Finding the Clinical Need Hiding in Plain Sight: Interview with LightForce CEO Alfred Griffin

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[upbeat music] It's also part of the product strategy when you think about it. It's like a- any new feature, any new thing we add on, and this might be helpful for other folks, is, you know, think about the new stuff.
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Does it remove things someone needs to learn, or does it add things that people need to learn to use the product? 'Cause anything you add that needs to be learned will create more friction.
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Welcome to MedSider, where you can learn from the brightest founders and CEOs in medical devices and health technology.
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Join tens of thousands of ambitious doers as we unpack the insights, tactics, and secrets behind the most successful life science startups in the world. Now, here is your host, Scott Nelson. Hey, everyone.
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In this episode of MedSider, I sat down with Alfred Griffin, co-founder and CEO of LightForce.
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LightForce is the developer of the first fully customized 3D-printed bracket system directly personalized for each patient's digital treatment plan.
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Alfred holds a DMD and PhD in craniofacial biology from the Medical University of South Carolina and completed his orthodontic residency at Harvard School of Dental Medicine, where he currently serves as faculty in the Board of Fellows.
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An ABO-certified practicing orthodontist, he continues to see patients every month while running the company. Here are a few topics we explored in this conversation.
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First, how do you identify treatment gaps hiding inside markets that already look fully served? Second, what does it take to build a new category beyond just building a better product?
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Third, what drives adoption when your product requires change across clinical, operational, and economic domains simultaneously? And last, how do you treat scaling as a product problem rather than a logistics one?
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Before we dive into the full episode, if you're a med tech founder or CEO preparing to raise capital, you should check out the MedSider Fundraising Cohort.
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This four-week live workshop combines small group sessions with real-time feedback to help you sharpen your investor story, build a targeted investor pipeline, and run a focused fundraising sprint instead of a never-ending slog.
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Over the month, you'll walk away with an investor-ready narrative and deck, outreach scripts that actually get responses, a refreshed LinkedIn profile, a simple content plan that keeps you on investors' radar, and a repeatable system for running your raise.
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You can join the wait list at medsider.com/fundraisingcohort. Again, that's medsider.com/fundraisingcohort. All right. Let's get to the interview. [upbeat music] All right, Alfred, welcome to, uh, MedSider Radio.
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Appreciate you, uh, carving out a little bit of time on this Monday. I'm sure your schedule's jam-packed running LightForce. But, um, but yeah, appreciate you coming on. I'm excited to be here, Scott. Yeah, likewise.
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So, uh, with that said, um, I recorded a very short bio at the outset of this interview, but let's start kind of hearing it from, from you first.
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Give us a kind of a one to two-minute elevator style pitch on your, your journey before founding the company.
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Man, well, the, the simplest way to describe my background is the way one of the, the analysts at Stifel referred to me at, at a meeting. They, they called me an inbred dentite, which- [laughs]...
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uh, I think stems from the fact that both my mom and my dad are dentists. As you can imagine, I grew up going to dental conferences for family vacations because they're tax write-offs.
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We talked about teeth at the dinner table, and it's just a world I grew up in and, and, you know, had a lot of passion for. We grew up on in a small town.
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We had cows, and you know, a farm, and you know, horses and things like that.
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But it was a small town, so you go to the grocery store and I hated going to the grocery store because, like, everyone wanted to talk to my parents. I could never get out. [laughs] Like, they want...
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And then they'd show them their teeth in public. And outside of that being a little bit weird, it also helped me appreciate, man, you can have a huge impact in a community as a dentist.
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And, uh, so it was always something I wanted to pursue.
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Given that both my parents were dentists, in addition to my grandfather, uncles, cousins, things like that, I wanted to have an impact in the field that my family cared so much about.
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I did a DMD PhD, uh, instead of just doing a DMD, which just turned into seven-year program instead of four, which makes me a bit of a glutton for academic punishment.
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I, I went to the 27th grade, so- [laughs] Which I don't recommend, but it taught me a lot.
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Originally wanted to have an impact in orthodontics by altering biology, which is why I, I went up to Boston, uh, to Harvard for my residency a- as a scientist and, and kind of pivoted once I realized what a phase one, two, three clinical trial costs and what the market would be for a biological intervention to move teeth faster.
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Hmm. So then we looked at, all right, can we move teeth more efficiently biologically, or would it be better to control the physics? Hmm. And ultimately landed on, hey, let's, let's control the physics.
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There's a massive opportunity here looking at, uh, the teen market, which is served by braces.
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One thing your listeners may not know is that generation Alpha is going to get the same braces that their grandparents got- Hmm...
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which is pretty surprising, uh, given the advancements in technology and, and innovation in med tech and all the incredible founders and CEOs in your podcast.
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So and we saw what digital orthodontics did to the aligner world. We created a market for adult orthodontics- Hmm... that previously didn't exist.
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I mean, you used to have, you know, 40, 50-year-old men and women come into your practice, and they just wouldn't get treatment because they didn't want braces. Hmm.
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And, and aligners came in, and they unlocked this huge market, which is phenomenal for everybody. If you think about an abundance mentality, it turned into a very good thing for the profession and for the world.
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It had great impact. And they did that by applying modern technology such as CAD software, such as 3D printing. Aligners were not invented by the aligner companies. [laughs] They were invented, like, back in 1946.
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What changed was that those technologies enabled aligners to scale. Hmm. And so I thought that was a really interesting take.
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And, uh, when I was going through residency, I remember I used to upload every one of my cases, whether it was an aligner case or a bracket case, into an aligner software just to see, how does that puzzle come together?
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Are the teeth the right width? Are the jaws the right relationships? How do those teeth and those jaws come together the right way to create the best aesthetic and functional result for a patient?
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'Cause the goal of treatment is not straight teeth. It's, it's far more than that than, than people realize. If you're, you know, thinking about your son or daughter, you, you would wanna know these things. Mm-hmm.
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And the problem was the only output of that software was a clear aligner, which is not a great fit for the biggest market in orthodontics.
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Roughly 75% of orthodontic patients are teens and adolescents that have never been treated before. They've got erupting teeth. Uh, aesthetically, you know, it's, it's a sensitive stage in life.
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And aligners have two main problems with that population. One is biomechanics. Aligners are really good at pushing teeth. They're not good at pulling teeth. Hmm.
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And so if you can imagine, like, pulling upper incisors down or rotating pre-molars, uprighting molars, I, I, I'll save some of the clinical details, but they're not good at that. They can push.
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They can't really pull well. And the second main thing is compliance, which simply means aligners only work if they're on your teeth. And as an orthodontist, I know that...
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And, and I love aligners, but the number of times I've heard a teenager say, uh, "My dog ate my, my aligners," or, "I put my aligners in a napkin at school and it got thrown away," like, that results in the aligners not being on the patient's- Hmm...
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teeth. And so, you know, you're year two into treatment and mom and dad are not blaming the aligner company. They're definitely not blaming their precious son or daughter. They're blaming you.
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[laughs] And then you gotta put braces on the kid. It's just not a great experience. So we said, "All right. There's gotta be a better way.
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What if we can apply some of those amazing technologies that enabled clear aligner production to the bigger market of braces?" And, and that's really, you know, where it came back to- Yeah...
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our if, if we're gonna have an impact in orthodontics, the best way is to control physics by applying those technologies to create a scalable braces solution that is meant for the patient. Got it.
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So, so tell us a little bit more about the technology 'cause I think that, that's a great backdrop, and I... And I... We- we're certainly gonna get into the, the, kind of the, uh, the deeper journey, right?
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Starting the company and kind of what you've been through and where it's at today- Yeah... and lessons learned along the way.
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But, but for those that aren't as familiar with your, your, your technology, I'm on the website right now, which is lf.co, so LightForce. It's LF, like the letters, lf.co.
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We'll link to it in the full writeup on MedSider.
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But give us a sense for, like, how this is distinctly different 'cause I think m- for most people that are listening, they're like, I, I mean, less than 5% chance that they're not familiar [laughs] with braces and probably, probably similar percentile that's, that, that's unfamiliar with, uh, with, with aligners as well.
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But give us a sense for kind of how this is different and, and, and whether it's the... what's... whether it's related to, like, the, the mechanics itself or even just kind of the workflow of a typical kind of patient.
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Yeah. I mean, as, as I mentioned earlier, you know, the braces that Jen Alpha is getting today are the same ones that their grandparents got. What I mean by that is that braces that are used are made for nobody. Hmm.
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They're made for the average, and they're, they're kept in a box in a closet in an orthodontist office.
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And when a patient walks in, you, you take the same bracket out and you stick it by line of sight on the patient's tooth, the orthodontist does this, where they think they go. Hmm.
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And again, it's, it's a bracket made for nobody. So then we have to see the patient back for tightenings every four to six weeks because we're not really sure where the teeth are going. We've gotta monitor this stuff.
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Hmm. We're reactive. Compare that to clear aligner treatment where a patient comes in and you take a scan and you design the outcome, so you're starting with the end in mind versus being reactive. Hmm.
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And so what we're doing at LightForce is we're applying that same concept, that same clinical concept where a patient comes in, you take a scan of their teeth, collect all the data, all the records, and then the orthodontist plans where should those teeth end up for that patient for their smile, their soft tissue, their jaw relationships.
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What's the best outcome for them? Uh, their tooth sizes. Hmm. And then we plan braces that will only get them to that position. So it's the same kind of approach as aligners. We're starting with the end in mind.
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Now, what that results in, Scott, is that we don't need to see the patient every four to six weeks because we're not being reactive. We're being proactive. Hmm.
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We can see the patient every 10 to 12 weeks or sometimes longer, depending on, on what the orthodontist wants to do. And, and what that results in is you get 43% shorter treatment time and 60% fewer visits- Hmm...
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which as, as, as you can imagine, has a huge impact on the experience for the patient. But it's not just that. Oftentimes you can only, you know, get cost, quality, speed. In this case, you kinda get everything- Hmm...
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um, because you also get a, a quantifiably better outcome for your patient. Got it.
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What, what were those two stats again in terms of re- reduction in, in, in time, so like the, the time that someone has to wear, wear the braces? What were those two stats again? 43% shorter treatment time. Wow. Okay.
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And, and that, that can be anywhere between eight and 10 months, and then 60% fewer visits- Wow... uh, which is... turns into about a year less treatment and six to eight fewer visits.
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And this is actually data coming from a clinical trial that was just published last month- Uh-... in a peer-reviewed journal. Yeah. Say, for example, I- I'm walking into your clinic.
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You're still practicing full time, as an example, and, and you're pitching me on this new alternative, right, Li- LightForce. It's instead of maybe a t- a two-year window of, of wearing these...
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wearing bra- you know, traditional braces, it's now, let's call it, I don't know, 14 months, 14, 15 months, something like that. And then I have to come in less for these tightenings, right? Mm-hmm.
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So instead of coming in every four to six weeks, it's like I come in every 10, 12, 14 weeks r- roughly, something like that? That's exactly right... and then, oh, by the way, as if this was an infomercial, right?
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[laughs] And there's one more thing. [laughs] You're actually gonna, you're actually gonna get a better result. Uh, that seems, that seems pretty, pretty compelling. That's a pretty compelling pitch.
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You have me, you have me leaning in with, uh, with, uh, six kids myself, right? Yeah. Oh. So, uh, [laughs] yeah. Seriously. [laughs] That's it.
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If you add up the nu- the trips to the orthodontist that you, you have in front of you, my friend, that, uh- I know. We've got-... could be quite substantial...
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we, we've got three, three, three that have already been through it. But, like, that's why it's like, you know, I think most people listening, they've, they've been... they've got kids, right?
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That have been, been through the, the typical kind of braces. You know what I mean? And so, yeah, it's like this is, this is interesting. Yeah. I mean- [laughs]... certainly, certainly, uh, certainly I'm...
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y- you have me leaning in. It's interesting, Scott. It's not a brilliant idea. I mean, like, if you're an orthodontist, this is... It's, it's pretty obvious. Yeah.
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You know, we're used to at the end of treatment repositioning braces by hand, we're used to bending wire, and those are the painful appointments for patients that they commonly refer to as the tightening. Mm-hmm.
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You can still do that with LightForce if you need to, but you really shouldn't, uh, need to once you master the technology because it's like every tooth in your mouth is taking a direct flight versus a round trip flight.
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Hmm. It's kind of funny. It's like you might remember when Google Maps replaced the paper map- Yeah... uh, in your parents' glove box. Like- Yeah, yeah... your parents didn't drive faster.
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They, they stopped getting lost. They stopped needing co-pilots. They stopped asking for directions. Yeah. And they stopped arriving late. Taking the scenic route was a choice, not a wrong turn they would take. Yeah.
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The drive was actually always that short. They, they just couldn't see it. So the same concept is true when we think about LightForce.
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When LightForce replaces the stock braces at your orthodontist office, tooth movement is not gonna speed up biologically. The waste just disappears. Uh, the, the tightenings, the bracket repositionings- Yeah...
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the extra appointments, the wire bending. It... That was never part of treatment. That was just the cost of using a tool that was not designed for your son or daughter. Right. Yeah. Yeah. Super... Like, I, I just...
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Like, taking a step back, the traditional, like, I'm gonna call them braces market, right? It's an uns- unsophisticated way to describe it, but, but the braces market, such a huge market, right?
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And, and everyone is familiar with kind of like the innovation that's happened with, with aligners, right? And the success story. This... The, the...
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I would say the, the large success story, but multiple success stories there. But you almost kind of... You forget about, like, what happens in the, in the, in the, in the big part of the, the middle, right? Yeah.
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The messy middle, if you will, right? There's lots of room for improvement and, and different ways to do this, and obviously you're, you're solving for it.
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So very, very, very interested to kind of learn a little bit more about the, about the journey getting to where we're at now, you know, recording this in, in early Q2 2026.
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But give us a sense for kind of where the company's at right, right, right now for those that may listen to this, you know, three, four months down the road. We started this company as a, uh...
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We, we got funded back in 2017, and, uh, obviously, the first goal was proof of concept, getting regulatory approval. We bonded our first patients in 2018, about the same time we got regulatory approval.
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We started a beta in 2019. And these were with braces that were very white. They were not translucent. I mean, we, we had the decision we, we could either make braces in ceramic, metal, or plastic. Hmm.
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Metal we couldn't 3D print at a resolution. You need to 3D print this to be able to scale it.
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The way braces are traditionally made is via injection molding where you stamp out the same thing as many times as you can, and then you get that economy of scale where if your mold costs a million bucks, your first brackets are a million, your millionth is a dollar.
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Mm-hmm. Um, but you can't change the shape. You can't customize it for the patient. Whereas 3D printing, uh, change and part complexity come free. So we knew we needed to 3D print.
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So we're really looking at, all right, what are the limits of 3D printing at the time? Hmm. For metal it was not there.
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Metal 3D printing applications were more focused on aerospace, automotive, which meant bigger parts where they had different application requirements that didn't need to be as high resolution but had maybe thermodynamic, uh, requirements that we didn't have.
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So metal was not there. Plastic, for biocomp reasons, aesthetic reasons, wasn't a good fit either. It also wasn't strong enough. And then enter ceramic. We, we... So we started with ceramic. Ceramic was there.
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You could make ceramic tiny parts. Uh, there's technologies used for casting cores. And we said, "All right. This could make sense for, for our application." So we investigated, doubled down.
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It, it wasn't aesthetic at first. Like I said, we called them the AirPods for your teeth- [laughs]... uh, because they were totally white. Uh, and there had never been white braces in the history of orthodontics.
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[laughs] But we leaned into it, and then, um, in '21 our, our material science team found a way to make them clear, and then we started making them for, uh, the molar teeth as well.
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We had a complete product in '22 and updated a lot of software, you know, figured out how to scale it, which is, is a whole story. Mm-hmm.
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And then, uh, you know, fast-forward to today, we, we've treated, uh, nearly 200,000 patients. Wow. And we're in 51 out of the 66, uh, residencies.
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Orthodontic programs in North America require their residents to use LightForce today. Wow. Um, so as, as I said, you know, this is something that makes a lot of sense. It's like asking an orthodontist is the sky blue?
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Is this gonna be the future of the profession? Uh, it absolutely will be. And you're, you're in... You said 51 of the... How, how many total residences are there? 66. Wow. Wow. So al- almost near...
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Like, almost all of them. Okay. What are, what are the last 10 doing? Like, come on. Like, what's, uh, what's going on with the last 10? [laughs] It's...
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The last 10, it's not necessarily the chairman, uh, or, or chairman. It's, it's the, uh, legal departments. Ah, okay. Things just move a little bit slower- Yeah, sure...
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in certain academic institutions, which- Yeah, got it. Got it. Makes sense... can't, can't fault them for. [laughs] That's, that's super helpful. But again, everyone listening, lf.co is the website. lf.co.
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I'm sure you're probably... Uh, y- this is probably compelling technology. I'm, I'm, I'm... I don't think I'm the only one that's like this is super interesting. I've... I haven't heard of this quite, quite yet.
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So even if, uh, you're largely listening to this interview for more of a...
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from a business perspective, you probably got kids or you know of friends that have kids that, uh, that should know more about this, uh, m- more about this, this tech.
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So with that said, let's spend the next maybe 20, 30 minutes kinda going through your journey building LightForce, Alfred.
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And I wanna start out with, um- With kind of this, this clinician to founder story 'cause that's...
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Although that's not maybe atypical per se, what is, what is maybe non-traditional is the fact that you're still running the company as CEO, right? Like almost 10 years later now, that is unique.
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So you decided to kind of like stay in the pocket, right?
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And stay in the saddle, drive- driving the ship forward, which I think is, uh, is probably a credit to your ability to kind of adapt and evolve with like the changing needs of the business.
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So, you know, when you think back about your, you know, your journey, are, are there like maybe one or two things that really stand out?
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And maybe frame this for other, other clinicians or physicians, whoever they are, right, in their capacity- Yeah... that have, have an idea, maybe wanna take- Sure... a swing.
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Like what are a couple things that really stand out, like that's, that's been impactful for your, your journey so far? Um, well first of all, I, I... There, there are a lot of people to thank who, who enabled this.
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I mean, I think one, one thing that's really important is having a very strong sense of self-awareness, knowing what you're great at and knowing what you're not great at. Mm-hmm.
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And, and being very intellectually honest about that, and then building your company around those strengths. So one of our HR tenets from day one has always been focusing on building a collection of strengths- Mm...
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versus an absence of weaknesses. And as a clinician, and, and I am still an orthodontist. I, I saw patients last Friday. So two days a month- Yeah [laughs]... uh, I'm in, I'm in clinic. Yeah.
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You know, that, that's a real strength for the company when, uh, someone...
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When you're making very important high-level strategic decisions a- as a CEO, having the context of what your customers go through every day using your product.
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And not every piece of data is gonna come through your business, uh, data center. It, it, it's... You're not gonna get every metric that's relevant to your business.
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Some of the things are gonna be qualitative, and some of the decisions will not made, be made just through data but also through instinct or a combination thereof.
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And as a clinician, having that close tie to both the product but also the user and the market- Mm...
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I think really helps inform some good decisions and, uh, enables you to, to go deep into a certain topic if you need to.
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But then, you know, looking around the company, uh, that's, that's not the only thing that matters, right? Yeah. So that's, that's one strength.
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But, uh, I, I'd say, you know, one of the voids I have is, you know, this is my first job. So I haven't run a large company or scaled opera- complex operations before. So- Mm...
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or led large engineering teams, things like that. So it's really important to find the best people you can to run those and give them the autonomy to, to make those decisions- Hmm...
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uh, within the strategic framework of, of the company's initiatives. So that and, and seeking expertise. Like, you know, surround yourself with great people, people that have been there.
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And one, one of the ways we got connected was, uh, obviously through, uh, Erica Rogers, uh, who's, who's on our board. Someone I have immense admiration for. Uh, she was the CEO of Silk Road for many years.
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Uh, did, did incredible things over there, built an incredible culture. Other, other board members, other in- investors as well I got lucky with very on, uh, very early on.
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It's, it's important, uh, you know, obviously who you take money from matters a lot. You're just not taking capital. You're also taking advice and guidance.
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Uh, so I was very lucky to work with some incredible early-stage investors who helped point me in the right direction and, and, and believed in me and the, and the, and the vision.
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The people that took a leap of faith to join me on, on this mission as well- Mm-hmm... um, massive kudos to them.
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I think we all learned a lot in, in the process and, uh, all brought those strengths, and that, that combination is really what, what enabled us. Yeah.
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No, I, I love the fact that you're still practicing even to this day, where you said two, two days a month. It reminds me of a... Uh, this was I think it may be last week I saw. It was just a clip of the interview.
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I haven't w- I haven't listened to the full thing. But I believe it was Mark Andreessen, I think that was... It, it might have even been the Founder's podcast. But he was talking about, um...
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He was comparing what happened in the early days of like some big tech companies like Oracle as an example where the, the CEO a- as the company, um, scaled and grew.
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There was so much distance between the CEO and the, and the, and the C-suite and, and the customer.
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It was ultimately hard to get to the truth of what was actually going on, um, in, in- inside the company 'cause you've got all these different layers.
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And he compared it to like how Elon, I think, is running-- runs most of his companies where it's like there's very, very little distance between the C-suite and the customer. It's, it's, it's quite flat actually.
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And individual contributors are actually h- very highly valued, um, in terms of like, you know, there's not this, this classic scenario where ICs want to get into management, and then they, they...
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You- it's so easy for any of us to lose sight of like what's, what's actually, what, what's the customer going through.
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And I don't know, like that really stands out, the fact that you're still, you're still see- you're still in practice. You're still seeing patients.
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You're still like you're that much closer to not only the, the end, the end user but also like what is a typical orthodontist clinic still, still going through, what challenges they have.
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And that's like, that's so, so critical. I, I think maybe it's more critical when you're, when you're building something that's not a commodity but a, a differentiated new technology. Mm-hmm.
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And, and that's what this is. This is not like another clear aligner. It's a totally new technology in orthodontics. Yeah. And when you're doing that, I think you have to...
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Another thing we say is you have to hire athletes, people that are good at learning new things quickly- Hmm... because there's no playbook.
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There's no blueprint for what you're building, so you kind of have to really be super connected. The cycle time has to be really quick as well.
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And so another one of the benefits of seeing patients is it's also executive onboarding. Hmm.
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So, you know, very commonly we'll bring, uh, new executives with me to clinic, and, and they can kind of experience that in-person use of the product as well. Yeah. But- Yeah... you know, I agree with you.
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It's a, it's a, it's a huge help. Offsets the other challenges of being a first-time CEO, so. Yeah, yeah, definitely. Yeah. Yeah.
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Well, well kudos to like your, your investors, your board for like letting you continue to kind of... I mean, g- I- that's, that's huge. And so, 'cause so many, so many others would like...
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It's just so easy to say, "Well, we need, we need this other person," right? They come in. They've, they've sc- they've scaled this startup before.
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But they lo- you lose sight of the fact that like the immense domain expertise that, that you have. You know, you still are, are very, very close to the p- to the, to the product, the end user, et cetera.
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But one of the other things that stood out to me though too in, in thinking about kind of your, your journey going from clinician to, to entrepreneur and like running this company as it scales is, um, is the fact that you said just be intellectually like honest about kind of where, where you're at.
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'Cause like I think so, so many, just like in, in life in general, like ego gets in the way of a lot of things, right?
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And you know, we think we can do everything and don't have the, the, the honesty or the humility to say, "No, you know, I mean, no, I can't actually, and I do need, you know, this other, like this other function need.
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I, I'm not, I'm less familiar with that. I'm not as good as that. Like let's, let's solve for that," you know? Um, and it sounds like that's credit, credit to you.
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Like that's, that's been something that's kind of led to, you know, you know, getting the company to, to this, to this stage is, is, uh, is, uh, is having, having that sort of humility to get there Well, I, I appreciate it.
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It's a lot of talented people and, and a lot of, uh, support along the way. Yeah, yeah. Cool. Let's get to the next topic on the docket, which is kind of development, right?
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Early-stage development, and it sounds like there's just like any, any startup, you know, you went through iterations of, of, of, of the product. But as a, as a first-time CEO, like this is one of the hardest...
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I mean, it's har- I think this is one of the hardest things for any, any CEO, but especially as a, as a first time CEO kind of going through the, the minutiae of this. But is...
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Like how to, how to, how to allocate w- resources, l- what are oftentimes very limited resources at those early stages, right? Trying to make the necessary improvements to kind of get to that next inflection point.
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But when you think about those first kind of, call it two, three, four years of product development, anything, anything stand out that was particularly helpful or maybe you, you kn- you know now that you, you know, wished you knew back then?
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Yeah, absolutely. Mass customizing braces is, is hard. [laughs] Mass customizing anything while maintaining quality and, and traceability is, is very difficult.
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That was one thing that I, I absolutely, uh, did not appreciate and, uh, and absolutely do now. So for reference today, LightForce is one of the world's largest manufacturers of directly 3D-printed medical devices. Hm.
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If you consider the roughly 200,000 cases that we've shipped, multiply that by something like 86 parts, individual parts, that are all very tiny and have very high application requirements for their precision. Hm.
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So scaling that while maintaining quality control is a challenge. It's hard to do that without... by, by just humans alone. The other challenge is traceability. Which part goes...
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forget which, to which patient, but to which tooth on which patient. Mm-hmm. So traceability is another challenge as well.
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This is not something that you just injection mold a bunch of times and then keep on a shelf for, for when you need it.
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It's, it's really complex manufacturing and then, oh, by the way, to make that harder, you've got to get it to the doctor in a very short period of time. Hm. So these are on, this on-demand manufacturing.
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So this is why we've had to bring in, and this is actually one of the things I'm so excited about, Scott, is the raw, like, intellectual talent we're bringing from the tech industry into the orthodontic space. Hm.
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A lot of it's coming from the robotic space, ex-Amazon robotics, Walmart robotics, a- and that's absolutely required because, you know, the robotic space, you have hardware, software, complex operations where you- Hm...
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we have to think very critically about logistics. That is a similar skill set to what enables mass customization. Hm. And, and that is a bigger problem th- than what I initially thought it would be.
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One of the benefits of being in Boston is it's the global home for, you know, 3D printing, for CAD software. Uh, there's a lot of strong med device material science folks here in Boston. Mm-hmm. Deep tech.
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And, and so a lot, a lot of talent is here, but then putting it all together under one roof, I, I think is, is a non-trivial problem. [upbeat music] Hey, everyone.
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Let's take a quick break to talk about Fast Wave Medical, the company I co-founded and lead as CEO. We're developing next-generation intravascular lithotripsy, or IVL, systems to tackle complex calcific disease.
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Over the last few years, we've closed a series of oversubscribed funding rounds, bringing the total investment into Fast Wave to over $50 million. Corporate interest in the IVL space is growing, too.
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The $900 million acquisition of Bolt Medical by Boston Scientific in 2025 and Johnson & Johnson's $13 billion acquisition of Shockwave Medical signal a lot of attention on emerging IVL startups like Fast Wave, and we're making serious progress.
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In addition to recently receiving our ninth patent, we've successfully completed peripheral and coronary feasibility studies and are gearing up for pivotal trials.
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If you're interested in investing in the fast-growing IVL market, head over to fastwavemedical.com/invest. Again, that's fastwavemedical.com/invest. Now let's get back to the conversation.
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[upbeat music] Where it went wrong in the past is where we would outgrow one factory and then have another and then have product people and engineering people in one factory and the people building it in another. Hm.
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Whereas the real strength and opportunity is unifying that under the same roof where you have the people building it looking over the shoulders of the people that are making it. Hm.
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It's not just a great way to improve the quality, traceability, uh, and improve product performance, but it's also a great way to, to look at technology solutions to bring down your costs, to improve your margin profile.
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So there's a lot of benefit to having all those smart people under one roof.
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Is that how largely how you solve some of those, some of those critical kind of challenges is, is by simply not setting up sort of individual kind of like buildings or, or factories, right?
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Is, is, is everything like right now kind of under, under one umbrella? Everything is under, under one roof in Wilmington, Massachusetts. Oh, wow. Yeah. Yeah. I'd say that's, that's going really well.
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The teams are, are working incredibly well together.
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It's, it's a beautiful thing to watch where you see people who are so talented in their respective areas work together to solve a common problem that's never been solved before.
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Uh, I mean, e- even the innovations on the factory floor recently that, that involved computer vision that solve for traceability, one of the engineers was, was generous enough to let me sort my own case.
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[laughs] I submitted a case and I said, "Do you mind if I sort this in the factory?" And, and they let me do that. Yeah. I probably brought down their average handle time, but just- [laughs]...
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doing it myself, like, created such an appreciation for what they've built and what they, they can accomplish going forward. It's, it's just an incredible thing to watch. So- Yeah...
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separate of the tooth story, which is obviously the thing that I'm incredibly passionate about- Yeah... there's a real Industry 4.0 story that is being told at LightForce right now. Oh, yeah.
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That's, that, that's awesome. Being built by such talented people. Yeah. No, that, that... I had, I had no idea that like everything was like literally under, under one, under one roof.
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I mean, it-- this is a different side topic altogether, but like it kind of gives me a little bit of hope for maybe like, you know, the, the possibility of sort of re-industrializing and seeing a lot more- Yeah...
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of that type of manufacturing again here in, in the US, right? Because we've lost... I mean, we've lost s- s- so much of that over the past, you know, 20, 30 years. Yeah. It's such an opportunity for the US, Scott. Yeah.
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I mean, you know, obviously, you know, B2B SaaS has taken a bit of a hit, but- Yeah... you know, why do people look at med device, invest in med device?
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It's because there's such a real competitive moat with a, uh- Mm-hmm... a non-volatile market.
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Yeah And, um, when you can build a company that is a, a new technology that can grow in the same way as a SAS company but has that major competitive mode around it where it's a really hard thing to scale- Mm-hmm...
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it, it's a really great position to be in. Yeah. Maybe, maybe you did realize you'd be in this position, you know, five, six, seven years ago, but I gotta think, like, yeah, you're sitting, sitting pretty good, right?
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'Cause that's not, as, to your, to your, to your point earlier, that's not easy to do.
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Let alone nail the product, but also to, like, build out this sort of infrastructure at, at, at scale, right, where you're doing this hundreds of thous- for hundreds of thousands, you know, uh, maybe millions at some point of, of patients.
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That's, that's pretty cool. That's awesome, actually, I'd say. Better than cool. It's awesome. [laughs] Let, let's, let's, let's, uh, switch to adoption, right?
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W- I- I think it was just especially interesting, you know, topic given your, uh, given the fact that you still practice, you know, a couple times c- couple times a month.
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When you first started introducing kind of the... Let's, let's take just the current, the current version, and feel free to maybe, uh, you know, address this earlier in the company's journey.
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But what, what do you think was one of the, one of the most challenging things for, for orthodontists to kinda get over the hump so to, so to speak, right, when it, when adopting something like this versus, you know, versus, uh, traditional kind of me- metal office shelf brackets?
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It, it's tough because, you know, every great disruption has a few things in common. First, it removes a problem that you accepted as permanent. No one really called them problems, they just called them the process.
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And so you, when you think about, like, putting braces on as an orthodontist, like bending wires, repositioning brackets, all those extra appointments, that was just kind of accepted 'cause we've been doing it for, like, now three generations.
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Hmm. Secondly is once, once you experience the new way, like, the old way kind of becomes unthinkable. So, like, as I mentioned earlier, like, you're never gonna refold a paper map and stick it in your glove box again.
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You're gonna use Google Maps, right? Same thing as, like, you know, w- with braces. God help me if I ever have to direct bond a stock set of braces on a patient's teeth.
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Like, it just does not feel right for me to do- Hmm... as, as an orthodontist, as a clinician. And, and then lastly, you get back something you stopped noticing was gone.
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So, like, I guess to use the Google Maps reference, like for drivers it's, like, kinda peace of mind on the road. Like, you, you know where you're going. You can see it on your dashboard.
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For orthodontists it's, it's the gift of time and knowing that you're gonna be done and have an awesome outcome without the extra, you know, seven to eight visits. Hmm.
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So, you know, for, for, for a lot of orthodontists it, it's getting the product to a point where it is easy to adopt as well.
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The, the other challenge I would say for any new disruptive technology, and this is a, a quote from Erica which really stuck with me, is that the, "The rate of diffusion for a new technology in an industry is rate limited by the new stuff people need to learn."
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Hmm. And in, in orthodontics, uh, it's not like adopting clear aligners, like it was a, you know, the, a solution for the adult population initially which is, like, maybe 20% of your practice.
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For braces it's, like, 80% of your practice. So the, the amount of change is 4X for, for this- Mm-hmm... versus clear aligners. So you've really gotta do new things.
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You gotta learn new things clinically, operationally, and economically. You know, clinically you need to learn, you need to train your staff to put these on. You work at the top of your license.
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So it's, it's like i- in modern medicine you have nurse practitioners, PAs that are now doing more. They're writing scripts and doing small procedures.
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I think the same thing's gonna happen in orthodontics where y- you have staff doing more. They're, they're putting on the hardware. They're putting on the aligner attachments. They're putting on LightForce- Hmm...
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or whatever future competitor we may have. And, and then operationally, every patient that comes in now is a scan and, and a down payment, see you back in four weeks for a delegated bonding visit.
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With stock braces you can put them on that day if you have the time in your schedule, but not everybody does and it's just a change in workflow. And then you don't have to see them as often.
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So there are operational changes there you have to get comfortable with. And then economically your lab bill is higher initially.
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It's, it's less than a clear aligner lab bill, but it's still higher than what you pay for stock braces by 2 to 3X, uh, depending on what stock braces you use.
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So you've gotta get comfortable a- and understand the cashflow implications initially getting started.
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Ultimately you, you make way more money i, as, as measured by profit per visit, but you've gotta get over those initial cashflow challenges for- Hmm... for a SMB.
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And not every orthodontist has a, an accountant that's helping them guide them through the change.
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So, you know, there are some real new things to learn as an orthodontist and, and pa- that's part of our job, is to help, uh, be facilitators of that change, help guide them, help show them how other practices did it, help show them how good it can be versus, you know, continue to live with those problems that they've before accepted as, as permanent.
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Got it. Yeah. Uh, that, that framework is actually really, really helpful that...
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I, I- kind of the analogy I think of is, like, you know, if you're, if you're running sprints on a track in, in track and field, right, and, and you're, you're training with a parachute, right?
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As a startup you're the sprinter trying to get out of the blocks as fast as possible, but if there's a whole host of, of things that need to change, right, like that's a big parachute that's gonna be...
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It's gonna, it's gonna take more effort.
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It's gonna take more time to implement, whereas, you know, if there's, if you're only asking kind of your end user to change maybe 20% of their practice as an example, whether it's clinical, economical, et cetera, workflow, et cetera, maybe that's a smaller parachute and you can get out faster.
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But, like, that's a, that's just really healthy to keep in mind, right?
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Whatever your idea, idea is or whatever you're working on bake that into your initial, your, your initial commercialization efforts, right, of, like, how much are we asking the end user to change because that's directly related to how fast we're gonna be able to, like, launch and what kind of challenges we're gonna, we're gonna expect to see.
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Totally.
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And it, it's also part of the product, uh, strategy when you think about it is, like, you know, a- any new feature, any new thing we add on, and this might be helpful for other folks, is, you know, think about the, the new stuff.
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Does it remove things someone needs to learn or does it add things that people need to learn to use the product? 'Cause any- anything you add that needs to be learned will create more friction. Yeah. Yeah, no doubt.
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And it's not just the physician or the clinician, it's also as you pointed out the staff as well- Staff... right? Whether it's n- nurse practitioners, nurses, techs, office folks as well, right?
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If there's a billing, if there's a billing kind of component. Yeah. All, all of that, all of that really matters, for sure. I'm looking at the clock and I wanna be mindful o- of, of the time.
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And if we, if we, if we, if we have a few minutes I, I'd love to circle back around to kind of the, the, the digital factories, right, as, as, as kind of your, your team has coined, or at least we've seen, seen that pop up in various, uh, you know, various, uh, as we were kind of doing research for this interview, various, um, kind of other, other, other pieces.
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But let's first talk about fundraising 'cause you're, you're coming off a pretty significant round of capital that you raised. I believe, let's see here, it was, uh, in 2024. Let's...
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Our, our notes say it was a $15 million around for, for, uh-... largely grow- growth, uh, growth related. But let's talk about getting to the, getting this far, right?
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Raising this, this amount of, this amount of capital as a, as a first-time CEO. For other, other folks that haven't, haven't done this, right?
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May- maybe they've raised some, some friends and family, but haven't raised from institu- institutional capital.
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Like, what, what would be like the, the one or two pieces of advice that they, they really need to get right in order to, you know, to, to raise their series A, to raise their series B, and hopefully, you know, follow on, follow on investments as they, as they, uh, as they continue to execute?
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I think the number one thing is make sure, A, make sure you know who you're taking money from. I, I think that matters a lot. It's, you know, in- investors are more, should be more than capital.
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They should be sources of guidance to get the company to the next stage. Uh, and, and that has implications in team building, in their network of investors, analysts, things like that.
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Second thing is, you know, they have jobs as well. So, so their job is to generate a return. So, like, making it extremely clear how that's gonna happen. How are you gonna create value in, in the company?
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And, and that can, you know, it, it varies industry to industry. Like in pharma, it's not as much about revenue, but approvals and, and s- and trials. And in our world a lot of it is about revenue.
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So, you know, hi- hitting your targets I think has, has a lot to do with it, uh, especially as you get to be the later stage.
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In the, in the earlier stages, you know, there's some things that are out of your control, such as demonstrating there is a real market that exists that is big.
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And I think th- that wasn't something I considered, but got lucky that, you know, actually orthodontics is pretty massive. It's one of the biggest sectors in, in dentistry.
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And then, and then showing that you can build something that people will value. I don't think it needs to be perfect, but having an MVP that demonstrates the core thesis of the product is, is really critical.
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Yeah, and then, and then I, I think take money when it's there is, is an important thing as well.
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I, I think a lot of times a lot of the founders I've met over-optimize for things like price and, and things like that, wh- what's just most important. Like, ultimately what matters is, is it gonna be successful?
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And m- maybe a little bit of dilution here or there or whatever. Ultimately when the outcome is huge, no one really cares. Uh, you shouldn't. You won't care.
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The last thing on, on that same topic is just making sure, you know, investors are really important, but I think maybe even more important is, is having a, a really talented team.
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So making sure that you, you share the equity in any way. Like, give, give meaningful, uh, grants to the people that are gonna move the business the most. Um, no one gets there alone. It, it always- Yeah...
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takes a, a team. So I think, I think tho- those are the things I'd, I'd say. Yeah, tho- those are, like, four or five, like, really good, really good points.
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But just to kind of double-click into the, the importance of having the right investors around the table. A lot of those things you mentioned kind of coincide with that. And like, huge, huge market.
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You're at a, you're operating at a massive market. You know, ob- obviously being able to demonstrate, you know, progress as, as you raise, as you raise kind of, uh, e- each additional follow-up round.
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But, like, sometimes it sounds cliché or maybe sounds easy. It's easy to say, harder to do, right, is find the right investors that are truly partners. And I, I couldn't stress that, like, all, all the more.
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I mean, and if you feel like, and maybe I'm just kind of, I'm gonna, riffing a little bit.
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But if you feel like you're, you're, you're desperate and, and you have to kind of, you know, fall into like a, a, a second or, or, or third option, right, to raise capital, I would maybe say pause, extend your runway long- try to extend your runway as long, a, a little bit longer so you can get to the next inflection point to find the right investors.
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Because you could very well end up at being, you know, be in a scenario where you take capital from the wrong partner, you actually do execute for two, three, four years, and end up in a very, very bad spot, you know?
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And so, uh, yeah. So, so, so crucial to take the right, [laughs] the right money from the right, from the right people. Yeah. As, as a CEO, I think you have three jobs.
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One is, uh, culture, two is the team, and, and three is don't run out of money. [laughs] Um, and, and so, like, making sure you take the money from the right partner is, is really important.
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I think i- in our case, you know, recognized very early on software was a key part of building not just the customer-facing product, but the back-end manufacturing is, is very software heavy as well.
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So we took a lot of money from tech investors such as Matrix Partners, Tyche, Kleiner Perkins. These are not med tech specific people. Mm. These are people that typically do a lot of software.
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So they were immensely helpful in- Mm... in building out the team and the technology in the early stages to, to build the product.
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And, um, now as we get later, we think about, all right, we're gonna be a med tech branded company. So let's- Yeah... you know, bring on some awesome people such as, uh, Ally Bridge. So, so that's kind of how- Yeah...
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we think about that, yeah. Yeah. That, that's a, that's a really good point too because not n- you obviously, software was already an important part, part of your business.
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But, but if you're in those, if you're in a company that's kind of straddling, I would say, um, I'm not even sure the best way to describe this, but kind of d- different, different areas, right?
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Whether it's software, whether it's deep tech, whether it's manufacturing, what, what, whatever you. Like, take advantage of that, right?
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Because there's gonna be different, different segments of investors that specialize in each of those areas. And like, like all the more to go, all, all the, all the more reason to go broad, right? With your- Totally.
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Yeah. Yeah. Totally. Yeah. So definitely something that if y- use that, if you, if you're in that, that could be strength, in essence. So yes, this is what I'm trying to, trying to, trying to, um, emphasize.
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Um, I wanna, I wanna get to this, the, the rapid fire portion of this interview. But, but real quick, kind of going back to, to, like, the, this idea of digital factories.
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Like, and may- maybe it just, uh, maybe it just, like, surfaced g- based on our, our research. But, like, tell me a little bit more about that.
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Like, how did, how did, like, what you, what you're operating in cur- kind of current infrastructure. How did that term kind of c- come to be, this idea of like, you know, a digital, a digital factory?
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It's k- it's kind of unique. So, so the category we're building out, Scott, is called generative braces. So what that means is that, is that every bracket is generated from two sources of data.
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One is the data from the patient. That's all, all their, their, their dental scan, their radiographs, uh, their cone beam CT so we can see the bone. That's one source of data.
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The other source of data is the orthodontist treatment plan. Mm. And from those two sources of data, the patient's data and, and the orthodontist plan, we generate patient-specific braces.
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So these are generative braces, N of one. Mm. So every, every part that comes out of the factory is a, a snowflake. Unique as a snowflake or a fingerprint. And, and that makes sense, right? Mm.
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Because teeth are as unique as fingerprints. That's why they're used in dental forensics. Yeah. So the challenge from a factory perspective is that you have to use a technology that will scale that mass customization.
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That is a new thing in, in our industry. Braces have never been mass customized before. Even, even, uh, aligners are not directly 3D printed. They're vacuum-formed on something else.
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It's with a much lower, like 12X lower resolution. Hmm. So it's a, it's a new challenge with no blueprint on how to do it, and it has to be made on demand.
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So there's a lot of bespoke technology that was never existed before that was created solely to scale this application. Huh.
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That means you've gotta get a lot of people that are very talented, that are extremely comfortable with ambiguity, you know, building something that only they design without clear parameters. Hmm.
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So, so that's why, like, a, a lot of our product is not as much, you know, the, the first thing we built. It's, it's been i- the scaling part of it. Hmm.
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And quite frankly, that's been where the majority of our challenges have, have stemmed from, is scaling it. You've heard other people say building it once is, is easy.
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Building it a million times is, is way more challenging. Yeah. So I, I can't underline that enough. Yeah. At least for our application, you're not injection molding.
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You're not, you know, using a contract manufacturer because we have to control the process.
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Building a- an app- operationalizing that machine, that digital factory is a major moat, and, um, one that I'm not sure everyone fully appreciates. But it's...
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You know, as I started this, this is not a brilliant idea that we're, we're building, and if that were the case, you'd think that other people would have done it. Mm-hmm.
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The reason people haven't done it is because it takes a lot of brain damage to scale [laughs] It's, it's hard to do. Yeah, yeah. Yeah, yeah.
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You're, like, literally doing the hard things, you know, uh, to get to this point. No, that's, that's super, super impressive. I know we don't have a lot of, a lot of time.
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I'd love to spend, spend, uh, spend even more time kind of discussing this, but it's, uh, it's, it's, it's incredible to kind of see, see what you've built. And like I said earlier, I think it's, um... I don't know.
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It gives me optimism for, like, what, uh, what reindustrialization could, could, could look like, you know, this time around, I guess.
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Um, so with that said, rapid-fire questions, Alfred, and feel free to expand a little bit if, if you, if you want to. But first one on the docket, fast-forward a year from now.
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What are you most excited about at Li- LightForce over the next 12 months? What I'm really excited about today... I'll start today and then, and then say what, what this looks like a year from now.
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But we're launching metal braces. Remember when I first talked about, uh, the limitations of 3D printing in, in metal? What's really interesting is that roughly 95% of teenagers get all metal braces, all metal braces.
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And when they get ceramic, they only get ceramic on the front six or the front eight teeth.
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So the world had never used all ceramic braces prior to LightForce, which means that, you know, orthodontists really value the customization to use it.
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And, and so why I'm so excited about our, our metal, uh, launch, which is, is just starting in beta now, uh, with select orthodontists, is that it really unlocks the market. Metal is a bit more...
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It can be lower profile. You can chew on it with... you know, eat Jolly Ranchers, and it's not gonna crack, uh, which is what a lot of teens do.
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And it has lower friction, so you can close spaces a lot faster clinically, which is, is pretty cool if you're an orthodontist. So you know, the data that I shared with you, 43% shorter treatment time, 60% fewer visits.
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I think we're just getting started. Yeah. That's a study that was done with all ceramics, which w- and ceramic is amazing for the aesthetics.
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But then I'll, I'll tell you one other thing that's interesting is for the teen market, a lot of teens actually want metal for the aesthetics- Hmm... which was a surprise to me.
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I guess it shouldn't have been, though, knowing adolescent psychology. Uh, you have some teenagers. You may, you may appreciate this.
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But at that sense of, uh, at that, uh, time in life, your sense of self is informed by your peers, not as much by yourself.
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So, like, if your friends on your travel soccer team or AU baseball team have metal braces, typically you want what your friends have. Yeah. [laughs] You don't want to stand out.
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So aesthetically, a lot of teenagers want metal as well. That's been a limitation for us in a lot of our practices.
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Maybe less in Beverly Hills and Manhattan, but in, in o- other areas, you know, they say, "You know, we, we can't use all LightForce because you guys don't offer metal yet." Yeah. "And we want to." Hmm.
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And so my hope and, and I guess what I'm excited for a year from now is to see the practices that don't have LightForce stock metal braces in their aligner du jour, but they have LightForce in their aligner du jour.
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And, and, and what that means is less complexity. They're only using two systems, and they have a single system for braces. That's, uh, that's great.
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I think by the, by the time this, uh, by the time this is released, maybe, uh, the, the, the metal option will be, uh, officially, officially, uh, officially available, I guess, um, or a- at a beta.
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So yeah, pretty exciting. Um, last, last question because I know we're short on time here. But, um, let's say we're in Boston, right? It's a group of, you know, I'm gonna combine these last two questions I typically ask.
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But it's a, it's a group of, you know, other, other kind of life science, med tech entrepreneurs, and you wanna leave them with, like, one thing, the one thing that, that maybe someone would...
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you, you wish someone would have whispered in your ear 10 years ago, you know, before you, before you started the company. What would...
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What's that one, you know, critical thing that you think every, uh, every med tech, life science entrepreneur needs to get right? Gain a deep understanding of your customer and the patient they serve. It sounds...
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And, and I wish I had something a bit more brilliant sounding. [laughs] But I think it's, I think it's that simple.
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I think if you create something valuable and you have a deep understanding for your customers willing to pay for something or their willingness to sell something, what... meaning are they...
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something they can't give up, then I think you'll know what to build and you'll be successful. Without that clarity on the road map, it's easy to spend a lot of money. Yeah.
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That's good, good, good piece of advice to kind of end the, end the discussion with. But, um, I know we're a little bit, little bit over, but can't thank you enough for, for coming on the program. It's lf.co.
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Company is LightForce, but lf.co. We'll link to it in the full, the full writeup on, uh, o- on MedSider. But, uh, uh, Alfred, you're, you're a brilliant guy. Uh, yeah, you know- Oh...
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obv- uh, that's, that's kind of obvious. But, like, you, you tell great stories. You're a great communicator. It's been fun, fun, uh, fun discussion. You, you're very kind, Scott. Thank you.
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[laughs] No, I, I genuinely mean that. Uh, for sure. You're, you're... This has been fun. So, um, I'll have you hold on the line, but for everyone listening, thanks again for your attention, as always.
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Until the next episode of MedSider Goes Live, everyone, uh, take care. [upbeat music] Hey, it's Scott again. One quick thing before you go.
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You see, I love bringing you insightful conversations with the best founders and CEOs of medical device and health technology startups.
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But here's the thing: I'd be super grateful if you could help me reach even more ambitious doers who share our passion.
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Leave your honest thoughts and hit that five-star rating if you think we're worthy.
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Stay tuned for another informative episode coming at you soon. [upbeat music]