Delivering a quality patient experience in Guam

Dr. Paul Sauget describes how he takes his experience practicing in the U.S. mainland to the island of Guam and delivers the quality he wants for his patients using the latest technology

Dr. Paul Sauget is home again. In 2018, he set up practice in the U.S. Territory of Guam and could not be happier to be back on the island with its tropical beaches and welcoming culture.

Returning to this 212-square-mile island to open Future Smiles Orthodontics was no small feat. After completing his undergraduate and dental graduate studies, he served 4 years in the U.S. Navy, helping to make the smiles of Navy pilots and Marines as healthy as possible. He went on to complete his orthodontic residency at Indiana University, and eventually launched various practices in Los Angeles and Sonoma County while associating in Beverly Hills, California.

Now, Dr. Sauget’s practice, Future Smiles Orthodontics, is bringing the “Hollywood Smile” concept from California to the Western Pacific. He also joins his brother Dr. Earl Sauget of Pacific Smiles Orthodontics as the only Board-certified orthodontists in the region.

It starts with a sound practice philosophy

Quality is a value that I prioritize in my practice. Quality has a lot of facets to it, like a precious stone. 

We prioritize complete quality care in my practice, from the smiles we produce to the daily tasks of record keeping. Patient cases should be completed on time and with Board-quality finishes. Cutting corners with patient care is not allowed by anyone on the team; we hold ourselves to the ABO level of care and ensure our patients feel they are getting the best we can offer.

Quality also means using the most advanced technology and techniques in everything we do. Relying on what used to be the highest standard of care or outdated products is not the experience we want to deliver at our practice.

This also translates into the office presentation. Everything should feel new and should be constantly rejuvenated. The cleanliness and freshness of the office reflects quality to patients; it sets the tone for the level of service they will receive from our facility.

Another facet of the quality value proposition that I strive to deliver is maintaining high morale within my team. We focus on maintaining enthusiasm and energy during patient care days — patients can feel that energy and the welcoming environment the moment they enter. Our team is viewed as a family, which ties into the island culture. We celebrate each other’s accomplishments, and everyone is cross-trained to help whenever a teammate is out of the office. I never want to be viewed as a boss. I am more like a head coach of a championship level team. I empower my staff to be professionals and own their skills and responsibilities. Lunch parties and beach days also help!

Efficient operations are also integral to a quality patient experience. In addition to my dental training, I majored in both biomedical sciences and business administration. My studies in science and business and my military experience running a dental clinic in the Navy gave me a strong foundation in practice operations. Everything must be “squared away” as they say.

How uLab^® helps me deliver the quality experience I want

Suppliers play a significant role in delivering the quality experience that defines my practice philosophy. uLab has been an excellent partner in this effort.

Efficiency is a key in delivering cutting-edge orthodontics to today’s patients. As the only two Board-certified orthodontists in Guam, we are very busy. We need to make the most of every appointment and treatment plan. I have noticed my uLab cases require fewer aligners than other systems, by as much as 30-50%. This efficiency in treatment is an advantage both for the practice as well as our patients.

In addition to requiring fewer stages for the treatment, refinements have been more reasonable. In the past, I used to have as many refinement aligners proposed as in the original treatment — sometimes more. How do you explain that to the patient? That can take away from the confidence they have in the modality of treatment or their practitioner. My experience is that there are often far fewer refinements with uLab than with other aligner companies because I have control over the treatment parameters. I can define proper staging so there are no collisions that can push things off course. I can define velocity of the stages and even the trimline I prefer for my patients.

Also, since uSmile aligners can be purchased a la carte, finishing a fixed case with three or four aligners is easy. To do this with the pioneer brand would have been cost prohibitive. By ordering a few aligners, I can avoid repositioning brackets, bending wires, or using tooth positioners to finish a case (though I personally still love repositioning and bending wire), and the patient is happy to get the wires off and have a removable option for those last few months. They love that I am doing them a huge favor!

Combination treatment is becoming more common in my practice now because uLab has made it more feasible. Combo treatment can save significant treatment time for patients by optimizing the right tool for the right movements and allowing me to think about the best option for that patient with their timeline and goals in mind. The associated pricing structure from uLab means I can affordably integrate aligners in more cases and create a bespoke experience. If a patient wants to remove their braces early and finish treatment with aligners, we can accommodate that; the reduced chair time easily offsets the modest lab fee. I used to treat 10% to 15% of my cases with aligners; now I use them in over half of my cases. With the many military families in Guam, the flexibility to transition patients to aligners to complete their treatment remotely during a deployment or after a transfer has been very helpful.

Making aligners available to a greater percentage of patients enables me to reach that high-quality service ideal that I hold my practice to on every level.

Employing sensible biomechanics reduces IPR and increases efficiency

I am fortunate to have a digital assistant on staff, and we utilize the uAssist™ concierge service from uLab to help with the bulk of the treatment planning. We appreciate receiving treatment plans back within a day or two from the licensed dentists and orthodontists on the uAssist team.¹ This resource increases our efficiency by providing individualized treatment plans without compromising quality. They allow our preferences to be the basis for the resulting treatment plans, and they care to ensure we are completely satisfied. With this service, we can review case designs, make the rare minor adjustment ourselves in just a few moments, and order aligners right away.

I also appreciate the uAssist team’s approach to biomechanics — the tooth movements make sense logically and are based on best practices gleaned from mechanical principles. Their recommended process of extrusion and intrusion and having relative anchorage around other parts of the arch helps ensure predictable outcomes. When we view the treatment plan animation, my digital assistant and I nod in agreement because the biomechanics are realistic. We can visualize the teeth actually moving the way the animation portrays it.

One example of this that I really like is the choice and placement of attachments for rotations while everything else anchors properly.

In addition, there is minimal round-tripping. Treatment plans from uAssist show excellent biomechanics and logical point A-to-B movements. They create space for de-rotations; we see an obvious demarcation of space opening as the tooth rotates. It’s like an open coil, making the space first so the tooth can turn instead of requiring IPR and rotating into a tight spot. Due to this, I use almost no IPR with my uSmile aligners, saving chair time and providing a superior patient experience.

I appreciate the uAssist team’s approach to biomechanics — the tooth movements make sense logically and are based on best practices gleaned from mechanical principles.

Logistics

Being in the Western Pacific, you can imagine the challenges we have with shipments from the mainland United States or other major manufacturing centers. We had always accepted long delivery times as inevitable and tolerated it due to our location. Before working with uLab, we waited weeks for aligner delivery. Patients would be impatient to get started with their treatment, and I would hesitate about prescribing aligner treatment when a faster start was needed.

Since starting with uLab, we receive aligners rapidly, which has been a game changer for our operations. uSmile™ aligners are delivered to the island in as little as a week — even Amazon takes longer! There is only one FedEx^® aircraft to Guam every week, arriving via Anchorage, Alaska, on Sunday afternoon. If we approve a case by Wednesday morning our time, it is usually manufactured and delivered to our office the following Monday.² As a result, starting cases is faster. Even converting from braces or functional appliances to aligners is met with minimal relapse due to faster shipping, improving the patient experience.

Branding

Orthodontists know it is essential to be a part of the community and give back to the people who support their practice. In a tight knit community, this is even more important. Future Smiles Orthodontics supports events and causes throughout the island that help to establish familiarity and trust between the community and our practice.

We take advantage of the custom packaging option for our uSmile aligners, so they arrive in a box printed with the Future Smiles logo. This reinforces our brand and our contributions to the community, highlighting the same logo that flies over our outreach projects; it gives our whole team a sense of pride, enhancing their love for what they do.

Quality is the driving force behind my practice. My team and I strive to provide it in every moment of our patient experience and the outcomes we deliver as planned and on time. We work with our partners at uLab to efficiently offer consistent and predictable results, supporting our standard for treatment excellence. Our patients can feel the difference, too. They can feel it in the welcoming environment they walk into, the streamlined delivery of their aligners, and the efficient treatment they enjoy using the latest technology and techniques, all of which culminates in the smile they see reflected in the mirror.