The Margin Line

A dentist who reads a P&L isn’t rare, but a dentist who steps away from the chair to run procurement for a whole DSO certainly is. Dr. James Marchigiani made that leap and approves every supply order across more than 45 practices himself.

In this episode of The Margin Line, Joe Lynch sits down with Dr. Marchigiani, VP of Procurement at Cordental Group, to unpack what it really takes to trade the handpiece for the spreadsheet. After 20 years running his own practice, spending time in group practices, founding a consulting firm, and teaching dental students, James is the only dentist we know of running procurement for a DSO.

He gets into:

• His honest playbook for any dentist thinking about leaving the chair: build a three-to-five-year plan, “internet coffee” your way into new relationships, and sell your practice at its height
• How he cut 107 labs down to about 27 with a preferred-lab model that covers 100% of the fee, and why dentists switched the moment the alternative hit their own pockets
• How he cut the purchasing formulary from nearly 8,000 items to under 4,000, saving on the things that don’t matter (gloves, masks, clear vs. pink saliva ejectors) so he can give dentists freedom on the materials that do
• Protecting the group from supply shocks, like a 35% glove price jump in a single day, and why diversifying suppliers is imperative
• How a dentist running procurement defuses the dentist-vs-corporate tension: a framework with real clinical freedom, free manufacturer samples, and the clinical director’s sign-off

It’s a candid look at life after the chair, the mechanics of running procurement for a multi-state DSO, and why having a dentist in the room changes what ends up in a patient’s mouth.

Check out Dandy here: https://www.meetdandy.com/

Sleep apnea doesn't always fit the profile you'd expect. Dr. Gregory Ceraso spotted it in the healthy, mid-30s host interviewing him within the first two minutes of meeting, just by looking at her face.

In this episode of The Margin Line, guest host Ally Bashir sits down with Dr. Gregory Ceraso, Chief Dental Officer of Cordental Group, to unpack why the mouth is one of the most overlooked windows into whole-body health. With more than 45 years in dentistry — starting in jaw reconstruction for cancer and facial-trauma patients, and placing his first dental implants in 1981 — Dr. Ceraso brings a rare perspective on where dentistry and medicine meet.

He talks about:

• Why he calls dentists "physicians of the oral cavity," and the sleep apnea signs that show up in the mouth long before a physician ever catches them
• Greg's Road Show - the initiative to bring standard of care to every practice without stripping the creativity out of dentistry
• The pediatric sleep case he calls the proudest of his entire career: a nine-year-old who was missing school due to debilitating headaches
• The honest trade-offs of oral appliance therapy, including posterior open bite in deep-bite patients and the morning repositioner he uses to manage it
• How he built referral relationships with physicians by screening patients for sleep apnea and sending them their way
• The oral-systemic connection he lays out, from periodontal bacteria in the bloodstream to the emerging link between sleep apnea, deep sleep, and Alzheimer's

The episode is a wide-ranging conversation on sleep dentistry, raising the standard of care, and why the mouth reveals more about a patient's overall health than most people realize.

Check out Dandy here: https://www.meetdandy.com/

Ask most dentists how they make money, and the honest answer is three words: drilling, filling, and billing. Dr. Ryan Lee thinks that model rewards the wrong things, and he has the experience to make the case.

In this episode of The Margin Line, Joe Lynch sits down with Dr. Ryan Lee — dental oncologist, dental director at CVS Health’s Aetna, dental interoperability consultant at BCG, dental subject matter expert to the FEHRM, and a Lieutenant Colonel in the Army Reserve — to unpack what dentistry looks like when you stop thinking about the tooth and start thinking about the patient behind it.

He gets into:

• Why "drilling, filling, and billing" makes up roughly 80% of dental income, and what he'd change
• Why dentists are best positioned to catch oral cancer early but almost never get paid to
• The brutal economics of dental oncology outside a hospital
• Why PDS Health putting Epic in every office signals real medical-dental integration
• The case for patient-owned dental records
• His unique role as the Dental SME on the federal effort to unify health records
• The one rule he uses to decide when to take on yet another job

Whether you're a DSO leader trying to make medical-dental integration more than a buzzword, a dentist wondering what's on the other side of the handpiece, or anyone who's ever asked why the profession best positioned to catch oral cancer gets paid the least to look — this conversation reframes what dental care is actually for.

Check out Dandy here: https://www.meetdandy.com/

Most dentists who burn out never say it out loud. Dr. Maggie Augustyn built a national platform doing exactly that, and still owns the practice where it all happened. In this episode of The Margin Line, Joe Lynch sits down with Maggie — founder and co-owner of Happy Tooth, Dentistry Today columnist, and National Media Spokesperson for the Academy of General Dentistry — to walk through the years of leadership before any of that was true.

She talks about:

• Her first day as a practice owner, needing to tell a panicked assistant it was going to be okay when she wasn't sure she believed it herself
• The credit card debt she couldn't quantify, and the loan she and her husband made to the practice just to stop paying the interest
• Why she described her early leadership as being a "bosshole," and what it cost her employees
• The cancer diagnosis that made going back to the same life unthinkable, and what she did differently moving forward
• What actually changed in the practice and in herself once she brought in Productive Dentist Academy
• The quarterly "dream list" that holds her accountable to this day 
• The tension she's openly still living in: compassionate care versus hourly production goals
• Her opinion on the most overrated thing in dentistry right now, which she believes will be controversial to many

Every group has a practice that looks like the one Maggie ran, and every high performer has had a version of those dreadful Sunday nights before the work week started. This is what the inside of it sounds like, from someone who found her way out and has spent the years since giving other dentists permission to admit they're struggling.

Check out Dandy here: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

A dental lab, historically, is a room full of technicians hunched over benches with paintbrushes. Dandy's Provo facility looks nothing like that.

In this episode of The Margin Line, Joe Lynch sits down with Daniel Hanover, Co-Founder and CEO of Dandy, to give you an inside look into Dandy's Provo, Utah manufacturing facility — the world's first fully automated dental lab. The facility now produces nearly 100,000 crowns per month, and Dan walks Joe through what it took to build it: two and a half years, hundreds of people, and more than a few things that almost broke the timeline.

He gets into:

• Why Dandy vertically integrated manufacturing in 2023 and why every attempt to run a traditional lab operation would have hit a ceiling
• The engineering shift from "rows of technicians" to a fully digital, AI-driven, self-calibrating system that eliminates human variance
• How mills that auto-calibrate every day (vs. weekly at most labs) drove down remake rates and drove up precision
• The move from 100-micron hand-painted resolution to sub-5-micron digital shade application, aka "the Retina Display of crowns"
• Why fully digital workflows finally let dentists co-design with a lab technician in real time — no matter where the crown is in the process
• The philosophy driving every product decision: break the trade-off. 
• Mass-market prices at craftsman-level quality.
• What's next: the new Indianapolis facility, expanded lines, and applying the same automation model to removables

If you want to understand where dental manufacturing is actually headed, not just where it's been, this is the closest thing to a factory floor tour you can get without flying to Utah.

Check out Dandy here: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

For decades, dentists have faced the same trade-off: pay up for beautiful crowns or settle for affordable ones. In this episode of The Margin Line, Joe Lynch sits down with Daniel Hanover, Co-Founder and CEO of Dandy, to unpack the launch of Polychromatic Shade™ - a cutting-edge digital shade technology engineered to deliver porcelain-level aesthetics on a zirconia crown.

He gets into:

• Why the rise of zirconia and the "factory lab" model came at a real aesthetic cost and what most dentists actually want from a crown
• The world's first digital application of color and shade onto a restorative unit, controlled at the square-micron level
• How AI-assisted design lets technicians and dentists customize incisal edges, mamelons, and imbrication lines without a phone call to the lab
• The three-year, seven-country engineering effort behind the launch - and why working closely with the engineers is the leadership lesson he keeps coming back to
• The economics for the practice: free remakes, a lifetime warranty, and what that does to fill rates, conversion, and cash-pay pricing
• Why he refuses to monetize complexity and how that shapes everything from pricing to warranty structure
• Where Polychromatic Shade™ sits inside Dandy's larger product arc, from Dandy Vision to two-visit dentures to AI scan review

For any dentist who has ever paid more for a porcelain crown because they cared about how it looked, this episode is the case for why that trade-off is about to end.

Want to see Polychromatic Shade in person? Dentists can order a free sample at:

https://www.meetdandy.com/request-a-sample/

Check out Dandy here:
https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

There's a population of patients most dentists will never see — seniors in memory care, adults with disabilities, people who are homebound or medically complex. They aged out of dental coverage and live in places where a traditional dental chair will never fit. Enable Dental built an entire company around them.

In this episode of The Margin Line, Joe Lynch sits down with Dr. Nathan Suter, Chief Clinical Officer at Enable Dental, to unpack how a portable DSO operating across 27 hubs in 12 states delivers comprehensive dental care to 40,000 patients a year — in their beds, their wheelchairs, their salons, and their living rooms. With a background in accounting and public health, Dr. Suter brings a perspective on dentistry that almost no one else in the industry has.

He talks us through:

• Why Enable describes itself as "part dental company, part logistics company"
• The four-customer model (patient, caregiver, facility, and payer) and the care coordination tech stack they built to manage it
• How a six-month digital denture pilot with Dandy cut turnaround time by 50% and saved roughly 10,000 appointments a year
• The shift from cash and concierge into value-based care contracts with medical payers — and what it takes to convince a Medicare Advantage plan that dentistry drives medical outcomes
• The 30-year vision: making periodontal disease as visible to medical providers as a wound on a diabetic's arm
• What he saw at the IDS dental trade show in Germany that finally made digital dentures viable for an edentulous, homebound population

The most interesting dental business in America right now might be the one you've never seen, because it never asked you to walk through a door. It's portable, payer-aligned, half logistics, and growing 30–40% a year. Take a listen as Dr. Suter walks through exactly how it works.

Check out Dandy here: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

Imagine a dental clinic where treatment plans aren't shaped by insurance codes, production targets, or what a patient can pay. There's only one question: what does this person actually need? 

In this episode of The Margin Line, Joe Lynch sits down with Dr. Khaleila Brannon, Director of Dental at Health Care for the Homeless in Baltimore — the leader of Maryland's only dedicated dental program for individuals and families experiencing homelessness. After seven years in private practice, Dr. Brannon walked away to lead a clinic where treatment planning isn't tied to revenue, dentures are provided at no cost, and patients sometimes need shoes before they need a crown. 

She walks Joe through: 

• The "truest form of treatment planning" — what care actually looks like when money is fully removed from the equation
• Why a patient's dynamic life (a couch one week, a tent the next) demands a completely different operational model than private practice
• The private foundation funding that makes no-cost dentures possible, and the digital workflow that delivers them in a fraction of the time
• Building trust with patients who have every reason not to trust a healthcare system
• Hiring for empathy and adaptability over credentials, along with her favorite interview question for surfacing both
• Why she sees children, the elderly, and the unhoused as the populations where dentistry can do its most meaningful work

Whether you're a dentist questioning if private practice is the only path, a clinic leader thinking about your own community's gap in care, or anyone who wants to see what patient-first dentistry looks like when stripped of every financial incentive, this episode will change your outlook on what dental care can be.
 
Check out Dandy here: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

Most dentists are told there are only two choices: go it alone or sell out to corporate dentistry. Dr. Layla Lohmann and David Lohmann built Apex Dental Partners to prove that was a lie.

In this episode of The Margin Line, Joe Lynch sits down with Apex Dental Partners' co-founders to unpack how a patient who got her first crown at 12 grew up to build one of the fastest-growing DSOs in the country, landing on the Inc. 5000 list six years in a row, scaling to 65 practices, and generating $1.6M in production growth for its first doctor leadership cohort alone.

They get into:

• The "supported dentistry" model that gives doctors private-practice autonomy inside a larger organization
• Why most DSO partnerships fail, and the exact culture levers Apex pulls to retain doctors and staff
• How clinical AI is closing the confidence gap for dentists and transforming case acceptance
• The leadership development engine turning individual doctors into growth drivers
• Why technology done wrong creates burnout, and how to use it so it doesn't

If you're a dentist weighing your options, burning out in a model that doesn't fit, or trying to understand what the next generation of group dentistry actually looks like, this is the blueprint.

Check out Dandy here: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast

Most DSOs scale by chasing deals. LADD Dental Group scaled by staying close to home and never losing sight of why they started.

In this episode of The Margin Line, Joe Lynch sits down with Mary Ladd, CEO of LADD Dental Group, and Dalton Albertin, Director of Marketing and Business Development, to unpack how a single family practice founded in Kokomo, Indiana in 1978 grew into a multi-million dollar, 10-location group without abandoning the mission that built it.

From Mary's father trading dental work for firewood in the early days to acquiring beloved family practices across North Central Indiana, LADD Dental has never strayed from one core belief: take care of people first, and the business will follow. 
They get into:

• The "operational density" strategy that makes acquisitions smoother, marketing cheaper, and staff sharing seamless, all within a 15-20 mile radius
• Why every piece of technology they adopt gets evaluated on one question first: will our people love using it
• Their acquisition philosophy: every deal has to be a win for the doctor, the staff, and the patients
• How they use administrative support and technology to rescue burned-out dentists without stripping away what made their practice theirs
• The educational partnerships with Indiana dental schools that are building a real talent pipeline from the ground up

If you want to see what it looks like to scale a dental group without compromising your values in the process, this conversation is the playbook.

Check out Dandy: https://www.meetdandy.com/?utm_medium=social&utm_source=linkedin&utm_campaign=margin-line-podcast