Finding the Right Aligner Partner: Leaving Legacy Status for Operational Support ၏ စာသားမှတ်တမ်းအပြည့်အစုံ

out of LSU orthodontic residency in two thousand eight. And so he approached Dad and they merged David, correct me if I'm wrong, in two thousand eight, that's correct. Kramer Sherman (02:58) you David Balhoff (02:58) Yeah. Stephen Sherman (02:59) And so then since then added another satellite a couple years later and then we've redone some offices. One of the main offices that we have that's in Prairieville, Louisiana, that David goes to a lot. We moved there in twenty nineteen and then we added one more so we got a total of four locations in Addis twenty twenty one, something like that. doctor Kramer and I both went to University of Oklahoma for orthodontic specialty. So we finished in twenty eighteen and nineteen, but started a month later, so I joined the practice in twenty nineteen and then doctor Kramer joined the practice in twenty twenty, which really worked out well. David joined on during the David Balhoff (03:35) you Kramer Sherman (03:34) Okay. Stephen Sherman (03:48) crash or I'm sorry sorry the the housing crisis shortly after two thousand eight and then a step back from that my dad started the practice around the oil crash in the nineteen eighties and so in natural fashion David Balhoff (03:50) Okay. Alison Werner (04:00) okay. Stephen Sherman (04:03) we added two new doctors for COVID. Kramer had been here for five minutes and then the entire world shut down. So it seems like if we're looking to add any associates or parties in the future we'll just find out when the world's falling down or there's a financial crisis then we'll we'll add a new doctor. David Balhoff (04:09) Okay. Alison Werner (04:17) Well at least if you add a doctor then you're going up after Stephen Sherman (04:20) That's right. Kramer Sherman (04:21) It's. Stephen Sherman (04:21) And so in the last year or so, all four of us still work. we have recently become where David and Kramer and I are partners and my dad is now an associate and he's working kind of like celebrity guests. Yeah, it's it's hard to catch him, but he still loves coming in. He's here I don't know, maybe fifty, sixty days a year. And the plan is to do the same thing next year, which is a great balance because we get to still hang out with him and learn from him and he gets to see patients and we can take off kind kind of when we want or need to and then the we'll see what the future holds from there. Alison Werner (04:56) Yeah, yeah. Well, okay, so Kramer and David, David Balhoff (04:59) Thanks. Alison Werner (05:00) I'm kinda curious, what has it been like working in this Stephen Sherman (05:03) It's here. Alison Werner (05:04) family based practice? And let's just start there. What is it like working in this family based practice? David, I'll start with you. David Balhoff (05:11) Yeah, the, you know, I'm originally from Baton Rouge and so I knew that I was going to come here. I don't know that Steve Sherman ever really thought that he was looking for an associate at the time. but I have, I have 66 first cousins here in Baton Rouge or Kramer Sherman (05:27) Okay. David Balhoff (05:28) grew up with 66 cousins. so, being part of a family practice, always, you know, always kind of wanted a smaller practice, but just to be more boutique and warm and. Kind of a caring atmosphere. so joining with Steve was really good. And I think he, in hindsight, obviously looked at me as somebody that was gonna come back and be a worker, take care of people here in Louisiana. I everybody, a lot of people know each other and families know each other too. So it was kind of a natural fit. And so I think I was a good bridge to honestly allowing Stephen and Kramer to have a chance to come into this practice as well down the road. And so I was able to help grow the practice and honestly, probably create some space for them to be able to come here in the first place. And they've just carried on Steve's tradition of care and fun and making it a laid back atmosphere. Alison Werner (06:28) Yeah. Kramer, what would you say in terms of like where h how have you seen the practice adjust since you came on because you came in in COVID? How has it changed so s from the practice you kinda grew up with to joining it and where it is today? Stephen Sherman (06:42) Yeah. Kramer Sherman (06:42) Yeah, great question. Remember growing up every summer, Stephen and I would either work in the lab or work in sterilization because I want to say around third or fourth grade, Stephen and I were pretty committed to wanting to come back and join dad. To the point where whenever Dr. Bell helped join, we kind of approached the subject of if everything works out, we'd love the opportunity to be able to work with you one day. And so having the original outlook of knowing everybody in one office every day, getting to know everyone's staff, everyone's families kind of created that family atmosphere that we had in our head to start with. Alison Werner (07:17) Mm-hmm. Kramer Sherman (07:18) But like Stephen was saying, whenever I graduated, I'd been here two and a half months and COVID hit. And that was a time where, six feet apart, everyone had to separate. So we couldn't as easily have everyone in the office as much as the office had been with us for the last 35 years. So pretty much overnight, we had to adapt to open at least two offices a David Balhoff (07:39) . Kramer Sherman (07:40) day. And I think if we didn't have that, I guess, world crisis, we wouldn't have the same operating structure that we have. We'd probably still be more in one place, but that kind of made that first leap and allowed us to overnight David Balhoff (07:56) you Kramer Sherman (07:57) grow and kind of divide up between locations. Alison Werner (08:02) Okay, okay. So at this point it's the four four offices and you each kind of are dedicated. Well, the three of you are kind of dedicated and then your father kind of steps in part time kind of coverage. Stephen Sherman

(08:14) Yeah. That's right. Alison Werner (08:15) Okay. So what would you say makes the practice unique in the community? Kramer Sherman (08:21) think a big thing is, you know, not only are we a family practice, but being around for 40 years, we've grown to treat and really know our families of patients. We've got three generations for sure that we've treated of numerous families, possibly four generations Alison Werner (08:40) Mm-hmm. Kramer Sherman (08:41) out there. But getting to know not only the patient, but their parents and their grandparents and the stories of their families and, you know, David's 66 first cousins, the community is, it's a large community, but it feels really small. David Balhoff (08:55) you Alison Werner (08:56) Yeah. Okay, so our topic today is gonna David Balhoff (08:57) Thank Alison Werner (08:58) be we're gonna talk about your journey with Spark Aligners. let me start with this. What's the percentage of aligner cases in your practice? Stephen Sherman (09:05) Last I checked it was like eighteen. we look usually at at one meeting we go to annually and it's generally hovers in that that realm. We always think it's thirty, but I think in reality it's it's a little bit closer to twenty. unless you all have looked since since that last meeting. David Balhoff (09:24) seven or eight years ago we had gotten up to closer to 30 at one point. But yeah, I think we're around there. Alison Werner (09:31) Okay, okay. So talk to me about what motivated you t transition to a new aligner system with Spark. What was what was that experience? What were you looking for in making that decision to switch? Kramer Sherman (09:47) I don't think we were really looking. Almost kind of the opposite. We were, we'd only known one aligner system in the past. We Alison Werner (09:55) Right. Kramer Sherman (09:56) started doing some in-house aligners and we were pretty comfortable, but the service that Kim and Sheridan started to show us, they were always present. They were always caring. They were always there for the staff. They have been incredible. It was kind of hard not to, you know, lean on them for the services they could provide because of how great they are with our staff and with our office and with their products. Alison Werner (10:25) Okay, and so th those are your sales reps for Ormco. Okay. Kramer Sherman (10:28) Yes. Yes. Alison Werner (10:29) So you guys had an established relationship with Ormco, I guess on the bracket side. Okay. David Balhoff (10:33) Thank Kramer Sherman (10:34) Yes. Alison Werner (10:36) Okay. And David Balhoff (10:37) Thanks. Alison Werner (10:38) so talk to me about that transition then. You know, it was very easy because you already had David Balhoff (10:43) us. Alison Werner (10:44) a relationship with your sales reps, and so onboarding a new aligner system, what did you kind of see as Stephen Sherman (10:50) Yeah. Alison Werner (10:51) the advantages? Stephen Sherman (10:53)

I'll I'd piggyback on that in addition to the you know the front end the the service part I think the bigger issue that I found at the time with our our previous aligner company, one of the the bigger ones, not our in-house aligners, is that you're so dependent on the the technician and so your clinical preferences just simply being followed can make or break a ton of time in the office. And so if you're constantly having to to rewrite the script on how to do the basics and you get back trash, well then it just consumes a lot of office time and so I think simple things like even though we we didn't regularly meet with the rep, when we asked something simple like, hey, can we just make sure that these get followed, it wasn't heard or listened to, we're followed. And so every request we had, how big or small, kinda fell on deaf ears. And then so when we approached about Spark, our concern was that we're gonna lose our status with the previous aligner our previous aligner company, which we were the largest, I found out not David Balhoff (11:52) you Stephen Sherman (11:53) only in the state, but the southeast And so we were concerned that we're gonna lose some some referrals by that. And so that was kind of the leap of faith we took in that, you know, I I think you can get excellent results with both, but I think a lot of it depends on you know, who you're working with on the other side, not only the technician but But our representative and so I think equally part you know the the clinical results, the time we spend in, but the help that Kim's given and anything we've asked, she's you know, sh it's done before even it it it leaves our lips. that helped convince me to make the leap because I'll be honest, I was very hesitant because of the status we had gained initially to to leave. David Balhoff (12:36) Okay. Alison Werner (12:37) Yeah. David, I wonder kinda your perspective because you've been that you were there at the practice longer and had been, you know, that transition would have been more significant maybe. David Balhoff (12:48) Yeah, I guess I had more of an established relationship with that aligner company. I really kind of took a leap of faith with starting to use aligners back in about 2014, like significantly more. Back in the time Alison Werner (13:04) Mm-hmm. David Balhoff (13:05) where really a lot of people still weren't using aligners. So I had Alison Werner (13:09) Yeah. David Balhoff (13:09) a relationship for a solid five or six years and always felt fairly comfortable. But I mean, Stephen and Kramer are correct. mean, Spark and Ormco's service was just great and Kim was always here and it really is amazing when you have not only that support but technical support to make sure that your cases are set up correctly and that you don't have to reset them up every single time. And with the previous aligner company, I was doing that a lot. So I was spending a lot of time both at night and during the office hours doing a lot of that work. Alison Werner (13:42) Hmm. Okay. So in addition to, you know, kind of helping with that homework you were left with in making sure your setups were right, what other advantages have you seen with Spark compared to your previous aligners situation? Kramer Sherman (13:59) I they're continuing to commit themselves to improving technology, not only improving technology, but improving education for their providers. The amount that Kim is always willing to give us, anything we need in terms of meeting with technicians, meeting with other providers, has really helped to, as a newer graduate, improve my ability to treat my aligners very quickly, which I didn't feel like I had that access to before. Alison Werner (14:29) okay. Okay. what kind of t what types of patients or cases do you find Spark particularly effective for? Stephen Sherman (14:37) Compliant ones. Alison Werner (14:39) Okay, well yes. That's a given. Okay, loaded question. David Balhoff (14:47) Loaded question. I would almost kind of go the reversal. I would say the cases that maybe are really just in general tough to treat with aligners and Spark are deep bite cases that don't have crowding. That's maybe Alison Werner (15:03) Mm-hmm. David Balhoff (15:03) just that's an aligner system drawback. But really the majority of cases Alison Werner (15:08) Yeah. David Balhoff (15:09) if you're trying to sequentially distilize a tooth, and correct a malocclusion like a class II malocclusion. It actually works really well if you can use certain mechanics. I know that Stephen and Kramer have both done a lot of those. Open bite cases are really good. Alison Werner (15:24) Mm-hmm. David Balhoff (15:25) Overall crowding cases are good as well. And patients who have really gummy smiles. Alison Werner (15:31) Okay. yeah, go ahead. Stephen Sherman (15:32) Yeah, I a a lot of crowding and open bites or I'm I'm gonna generally push a patient that direction. Alison Werner (15:39) Mm-hmm. Stephen Sherman (15:40) but again it most of my time in the T C room is spent kinda reading them and their enthusiasm. If they're not if they're not, you know, asking for well I'm gonna say, look, I think our best treatment option isn't gonna be Spark aligners but if you're not gonna wear twenty two hours a day, well you what we're just gonna you know, either cut bait early, we're not gonna get the result that I want. And so Alison Werner (15:59) Mm-hmm, right. Kramer Sherman (16:01) Yeah, kind of piggybacking off of Steven and David, I think Spark gives me the confidence to know that we can treat almost all the cases that the patients are adamant about using aligners for with aligners Alison Werner (16:12) Mm-hmm. Kramer Sherman (16:13) and seeing David Balhoff (16:14) Thank Kramer Sherman (16:14) the different cases that have been treated with courses that we've treated in the clinic here, the office really proves that it's just one of the appliances that we can have,

whether it's braces or aligners that we can get the same result with. David Balhoff (16:27) Okay. Kramer Sherman (16:28) When I think in the past, there's a lot of providers that didn't think aligners could get the results with a lot of cases that braces could. Alison Werner (16:33) Mm-hmm. Right, right. You you g you kind of all have mentioned the fact that like kind of the continuing education and that aspect. What have you kind of availed yourselves of as you've s it David Balhoff (16:46) Okay. Okay. Alison Werner (16:49) onboarded Spark and as you continue to work with it? Stephen Sherman (16:54) Probably the best continuing education course I've been to and I think they'd probably agree. I guess taking a step back in residency I took another major aligner company's a aligner course without getting too specific, and thought that that was you know, the golden rule with how to treat with the liners and so I'd set all my clinical preferences based on that and I was kind of tried and true with that and was not getting the results that I was hoping for. So whether it be the the preferences, whether it be my setups or the technicians you name it lost a lot of confidence and then since switching to Spark went to the C O I P course, I don't know, David, two years ago or so. what we learned there completely David Balhoff (17:37) about the MasterCOIP course. Stephen Sherman (17:38) changed how I think Yeah. completely changed how I think a lot with aligner mechanics and how we do set ups and really changed the scope of what I'm willing to treat now. Alison Werner (17:52) Hmm. Stephen Sherman (17:53) in fact it the only I've not done the follow-up course to that, but that's I told them recently that the next course I want to go to would be the follow-up to that. and I'd highly recommended that to anybody, whether they're training with Spark, whether they're training in house or another aligner company. I think going to that course, no matter what treatment modality they use of clear aligners is a no brainer. Alison Werner (18:15) Okay. I'm kinda curious, how how do you think Spark has impacted your practice overall? So like efficiency, practic patient satisfaction, digital workflow or even just growth overall? Kramer Sherman (18:29) I think a big one, whenever Steven and I first joined, you we were new grads and we wanted to try out all kinds of stuff. And we bring something to the clinic and we wouldn't have the best implementation strategy to change something up. so, you know, chair sides or team members of the office don't exactly love when you change systems up really quickly. They weren't thrilled when we first mentioned we're going to try Spark, but Kim and Ormco were so great at bringing a team in. and being there every day to make sure that the team knew how to pull the website up, to put the aligner templates in, to have spark works how it operates, really made things easy and really got the buy-in from the team, which made

it pretty seamless. So that's helped David Balhoff (19:15) Thank Kramer Sherman (19:17) other systems that we've implemented kind of knowing better how to do this. Alison Werner (19:20) And then you know, you talked earlier about just like, you know, the homework you had with your setups with your previous aligner company and how talk to me about how that has changed and how you're not having as much of that digital homework. Stephen Sherman (19:34) I find that and I made s a few changes after going to that course on my clinical preferences. We call all three of us kinda have our standardized now, but overall it's rare that I get a case back and I kind of scratch my head and say a four letter word like what was this person thinking? David Balhoff (19:48) Okay. Stephen Sherman (19:54) you know, at the most I may say, Hey, let's, you know, look at this part of my clinical preferences because they overlook something, but generally and I don't know if we have the same person every time, but the consistency on setups is much better. And so David Balhoff (19:59) Okay. Stephen Sherman (20:07) I would say I haven't tracked my averages. I would say on average for a new case I have two refinements where I'm doing work on a case setup, whereas before it would be I don't know how many and more important than that, the amount of time that I would spend David Balhoff (20:21) Okay. Stephen Sherman (20:25) per setup is drastically different. And so that all equates the time at home, time to, you know, focus on other parts of the office, time to spend with patients, you name it. and I'm not spending a half day on a day off or, you know, nights throughout the week. I can do majority of my like you said, spark homework in between patients or throughout lunch to where it's not really changing my my work life balance. David Balhoff (20:41) you you Alison Werner (20:46) Mm-hmm. Yeah. Yeah. talk to me about, you know, kind of the response from patients. Ha you know, David Balhoff (20:57) Thank Stephen Sherman (20:57) Yeah. Alison Werner (20:59) in terms of have you noticed anything with their s how they respond to Spark and their treatment David Balhoff (21:06) Thanks. Kramer Sherman (21:06) Thank Alison Werner (21:07) versus, you know, what you were kind of seeing before? Stephen Sherman (21:11) I know there's a lot of talk in terms of the you know, different types of plastic and this one's clearer or this one's, you know, clinically more effective. Just my two cents I I I think it kinda comes down to the setup and so I think Spark's ability to educate the doctors. like I said, I I think a lot, you know, give credit to the the master's COIP course and then just the improved communication between the meetings we've had with our technicians via FaceTime or Zoom or whatever it may have been, the responses and the the clinical knowledge and setups from the technicians plus what we've learned since using Spark I think ultimately is probably the main contributing factor to clinical David Balhoff (21:44) Okay. Okay. Stephen Sherman (21:55) success. Alison Werner (21:56) Mm-hmm. Stephen Sherman (21:57) Not saying that one aligner company does or doesn't have better plastic, but I think that the overarching dominant factor there is is probably how it's set up. You know I think that Spark does a real good job making sure that the doctor has an open line of communication with anybody they need, whether it be with a CE course, with their technician, with their rep, to make sure they've got all the tools they need. David Balhoff (22:24) Yeah, I think, you know, Steve Sherman always talked about systems. I mean, that was his biggest thing in the office when I joined with him. It's like better systems always lead to better outcomes and better outcomes lead to better word of mouth referrals. So now, I think General Dentists and the greater population in the area realized that we are known for really good aligner treatment. So as a result, that Kramer Sherman (22:51) Thank David Balhoff (22:51) helps us to grow. And then as we grow, the systems help make our lives easier, honestly. Alison Werner (22:59) Yeah. Related to that, you know, what does it mean for you to kind of have your aligner system and at least part of your bracket, if not all of your bracket system, within the same platform within with the same rep? How does that help with that kind of just efficiency of systems and growth? Kramer Sherman (23:19) We do use some Ormco brackets. We don't use all Ormco brackets. Alison Werner (23:23) Yeah. Kramer Sherman (23:24) I think it helps our team members who order have less points of contact. The financial side invoices, I think, are easier in that way. But I think it mostly just comes down to who they have working for them, because Alison Werner (23:42) Hmm. Kramer Sherman (23:42) they're so easy to have access to in the office. She answered all our questions. very fast. Alison Werner (23:49) Yeah. Okay. How do you see Spark kind David Balhoff (23:52) Okay. Alison Werner (23:54) of shaping the future of orthodontics and your practice in particular? Kramer Sherman (23:59) I think they're committed to wanting things to all be in one platform. They want to have indirect bonding in the same place, in the same platform as Spark does. Alison Werner (24:10) Right. Kramer Sherman (24:11) So using Ormco brackets, you're never changing websites, you're never changing systems, which will make it easier for the chair side, because I think there will be more indirect bonding in the future. I know that they're David Balhoff (24:16) Thank Stephen Sherman (24:18) Mm-hmm. Kramer Sherman (24:23) trying to stay on top of technology with pre-filled aligner templates, with improving David Balhoff (24:26) Thank Kramer Sherman (24:27) materials. I think we don't, know what the future holds, but I know that they're constantly trying to make sure that they're standing in the front lines of it. Alison Werner (24:37) Yeah. What advice would you give to other orthodontists who are considering an aligner switch? Because sometimes it can seem David Balhoff (24:41) Okay. Alison Werner (24:44) daunting to make a change when you're used to a certain system. David Balhoff (24:47) Okay. Stephen Sherman (24:50) I would say if you're concerned about losing your status, 'cause that was kind of our biggest drawback and concern was like, hey, we got this top tier status with this big aligner company, we get referred patients from them and we save this much money and we're paying, you know, this low case fee. that has not it slowed us down at all and it's only gotten better. I don't think it's the David Balhoff (24:54) Okay. Stephen Sherman (25:14) the referral has not affected our share of chair for aligners It has not had a financial impact on us for case fees. and going back, I would ten out of ten do it again. And there's a reason David Balhoff (25:28) you Stephen Sherman (25:29) that we haven't tried any other I know there's been new aligner companies that have come up since then. There's been a reason that we have have not tried any other aligner companies. We haven't in fact we've had offers to have cheaper cases with some you know, multiple other big aligner companies, and there's a reason that we've stay Spark David Balhoff (25:37) Okay. Kramer Sherman (25:47) Yeah, I just say if you're not getting the care that you need to properly take care of your patients, look at other options, no matter who you're using now and who you're looking for. Because wherever you're at, I think it's going to depend on who may be best for you. Ormco and Spark have for sure been best for us since we've made the changes. Alison Werner (26:06) All right, well thank you so much for joining me. I really appreciate talking to you guys and for sharing David Balhoff (26:10) Thanks. Alison Werner (26:11) your insights. Kramer Sherman (26:13) Thank you very much. David Balhoff (26:13) Thanks so much. Stephen Sherman (26:14) Thanks for having us.