- Highly trained team
 - First-class technology
 - Adopters of working systems
 - Consistent excellent results
 - Excellent patient base
 - Strategic position for the patient base
 - Top-notch website
 - Constant reinvention of office
 - Beauty is always in style.
  Good looking nerds with huge balls
 

- Lack of lasting systems
 - Strategically placed goals
 - Lack of follow-through with systems or developing projects
 - No system of accountability
 - No reach out to patient base- constant communication
 - Lack of strategically placed measuring tools
 - Compartmentalization
 - Lack of training

- DIY systems available
 - New technology- always evolving.
 - Introduction of in-office products
 - Social Technology- specifically videos
 - Social Media
 - Addition of Neuromuscular Dentistry
 - Ever changing Social and lifestyle patterns
 - Beauty is always in style
 

- Economic crisis
 - Dental phobia/anxiety
 - Always new competition rising
 - The price-tag, and the completion to be on top