I finished Ortho with similar debt, and here's what I tell a lot of new orthodontist.

1. Get a full time job where you can learn what things are like outside of dental school. Pay debts and save.

2. after 1-2 years look to buy a small to mid sized practice with a low overhead. Don't buy the most high tech thing out there with high overhead. They look awesome but trust me all that high tech stuff is worthless if it means high overhead and will only lead to increased stress.

3. Work hard to grow your practice, at this point the dentistry will be easy and you can put more effort into customer service and growing you practice.

4. After a few years and you've enjoyed a good cash flow from a lower overhead and you've established a loyal patient base who like you, not the gadgets and posh environment, then look to do any updating, relocation of practice etc...plus at this point banks will be more willing to invest in you so you don't have to mortgage you house etc...

This is what I did. I bought a 2 day a week Ortho practice with a 37% overhead and only 4 staff members. I devoted all my time to each patient and tried to provide a real personalized feel. Having a low overhead was great because I had sufficient cash flow to pay bills. After 2 years I relocated the practice and bought some new equipment etc, I saved a lot of money because I knew what was important and what wasn't. I hear about these new grads building or buying these expensive state of the art facilities with 70% or higher overheads and can't imagine the stress of that plus practice loans, student loans and a young family and don't know how they do it.