Case 01 · Long-Term Account Management · Dental Implants · Chicago, IL
Three years of testing,
turned into a repeatable lead engine.
The problem
The client runs an All-on-4 dental implant practice in Chicago — a high-value, competitive procedure where the client wasn't generating enough leads to keep the pipeline full. When the account launched in July 2022, there was no existing performance data to build from, so the starting point had to be a clean, testable structure rather than a quick fix.
All-on-4 implant marketing is unusual: the customer journey is long, the ticket value is high, and search volume in any single geography is limited. That combination means a campaign structure that works well for month one often breaks down as the algorithm matures, seasonality shifts, or the service radius needs adjusting — which is exactly what played out over the life of this account.
What I did
Launched with a clean, testable structure
Started two focused Search campaigns in July 2022 — "All on 4" (30-mile radius) and "Dental Implants" (25-mile radius) — on Enhanced CPC at $50/day each, with weekly reporting on ad groups, ad copy, and keywords from day one to build a real data trail.
Evolved the bid strategy as data matured
Moved the account through Manual CPC → Maximize Conversions → Target CPA over 2022–2024, adjusting Target CPA (from $45 down to $25 on one campaign, later up to $65 as competition increased) each time the account had enough conversion volume to support the change safely.
Separated Performance Max from Search-only traffic
In November 2024, split out a dedicated Search-only campaign (excluding search partners) from a new Performance Max campaign, so each channel's performance and cost per conversion could be judged on its own instead of blending into one number.
Ran real geographic radius tests
Tested 5-mile, 15-mile, 20-mile, and 30-mile radius variants through the first half of 2025 to find the profitable service area for a procedure this specialized — rather than assuming a wider radius automatically meant more volume.
Consolidated into one intent-based campaign and scaled it
By September 2025, paused every underperforming variant and moved full budget into a single "All on 4 – 15 Mile" campaign built around cost-intent and problem-intent keywords with heavy negative keyword filtering. Once that structure proved itself, scaled the daily budget from $250 to $450 through October 2025 while continuing to layer in high-intent keywords and filter out comparison/competitor searches.
Results over time
Rather than one clean before/after, this account's story is in the pattern — each restructuring point produced a step-change in performance:
Full results (Sep 2025 snapshot)
The key shift
Before, the account cycled through structures hoping one would stick. After, every restructuring was a direct response to what the data was actually saying — radius, bid strategy, and keyword intent all rebuilt around evidence, not assumptions. That discipline is what turned a three-year testing process into a 541% conversion jump instead of just another change that faded out.
Recognize this in your own account?
If your Google Ads account has been running for years without anyone questioning whether the original structure still works, let's talk. I'll show you exactly what I'd test first — no pressure.
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