Botox with your braces?

Aug. 5--It blends routine dentistry with that Orange County passion for cosmetic improvement. Health and beauty meets X-rays, cleanings and root canals.

Maged Zakhary, an Egyptian-born dentist trained at Cairo University and UCLA, believes his spiffy, state-of-the-art clinic, coupled with the insurance plans he offers, will revolutionize how dental care is delivered.

Zakhary's business, TruDental, is an oral-hygiene and wellness center occupying 20,000 square feet on the sixth floor of a swanky office building in Newport Beach.

It offers basic dentistry plus all the specialties -- oral surgery, orthodontics, endodontics and periodontal treatments -- under one roof, and at a fixed monthly price with purchase of one of the TruDental HMO plans, offered through American HealthGuard. Valet parking is included.

And for those with a little extra cash who believe healthy teeth go with enhanced lips, sculpted faces and well-groomed skin, there's the Degam -- Zakhary's first name backwards -- medical spa right next door.

Zakhary is selling this concept at a time when patients are paying more for their care and when health professionals, their income squeezed by insurers and government programs, are offering untraditional extras such as body piercing, tattoo removal and Botox injections.

He says comprehensive dental services at a set monthly price will appeal not only to patients, but also to dentists weary of haggling with insurers over what's covered.

TruDental has 34 chairs and treats up to 80 patients a day. Digital X-rays are processed on the center's $100,000 computer system, which designs crowns and fillings. The computer then transmits the blueprints to a milling station, where the pieces needed are made on the spot, allowing patients to get the treatment they need without returning for a second appointment. In keeping with Zakhary's desired fusion of dentistry and aesthetics, all crowns and fillings are made of white porcelain rather than silver.

Zakhary says his brand of one-stop dental shopping is good for patients, who don't have to run all over town.

And with the savings he sees from reduced overhead and administrative costs, he says he can offer more services than most dental plans.

"Some of this has been done in the medical profession, but to my knowledge it's the first model of this kind that is being tested in the dental profession," says Andre Van Niekerk, a TruDental patient and dean of the business school at Woodbury University in Burbank, where his academic specialty is health-care management.

Zakhary clearly thinks he's onto something, too, and he has big plans.

"I think a lot of HMOs and dental plans have to look at this because this is the wave of the future," he says. "Where I want to go with this is obvious -- to go nationwide. We have things in the works that are heading in that direction. But we have to demonstrate a certain record, a certain performance before we can take the next step." TruDental opened six months ago and has about 2,500 patients. Zakhary says it could probably handle up to 18,000 patients a year, but once it hits 10,000 he plans to build another clinic nearby.

Though TruDental accepts most insurance, Zakhary says the company's own HMO plans help distinguish it from others.

He has four HMO plans with varying levels of coverage.

His most expensive, the "platinum plan," covers most major dental work, with no deductible, no copayment and no annual maximum. Fillings, porcelain crowns, root canals, dentures, metal braces and retainers are all included free, as are four cleanings and two teeth whitenings per year. The plan costs $130 a month for an individual and $240 for a family of four.

"It's an expensive plan," says Dan Abrams, a medical and dental insurance broker in Laguna Niguel. "But it includes it all." Abrams, who sells most dental plans available, says he had never heard of TruDental until one of his clients, an employer with about 100 covered workers, told him about it. Abrams lost the account but gained valuable information. "I've thanked him plenty of times for referring this plan to me." Abrams says other dental plans with cheaper premiums usually have high copays and strict annual limits on coverage.

Because dentists don't get paid much under cheaper plans, they often push services for which they can charge the patient extra.

After touring TruDental, Abrams and his wife joined and have been very happy as patients, he says.

Ken Bernard, a platinum plan member at TruDental, says he pays $170 per month. He has had two crowns and a veneer fixed in addition to regular cleanings.

"God, I would have paid three or four times that already just for the work I've had," he says.

Sam Morcos, a longtime friend of Zakhary with his own dental practice in Westminster, says the TruDental concept is good for both patients and dentists because they can do what's best without worrying about the money.

"When a patient comes to the dentist, we don't want him to think about how much he's going to pay for his services, and we don't want the dentist to keep worrying about what the insurance is going to pay and what the patient is going to pay," Morcos says. "As a dentist, we want to focus only on dental care -- how to make this patient have a healthy mouth and functional teeth." Morcos says he likes the idea so much that he's planning to sell his practice and join TruDental in the next couple of years.

Van Niekerk, the Woodbury University business dean, says it's not the focus on cosmetic beauty or the coverage for major dental work that will make TruDental's fortune over the long term.

He says it's the intense focus on preventive care: checkups every three months instead of every six; cleanings four times a year rather than two.

"If patients stay with the program long enough, not only will they benefit by having better dental care and their own natural teeth for a longer period of time, but in the long run the dental group will be able to spend less money," he says.

"I would compare it to maintenance programs that automobiles have. If you wait until something goes wrong, you're going to have a very big expense. But if you do preventive maintenance, your overall expense over the lifetime of the car is much less."

Despite this simple principle, what is really striking about TruDental when you walk through the doors is the highbrow feel of the place: the elegantly appointed rooms, the fancy equipment and the well-heeled clientele.

Zakhary figures his average patient is upper-middle class with annual income over $100,000.

That, no doubt, is one of the main reasons he built a spa on the premises.

Patients can get their teeth whitened, then walk down the hall for a massage, a facial or even plastic surgery.

The spa held an open house one night earlier this month, and the gathering bore a strong resemblance to a casting call for supermodels.

But Zakhary thinks, as the concept behind TruDental catches on, it will appeal to a wide range of folks.

"I want to offer that kind of look and quality to the average Joe also," he says, "not just people who have a lot of income."

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