTED
TREATMENT PLANS

Practice Multipliers

Number of Number of corporate Number of


patients with employers in pharmacies in
dental insurance catchment area catchment area

Practice Accelerators

Online booking Digital Simulation Intra oral scanning


Book Now
in place? in place? in place?
In these turbulent times it has never been more important than ever to leverage
technology to run your practice more efficiently ensuring it is more productive for
both you and your patients.
There are 3 objectives you want to achieve to strengthen your practice:

1 2 3
Strengthen your Help them understand Offer more affordable
relationships with all the best options for options that minimise
your patients their health chairtime

Digital Patient Reactivation

Strengthen your relationships with all your patients.


In the average dental practice, 20% of patients per year become inactive, this
means they haven’t attended an appointment in 12months. These are people who
came to your practice and you had a good relationship with, but then they moved
away or for whatever reason didn’t come back to your practice.

The majority of these people that didn’t re-attend due to some life circumstance or
convenience, for example they may have moved slightly further away and so would
potentially come back to you if there was a sufficient reason and incentive. For
your practice as well, you already invested time, energy and potentially marketing
money to have brought them to your practice so extending your relationship with
them is beneficial for you and increases the efficiency of your practice.

Your goal is to have the highest number of active patients that complete these 5
dimensions:

Happy Healthy Paid In Full Completes Refers


Treatment Friends
Given the emphasis on minimising non-essential contact in your practice offering
a digital dental assessment is an innovative way to re-engage these patients to
get them to come in for

Action: Digital dental assessment reactivation campaign

Email & SMS campaign, focused on the inactive patients offering them a
comprehensive digital dental assessment which they can do from the comfort of
their home, with an offer that treatment scheduled by a specific date comes with
a saving of £50 or so off their treatment.
The objective here is to schedule more and more quadrant dentistry sessions

Create a list of patients that have not attended for >12months.

Offer a digital dental assessment

Get them to send the report to you,

Discuss the pricing and finance options for treatment

Schedule appointment

This can help you reactivate and strengthen relationships with your patients.

Opportunity

2500 1500 1000


The average practice 1500 may be This means there
has 2500 patients active are 1000 inactive
patients

£50,000 10%
At an average value of £500 that’s 10% of patients
100 x £500 = £50,000 in revenue. engaging = 100
patients.
DATA DRIVEN DIGITAL DENTAL ASSESSMENTS
Most people will keep 1-2 hygiene appointments per year and only book 1 checkup
if that.
Patients tend to value outcomes where they see something physically change. In
addition to this most patients that attend routine hygiene feel they are ok and they
have no problems, so if a dentist starts explaining complex procedures or items
and they had not even been aware of any issues then they will immediately lose
trust. This is what often happens when a new dentist takes over a practice and all
the patients are just not used to a more comprehensive method of assessment. In
dentistry as all the patient actually sees is a treatment plan which is a list of
procedures with a large price, that’s all they actually see and hear. So the new
patient now thinks you are trying to sell to him and they wish they had their old
dentist back they saw 6 months ago. There is a better way by using data and
digital assessments so that the patient actually understands their oral health
status in a quantified way.

VS

An even better way for this to be done is the digital assessment be done by an
independent digital dentist which saves you time and also provides the patient
with the advice first, making you the second person to confirm to them their oral
health status. This maintains your position as a professional.

The very action of visual communication and data driven assessments will mean that
patients themselves will look at the scores and the pictures and ask how they can
improve their scores. This transforms from “You don’t need any fillings” to “Why is my
enamel score low, I thought it was strong, how can I protect it and what do these
cracks on my teeth mean?” This yields much more productive conversations and
potential ways for you to help your patient achieve optimal oral health.
Action: Digital dental assessment campaign

Email & SMS campaign, focused on the inactive patients offering them a
comprehensive digital dental assessment which they can do from the comfort of
their home, with an offer that treatment scheduled by a specific date comes with
a saving of £50 or so off their treatment.
The objective here is to schedule more and more quadrant dentistry sessions

Create a list of patients that have attended in last 12 months

Explain your new upgraded service

Offer a digital dental assessment

Get them to send the report to you,

Offer a complimentary discussion appointment - can be Zoom video call or

in clinic

Agree Treatment plan, provide link for finance approval

Schedule appointment

This can help your patients have fresh conversations about their oral health in a

completely new way and help patients choose new cosmetic and health solutions

for themselves

Opportunity
The average practice has 1500 patients. If we think about it:

70% of adults have 5% of adults have a


70% crooked teeth - that’s
1050 potential aligner 5% missing tooth - that’s
75 potential implants
cases

40% of adults have erosion 50% of adults have


gingivitis - that’s 750
40% - that’s 600 potential
remineralisation tray 50% potential gum protect
cases packages

50% 50% of adults would like to improve their smile - that’s 750 potential
whitening / mini-smile makeover bonding cases
The barriers to someone accepting treatment is them

Knowing about their oral health condition

Understanding the implications of it, what happens if it gets worse

Being motivated to doing something about it.

Understanding and accepting the potential solution

Being able to afford the solution.

For your practice, you cannot deliver what you didn’t diagnose and present.

Solution

Comprehensively diagnose & educate


everyone in an engaging way

This is a solution that means everyone has a comprehensive assessment .

and everyone gets to discuss their report, and if helpful see a digital / cosmetic

simulation.
This increases understanding and emotional engagement.

This means you can schedule quadrant type appointments and deliver many

procedures with less physical reviews by leveraging digital monitoring so that you

minimise chairtime so that you can offer more affordable prices pr procedure (as

more procedures done per hour) whilst increasing your practice production.

In addition to this you can avoid days where you waste lots of time on checkups

where the patient isn’t ready mentally for a complex assessment)

You are then able to ensure the maximum number of people can accept different

proposed solutions.
DIGITAL PRE-HYGIENE ASSESSMENTS
Everyone likes and trusts their hygienist. They are perfectly positioned to help
patients understand their mouth and care for it. They also recommend the right
times a dentist should look at an item or discuss an area further e.g crooked teeth
and potential solutions and when someone is in the hygiene chair they are more
likely to schedule next procedures at the front desk. However hygienists are busy,
patients often arrive late and this disrupts the schedule, they are also trying to
educate patients that have gum disease that they need more than a “scale and
polish” but need several sessions of soft tissue therapy. Patients have limited
attention span and time and so a pre-diagnostic tool that the patient completed
before the appointment could be of huge benefit.

This would pre-explain:


Their gum health & inflammation

Gum recession and implications

Their gum biotype

The cracks on back teeth

Loss of canine guidance

Evidence of enamel damage through clenching / grinding

Darkening of tooth colour

Crookedness / position of teeth.

This means the patient knows all this before the appointment and so the hygienist
and dentist can use the report as a communication tool to evaluate the patient’s
understanding and more importantly motivation to improve various aspects.
Opportunity

The average practice has 1500 patients.

Let’s say hygienist does 3 days a week with 30minutes per patient.
That’s 16 patients per day x 3 = 48 patients per week x 48 weeks = 2300 sessions.

2300 48
weeks
sessions

That’s 2300 visits to the hygienist. 2300 times they are seeing pre-educated
patients who understand their health status and how it may have changed over
the last 6 months, as one key benefit of this type of digital assessment is the
patient themselves can also see their teeth over time to track changes visually.

This will yield patients to accept treatment faster.

This is a huge amount of potential additional production and transformative


outcomes.

This process will increase the amount of quadrant dentistry, whitening,


aligners and implants you will do.
ENHANCED HYGIENE ORAL HEALTH
E-COMMERCE
Dentistry is unique as a health discipline as there is an intrinsic link between
health and aesthetics. Most people buy power toothbrushes and toothpastes that
have additional whitening benefits. Everyone wants whiter, cleaner teeth. This
presents a large opportunity for practices to sell specialist regimes to their
patients to help them actually get improved outcomes.
This means actual prevention. This is excellent for the patient as they look after
their teeth more, meaning your restorations last longer and there are less
complications therefore happier trusting patients (versus patients where
everything keeps failing and its all your fault).
The average price of an electric toothbrush can be £100-£200, and there are many
premium toothpastes £10 or more. These products and home care solutions are
still much more affordable than in clinic treatments as a single filling can be
£200 or more.
Most patients prefer to look after their teeth so why not offer them access to
specialist preventive regimes to improve their health.

These regimes can:

Improve gum health- so less

inflammation, decay and bleeding gums

Decrease sensitivity - so more

comfortable hygiene and whitening

treatments
If we imagine 2300 sessions of hygiene and a 20% uptake of recommended
regimes at an average price of £80 that’s £36,800 of additional revenue and that’s
NOT including new potential patients who may be interested in joining you to get
digital assessments, hygiene and these packages from you.

These are large additional opportunities that decrease your medicolegal risk by
ensuring optimal oral health, patient education and trust.

These can be evolved even into subscriptions and that’s why we have a section on
that coming up.

2300 sessions

20% uptake
average price of £80

£36,800
additional revenue
DIGITAL REFERRALS
How to engage your patients to introduce their friends as digital patients”
It’s hard to get patients to refer their friends, there are a lot of perceived barriers.
Cost, distance and fear of the unknown. Typically this is what happens

Do you know a good dentist?


I still travel to my home town to see my GP.
I travel across the city for my favorite hairdresser
Yes! You should see my dentist.

Where are they? Based on relationships, trust and impact people


will travel.
They are in ______

Awww that’s a bit far for


With a digital practice referral system you can
me nevermind.
transform these conversations into an entirely new
way of referring and engaging.

Aa

You create a whole new level of opportunity and Do you know a good dentist?

trust where the relationships become


exponential. The practices that adopt this first Yes! You should see my dentist.

will grow much faster than those that don’t.


Where are they?

This also eliminates all the headache of google They are state of the art, you can
actually start and do a digital
marketing and facebook as you are going assessment here as a first step
to get this amazing report, they
are really professional - here use
directly from new person → comprehensive my introduction link
www.instant-dentist.com
assessment & education → provisional diagnosis
Wow that’s amazing and it only
and scheduled appointment where the patient is takes 5mins? I’ll do it this
lunchtime.

already invested in the relationship and


motivated to proceed
Aa
Opportunity

The average practice has 1500 patients.

Let’s say everyone is given a referral link and they get an Amazon gift card of £20
per referral.
Each person may have 5 friends who could be interested in improving their dental
health.
Let’s say 25% of patients want to refer.
That’s a new audience of 375 x 5 = 1875 new potential digital patients.
Let’s assume a 20% acceptance.
That’s 375 new patients and at an average production of £500 = £187,500 of new
revenue.
This is a transformative approach to expanding your practice and filling it with
trusted patients similar to those that already know, like and trust you.
l
rra

25% 1875
e
ref

l
ra
fer
re
l
referra
new potential
of curent refer digital patients
patients ral

re
f er
ra
l

20%
acceptance

375 New Patients

New revenue

£500 = £187,500
DIGITAL PRACTICE DENTAL PLAN
We all like to be members. Members get superior service, upgrades and
preferential offers.
There is an opportunity to create truly unique practice membership plans.
Plans with a real reason to join your practice.
We all know of the usual practice dental plan, £10/month for 2 checkups and 2
hygienes and 10% off treatments. This is £120 in spend per year per patient and
they have nothing tangible in their hands. This is just not attractive for most
people and would be one of the first things to cancel.

Now imagine something much much better

A practice membership which was £10/month and you got:

A Smartpower electric toothbrush with 4 brush heads to

refresh your smile every 3 months

2 Digital assessments per year

2 hygiene appointments per year

10% off e-commerce professional health regimes packages

10% off treatments needed

This is an example of an enhanced practice membership which could even be


offered as a gift in a branded package. Everyone likes to receive professional level
packages and this could be a unique solution for your patients.

This can help your patients save money by


consolidating some of their oral product spend into
their dental spend and more importantly you get to
enhance your relationship with your patient into their
bathroom with them using one of your practice
branded brushes at home.
In addition the prompt of changing the brush head
every 3 months can be linked with a voucher or prompt
for a digital assessment or hygiene appointment thus
meaning patients could be supervised every 3 months -
depending on your choice of plan design.
DIGITAL HYGIENE PLAN

Digital
assessment

Hygiene Hygiene

Digital
assessment

This delivers more prevention and education throughout the year and is much more
convenient for your patients. The enhanced relationship increases trust and
awareness meaning greater acceptance of treatments when needed.
This package can be a compelling benefit which local employees could also find
interesting as a work benefit. We have a section on that coming up.
1HR DIGITAL ALIGNERS
Straight white smiles have never been more popular than they are now.
Invisible aligners are one of the most in demand cosmetic procedures globally.
Whitening, straightening and bonding enables a minimally invasive smile
transformation in just a few months. By all patients having a digital dental
assessment which includes a cosmetic assessment discussing tooth position,
tooth shape and colour, more patients will be interested in options.

70% 50%
of adults have of adults would
crooked teeth like to improve
their smile

70% of adults have crooked teeth, 50% of them would like a nicer smile so if you
were able to use an aligner system specifically designed for teledentistry you
could deliver cases with less than 1 hour of chairtme, meaning you could sell the
packages for a much lower cost than usual whilst maintaining a high hourly rate
of >£600/hr.

This means if you could sell dual arch aligner cases to the patient for £1650 plus
additional packages of bonding / whitening as a mini-smile makeover you can deliver
a minimally invasive highly affordable and desirable solution for many many patients.

Opportunity

10 new cases a month of this new affordable


aligner option means 120 hours of chairtime “120 hours” £240,000
could yield an additional £240,000 of practice
revenue.

To understand exactly how this can be


implemented read our Aligner Growth Guide.
Email us for more information.
EXPAND: OUTSIDE PRACTICE
By now you are starting to understand the true potential of asynchronous digital
assessments and how they enable you to access new patients and enable more
informed and motivated patients too.

This means you can now suddenly gain access to whole new categories and
cohorts of patients without spending on facebook and google without you being
reliant on facetime calls. These new patient opportunities are invisible and unseen
to other dentists yet are highly trusted as they go directly to the patient
assessment versus the approach of:

The exponential way


Online advert

See material from


Visit website your practice offering Do a digital
digital assessment assessment then
Call practice (hope and there
receptionist answers well and
schedules appointment)

Get appt date


VS Schedule
productive
quadrant
Get educated
and informed on
oral health
Wait status in excess
appointment
of any previous
experience
Get reminder for appointment

Attend appointment
Discuss options
Pre-apply and by video call /
Get assessment get accepted for clinic appt
finance

The key to scheduling more treatment is to establish trust digitally fast.


Digital assessments give you the ability to provisionally diagnose, explain the
issues and items needed and also for the person to know the key three questions -
How much will it cost?
How long will it take?
When can you see me?

By using this method of communication your practice footprint will expand to


whole new audiences of practice.
New Patients

EMERGENCY PATIENTS

Hotels Schools Universities

Dental emergencies can happen anywhere. In your local area within driving
distance there is a huge number of people that flow in and out over time. Many
attend conferences, events, staying in hotels, schools, universities and tourists. All
of these people are subject to potential dental emergencies such as a cracked
tooth. lost filling, sensitivity, gum problems, abscess, lost crown or infection.

By having the systems in place to show your


practice is on the network offering digital How much will it cost?

assessments you can be the first to access these


How long will it take?
new patients. The ability to provisionally
diagnose, explain the issues and items needed and
When can you see me?

also for the person to know the answers to the key


three questions:

Aa

This means you will be able to acquire new patients into your practice and help
them in a productive way.
New Patients

PHARMACY PATIENTS

550
people seeking dental
solutions per month
550
people seeking dental
solutions per month

550
people seeking dental
solutions per month

Most people that have a problem put off going to a dentist until they absolutely
have to.

There is one place however that they do visit a pharmacy. The most common issues
are bleeding gums, infections, lost fillings, broken teeth. Nobody wants to have
these dental problems but there are many perceived barriers to visiting a dentist for
many people.

The barriers include fear of a huge bill, fear of


being judged, fear of seeing a non-empathetic
dentist, all of these elements mean many people
try to self medicate and seek solutions in a
pharmacy. In an average pharmacy this would
mean about 550 people seeking dental solutions
per month or 6600 per year. In larger pharmacies
there are a lot more people and in a commutable
distance to your practice there could be 5-10
pharmacies, meaning 2750-5500 people a month passing
through these places. This is a huge flow of dentally focused potential patients. Our
program enables in store digital dental assessments and these patients can
potentially be accessed by your practice. This presents a whole new source of
patients that others cannot access.
New Patients

Corporate employee patients

Workplace wellbeing has never been more important than ever. More and more
employers are offering workplace benefits for their corporate employees. The HR
department often uses benefits as a competitive tool in recruiting talent. This has
led to the expansion of benefits into medical benefits such as providing digital
doctor services for local employees. Dental benefits are historically very seldom
offered in workplaces due to the cost of providing them however dental benefits
are greatly in demand. Instant Dentist has developed corporate digital dental
plans which can be provided to workplaces at a low cost. This opens up the pool
of potential patients enormously. By being a member practice you can provide
digital dental plans to corporate employers locally and benefit as the practice of
choice for the procedures that inevitably are required and desired. The additional
benefit of leveraging technology is that you require less chairtime so as described
before can offer lower priced solutions on aligners, whitening and other in demand
cosmetic procedures enabling you to run very productive treatment rooms.
New Patients

Domiciliary / Care Home patient

Implants 3D intra
oral scan

Dentures Gum protect


packages

There are many people who for whatever reason simply cannot easily travel to a
dentist for regular appointments. They may not be able to attend checkups but they
certainly could attend treatment as and when needed. The key is being able to
monitor their health remotely in an accessible way, even offering access to oral
hygiene products and packages so they can self care more effectively for gum
health and decay prevention. By monitoring their health digitally and being able to
understand what procedures would be needed, they could then know the cost
implications and visits needed and so schedule the time to come for a longer
appointment to do all their procedures in one go. This provides a lot of potential
work for the clinic, in addition to this there could be strategy for care homes where
digital assessments could assess patients need for new dentures or implant
dentures, then domiciliary appointments where needed for 3D intra oral scanning
and then using 3D printed dentures or equivalent as a rapid way to manufacture
prostheses this minimises chairtime and office visits. This can be a very gratefully
accepted potential solution for many care homes. By doing some calculations on
the number of care homes in your district you can calculate the potential additional
digital patients your practice would be able to help supervise and care for.
New Patients

Dental Phobics

<60%
people are scared
of the dentist

More than 60% of people are scared of the dentist, this already restricts them from
visiting the dentist, phobics are people that have an even greater paralysing fear.
Often they also suffer from dental neglect meaning they feel self conscious about
their oral health and smile.

These patients when they do come in prefer to have as few appointments as possible
and they also prefer to have sedation or other techniques to ensure the session
passes smoothly.

This means a session will be multiple quadrants


of dental care and this would be highly
productive. To be able to offer dental phobics
digital assessments first for them to be able to
impartially and safely understand exactly what’s
needed for them from the comfort of their own
home is profoundly reassuring and game
changing. This channel can create a practice
within a practice for you as you look after and
help more and more people secure their oral
health. They would also be very interested in
digital dental plans and home based
professionally supervised regimes that mean
they can look after their health at home and
prevent further damage.
READY TO EXPAND & FUTURE PROOF
YOUR PRACTICE?

Deliver state of the art


Deliver a prevention beyond what
differentiated other practices provide
experience
Unlock new
revenue
streams Unlock new
patient
sources

Do more Do more
comprehensive implants
dentistry
Do more
Have more aligners
engaged &
grateful patients

NEW TYPES OF PATIENT

Physical patients Digital / Physical Digital patients


patients
FIND OUT MORE ABOUT THE
EXPONENTIAL PROGRAM

Gain access to the Gain access to the Get coaching and


platform to become systems, tools and support from experts
an exponential documents to on how to implement
practice digitally expand. these systems

Secure a competitive advantage for the future


of your practice

Book your discovery call today to learn more here

www.exponential-dentistry.com

Exponential by

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