A conversation with Dr. Carl F. Gugino


Dr. Rohit C.L. Sachdeva discusses the revitalization of the ZeroBase Contemporary Bioprogressive Philosophy with today’s dental practices in mind

Carl, you have reframed ZeroBase Orthodontics. What triggered this change?

We are revisiting, rethinking, and revitalizing the Contemporary ZeroBase Bio-progressive Philosophy.

Many years of teaching around the world have given me the opportunity to be a more “global” thinker than most. Today, the world is getting smaller, and similar experiences are available to nearly everyone by way of electronic connectedness and technology, including artificial Intelligence, algorithms, and instantaneous translation of languages.

To create worldwide peace and inner order, we, as doctors of medical dentistry and as part of the universal health care team, need to exercise the Art of Acceptance while incorporating the Art of Innovation into our daily practices.

So what is the Art of Acceptance?

To conduct ourselves with a global appreciation for others, using love, wisdom, respect, compassion, and friendship with our office team, our patients, and the world at large.

One major concept of ZeroBase is Individualization of patient care. Can you elaborate?

“Individualization” is the ability to adapt to the needs or special circumstances of an individual or the basic difference between individuals. What do most techniques do? They work on the “average.” Harvard graduate and author Todd Rose explores the need for individualization in his book, The End of Average, which explains people’s innate need for individualization. You want to individualize your treatment design to the diagnosis of the individual patient.

Let me also add, individualization is the backbone of everything. What is required for effective treatment? The answer is individualization based on the degree of difficulty of the individual patient.

Doesn’t this add to the complexity of care?

On the contrary, no. Being Italian, let me quote a famous polymath — Leonardo da Vinci said, “Simplicity is the ultimate sophistication.” Your goal is to simplify things. You don’t want to get over detailed, unless the details are helping you — helping you in your information gathering, helping you by reducing your cost, helping you by reducing your treatment time. People are looking for less treatment time today.

ZeroBase is developed around the organizing principles of systems integration. Kindly share with us your perspectives on this subject.

Yes, my approach at looking at systems is based on channeling the flow of energy most efficiently in a collaborative environment.

Futurist and author David Houle described the inner experience on a personal level as one where there is an order in the flow to the individual consciousness — a systematic, orderly flow of energy or attention that is focused on realistic goals. When the person’s skills connect with his/her actions in pursuit of a goal, it brings order and awareness, as in awareness/wellness training, because that person must direct attention to the task at hand.

In orthodontics, focusing on the end goal (a positive holistic care outcome) is the trigger that should generate the systematic actions. This, I believe, requires a more robust strategy to implement than the common operational management techniques. We need awareness/wellness training of the entire team to bring about system cohesion. This is a much undervalued skill. Effective use of a series of systems based on a bedrock of mindfulness and wellness mindset defines Contemporary ZeroBase Bioprogressive thinking!

Your thoughts on flow of energy are captivating. What is the human dimension to this notion?

Energy in an office is super important; it takes positive energy to bring change. You want that positive energy to abound in your office, so that when people come in, the dentist and staff feel good and proud of the care they provide to patients. It is this sense of pride that provides the fuel to bring about change in the practice. And might I add that this energy, to revitalize the practice ecosystem, has to be selectively channeled. Success in improvement efforts are best accomplished when they truly reflect the persona of the team.

And what do you see as the role of technology in systems integration?

Technology is necessary to take your practice into the digital world. Technologies should be used to help increase your information gathering, decrease your costs, and decrease your treatment timing. You need systems to help you incorporate these technologies, with your goal being to simplify your flow of information. So it’s almost a “chicken-and-egg” story — technology drives system integration and, in turn, systems integration maximizes the benefit of technology. Also a systems approach allows you to continually evaluate change.

What is your philosophy on pre-ventative care in orthodontics?

In ZeroBase, the main idea of prevention is that “the earlier you treat, the more the face adapts to your treatment/concept; the later you treat, the more your concept has to fit the face.” In the Contemporary ZeroBase Bioprogressive Philosophy, diagnosis and treatment of the functional matrix is vital in prevention.

Orthodontics has not aged you one bit. Any thoughts on preventing burnout in orthodontics?

Love what you do. Practice the art of acceptance. Keep questioning, and evaluate the what, the how, the why, and the if. Live “a balanced life,” and let your practice reflect your style and your comfort zone.

Would you kindly share the Contemporary ZeroBase Ortho-dontics charter with us?

Yes, by all means. It is a 10-point charter that provides the loadstar for the contemporary zero-based practice.

1. Our primary goal in orthodontics is a satisfactory outcome. Diagnosis and treatment management are merely a means to an end; results come first. The question is, “How do we get our results consistently?”

2. The practice of orthodontics in the future may be different from what it is today or has been in the past.

3. Orthodontics, being the oldest specialty in dentistry, should be the leader in initiating true preventive procedures for the future. Therefore, early treatment is essential.

4. Early treatment has to be part of future orthodontic planning. It is essential in true preventative procedures. If, for no other reason, general practitioners and pedodontists will do it.

5. Success is a pattern; failure is only a few mistakes.

6. Nothing will be accomplished if we look at every objection as something to be overcome.

7. Quantity is not necessarily an enemy of quality, if quality comes first.

8. Orthodontists need to better understand the field of communication with associates, parents, patients, and the public (which is marketing).

9. Occlusion is the common point of dentistry.

10. Time is really the fourth dimension (4D) and is one of our most valuable assets.

The ZeroBase Orthodontics’ mission statement remains universal for all orthodontists, irrespective of the philosophies of care they practice. I know many of our colleagues would appreciate being reminded of it. Please share it with us.

Certainly. And might I remind you that this mission statement very much remains intact and gives me a reason to wake up every day and do better for a profession that I so much love.

“To improve the quality of life and enhance the self-esteem of our patients. We will accomplish this by being one of the leading healthcare professionals in treating patients to achieve their maximum, occlusal, esthetic, and functional potential stressing the importance of oral health to overall health. Patient needs will be addressed employing ethics, integrity, innovation, excellence, and the highest quality in everything we do.

Carl, thank you so much for giving your time for this interview and for your devotion to the betterment of our profession and patient care.

Rohit C.L. Sachdeva, BDS, M Dent Sc, is a consultant/coach with Rohit Sachdeva Orthodontic Coaching and Consulting, which helps doctors increase their clinical performance and assess technology for clinical use. He also works with the dental industry in product design and development. He is the co-founder of the Institute of Orthodontic Care Improvement. Dr. Sachdeva is the co-founder and former Chief Clinical Officer at OraMetrix, Inc. He received his dental degree from the University of Nairobi, Kenya, in 1978. He earned his Certificate in Orthodontics and Masters in Dental Science at the University of Connecticut in 1983. Dr. Sachdeva is a Diplomate of the American Board of Orthodontics and is an active member of the American Association of Orthodontics. In the past, he has held faculty positions at the University of Connecticut, Manitoba, and the Baylor College of Dentistry, Texas A&M. Dr. Sachdeva has over 90 patents, is the recipient of the Japanese Society for Promotion of Science Award, and has over 160 papers and abstracts to his credit. Visit Dr. Sachdeva’s blog on https://drsachdeva-conference.blogspot.com. Please contact rcsorthocoach@gmail.com to access information.

Carl F. Gugino, DDS, graduated from the University of Buffalo in New York in 1953 and served in the United States Navy Dental Corps from 1953-1955. Following that, he entered a group dental practice and then attended his residency in Orthodontics at the University of Buffalo, New York, which he completed in 1961. In 1962, he developed the ZeroBase Contemporary Bioprogressive Philosophy with Drs. Robert M. Ricketts, Ruel W. Bench, and James J. Hilgers. He has delivered more than 2,000 presentations and courses around the world since 1964 and is honorary president of the Bioprogessive study club in Japan, Italy, France, and Spain. Dr. Gugino currently still offers lectures, courses, and coaching worldwide.

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