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Episode #413: Building Your Cosmetic Practice Within Your Practice, with Dr. John Cranham

the best practices show podcast Apr 29, 2022


If you had to guess, how many of your patients dislike their smile? You've got more than you think! Some of your patients just aren't talking to you about it. Whether it’s whitening, veneers, or bonding, there is a growing demand for these types of procedures. And to help you build this area of your practice, Kirk Behrendt brings in Dr. John Cranham, co-founder of Cranham-Culp Digital Dental, with the best advice for getting started. To learn how to build your cosmetic practice within your practice, listen to Episode 413 of The Best Practices Show!

Main Takeaways:

  • Balance your general and specialty procedures.
  • Intentionally block out time for your larger cases.
  • Understand your patients’ problems and desires.
  • Cosmetics can be a gateway to better oral health.
  • Visualization and planning are especially important.


  • “What I love about cosmetic dentistry is that, with my training and background in occlusion from Dr. Peter Dawson, I learned really early that there were a lot of people that had ugly smiles because of underlying functional problems. And form follows function, and function follows form, and it became my gateway into restoring and helping people become more healthy, biologically and functionally, even though they may have been driven by esthetics.” (4:03—4:33)
  • “The practice within the practice, to me, is figuring out how much of my time as a general dentist that I'm going to spend doing specialty procedures, and what is going to be my balance on the general side doing my bread-and-butter.” (6:15—6:30)
  • “I think the healthiest practices that I've seen in the people that I've coached and taught over the years are those ones that have this really healthy general practice. They’ve got a couple hygienists, and they are good at bread-and-butter dentistry and single crowns, and they’ve got a good perio department, and all the things that make for a healthy general dental business. And if you can get to the point where your salary and your bills are being paid out of that general practice, and then you take two, three, four days a month to block to do a large case, well, after you pay the lab bill, all that money falls to the bottom line and it becomes your fastest way to really significantly increase your income.” (8:27—9:15)
  • “The one thing you've got to remember about cosmetic dentistry is, the occlusion can be dead-on, the restorations can be fitted perfect, perfect margins or near-perfect margins. But if the patient doesn't love it, it’s kind of a failure.” (13:53—14:10)
  • “There's a definite process, when you go to the specialty side, that I think a lot of dentists underestimate.” (17:29—17:38)
  • “When I do a smile design case, I want the temporaries to blow [the patient’s] socks off. I want them to look at the mirror and be thrilled with where we’re going. And that only happens with a process of data collection, having time to do that, having time to study it, do some designing.” (20:27—20:46)
  • “For a long time, we taught that you should always bring everybody into the doctor first and do an hour-and-a-half exam, and do full records, and all this stuff. And I tried that, and a lot of the patients were turned off by it because they didn't need all that. So, I think it’s important to first look at your patients through the lens of, what kind of problems do they have, and what are their desires.” (23:19—23:45)
  • “A great diagnosis, like getting really confident about what is going to be the best plan for this patient, is critical for the patient to accept treatment.” (26:14—26:23)
  • “As time has gone on, I have learned that the more I can think about a case upfront — and I've done a lot of cases so I can think through things pretty quickly — I know that the clearer the picture in my mind of where I'm going, the more profitable I'm going to be in this case, and the smoother it’s going to go.” (29:33—29:53)
  • “If you're wanting to have this kind of practice, there is nothing more important than this part of it: it’s the visualization and planning.” (31:41—31:50)
  • “I'll have patients say to me, ‘Could I come in at 1:00 for you to prep my veneers?’ And I just look at them and go, ‘You don't want me to be your dentist at 1:00,’ and I laugh. And then they kind of look serious. And I think sometimes we forget that we have the ability — like when I had cataract surgery last year on an eye that had some damage when I was younger, I really wanted them to do my procedure on Friday. And he goes, ‘Well, I do cataracts on Tuesday and Thursday.’ So, that's when I did it. We have control over when we do stuff.” (34:24—35:01)
  • “I've loved dentistry my whole career. This is the most excited I've ever been about dentistry, because the things we’re doing now in the digital world were the things that I was dreaming about doing for 15 years.” (40:12—40:24)
  • “Don't do digital just to do digital. And what I mean by that is, if you're going to go digital, the first thing you want to make sure is that you're founded in really good principles of occlusion, biology, structural integrity, and esthetics — like, you really understand what these goals are, whether you're working analog or digital. And then, when you start looking at a digital workflow, you want to make sure that the workflow is going to at least be as good as what you were doing, like you can still accomplish the same goals. And, in my mind, I'd like it to be better. I would like it to be an improvement. But if it’s not an improvement, it at least should be more efficient.” (40:38—41:26)
  • “Most general dentists out there, we get so focused on looking at the individual teeth. Or a lot of times, we’re driven by what the patient is complaining about that day. And what [Dr. Peter Dawson] taught us was to be thinking about this as a system. And whether you realize it or not, that system, that human being that's attached to the teeth, they may have occlusal problems you're missing — wear, mobility, migrations, sore muscles. And there are a lot of patients that are unhappy with how their teeth look that might not be talking to you about it.” (43:16—43:53)


  • 0:00 Introduction.
  • 1:20 Dr. Cranham’s background.
  • 3:25 Building your cosmetic practice within your practice.
  • 6:32 The balance between general and specialty procedures.
  • 9:38 Practicing “aerobic” dentistry.
  • 12:48 Risks in cosmetic dentistry.
  • 15:13 Higher fees mean higher expectations from patients.
  • 17:38 The designation between general and specialty.
  • 21:08 The evolution of Dr. Cranham’s workflow.
  • 26:46 Habit stacking the important things.
  • 27:50 Evolving as a restorative dentist.
  • 31:50 The visualization and planning.
  • 33:29 What a typical week looks like.
  • 35:50 The transition into a digital workflow.  
  • 42:43 Cosmetic opportunities within your practice.
  • 45:24 Dr. Cranham’s upcoming course.

Reach Out to Dr. Cranham:

Dr. Cranham’s Facebook: https://www.facebook.com/john.c.cranham

Dr. Cranham’s social media: @johnccranhamdds


Cranham Culp Digital Dental: www.ccdigitaldental.com

Dr. Cranham’s May 2022 hands-on class: https://www.ccdigitaldental.com/product-page/digital-immersion-1

Atomic Habits by James Clear: https://jamesclear.com/atomic-habits

Dr. John Cranham Bio:

Dr. John C. Cranham is a highly respected and renowned dentist in Chesapeake, Virginia. At his state-of-the-art office, he delivers unsurpassed general dentistry, cosmetic dentistry, and restorative dentistry, including TMJ THERAPY and DENTAL IMPLANT SERVICES. Dr. Cranham uses his vast experience and expansive knowledge to create healthy, natural-looking smiles.

Dr. Cranham was an honors graduate of the Medical College of Virginia in 1988. He’s an internationally recognized speaker on the esthetic principles of smile design, contemporary occlusal concepts, treatment planning, restoration selection, digital photography, laboratory communication, and happiness and fulfillment in dentistry.

Dr. Cranham founded Cranham Dental Seminars, which provides lectures, mobile programs, and intensive hands-on experiences to dentists around the world. In 2008, Cranham Dental Seminars merged with THE DAWSON ACADEMY, a world-famous continuing education facility based in St. Petersburg, Florida.

As The Dawson Academy’s acting Clinical Director, Dr. Cranham is involved with many of the courses and provides continuing education to dental professionals across the globe. He spends approximately two-thirds of his time in private practice and the other third as an educator. He believes this balance keeps him on the leading edge of both disciplines.

A published author, Dr. Cranham is committed to providing the highest quality patient care, as well as developing sound educational programs that exceed the needs of today’s dental professional.

He is an active member of numerous professional organizations, including the American Dental Association, American Academy of Cosmetic Dentistry, American Academy of Fixed Prosthodontics, and American Equilibration Society. 


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