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Office Visit: Dr. Jonathan Ehlers by Kyle Patton, associate editor

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Categories: Practice Management, HR and Accounting;
Office Visit: Dr. Jonathan Ehlers 

by Kyle Patton
Photography by Matt Hutchings, except where indicated

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.

In Sedalia, Missouri—a small town 90 miles east of Kansas City— Dr. Jonathan Ehlers has built something big near his hometown. After graduating dental school and receiving advanced training in oral surgery, this Townie knew that if he was going to practice, he’d do it his way—with a focus on full-arch treatments and implants with the best tech the market could muster. Ehlers’ startup practice, Tiger Family Dental, opened its doors in 2016; three years later, he built a new location that more than tripled the practice size, and his plans for 2025 involve a 2,000-foot expansion, including a custom surgical suite. But Ehlers won’t be alone in that suite: He was one of the first general dentists in the U.S. to adopt an ultramodern implant robot that helps him deliver a quality of care most patients wouldn’t expect to find in a small town.

In our exclusive Q&A, Ehlers breaks down what he did to make sure his startup kept evolving, the most important areas to focus on for practice growth (physical as well as financial), what doctors must do to successfully land implant cases and more.

Office Highlights
NAME:
Dr. Jonathan Ehlers

GRADUATED FROM:
University of Missouri–Kansas City School of Dentistry

PRACTICE NAME:
Tiger Family Dental
Sedalia, Missouri  

PRACTICE SIZE:
Today: 4,000 square feet; 10 operatories
By 2025: 6,000 square feet; 14 operatories and a dedicated surgical suite

TEAM SIZE:
16

Tell us about your career so far. In high school, I was set on medicine and pursuing plastic surgery as a specialty. When I started undergrad, I was fortunate enough to have roommates whose family members were in dentistry. After talking with them and shadowing the daily routines of dentists and physicians of multiple specialties, it became clear that dentistry provided the work/life balance that I needed. It was also exciting that dentistry was the perfect blend of medicine, artistry and engineering. Once my second year in college started, I entered the reserved admission program with the University of Missouri–Kansas City School of Dentistry.

I graduated dental school in 2010 and worked in a federally qualified health center for two years before interning for a year at Truman Medical Center’s oral and maxillofacial surgery residency program in Kansas City. The intern year was a good experience in introducing me to surgery and, more specifically, how I wanted to practice: Although I didn’t pursue OMFS as a specialty, it was clear to me that I wanted to have a surgical-based practice going forward.

I associated at an implant-heavy practice, where I went to the Alabama Implant Education Comprehensive Implant Residency Program—a great experience that dove into multiple aspects of implant dentistry. In 2016, I decided to move back to my hometown and do a startup practice. That year, Tiger Family Dental was born.

We applied Breakaway principles and kept startup low: Our initial footprint was 1,300 square feet and three operatories. Through hard work and an aggressive marketing strategy, by 2019, we were ready to expand into a new location. In October of that year, we opened our new location, with more than 4,000 square feet and 10 operatories. This allowed us to add an associate dentist in January 2020 and additional hygienists. We’re now anticipating adding another 2,000 square feet in early 2025, which will give us a dedicated surgical suite and the capacity to hire another associate dentist.
What did you learn going through the startup process?

The startup process is a challenging endeavor that is absolutely worth it. I’m a bit biased because I’ve gone through it, but in my opinion, the greatest advantage to a startup is it gives you the ability from Day One to put your stamp on culture, treatment philosophy, marketing, patient base and practice identity.

My best advice is to take advantage of those opportunities and have a plan to execute the vision. It was important for me to develop the space with cost efficiencies in mind. I wanted to have a state-of-the-art office with all the technology I needed to give my patients the best care possible, but also maximize cash flow as quickly as possible. My build-out expenses—including a CBCT, IOS and digital radiography—came in at around $350,000. We were able to eliminate this debt in less than six months. When you focus on the systems and an effective marketing strategy, the numbers begin to make sense quickly.

Another piece of advice is to know your demographic. My community is a blue-collar, heavy industrial/farm community that relies on insurance. I knew going in that it would be in the best interest of my startup to find a way to make the insurance industry work for me and my patients. I ended up using Unlock the PPO, which was a tremendous resource. It single-handedly added 15%–20% reimbursement, compared with my peers in my area.

The main thing I would do differently is to better plan for growth. Implement policies from the beginning that foresee the growth and handle the challenges of growing staff from three to almost 20. I didn’t have plans in place to handle the growth of the team and how that growth affects office culture. So don’t wait; invest in yourself and your practice. Treat growth and success as a given and plan accordingly.

How have your priorities and mindset changed since relocating?

The mindset that comes along with a startup and expansion is completely different, in my opinion. As a startup, my focus was getting patients in the doors, keeping expenses low and achieving the ability to cash flow as soon as possible. From marketing to scheduling, the goal was to attract patients and stay busy. The expansion for my office was about utilizing the brand we’ve created and becoming more discerning with our marketing. It was no longer about getting generic patients in the door, but the specific patients we wanted to treat, using our skill sets in the best way possible.

A relocation/expansion also presents opportunities for planning and homework. I used Design Ergo for a block diagram for my new space. I read up on the things offices struggled with, and what kept coming up were efficiencies and patient-flow disruption. It was important that we focused on a centralized sterilization unit and mapped out a flow of our patients to prevent bottlenecks at check-in/check-out. Paying attention to the details of something like this has made a tremendous difference in our practice.

I’d also suggest not forgetting about the minutiae, like making sure to have a system of informing all insurance networks of the location change. This was something that we overlooked, and claim payments were delayed significantly.

How are you gearing up for your expansion? What will it include?

With each expansion or achievement, our practice vision becomes more and more clear. Our goal as a practice is to have two full-time associate dentists providing comprehensive dentistry, and my role will be to provide full-arch implant dentistry from all-on-X to implant overdentures to single-implant restorations.

Our expansion will include a dedicated surgical suite that I will mainly work out of, a dedicated entrance/ exit for our surgical patients, and a recovery room.

We are also adding more hygiene operatories, expanding team spaces, sterilization and the lab area.

My planned expansion will get us to 14 operatories and a dedicated surgical suite. I believe this will most likely take me to the end of my practice career, but one thing I’ve found over my career thus far: Plans will always change, and the future holds opportunities that we’re not even aware of, so I can never say for certain where that leads me.

How do you like to run the business side of the practice?

I’m a big believer in delegation. Identify the strengths of your team members and empower them to serve that role to the best of their abilities. Practice ownership requires us to wear many hats, but the practice is at its best and most productive when systems in place allow you to produce dentistry when you are in the office. Our office manager helps with team decisions as well as marketing conversations.

When you operate a large practice with many employees, it’s imperative to have a highly driven, highly compensated office manager. They will become an extension of you, so you can focus on the things that generate revenue for the practice and be confident that the business side of things is being taken care of.

Some of your success came from your positive experiences with a consulting team. What positive changes did they help you make?

Consultants and coaching are some of the biggest ROI in dentistry. It’s so easy to get pulled into the day-in and day-out of owning a dental practice. Consultants provide clarity to your practice’s mission. I have been fortunate enough to work with great consultants over my career; currently, I’m a member of Productive Dentist Academy (PDA), which approaches your practice holistically.

PDA helped us have a mindset shift regarding scheduling. It’s a common error for schedulers to schedule until the holes are filled. This creates stress and many times hinders production. Many days, I would find myself exhausted and when I’d look at production, I was at $800 or $900 an hour. Now, we schedule a daily goal of hourly production. If we hit our goal with only a few patients because of high-production procedures, we don’t stress to fill the schedule. This has really made a tremendous improvement in our production and stress level. Now, we schedule $1,800 an hour for production, and it’s not out of the ordinary to reach $2,500 an hour in production on high-production days.

We all have different timelines and aspirations with our practices, but PDA has done a great job focusing on what that looks like individually. More specifically, how to measure your earnings before interest, taxes, depreciation and amortization (EBITDA). Knowing your EBITDA is a question many dentists might not know they should ask—which is problematic, considering this is the basis of what your practice is worth. So whether you’re planning on selling your practice next month or 10 years from now, having the knowledge and analytics to monitor where you’re tracking is essential for planning.

Clinical calibration is also an integral aspect of coaching. We want the patient to receive the same high-quality care no matter which hygienist or dentist they see. Calibration among the team ensures the patient is receiving the same message, and prevents confusion and potentially poor case acceptance.

Give us a before and after of your marketing approach.

One of the things I adopted early in practice ownership was spending a significant amount on marketing for the practice—roughly 5%–7% of collections. I used radio, print, mailers, streaming TV and Google ads.

Initially, any way to get your name out will generate ROI. As we grew as an office and patient flow was steady (roughly 100 new patients per month), it became clear that getting patients wasn’t the issue, it was getting patients who needed the treatment we wanted to do. With PDA, we now have a focused, broad-stroke message across all platforms. Our message is specific and the same whether you see us on TV, radio or a Google ad. We advertise comprehensive dentistry to patients who have broken-down teeth or need extensive work, because that’s the dentistry we want to do.

You have a unique piece of equipment in your office. Tell us about the implant robot!

The Yomi robot is the most innovative piece of dental equipment on the market. As I’m sure most readers do when they first hear about robotically assisted implant placement, I thought, “No way—I’m sure it’s too expensive for my current implant production and office workflow.” I scheduled a demo to work with the technology, and a few days later I decided to make the purchase.

I consider Yomi a disruptive technology, much like Cerec was, or even CBCT. Will there be a curve of acceptance and adoption of it? Sure, but like 3D imaging and digital scanning, it will soon become commonplace to have preplanned, real-time surgical guidance for our implant procedures. Surgical medicine has embraced robotic technology for years to improve surgical outcomes. I think it’s time for dentistry to join the wave.

Yomi will come with an initial investment of around the $200,000 mark, and service packages are available that make the ownership seamless. Yomi also provided (and continues to provide) amazing training for the doctor and the entire clinical staff. It also has a dedicated marketing team to assist in making your local community aware of this truly innovative technology.

Many of my colleagues asked me if it was worth it. I say with no hesitation that it was. Since purchasing Yomi in December 2022, my full-arch cases have more than doubled and my implant volume in general has gone from 250 implants placed to a current projection of more than 400 this year.

Top Products
Yomi YOMI BY NEOCIS
This robotic system for dental surgery allows us to have a real-time guided implant system that we can make changes to on the fly. It has design modules for crown design on individual implants, but also full-arch restorations, implant placement and even guided bone reduction that allows for adequate restorative space for the fixed prosthetic.

TRIOS 5 INTRAORAL SCANNER (3SHAPE)
Our office workhorse, this is an imperative tool in capturing the soft tissue necessary for a digital record in full-arch implant dentistry. We also use it for crown and bridge scanning, clear aligners and night guard scans.

PRO55 3D PRINTER (SPRINTRAY)
Another integral part of our office’s digital workflow, the Pro55 lets us print our full-arch implant restorations the same day as the surgery: No more chairside pick-ups. We have Power Dental Studio design a direct-to-MUA arch and we print that while the patient is relaxing in the treatment room on the day of surgery. We can also print occlusal guards, clear aligner models, and definitive restorations like crowns, inlays and onlays.

MICRONMAPPER PHOTOGRAMMETRY CAMERA (SIN 360)
This technology allows us to eliminate the need for verification jigs during the full-arch fixed workflow. We can use this on the day of surgery and from that point on, the implant position is verified. This eliminates multiple steps and appointments and wasted production time.

X-MIND PRIME 3D CBCT UNIT (ACTEON)
If I had one tool I could not practice without, this might be it. From a diagnostic standpoint, this was a game-changer for our practice. From diagnosing asymptomatic failing restorations to pathology to precise planning for implants, I couldn’t practice the way I do without this technology.


You’ve mentioned the digital workflow for your full-arch implant cases. Can you go into a little detail about that process?

Our first digital acquisition starts at our consult appointment. We capture the 3D scan of our patient for diagnostics and treatment planning. If the patient is on board with treatment and ready to move forward, we will also do a full-mouth IOS scan and bite. We also take several photos, showing smile line and symmetry to aid in planning.

At this point, we take all that data and send it to our lab. We use Power Dental Studio for our full-arch cases; the data gives Power the ability to begin the process of designing the case. Before the patient returns to surgery, I can plan the case using the implant library in Yomi’s software for almost any implant. It also lets me see if I’ll need any angled multiunit abutments and the height of each. With Yomi’s bone reduction module, we can also digitally plan the necessary bone reduction and reproduce that on surgery day.

Surgery day begins with placing TADs in the posterior region if the patient is missing molars. We’ll then do a day of IOS and bite to begin the process: We remove all the patient’s teeth and attach the Yomi bone link, a fixated device that provides haptic feedback to Yomi about where the patient is in space.

We then take another 3D scan of the patient with the bone link in place. The preplanned 3D and same-day 3D scan are merged and verified. We then proceed with our robotically guided bone reduction and subsequent guided implant placement.

Once multiunit abutments are on and the tissue is sutured, we place white caps for the MicronMapper. A photogrammetry scan, followed by another IOS scan of the soft tissue, provides Power Dental Studio with the necessary data to design the provisional prosthesis.

Power Dental Studio provides a 45-minute turnaround time, so the workflow gives us the ability to complete the surgery and deliver a screwed-in, direct-to-multiunit abutment provisional in the same day. Once we have the design file, we will print the provisional with our SprintRay Pro55 3D printer using OnX Tough. Our team members will stain and glaze the provisional, and we’re ready to deliver it to the patient.

The patient wears the custom provisional for a few months, and at that time, only a healed IOS tissue scan is needed to fabricate the final restoration. This efficient, predictable workflow has made the restoration phase of all-on-X treatment fun and exciting, rather than stressful and unpredictable.

You’ve had advanced training in oral surgery. What are three tips you have for docs who want to do more implants or improve their proficiencies?

Rep, reps, reps! As with anything, experience with the variations of clinical presentations will provide you with a knowledge base to handle what comes your way. The top three things I’d suggest would be:

1. Go all in. Implant dentistry is so complex with the different applications, so a weekend course will just not cut it. A comprehensive program that covers basic implantology, site preparations (sinus grafting, socket grafting, soft-tissue control), troubleshooting and complications is imperative. What will you do if the plan doesn’t go as planned?

2. Never stop sharpening the skill. Learning lateral window sinus augmentation and doing one sinus a year will not be adequate. There are some great courses to keep your skills sharp as your practice ramps up the volume of these procedures.

3. Invest in yourself. We all have doubts at times, and it’s easy to look at the superstars of dentistry and think you’ll never get to that level. The truth is that they all started somewhere as well. They are highly skilled, but it’s because they invested in themselves and got in the reps to sharpen their skill. Don’t get discouraged early on. The learning curve can be sharp, but investing in yourself will pay dividends over time. Likewise, what are a few common mistakes you’ve seen made in implant cases, and how could they have been avoided?

At a lecture on implantology a few years ago, the speaker said the more you learn about implants, the more you realize you don’t know. This is a universal truth, and I would caution against jumping in without a solid foundational core of knowledge.

Another common mistake is not dedicating enough time to restorative education. Nothing will destroy good surgical implant dentistry quicker than poor restorative implant dentistry. Take the time to learn the principles behind restoring implants, and consider planning your surgical case with the restoration in mind ahead of time.

What’s your favorite patient story?

I have so many wonderful patient stories that have shaped my career that it’s hard to pick one, but I’ll go with Rick, a hard-working Tiger Family Dental patient who has a story that deserves to be heard.

At our consult, Rick was reserved and didn’t make eye contact. He was even slightly irritable with our initial questions. Rick had lost his teeth because of a history of life choices that led to rampant caries and periodontal disease. His gag reflex was so intense, he was unable to have anything removable in his mouth, so he thought the only solution would be to go around with nothing in his mouth and chew food with his gum tissue.

He had heard of the all-on-X procedure and wondered if he was a candidate. We used our CBCT to evaluate his case and although he was a candidate, he was going to need bilateral sinus grafting to make all-on- X a reality because of his maxillary sinuses extending so far anterior. We talked about the process and finally presented a solution for Rick. He was so excited that although the process would be long, it would finally give him the ability to chew his food and smile with confidence.

Today, Rick enjoys eating foods that he would have otherwise never been able to. He smiles when he walks through the door, and his outlook on life has been changed forever. Using the digital workflow streamlined the process and provided predictable results—results I had the confidence to present at consult day. (Before and after photos are below.)

Every time Rick sees us, he tells us how we’ve changed his life and how he tells everyone he can about the procedure. This patient story reiterated to me that I made the absolute best decision not only going into dentistry but also investing in my implant education and investing in technology that helps my team and I deliver the best care possible to our patients.

Office Visit: Dr. Jonathan Ehlers
Before
Office Visit: Dr. Jonathan Ehlers
After



Give us a snapshot of your life outside of dentistry.

My wife and I are blessed with four children: Kaylen (14), Calum (4), Gemma (1) and Mara (1). Our life is both blessed and chaotic, with sporting events, traveling and just spending quality time together. My parents and sister also live in the area, so there are many get-togethers and family dinners. I’m an avid sports fan, so making time for Mizzou athletic events and Chiefs games is also in there. We’re also people of faith, so being active members of our local church grounds us and reminds us of the many blessings we are afforded daily.

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