DR. NEIL PARK: Let’s start with your background and how you became interested in dentistry.

DR. TIMOTHY KOSINSKI: That’s an interesting story, because I really had no intention of going to professional school. After college, I wanted to be a professor. I was in the doctorate program in biochemistry at Wayne State University Medical School. For some reason — I can’t tell you exactly why — I applied to Detroit Mercy Dental School, which was University of Detroit at the time, and I was accepted. I just fell into something that fits my personality. I think dentistry is the best profession out there. It allows us a lot of freedom. 

After dental school, I got accepted to a general practice residency at Miami Valley Hospital in Dayton, Ohio, which was a phenomenal experience for me — one of the best experiences of my life. There were eight residents out of three hospitals. We did in-house calls. Every third night we had to sleep in the hospital, and we saw patients all night long. Just great mentors and great people. After the residency for one year, I started looking for jobs. One of my faculty members, Dr. Paul Mentag, was one of the early implant pioneers in Detroit. I remember he was doing a case and he couldn’t get the patient numb. It was probably a blade implant back then. I asked if he wanted me to try it, and I did a Gow-Gates technique because we did all kinds of things as a resident, and got the patient numb right away. He hired me on the spot and the rest is history.

NP: So, you were an associate in this great practice with Dr. Mentag. How did you start your own practice?

TK: We worked together for five years, and I knew that at some point I had to go on my own. The building that we’re in now became available and was the perfect place as it is in the center of the city. It’s where I wanted to be. 

NP: You went right from being an associate to starting from scratch?

TK: Five years later, yes.

NP: And are you in solo practice now?

TK: I’ve had associates for probably 23 years of my career off and on. But at this juncture, I’m working by myself.

NP: Tell me a little bit about your practice. What’s the mix of services?

TK: I would say placing and restoring implants is probably 75–80%. We probably do an average of 60–80 implants per month. I still do a fair number of regular crown & bridge and fillings. 

NP: How long have you had this practice now?

TK: Since 1992. It’s been a lot of years and I have a great team. Cheryl, my main assistant, has been with me the entire time. I have three chairside assistants, one hygienist, and my daughter, Jessica, handles all the administrative duties. She is really the brains behind the practice. I just do dentistry.

NP: How long has Jessica been in the practice?

TK: About six years now. She manages everything and takes good care of her dad. I just come in and she does all the financial arrangements. The patients love her. She has a lot of flexibility and has brought in great staff members. These are exceptionally talented people who really make me look good.

NP: How about your patient base? Do you serve a particular demographic?

TK: We’re in the suburbs of Detroit, not a particularly wealthy area. Working with Glidewell and the Glidewell HT^™ Implant System (formerly known as the Hahn^™ Tapered Implant System), we’re able to do high-quality work at a fair price. That’s why we have so much volume.

NP: I think that it’s important for young dentists reading this to understand what a great practice you have and that the large number of implants you’re able to do isn’t something that happened overnight. There were a lot of years of building that. Can you talk a little bit about how you got started with implants? I know you mentioned you associated with an early leader in the field, but you don’t do implants the way he did them, right?

TK: It morphed as materials, procedures and drilling systems improved. Everything is better than it was before. Bone grafting has changed dramatically. We tried everything. I started with Plaster of Paris, glass beads, hydroxyapatite, tricalcium phosphate, and none of it really worked. We can now build bone very efficiently to prepare the foundation for implants. Our successes have increased dramatically with technology, and I’ve worked with a lot of implant systems. What’s important to me is the communication and family-like environment with my lab. Not every case is ideal, but when you’re working with exceptional team members, they really help you elevate and be successful. That’s the key. It’s making sure that I am a successful dentist by providing as much high-quality dentistry to as many people as I can. Patients deserve that. Once you realize it’s not about the dollars but about providing a service to our community and changing their quality of life, our patients send their family and friends to us. That’s the best marketing you can do. It’s really word of mouth. People hunt for quality. My dad always said, “Timmy, do a good job at a fair price and you’ll always be busy.” And we always are. Even during the darkest days of 2008, the recession that bludgeoned Detroit, we were always busy.

NP: Whenever I talk to someone that has a very successful implant practice, I usually find that one of their main skills is communication. It’s not just the ability to grow bone and get an implant to integrate. There’s some ability to integrate with the patients behind it all. Tell me a little bit about the workflow in your office. Who sees the patient first? Who talks to them?

TK: I think that’s really important. Number one, your receptionist has to have exceptional people skills. Caroline, who works in our office right now, came in with zero dental experience. She is so friendly, so nice and positive. When patients come in, she stands up and greets them with a smile and tells them, “You’re going to have a great experience with Dr. Kosinski.” We try to respect people’s time. Time is valuable and we respect that.

From there, the patients go to one of the operatories. I really try to address the initial problem that the patient presents with. If they tell me their tooth hurts, that’s what I’m going to look at. If they say, “I’m missing this tooth. I hate my partial. I hate my denture,” or whatever the issue may be, my staff will go through the health history and take specific radiographs or a CT scan. They interview the patient then come back to me and explain what’s going on.

People today are very astute about implants. In today’s environment, when people have a toothache, they’re going to Google it and implants are going to come up. We know that not everything on the internet is correct, but they come in with some concept. When I come in, the first thing I say is, “I know you have a problem, but before we begin, I want to make sure, has everybody treated you well here?” I expect them to nod yes, and that’s really important. That sets the tone for our entire conversation. Then I say, “We’re going to look at your situation. But before we begin, I want to introduce myself to you. I’m a big talker. The more you understand about what we can and can’t do, the better the result. But communication has to go both ways. It’s not just me talking to you.” I also say, “I have a tendency to speak fast. If I need to slow down, please slow me down.” 

What that means is that the patient is now in control of the entire situation, instead of me looking down on them. They can stop me. They can ask me a question. I review my credentials by saying, “I’ve been practicing for 39 years. I did my hospital training down in Dayton, Ohio. I did my implant training at Harvard. I have placed a lot of implants and am an educator. I’m an adjunct clinical professor at our University of Detroit Mercy Dental School and lecture all around the country.” They are comfortable with my sincerity and my training. They know I’m trying to give them the best result, not X-ray their wallet.

NP: Right. In other words, it’s important to explain to the patient that you’re qualified and committed to choosing the right treatment plan and executing it in a way that’s comfortable and gives the most ideal result.

TK: That’s right. Tell them, “I’m working on my fellowship through the Academy of General Dentistry.” That’s impressive. “I’ve taken symposia, I’ve done a continuum in implant dentistry.” That exudes confidence to the patient, which I think is very, very important.

NP: Exactly. In other words, emphasizing that you don’t do implants as a sideline. But rather, that you’re committed to excellence in implant dentistry. But what do you think holds some patients back?

TK: That’s changed over the years. In today’s environment, I think it’s cost. I think people are really struggling. I see cost as an issue in my practice, but doing a good job at a fair price allows us to do a lot.

NP: Do you think sometimes dentists charge too much for implants?

TK: When I started it was a long procedure, and the lab work was very expensive. Now we’re working with the highest quality implants on the planet and the cost has been dramatically reduced. And CAD/CAM technology is like magic. Procedures that used to take me two hours may now take 20 minutes. It’s not fair to charge the patient what we used to because you’re paying for my time and material costs. Implants used to be $400, now Glidewell HT Implants are priced at $99 and are every bit as good as the more expensive alternatives. Dentists now have the chance to offer affordable implant treatments to their patients with better quality and support.

What does it cost you to run your office? What do you need to make per hour for the lights, your rent, your mortgage, your staff, your supplies, and a salary that you feel comfortable with? You have to determine that number. You need to know that number and then work your way from there. That’s how you determine what to charge. 

NP: That’s a great point — make sure you’re charging a reasonable fee. But still there are cost challenges for patients. How can a dentist overcome that?

TK: We offer CareCredit and GreenSky. But I never talk about money with my patients. I tell patients, “You’re going to be meeting Jessica. She runs the business part of the practice. My job is to give you the best dentistry I can provide. Jessica’s job is to make it affordable. So, I need you to be honest and open with her and tell her how you feel. We are going to try to work within your budget. She has payment options. Our job is to provide the service that you want and work within a budget.” Make it affordable. Because we’re trained to do comprehensive dentistry, we have a tendency to give them an estimate for $25,000, and they will say, “I have to go talk to my spouse.” Then you never see them again.

NP: In the last ten years you’ve become one of the biggest users of the Hahn Tapered Implant System, now known as the Glidewell HT Implant System, and are a big customer of the laboratory. You tend to stay within one group. Is that something you would recommend? 

TK: Yes. What I like about Glidewell is the family aspect. They want me to be successful. It’s more than selling me a fixture. They want success from start to finish. They have a high-quality product and it’s U.S.-made, which is important in Detroit. The warranty is excellent. In the rare case it doesn’t work, they give me another one. If an implant abutment and crown don’t work, they replace it. Dentists often say, “Hey, it’s not the implant that’s important. It’s the final result.” And at Glidewell, they bring meaning to that because they fabricate that final result.

NP: How do they accomplish that?

TK: The team at Glidewell is exceptional and they communicate with me. They tell me when there’s an issue, and we can talk it through with mutual respect. And when things don’t work right, they’re there. They’re not nickel-and-diming me. There are a lot of implant companies that would be happy to sell you the product and will even guarantee that if the implant fails you can send it back, along with a myriad of paperwork — but not the abutment and crown. The Glidewell team is mostly concerned, in my opinion, with the final result — not the spark plug that’s in the jaw, necessarily. And that’s important to me. That’s really important. Why would you work with a company that doesn’t do that? It doesn’t make any sense.

NP: You mentioned earlier that you concentrate on the patient’s chief complaint, the thing that brought them in there, and make sure you handle that. Now, obviously, that’s not comprehensive dentistry at that point, but do those patients tend to come back later?

TK: People have a lot of responsibilities. They have kids, they have ortho, they have car payments, they have mortgages and inflation. Work within their budget. It can be a five-year plan and I’m okay with that. As long as they know what they need, we can work with them. My job as a dentist is to say, “Look, we have to address this tooth. I know it’s a budget issue sometimes, but if we don’t address this in the next six months, we may lose the tooth, or it may be a much more expensive procedure down the road.” That’s how I communicate with them. They are in control of their body. They’re telling me, “Okay, we better do this one. I’m going to schedule this.”

NP: If you could identify some secret sauce that makes your practice so successful, what do you think it is, and how can a young dentist get to where you are?

TK: Number one, surround yourself with incredibly talented people that really care and have a lot of empathy. 

NP: Do you hire for that?

TK: Yes. Sometimes the most successful, best staff members are the ones that communicate. They’re friendly, and they have empathy. They may not have the best clinical skills, but they care, and they’re trying to provide the best service for our patients.

NP: We know exactly where a dentist should go to learn how to do a socket graft. But if they need to learn how to talk to a patient, or even more important, how to listen to a patient, where do they go to learn those skills?

TK: The business part of it is a hard thing to do. I think most of the speakers at Glidewell symposia take a lot of time on that, and the Glidewell webinars that you do are a great resource.

NP: You talk about having dentists come to your office to shadow you. They are probably hearing how you communicate, too. 

TK: Yes, absolutely. I think mentoring is important. Drilling a hole in bone is not the hardest part about success. It’s knowing what the tooth is going to look like when you’re done. When we started, you put an implant in bone. The patient should be happy that they have something. That’s not the case anymore. People are very particular, and you have to be able to reach their expectations.

NP: They’re paying a lot of money, and their expectations are similarly very high.

TK: That’s why working with the implant team at Glidewell is so good. These are the best technicians, and they communicate. They call me and say, “Dr. Kosinski, what do you think of this? Can you do this? Can you do that?” And that’s why I think that general dentists probably are the best implantologists once they become confident and competent, because they’re seeing teeth. If the implants are improperly placed, it makes the restoration very challenging for us. And all people see is the white in their mouth. They’re going to blame the person that made it white as opposed to the malposition of the implant.

NP: I agree completely. Let’s talk a little bit more about your teaching. We’ve talked about what a busy practice you have, yet you also spend a lot of time teaching. That’s about 25 weekends a year, right? You started off by saying your original intention was to be a college professor and now you spend all this time teaching. Is there something in your personality that makes you want to teach?

TK: I was blessed with great mentors. I was constantly developing my skills, thinking and getting better. At this stage in my career, it’s awesome to give back. The traveling is hard. But once you’re there you meet so many great people. Every time I do a course, I get as many as ten emails. And sometimes I feel bad because they’re asking me a question that I think I covered. This tells me I didn’t do a good job. So, the next time I do it, I try to correct what I perceive was missed.

Professionally, I have a good balance. We work hard in the office. When we’re there, we do a lot of dentistry. And when I’m traveling, that’s rewarding. I take care of my health, too. I lost weight, had my knee done, and I do Pilates twice a week. I leave the office at 4 p.m. I think it’s very important that doctors realize they have to take care of their bodies.

NP: Any advice to a young dentist that wants to add implant dentistry, specifically implant surgery, to their practice?

TK: The most important thing is to find a course or a mentor. For example, Dr. Randolph Resnik. Or start with a Glidewell symposium. Find personalities that you agree with. You’re going to have to travel. Hands-on training is the best — more than a lecture. Working on models or simulators is also a great way. But if you can work on patients, even better. You have to train your hands and your eyes and visualize. Then ask yourself, “Is this a case I want to do? Is this in my wheelhouse, or do I not feel comfortable? Do I need help? Or should I refer it out to somebody who has more experience?”

NP: Regarding 3D imaging, when we started it was, “Where is that mandibular nerve? I don’t want to hit that.” Now that’s a done deal. If you’re worried about it, just do guided surgery. There’s been so many technical advances that have made this better, safer and more predictable. In addition to all the new materials and better implants, there is also the advancement of CAD/CAM technology that significantly enhances the quality of the restoration, as you mentioned.

TK: Scanning too. The scanners have gotten better, and that makes us better dentists. We can see how bad we were visually, and now you can’t make a mistake. That goes for milling in the office too. You can see the difficulties that the technicians have when you send them subpar scans. It just keeps making us better.

NP: That leap in quality also applies to the products you can deliver now. 

TK: Yes, unbelievable and at a reasonable cost. It’s more profitable, too. 

NP: It sounds like you think the prospects for dentistry are pretty good.

TK: I think dentistry is in a phenomenal place. As long as we stay professional and have empathy toward the public. It’s more than the money. I tell young people, “I envy you so much. You’re going to have such a great life.” And they say, “What are you talking about? I have all this debt.”

NP: You don’t get successful by chasing money. You do the right stuff, and the money follows.

TK: Exactly. Dentistry gives you a lot of flexibility. I didn’t miss seeing my kids grow up. You can work as many or as few hours as you want. 

NP: Would you say the biggest mistake that doctors make when they’re starting out is taking on cases that are a bit outside their wheelhouse? 

TK: Absolutely. I think you see dollar signs and you want to do it, but there’s a lot of art that goes along with the science in what we do. And that takes time. Do the cases that you feel comfortable with, and don’t overextend your abilities. Cherry-pick when you’re starting out and move on to the more complicated ones when you have the skills. 

NP: There are many dental practices that are focused on insurance plans that limit the fees and procedures you can do. What advice would you give?

TK: Insurance really isn’t insurance, right? It’s a benefit. Before you talk dollars with a patient, it’s important to make them aware of what they need and how you can achieve that. They understand they have an issue. You’ve explained the options to correct that issue. Now it’s their decision, not yours, on how they want to proceed. If it’s $5,000 and they decide that’s what they want, but insurance is only covering $2,000, that’s on them. If they want it, they will come up with it. 

If you’re having a big party at your house to watch the Super Bowl but your TV breaks, you’re not going to think twice about going to Best Buy and getting a new TV. It doesn’t matter what the cost is because it’s important to them. I don’t care if you’re in a DSO, large practice or solo practice, if you’re able to make the dentistry important to them, it’s the patient’s decision. Give them options, make them aware of what you can and can’t do with confidence, and meet their expectations. That’s success.

NP: Let’s finish off with maybe your best three pieces of advice that you would offer to a young dentist right now. What would they be?

TK: First and foremost, dentistry is hard. Take care of your health. Respect your eyes, your ears, your neck, your back and your hands. That’s your lifeblood. Those are your tools. It’s very important that you take care of your health. Number two, continue your education. I’m a big advocate of the Academy of General Dentistry. I’m on the executive board, and I’m the editor. Learn from high-quality, ethical mentors and absorb their knowledge. You can find high-quality education through Glidewell and the Academy of General Dentistry. And third, technology has really advanced our ability to treat our patients. Invest in your future. All of this will give you the ability to confidently exceed your patients’ expectations.