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Office Visit Dr. Michael Kelliher by Kyle Patton, associate editor

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Categories: Practice Management, HR and Accounting;
Office Visit Dr. Michael Kelliher 
by Kyle Patton, associate editor
photography by Karen Slack
Dentists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.
Every year, Dentaltown asks readers to vote for their favorite products and services, then tallies the results and publishes the full list of Townie Choice Awards winners in our December issue. (Check out this year’s roundup here.) Out of all the readers who completed their ballots, we draw one person at random to win a special prize: $1,000 and the chance to appear on the cover of Dentaltown magazine as part of an Office Visit profile.

This year’s winner, Dr. Michael Kelliher, decided to hand over the reins of his practice in Longmeadow, Massachusetts, nearly two years ago after more than 20 years of ownership. Now, he’s free to focus on the clinical side of dentistry without the stressors of running the business—which also leaves him more time to moderate Dentaltown’s online message boards!

Kelliher has been a Townie since 2001, back when the message boards were like the Wild West and dial-up was the only horse into town. In addition to keeping our online forums friendly and professional, he’s also contributed nearly 13,000 posts himself.

In our exclusive Q&A, Kelliher talks about the changing landscape of patient expectations, the three biggest mistakes in implant restoration cases, why every doc should get a digital scanner already, and more.
Office Highlights

Name:
Dr. Michael Kelliher

Graduated from:
Tufts University School of Dental Medicine

Practice name:
Flagship Dental
Longmeadow, Massachusetts

Practice size:
7 operatories

Team size:
10 (2 doctors, 3 hygienists)

How did you get into the profession?

Junior year in college, I was trying to figure out what I wanted to do. I had been working in a research lab and thought that would be the plan, but wanted something that was hands-on and dealing with people. Dentistry seemed to be a good fit, so I started looking into the profession.


After 20 years, you handed over the reins of your practice. Walk us through coming to that decision. And how are things going now?

Both of my partners had reached retirement age—one retired about five years ago and the other was looking to retire. The plan had always been to look for new dentists to buy into the practice, as I had, and continue passing it on.

The reality today is that finding the right fit can be very challenging, and we just weren’t able to make that happen. Then we got hit with the pandemic—shut down for almost three months, battling for supplies, and navigating state and CDC regulations. Practice ownership was not looking like an attractive position for me to be in, so we started looking at options.

We got a broker involved and began looking for a group to purchase the practice. It was important to be sure the practice would continue—that our staff and patients would still be taken care of. We found a good match with Simply Dental Management and sold the practice in February 2021. I still work in the practice, and plan to continue for at least a few more years.

One of the things I appreciate is that the new owners haven’t come in and asked me to change anything regarding how I treat patients. I’m still able to practice how I have for decades, using the same materials and schedule as I always have. That’s made it easier to give up the reins.

Of course, it is a challenge to go from being the one making all the decisions to having a boss. I no longer can just make the call on things like staffing or equipment. The trade-off, though, is that I don’t have to worry about making payroll and all of the other ownership stressors. It’s a balance, but so far it’s working out well.


How did the business landscape change in your area?

Our practice is about 100 miles west of Boston. In many parts of the country, that might still be the suburbs, but in Massachusetts, the population is mostly in the eastern part of the state. Younger professionals tend to gravitate toward the Boston area and this is no different in dentistry, so attracting and retaining dentists in our area is a big challenge.

When I first graduated and was looking for a practice, it was common for relatively new graduates to start or buy a practice. That doesn’t seem to be the case anymore. With the levels of student debt many new dentists have, taking on even more debt to buy a practice just doesn’t seem to be all that attractive of an option. That means many people in my situation are selling to groups, which I think is going to become increasingly common in the future.

One of the advantages of joining a group has been that it has the staff and resources to recruit, something a typical practice just doesn’t have. We are fortunate to have added a new dentist to our practice. Dr. Lainie Foerster joined us about a year ago and has fit in very well. Patients love her!


One of the biggest changes in the profession has come from the patient expectation side. How can dentists adapt and evolve to fit the new shape of the market?

Patients certainly have different expectations today versus when I first started. And I don’t see that as an entirely bad thing!

Years ago, it was very common for patients to not ask many questions and just defer to our judgment on what care they needed. Today’s patients are much more inquisitive and want to know the details of their care, so a dentist’s ability to communicate is critical—and, thankfully, we now have tools available that make that much easier.

When I was in school, we had one intraoral camera on each floor, and it was a project to roll the equipment over to take a photo, which was printed onto a small piece of photo paper. Now we have cameras and patient-facing monitors in every room. It is so easy to show patients their films or photos of their teeth, which is a fantastic way to communicate and encourage questions.

One downside to today’s patients is that many of them view what we do as a commodity. They’re used to shopping— and shopping around for—everything. Comparing costs. Reading reviews online. And for a profession where treatment is very individual and patient-specific, this can be challenging at times. Again, communication becomes key.

You have a lot of CAD/CAM experience. What do you wish every dentist knew about the tech?

We’ve been doing same-day CAD/CAM in our office for about 13 years. I started out with the original E4D system, which back then was a scanner that stitched together individual photos to create the 3D model. It worked, but was considerably more challenging to use than today’s scanners. However, I was hooked! I loved the ability to deliver indirect restorations in one visit and liked having control over the restoration design. We’ve had every version of the E4D (now Planmeca) scanner in our office and we’re on our second mill. The evolution of this area of dental technology in the past decade is astounding. It’s been really cool to watch it develop. I’ve even helped beta-test some of the new hardware and software.

At this point, scanning has become fast, super accurate and—most importantly— easy to learn. It is the ideal gateway for an office to get involved in digital workflows. And today, that means more than just crowns and bridges: Implants, nightguards and even partials can be done using digital scans.

What every dentist should know about CAD/CAM now is that whether you scan or still take PVS impressions, the majority of your crown and bridge lab work is being done with CAD/CAM. Every zirconia crown, every milled custom abutment and even PFM frameworks are being designed in CAD from scans of your models. Having a scanner is something every dentist ought to consider.


You also do a lot of implant restoration cases. What are the biggest mistakes you see and what are the solutions?

This is an area that has exploded in the past decade. It’s now rare to do a three-unit bridge to replace a single tooth. It certainly is easier to restore these now, but there are a few pitfalls to avoid.

First, you need to plan the placement of your implants with the final restoration in mind. We’ve all seen posts on Dentaltown’s message boards with the poorly placed implant that now needs to be restored. No need for that to happen today. With all the tools we have like CBCT and implant planning software, this can be avoided.

A lot of clinicians and their patients would benefit from using more custom-milled abutments versus stock or titanium-base-type abutments. This is easy to do today and provides an ideal emergence profile on the titanium with a very strong abutment. Little titanium bases may be OK in some areas of the mouth, but not for molars!

The second mistake I often see with implants is a fracture of porcelain when PFM is used as a restorative. The veneering porcelain isn’t very strong on a PFM and with an unyielding implant, something will give. Since I’ve switched over to monolithic materials like E.max or zirconia for these restorations, fractures have become rare.

The third mistake is the impressions. There’s a decent bit of inaccuracy, especially with a closed-tray impression where you have to reinsert the impression coping. Open-tray impressions can help, but even then it always seemed that implant inserts took way too long. The solution to this problem is to scan these digitally. When you do this, you scan a scan body that can very accurately create a digital model of the implant location. Since I switched over to scanning for implants a few years ago, my inserts have become very quick and predictable.


You have a strong opinion about screw-retained implants. Hit us with it!

This won’t be at all popular, but I don’t understand the drive toward screw-retaining every implant crown. The argument is that cement sepsis causes implant failure. And I could see that, possibly, if you were using a stock abutment or a titanium base where the crown margin is deep subgingival. But on a milled custom abutment with margins just subgingival? Is it any harder to clean cement on a case like this versus cementing to a natural tooth?

I think in many cases, we’re making implant restorations harder than they need to be.


What has brought you the most fulfillment in your career?

Two things come to mind. First is when you can really make a difference in a patient’s life: Giving them the smile they’ve always wanted and seeing their reaction after they get their new veneers or crowns is just awesome! But it can also be as simple as getting a patient out of pain or delivering a denture they can eat with.

The second thing I find really rewarding is passing along what I’ve learned to other dentists. I’ve been fortunate to have been able to teach a few courses and mentor other dentists on CAD/CAM. It’s really rewarding to see someone you’ve worked with be able to succeed.


You’ve been a Townie for a long time! Shameless self-promotion here for us: How has Dentaltown helped you? What do you think it does better than other social media dental groups?

Dentaltown has had a huge impact on my professional life, and I’ve made some great friends through this community. A site you can go to and ask questions, or even just read through the discussions on such a huge array of topics, is a resource we are all fortunate to have.

I’ve learned so much about different products, techniques and equipment through the community. I couldn’t even guess at how many hours of CE that’s been worth in the 21 years I’ve been a member.

We’ve all seen dental-oriented content on other social media platforms over the past several years, but in my opinion, none of them is as useful as Dentaltown. It contains a truly massive amount of content from contributors all over the world that is well organized and easy to search. Trying to find something on most social media sites is an exercise in frustration.

Add to that the great variety of Dentaltown’s on-demand, accredited CE courses, and you’ve got something very special and unique for our profession.


You’re also a moderator on the message boards. How did that come about, and why is that role important?

Dentaltown’s message board director, Dr. Howard Goldstein, asked if I would moderate the E4D forum way back in the days when we had the sometimes fun, but ultimately not very helpful, battles between the Cerec and E4D users. It’s important to keep the conversations civil and productive, especially if we want to encourage people to post and ask questions.

That eventually led to being asked to moderate more forums and eventually becoming an administrator. I’m happy to give back a little to the community where I’ve learned so much. It’s important to keep things on the boards civil and keep them from being filled with sales pitches.

We’ve got a good group of volunteers who help keep things running smoothly behind the scenes.


What cases or patients excite you the most?

At this point, the best cases are the ones that aren’t exciting! The best days are the ones where it all goes nice and predictably. The fun stuff now is CAD/CAM and implant cases. But I have to say I weirdly enjoy doing big posterior resins—ones where the patient really needs a crown but can’t afford it. Even better is seeing these restorations in service and doing well years later.

You develop some really great relationships over the years. Most of my patients know I’m a huge Boston sports fan; my main operatory is full of memorabilia. So that leads to some great conversations about how the Red Sox are doing this year or how the Patriots season is going. People want to trust us. We’re seeing them in situations where many of them are understandably nervous. It’s helpful to try to connect with patients and take their minds off an appointment they most likely weren’t looking forward to!


What piece of technology or service could you not practice without?

We have all kinds of dental technology like CAD, CBCT, etc., but really the piece of tech I couldn’t see practicing without would be my loupes and light.

Younger dentists probably have never worked without these items, but for us older dentists, this isn’t the case! I got my first loupes about five years out of school, and I added a light a few years later. At the time, lights were not the portable units we have now—they were big boxes with a halogen bulb in them and you were tethered to the box by a fiber optic cable! To say the current setup is an upgrade would be a massive understatement.

Having the magnification and light available for every patient and every hygiene check is simply indispensable.
Top Products

SurgiTel loupes and Lumadent uniLux lights. Of all the equipment and gadgets we have, the most indispensable items to me are my loupes and light. My 4.5x SurgiTel loupes are paired with a Lumadent uniLux light and used on literally every patient I see. I can’t imagine practicing without magnification and light.

Planmeca Fit CAD/CAM system. This equipment transformed our practice. We’ve used it for 13 years now. Currently, the system consists of an Emerald S intraoral scanner, a PlanMill 30 S chairside milling unit and PlanCAD Easy dental design software. The ability to provide our patients single-visit indirect restorations has dramatically changed how we deliver dentistry to our patients.

TruAbutment custom abutments. TruAbutment gives us the ability to restore implants far more easily and accurately than we ever were able to with traditional impressions.

Surpass adhesive (Vista Apex). Early in my career, performing direct resins was a challenge. Postoperative sensitivity was an issue many of us dealt with. Surpass has dramatically reduced sensitivity issues and gives us a reliable bonding agent we can use for all direct and indirect restorative procedures.

Intraoral cameras and patient-facing monitors. Having this setup in every treatment room allows us to inform and educate our patients.

Where do you see dentistry headed in the next 10 years? Where do you want to be?

I see an awful lot of change happening in our profession—some good, some not so good. On the good side, I expect we will see technology continue to advance and make it easier to deliver care to our patients.

One area that will be very impactful is 3D printing: We’re already printing models, nightguards, surgical guides and even dentures, and new resins on the horizon could be game-changers for indirect restorations. Printing has the advantage of being able to create restorations at a higher level of detail than we can with milled restorations. If these resins are durable enough to be used for indirect restorations, it’ll be big. The resins are far less expensive than ceramic blocks or pucks, and printers are a lot cheaper than mills.

We will see an awful lot of challenges as well. We’re already seeing third-party reimbursement rates not keeping pace with inflation—and in some cases, those rates are actually going down. This of course creates fiscal challenges for practices.

The high rate of student debt we see with new graduates is a problem for the profession as well. New dentists need to take jobs that provide an income level that will allow them to service that debt. And taking on new debt to buy a practice is impractical for those who already have high student loan balances.

Ultimately, because of the combination of fiscal pressures on practices and the debt loads of new graduates, I believe we’ll see more practices being sold to groups instead of individual dentists.

My plan right now is to continue to practice for about five more years. After that, I think it would be interesting to get involved in a different aspect of our profession. I’ve enjoyed the bit of teaching I’ve been able to do, so I could see maybe doing that a few days a week.


Give us a snapshot of your life outside of dentistry.

I’d say it’s a transition time. Our kids are both young adults now; the youngest is finishing up college this spring.

When the kids were younger, I spent a lot of my free time coaching youth baseball or volunteering for their various activities. I also just finished up a 12-year stint serving on my local school committee.

But as these activities have wrapped up, I’m finding more time to play golf—admittedly poorly—and my wife, Elinor, and I are doing more traveling. We actually just celebrated our 30th anniversary with a great trip to Saint Lucia!

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