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Inject some life into your practice's bottom line with these high-ROI services

Sept. 27, 2021
Mandatory shutdowns in 2020 were hard on most dental practices, but some bounced back better than others. This article highlights some high-ROI, low-risk services that could give your bottom line the post-shutdown boost it needs.
In my article called "COVIDonomics in dentistry," I broke down how some practices were more pandemic-proof than others. Now that we are in the post-shutdown stage, the dental practice economics are still undergoing rapid changes. There has been a significant separation of different types of dental practices in terms of patient rebound, appointment volume, and practice production. Statistics provided by the American Dental Association Health Policy Institute (HPI), under the direction of Dr. Marko Vujicic, have closely followed economic trends of dental practices.

Data doesn’t lie

HPI has had an ongoing study during the pandemic titled COVID-19: Economic impact on dental practices. This study has been measuring certain parameters week by week throughout the pandemic. Let’s take a look at the latest report as of this writing— the week of June 14th.1 I encourage dentists to look at the
comprehensive report, but for now, let’s take a look at some specific parameters which I hope will specifically help solo practice owners so they may make choices that will immediately improve their practices.

In my previous article, I compared solo practices to DSO practices. In this article, I’ll compare solo practices to a recent survey of American Academy of Facial Esthetics (AAFE) member dentists. AAFE member dentists are reflective of general and specialty dental practices with one addition—these dentists have integrated the use of injectables such as Botox, dermal fillers, and polydioxanone (PDO) threads into their practices. These services are insurance-free and high return on investment (ROI) with minimal treatment time once the clinician is well-trained in their use. Dentists surveyed in the AAFE member study were split between those who have had at least AAFE Level I live patient certification training (AAFE I) and those who have had additional Level II live patient certification training and more (AAFE II).2 This will give us some perspective to better understand how pandemic and post-pandemic economic trends are affecting solo versus AAFE dental practices.

Patient volume

It is mind-boggling to find out that nearly a year after many dental offices were able to open their doors for non-emergency patient treatment, almost 35% of solo practices are still reporting lower patient volume. Contrast this number with dentists who have invested in their skills to add injectables such as Botox to their practice. Here is a statistic that should make you seriously think about the services you offer in your practice: AAFE I member dentist practices are booming with Botox, dermal fillers, PDO threads, and injectable treatments, having increased 2021 year over 2019 year by nearly 40%. AAFE II practices are up nearly 50%, proving that more education results in higher production through treating more comprehensive facial esthetics cases.

Clearly, AAFE I and AAFE II practices are doing a better job at attracting patient volume into their offices during this post-shutdown stage. Why? It has been widely reported that all esthetic dental services have increased post-pandemic, including whitening, esthetic dentistry, and porcelain veneers.3 Why is this happening? We call it the Zoom boom: patients have been isolating for months and practicing social distancing and wearing masks, hiding the most expressive
parts of their faces. Vaccinations are up and mask mandates are inconsistent; patients look at themselves closely on Zoom or in the mirror and don’t like what they see. The pandemic and mask-wearing accelerated facial aging dramatically.

Combine these reasons with the fact that patients now have more elective money in their pockets from not traveling or doing much of anything for the better part of a year, plus government payouts—these patients now and for the foreseeable future are investing in their own facial esthetics first, before they get back to their normal lifestyles and see their friends, families, and meet new people at social events. Patients want facial esthetic dentistry treatment and they want it now (figures 1–2).

A key advantage

What advantage do AAFE I and AAFE II practices have? These practices offer Botox, dermal fillers, and PDO threads—the most popular esthetic services in the world. These services have proven, once again, to be recession proof. Here are more amazing survey results: AAFE member practices averaged increased production of 3% in 2020 over 2019, which is absolutely a miracle considering all dental practices were closed for a minimum of two months in 2020.2

Botox and dermal filler treatments are some of the safest treatments to deliver during the pandemic (and now) because there are no aerosols involved, all treatment is delivered through disposable, single-use syringes, and the average appointment lasts only 5–30 minutes. Many AAFE member dentists only delivered injectables for the first few months of reopening as patients did not want to come in for regular dental services but they were willing to come in for their facial esthetic treatments.

Here is a question you need to ask yourself: Was your practice production up 3% in 2020 compared to 2019? According to the HPI, most dental services were down 25%-plus in 2020 over 2019. With many practices still experiencing lower patient volume, this trend will continue unless you start adding services people desire and are willing to pay for out-of-pocket.

Highest ROI

Injectable procedures have the highest ROI in a dental office by far, since there’s no lab fee involved, no capital investment, and most cases take just a few
minutes. More comprehensive injectable treatments will take longer and the patient fee will be higher. A common example of a typical Botox procedure would be a patient fee of $600 and an injectable cost of $300. This equates to a $300 profit in less than the five minutes it takes to deliver treatment. A typical dermal filler procedure patient fee may be $1,400 with the cost of injectable at $500. This yields a $900 profit for a 10-minute procedure. Assuming you have the capacity of extra chair time and space, which nearly all dentists do, there really is no traditional office overhead associated with these procedures as they are filling up unused chair time with profitable procedures. And the best part? No insurance to deal with, ever.

A wise investment

Your single best investment is and always will be you! Botox, fillers, and PDO threads are skills-based services, which means you’ll have these skills forever. The AAFE has trained tens of thousands of dentists in every state to deliver injectables within the scope of dental practice at 40 locations around the US and at the ADA headquarters and ADA annual meeting, including Smilecon 2021 in Las Vegas next month (figure 3). Your patients are investing in themselves by coming in for these elective esthetic treatments. Invest in yourself and get trained today!

Editor's note: This article appeared in the September 2021 print edition of Dental Economics.


  1. COVID-19: Economic impact on dental practices. American Dental Association Health Policy Institute. June 14, 2021. https://tinyurl.com/44sr5ejd
  2. American Academy of Facial Esthetics internal member study. June 30, 2021.
  3. Lukas E. Everyone is suddenly getting smile makeovers. InStyle. April 29, 2021. https://www.instyle.com/beauty/porcelain-veneers-dental-trends-coronavirus
Louis Malcmacher, DDS, MAGD, is a practicing general dentist and an internationally known lecturer and author. He is the president of the American Academy of Facial Esthetics (AAFE). You can contact him at (800) 952-0521 or [email protected]. Go to facialesthetics.org for information about live-patient Botox and dermal fillers training, solid-filler PDO thread lifts, frontline TMJ and orofacial pain training, dental sleep medicine, bruxism therapy and medical insurance, and to sign up for a free monthly e-newsletter.

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