2. Pierre D. Mourad, PhD Research Associate Professor of Neurosurgery, and of Pediatric Dentistry (adjunct) Principle Physicist at the Applied Physics Laboratory PhD in Applied Mathematics/Atmospheric Sciences

3. how Jack and I got started I wanted some of his money for research on brain monitoring. He suggested we form a dental company instead the value of serendipity! connections matter! - then act fast!

4. old news: ‘ordinary’ power brushes power brushes move their bristles several hundred times per second and clean primarily at the point of bristle contact, in a manner vastly more efficient than manual brushes. I felt we could do better

5. what is special about the Ultreo note the transducer & waveguide note the ultrasound coming out we figured out how to put that ultrasound to good use

6. bubbles can clean bubbles in the presence of ultrasound get bigger and smaller and bigger and smaller...

7. bubbles can clean bubbles near an surface - such as teeth - can get bigger and smaller in a highly asymmetric way, applying mechanical and therefore cleansing stress to that surface

8. bubbles can clean a bubble, in ultrasound, can generate significant mechanical stress on things that come near it, whether or not that bubble collapses violently.

9. what is special about the Ultreo the Ultreo’s bristles scrub on time scales similar to that of other power toothbrushes - hundreds of times a second. Thanks to the ultrasound- activated bubbles, the Ultreo also scrubs teeth several hundred thousand times a second, wherever the ultrasound and foamy dental slurry intersect, including where the bristles don’t reach. ultrasound emitted from brush head into dental foam

10. some of our earliest prototypes a value of working within UW at the early stages: you don’t have to create an entire laboratory and gather the experts - they already exist on campus!

11. we’ve come a long way a testimony to the initial vision, the initially applied resources and alacrity of SAP/APL/Neurosurgery/Pediatric Dentistry/Periodontology/Public Health, and the subsequent and considerable effort and expertise utilized at what is now Ultreo, along with continuing efforts of UW among other institutions. vs ‘first brushing story’

12. ultrasound from a stationary brush rapidly removes a ‘line’ of plaque. Artificial teeth with plaque dyed pink before (left) and after (right) application of ultrasound from beyond the reach of the bristles. Discrete plaque colonies along a band stretching from lower left to upper right were removed by the ultrasound, in a shape corresponding to the shape of ultrasound emitted from the face of the stationary brush head. no bristle contact!

13. plaque removal via combined sonic & ultrasound processes A rtificial teeth with plaque dyed pink before (left) and after (right) treatment with a sonically vibrating brush head that emitted ultrasound in the presence of sonically produced bubbles, from 2-3 mm beyond the reach of the bristles. Discrete plaque colonies were reduced or removed across the entire tooth surface after only 5 seconds of application of the prototype. no bristle contact!

14. Research Models & Capabilities Laboratory Clinical & Subjective once one has raised enough money, one can match the business & business-science needs with unique, non-UW resources

15. Dental Plaque Biofilm Removal Oral-B Triumph Sonicare Ultreo Hydroxyapatite disks (5mm dia., white) coated with Streptococcus mutans biofilm stained with disclosing solution (pink) Disk placed 2-4 mm from active cleaning surface (bristles / ultrasound waveguide) in dental slurry and exposed for 5 sec. Removal of biofilm after exposure compared to non-treatment control disks Exposure without bristle contact: Research Conducted by: Frank Roberts, DDS, PhD Pierre D. Mourad, PhD University of Washington, Seattle WA

16. Ultrasound activated bubbles clean into areas bristles do not reach Ultreo Sonicare Oral-B 1 mm Ultreo 1 mm Dental Plaque Biofilm Removal

17. Longer Lasting Clean (in-vivo) 2 hrs after brushing it appears that Ultreo resulted in less plaque formation than brushing with sonic alone. (2 treatments, n=5) Research Conducted by: Baltuck C et al. Ultreo Inc, Redmond, WA

18. Hypothesis Typical Brushing Ultreo Ultreo’s ultrasound – activated bubbles extend cleaning deeper than typical brushing Ultreo results in a more thorough clean Use of Ultreo leaves a long- lasting feeling of clean bristle plaque tooth bristle ultrasound activated bubbles plaque tooth Immediately after brushing Several hours later

19. lessons from the field.

20. Evolution of my relationship to Ultreo 2004-2006 Optimize Parameters: what are the optimal technology conditions? 2006-2007 External Testing: independent confirmation of safety & effectiveness Internal Testing: what are the primary benefits? 2005-2006 Concept Testing: does the concept deliver a benefit? 2003-2004 University of Washington WTC Grants Univ. of Wash. & Ultreo NIH SBIR Phase I Grant Ultreo, Inc. NIH SBIR Phase II Grant Ultreo, Inc. & Universities NIH SBIR Phase II Grant Pierre as critical player -> Pierre as an important pet. time of appropriate rapid growth time of inappropriately rapid growth

21. how is ultreo doing now? first year, generated revenue at an annual rate of $10M! but, it cost more than that to sell the brushes!! oh no! strong CEO, with complicity of a weak Board, led the company to market too fast, too optimistically. (there are lessons here!) Board fired the CEO in Winter of 2008 Board - now alone - did additional damage to the company (alienating the dental professionals - the key to the long-term growth of any dental company). VCs took over the company (cramming down extant investors) VCs reconstituted the company, for possible sale of technology or re-invigoration of the company - who knows.

22. cautionary tale you have to get everything right to succeed in business, especially a start up, where there is no room for failure. your biggest asset, your weakest link, is people, sometimes even the same people. balance of power is critical to success (technical vs business; CEO vs Board) enormous work at first -> your baby grows up and leaves the home, while still needing to grow up more: learn to let go! thank you.