Author Archive
The impossible is nothing .It so the reality of lasers for every day dentistry. For those of you that had been with sus the whole time I want to thank you for your time again tonight. It has been a pleasure woo join you this way tonight. I hope that I provided you with some information that you’ll find very helpful in making lasers part of your very day , every way practise and I will be on the line now with Lorne to fill as many questions as much as we possibly can and feel free to contact me in the future. Lorne?
Lorne: Thank you doc that was great and you are not done yet. We have a lot of questions here. I’m going to get to it because we do have a number of questions and they are still pouring in. Thanks again that was just fantastic information. Matt are you still on the line as well?
Matt: Yes.
Loren: There may be a couple of questions that I’m going to ask you as well. One of the first question we got Don was how was the learning curve for you? How difficult was it for you to start incorporating this into your practise?
Don: Please bear in mind that when we started lasers it was back in 1998 and we had to learn by asking all the mistakes. There really weren’t good course for me to go to back then and so those of use two were using lasers around the country sort of had to learn by trial and error . I’m going to tell you I think we’ve made this big mistake around laser and I wane say that I think I’ve been a part of that as a laser educator. Folks this is just not hard and we’ve have some wonderful courses around the country , we have this great course in charlotte that Patrick Brim does , Bill Chin has one in St Louis and there are others around the country . Those are just two that I personally attended. Brett Dior is a wonderful periodontist. There is plenty of help out there but you already know how to do this procedures it just a matter of adapting the techniques. I want to tell you the learning curve in my opinion is not steep at all.
Lorne: I guess this question is more for mat? Matt is there a formal trading program that sis typically recommended for people that are getting to lasers?
Matt: Yes there is .When you purchase the Water Lays and the Odessa 100 it comes with a day and a half to 2 day training course and they’re going to go over all the ins and outs of how to add the water , woo to change the tips but importantly going over the basic procedures, how you’re going to class one through six cavity preps , how you’re going do periodontal procedures, things of that nature to get you very comfortable with the basic procures day in and day out that you are going to encounter .
Lorne: Great thank you, Don did you change your fees when you started using lasers?
Don: No we really right at first. I felt like I needed time to establish them in my practise and really we have not increase because we own a laser per say. I think out quality of dentistry have improved and we have increased our fees across the board annually as I’m sure that each of you do but the laser becomes a tool in the toll box and it really pays for itself . I will tell you that think, I know that my patients perceive this as a wonderful thing. There is not a day that goes by that I don’t have a patient tell me that you know why I come here doc? It’s because you use a laser, I really appreciate it. So I think they are willing to pay y more. We don’t charge a laser fees we just incorporate that into our regular fee schedule.
Lorne: I guess this question is for both of you, there is a question about the new Boa Lays laser which I assume is the I-Lays. I thought in Chicago when you manage it now I know it just got FDA approval when I first saw it.
Matt: Yes. The I-Lays is currently shipping. We have had a very strong response form he market and we arte juts about caught up with all the back orders which is good thing .Now if you order a boa lays that will be shipped very quickly after the order comes in . The answer to that question is yes, and we will be happy you talk to you mire about that.
Lorne: Don have you had a chance to see the new I-Lays?
Don: I do not have one in my practise yet, I want to put it on there. I saw it just before it was released and I think it is a remarkable tool I think it’s amazing to have that much technology in something that can fit inside your pocket.
Lorne: Another question for you Don, how do you keno when you are going to need anaesthesia and how common is it for you to stop and give an injection after you start?
Don: I don’t always know in advance that we won’t need the anaesthesia. I make the assumption that we will not. You a kind of tell by Workington some patients that they are a little but more nervous, or a little bit more fraud perhaps than others. So we explained to all of our first time patients who are suing the laser for the first time what to expect and if the patients have some sensitivity the first thing that I don’t do is to grab for my syringe. Once you got through some laser training you can learn how to adjust your settings and you can keep adjusting those settings until you can get almost anyone comfortable and as you go into the procedures, then a lot of time you an up your pulses per second or you can up your energy per pulse and you can go on at a good speed.
There are things that you csan do to help regulate that but if I have a patient that requires anaesthesia I want to tell you guys that it takes very , very little . They do not have to be just profoundly number. Even the ones that are really skittish about that.
Lorne: What about the up keep on the laser. Are your staff the ones that are doing that and do they need any special straining?
Don: When Boar Lays install a laser they will come in and give training to you and your staff on site plus when you go to the training courses you get even more but I have an wonderful staff, my girls are highly trained in laser use because we’ve used it so long but they do all the maintenance and the day to day cleaning and do it very appropriately an take care of our hand pieces and tops a den that sort of thing and off course we have boa lays to come in and check tour laser at least on an annual basis .
Matt: Ok this is an orphan question now. Can you do a transection friberaotmy for post orthodontist tabulation easily with this units?
Don: Yes you really can. On one of the trice things that Boar Lays offer are some really small tips. You can go down to 200 microns and yes you can do a transperol frioberontomy using these smaller tips. It’s actually a very great way to do that.
Matt: This other question I guess it came right around the time of you were showing your first peril case and the question is do you need tot the patient number for those procedure that you are showing.
Don: Yes you do. We talk about anaesthesia fee dentistry. I do that operative and there are some fast tissue procedures where you can use anaesthesia free or application of maybe just a typical but in a peril procedure like that no I do have amnesties and we dint have to have as much as we were dignity conventional l with the blade and seatrain and that sort of thing but yea I have amnesties for that.
Matt: There is another question related to that procured what do you believe ease the eulogy for the pocket and access on number 9 with [Inaudible] removes during the use of the RFT.
Don: I think mainly the eulogy of that was traumatic exclusion for an extending period of them when this patient when it perfusion she was really riding heavily on that tooth and the reason I said that is because the surrounding teeth as you remember in the photograph they look and her over all dental health was good so this was an isolated teeth so for that reason I think it was due to the traumatic allusion that she had and I don’t know that I remember specifically. I would say that we had some cactus come out of there bit I don’t think much. It wasn’t like there was a lot of calculus under the tissue there.
Lorne: Another question here, what about using a Boa Laser to treat perusal pockets?
Don: You definitely can use a BAO laser in treating personal pockets. That’s a very common practise in my state in Alabama as well as a few of the other states. I don’t remember how many they are now. I would say probably 10-12 where hygienist cannot use a Boa laser. In my state if I want to use a Boa laser in routine perio therapy I ‘m going to have to do that not my hygienist.
Yes it does work very well. If it’s a 4-6 mm pocket we would still follow up with the new erbium technique using the radio fire tips on the YSGG. Those are the perfect cases. You will get reattachment on those but yes a Boa laser can be used.
Lorne: Are there a variety of tips that are available for Boa Laser?
Don: Yes there are quite a few different tips that were available now. For those of you that are in the audience now that have an existing Boa Laser you probably are accustomed to using your Boa Laser of having to cleave the fibre. The fibre is your tip and sometimes it’s difficult to get a really good cleave. With the Easy Lays it has removable, supposable tips. No more cleaving , just screw it on and thy come in different diameters bad different lens and I don’t think I showed one in my PowerPoint tonight but you can bend that tip to get a true right angle so that you can reach distal to number 3 or number 15 very easily .
Lorne: This question is more for Matt. We have a number of questions here about the cost to purchase from entry level all the way up to the MD turbo would be best for the local Schein reps to contact those individuals ?
Matt: That would be great and again I know Dr Wilson has left the slide on the screen. You can either call us or go to the website and we can address all of j the different financing options that we have e, different terms, different lengths and any promotion that we currently have going on the product. If you have specific questions Lorne I can address those as well.
Lorne: We do have a few questions on the pricing, we know who ask them so we will be able to give that information to you in case the Schein reps want to follow up with that.
Now then a gingivatomy per quadrant, again maybe a procedure that you are not currently doing but a very simple procedures that you can do with the lease. I you add one per week $33 350 added to this practise. Gingiva flat surgery. This is the perio procedure that I was just showing you just a few moments go. Maybe you currently send toss out to the periodontist. You can do them in house. No cut, no sew m peril surgery. if you can do just one power week and I know how many of your patients have periodontal tissue j but if you just did one per week you could add $4 150 to this practise.
Clinical crown lengthening .If you do very much cosmetic dentistry I know that you are going to run in to the need for crown lengthen or if you work with crowns in the posture part of the mouth with large deep amalgams that go down near the born level it know you’re going to need the crown lengthen to not violate biological width in your restoration . So we do far more that one of these power week but if you just dis one per week you could add $38 750 to this practise .
Osco surgery with the graph. These things just come up from time to time. This is every day, every way dentistry. We see patients with these problems, we have a solutions if we just did one per month we could add $19 896 to this practise. An apical rectum y you think might be beyond your scope. I will tell you the first time in my life my career that it ever did in apicalectomy I called a good friend of mine in California on Sunday night t he gave me directions how to do it with a laser . I did it on money and since then we’ve been doing apical atomies all the time even m on molars .So if you just do one per month you could add $23 352 to this practise . In new procedures that will total up to $170 8978 that you can add.
Let look last of all at time savings .We definitely can save time with lasers, no waiting door anaesthetic in at least 80% of the cases in restorative work, faster restorative procedures. . I’m not trying to say the laser is going to cut faster than a hand piece I’m just saying that because we don’t have to wait for anaesthesia the overall process is short, we can treat multiple quadrant in one visit j instead of having to have multiple visits that it such a savings and over hit for our office and gingival trifling your crowning bridge instead of having to pack cord. . Faster soft tissue surgical procedures. No sauterne following a lot of them the way the laser works, a lot of times we would have to serene things it the past we don’t have to do that now. surgical and restorative procedures in one appointment for example if we are going to do a flapless or a modified close flap crown lengthening if we need to we can go ahead an d make out r impression for our crown at that same appointment . Surgical and restorative procedures during hygiene , if we have a hygiene patient that needs a little procedure done and we have a equity chair in a fee w minutes we can move that person over and just do it there instead of bringing them back for a separate appointment and more efficient treatment of emergencies and non-schedule patients if you remember the photograph earlier of the kid who fractured the central incisor . We did not have an appointment for them, we work them in and we did definitive treatment instead of just temporary.
One appointment root canal most of our root canals we are able to do in one appoint and confident that we have sterilise the inside of the canal because of the laser in faster and improver cosmetic procedures and I think we have shown several examples of those this evening already .
So one hour per day at 950 an hour times 200 days per year we can add about $190 000 to this practise so all total we will be able to add $580 048 to this $750 000 practise. That is a 77% increase. Now you say you’re crazy those are not realistic numbers actually they are realistic numbers h because those are numbers these have actually taken from our own practise but if you think it’s too much , if you think it really, of the all that lasers can do that lets cut it in half. Even if you can only y do half that much that’s still a 39% increase $290 000 increase on this practise. That’s enough to pay for a laser and all the canned ham or smoked ham that you can possibly eat during the year and still have $175 000 in your pocket.
Briefly it want you to think outside the box, think outside the box for the gentlemen in our office to night. Won’t you look at the bigger precise by expanding ding your practise by adding partners or associates. If it ask you the question what’s the back bone of a good practise? There are a lot of correct answers but it think the most correct answer r is a strong and consistent flow of your patience. These are actual numbers from our practise, we put a laser in our practise in 1998 and the only thing that we did differently from here to here is that we put laser dentistry into our practise and we properly marketed it and during that time we were averaging 189 new patients over month and all we did jaws to market the fact that we had a laser to our community.
Our production also increased. We went from one million to 2.4 million in production during that same time period. Again the only difference between here and here is the laser in the practise and proper marketing. New patients do equal near partners or associates so we j grew a regroup practise from 97 to 2003 we were able to add two partners into the practise from 2004-2007 we wren bale to have 5 different associates in the practise. 2008 I sold out two partners and started a new practise and nice that time we now have go grown that practise over a million per year and we were talking about a buying associate. In fact it got a phone call from two people ahoy are interested in coming and looking at the practise to join us as associates.
In the end are the results worth the effort and the answer is you bet they are. As some of you may know or may have gathered from an earlier slide I do like to fly and if I’m going to trust my life to an air plane I don’t want to settle for second k best l I chose a serious aircraft to be my own [personal aircraft for a reason and one of the reason is a parachute. If all goes wrong while we are flying and there are no other solutions we can pull a handle it rocket launches, a parachute that gooses out behind the lane, it opens up and safely floats the plane to that’s the only aircraft that has that .Even though it cost a little but more money I don’t ant to fly second best when my life depends on it. If I’m going to trust my practise through a laser well you know the rest of the story , I want the very best and after having used all the lasers that are on the market today my feeling is that the Water Lays MD is by far the best laser out there and I have used all of them .
I want to conclude tonight with laser marketing. We must learn to think like our patients think, not like dentist we must think like patients. Stewart Sink why is frim our are here in fact his parents olive right down the street from us he drives for show but you put for dough and in talking about that and comparing that too laser marketing we can do all of our marketing relative to operated dentistry . As you can see we do many, many procured besides operative dentistry but thinking like the patient thinks. When a family member goes to see their dentist for a recall visits and they get home the first question that is asked is how many blank you had. The answer for the blank is how many cavities you had because patients equate the dental office to fillings. That’s what they think about. I now we do all toads other wonderful procedures but the patients think about how many filling s I need.
With that in mind we did all off our marketing really based upon filings. No shots at the dentist suite, we talked about no shot, no drill, and no numb lift. [Mumbles] I should have used the lasers, translated I should have used the laser. Again talking about anaesthesia free restorations, not shot no drill, no numb lip. Seven R campaign was how refreshing talking about laser dentistry and aso2008 a reason to smile and then No shot No drill No numb lip. So you can see all of our marketing that’s focused around that patients think about and that is restoration. In our 2009 we have switched to a little bit different twist, lasers and cosmetic destroy because we switch to our nee practise signature smile and then 2010 falling in love with your smile.
We do a lot of marketing. These are some of out marketing campaigns that we sues. If you don’t like this , talking about if you don’t like an injection or if you don’t like a drill or if you don’t like a numb lip then we have those to offer you. no problem campaign , real life situations a dental filling , a free clean up no problem because a lot of our patients do leave here and go to a school function our a luncheon meeting or a church function or an outing and they are able to go without a numb limp an they really like that .
The no , no, no campaign , no shot , no drill , no numb lip and this can’t be dentistry campaign and then we did get with the times. We did ads that related to the months in which they ran. This was our January add , anaesthesia is so last year, talking about the fact that can do Anaesthesia , free dentistry , sweet campaign , no shots at the dentist, eating right after a filling, you can still feel your face sweet and these were one of my favourites . These ads were not ours, issued a company of DR. Olsen was away dental but self-confessed ads .Talking about people that have phobias about coming to see h the dentist and how the laser releases their phobia.
I don’t know if you can hear this one our not… I front believe it’s going to. I had one of the radio spots I ants sure that you would be able to hear that or not. We also have post cards, brochures, direct mailers, talk about laser destroy. Feel free to copy anything that we do in our practise. Our marketing is done by a dental promotional group that is here in the Florence areas. You can contact them at the number you see or Angela Bailey, [email protected]. She does a wonderful job for us and she has laser campaigns that are available for purchase if you would be interested in one of those once your purchase your laser. No fluff with proper marketing, the results can absolutely blow you away. I encourage you to take you practise to the next level. Let that rocket and enter the world of laser dentist. You mission if you decide to accept it is very possible. This is every day, every way dentistry and I’m here to tell you that if a guy in Alabama can do it then you can certainly do it too.
Dr. Daniel Vinograd has established a long and prosperous career as the dentist San Diego prefers, because of his holistic, pain-free and biocompatible approach to dentistry. What you may not know is that he has a longstanding relationship with his alma mater, the University of Southern California.
Today, he’s a professor of dentistry for the university where he received his DDS degree.
USC is a private university founded in 1880 and based in Los Angeles. It’s the oldest private research institution of higher learning in California, trains a large number of international students and fully embraces its close proximity to Hollywood. It’s also consistently rated as one of the top colleges in the nation.
Here’s a bit of trivia that makes dentists like Dr. Vinograd proud: USC’s well-regarded fight song “Fight On” was composed by dental student Milo Sweet in 1922 — although Glen Grant has to be given partial credit for the lyrics.
Even if you’ve never been on the USC campus, you’ve probably seen it. That’s because its location means it features prominently on film and on television. You may have seen it in Forrest Gump, Ghostbusters, The Social Network or The Graduate. You may have also seen it on The Fresh Prince of Bel-Air, House MD, The Office or Monk, to name only a few of the many TV series that have filmed on the campus. Even Wheel of Fortune and Jeopardy have shot there.
The University of Southern California’s close relationship with Hollywood and pop culture doesn’t mean it takes its professional programs less seriously. If you think about it, good teeth are an important part of any Hollywood career, and quite a number of the entertainment industry’s top names depend on USC dental school graduates for their award-winning smiles.
Will you be the next to turn to the San Diego dentist citizens of all types entrust with their precious teeth? Getting started is as easy as setting up an appointment.
Not really concerned what brand of toothpaste you buy? Not interested in making your own toothpaste when you can buy one at the store that works pretty well?
Perhaps the best reason of all for making toothpaste at home, or carefully choosing what brand you use, is avoiding SLS. But what is SLS and why is it so bad? Keep reading and you’ll understand.
Getting To Know SLS
Sodium Lauryl Sulfate or SLS is found a lot of personal care products. But it doesn’t really belong there. In fact, putting it there doesn’t make much sense at all.
While it serves as a surfactant — a substance that breaks surface tension so a product can penetrate — it can cause skin irritation, the worsening of skin problems and other issues. Even worse, some people have an allergy to it, causing even more severe adverse reactions. And still worse yet, it can cause canker sores — those round white sores in your mouth that sting for days — and can cause dry mouth.
If you have a problem with skin issues, canker sores or dry mouth, you need to eliminate SLS from your toothpaste and from your other skin, mouth and healthcare products. Doing so could eliminate your problems or at least make them not as bad. In fact, research has proven a decrease in canker sores when using an SLS-free toothpaste.
If You Love Food…
Perhaps worst yet if you’re a foodie, SLS in toothpaste has been shown in one study to cause a temporary alteration in your ability to taste. Have you ever noticed that food tastes strange if you eat immediately after brushing your teeth? SLS could be the reason.
The reason this issue isn’t talked about more is that most people intentionally avoid eating after brushing their teeth to keep their teeth clean, so they may not necessarily notice this side effect.
Simply put, avoid SLS at all cost to avoid its side effects for a healthier and better life.
For a great homemade toothpaste recipe without SLS, visit: http://homemadetoothpaste.net
I want to share with you this case. Many of you may know this guy Lenny LeBlanc. He is a recording artiste and song writer. Back in 1977 Lenya had a fabulous hit ‘falling ‘ and doing the time he has converted over as a Christian arties. One of is some that’s just a mega hit is “above all”. Perhaps you have herd that Lenny is an outstanding arties. We have many song writers and recording arties that live in our area because of Fame studio and several of them arte actually my patient and penny is one of our best His new CD has Fallen on it , it’s total of it is Love like no other. Lenny recently did a benefit concert here in the area and we see Lenny, myself, my wife and our staff and this was a fundraiser benefit for underprivileged children in the area but anyway we just finished jay new smile o penny. This what he did look like and I notice nan a lot of his photographs early on that he just didn’t smile for his album so he wanted to do something about it.
We did one single crown and some veneers and tried to rebuild his smile. We made his teeth a little bit exaggerated because of his stage presence. We checked him on stage to see what it would like and this gave us good results .Now we’re about to get started on a lower on Lenny and he’s just a wonderful guy and based on his song Fallen we ‘eve done all of your marketing on Falling in love with your smile and we use Lenny’s song in a lot of out advertising and promotions.
Laser bleaching
One good thing about the easy lays is that it has a belching wand that comes with it and you can bleach a quadrant of teeth at a time. It’s a very short cycle and it does a great job. The system is just wonder foul and the appointment is about a one hour appointment with outstanding results. You see untouched photos of before and an immediate one hour after. very good results for your patients.
Let’s talk briefly about Period. Very exciting things are happening in the laser world relative to period and mechanical treatments such as [Inaudible] are not able to remove bacteria .Its just no longer enough. The thing we have to contend with in period is of course bacteria, the bio fame we have to be able to get rid of the snot inside of the gums. It’s just a horrible collection of microbial matrix there and we want to get rid of it , There’s plaque attached to the tooth , there’s unattached plaque , there is epithelia plaque . Plaque are bacteria and the connected tissue and bacteria on the bone surface. We are dealing with a lot of bacteria so we will like to get rid of the bacteria in the area around the tooth. The pocket therapy with resulting new attachment thanks to the radula fire peril tips.
I know we talked about radial fire tips in indo and this tip is similar but again it is different. The thing that’s different again about that is you will notice that the end of the tip is blunted slightly and the sides are bebble. This allows about 60% of the energy to come out the side so that we can depothilize the lining of the pocket and remove calculus and about 40% comes out the end so that we can reach the bottom of the pocket and we can interact with the bone if necessary.
This is a really neat tip and these have been out a little before the first of the years and we are getting great results with them. This is techniques. You see the radio fire tip here in the photograph and we use it first and foremost for trapping to open it up a little bit and to remove the inner epithermal lining. The radio fire tip goes to the side and to the bottom of the pocket towards the tooth and then we can turn the tip slightly towards the tooth and actually remove calculus form the trot surface. When we are doing I’m always seeing little bit of calculus foot up and come to the surface and this is after they have been through root plaguing and scaling. There is always that little bit that you did not get.
In here in the photograph you see a piece of calculus that came out right after we used the laser. This is way the tip looks going into the pocket. Once we’ve done the pocket itself we’ll move outside to the outer epithelium to remove it and this is what that would look like. Here’s the reason for that. As we go down and we depethalize the lining of the pocket and heal it quad clean the side of the tooth the healing process begins , the epelthial cells from here will grow much more rapidly than the functional epithelium down in the bottom of the pocket . Remember err we are trying to establish reattachment.
In order to be of service to the functional epithelium don here we take the epethialnn cells here and move them back away from the starting line. We make them run further. They arte going to grow faster so we make them go father and so we remove that outer epetelhelium and then about a week later we go back and do the same thing and grab those cells and take them back to the starting line again to give the junction epithelium more time for reattachment . After we do that we just apple pressure for about 5 minutes to get a really good broadcloth and then we apply derma bond, a sisal to seal up and this is what it looks like immediately post opposite.
A far cry from bridal peril surgery where we would have made the incision, we would have a lot of bleeding and we would have sutures showing and peril dressing. We are really proud of this case. This is one that we just recently worked none. This is the way that the patient present it to our office. A portion of the metal crown on number 9, some obvious periodontal problems and association with that. You see the lingual side. Graphically it looks like this. We plan to get the patient in for treatment but before the patient can actually commence she presented with this, an obvious perio abyss. Things are just not going well where. This is the radiograph, you can see the obvious bone loss around the tooth and these were the measurements a collection of 5, 6, 7, and 8s. So not a good situation. We did the procedure that we just described with the laser. Here you see the radio fire perio tip and one week later it definitely looked better. The day what we did the procedure w definitely went in and adjusted the avulsion not the lingual side of those tooth that was in traumatic inclusion. Four weeks later it look like this and at that point in time we took a whole portion of the metal cram and we fabricated a temporary cram to go on it and three months later it looks like this .A huge noticeable improvement and all we’ve done here was the laser procedure with the radio fire perio tip and look at our new measurements, I’m not exaggerating , I use the same force in making this measurements that we did the first stage when she came in and we got the 5,6, 7, an and 8s. She was down to 2s and 3s all the way this tooth, just a reachable improvement over a three month period.
Three months post operatively radio graphically she looks like this and in my opinion I t think we are beginning to see bone formation in them and so bone growth in that area. If you go back and compare it to April of this year and you look at the same area I think you would have to agree things looks considerable better in there. We had plan to do dome surgery and a graph but quite honestly at this point we were juts allowing thinks to just go along because she is doing so well and if things continue it will be a permanent cram in the near future.
Now in the last couple of segments want to talk about profitability with lasers. If you are going tom make an investment like this I think you need to think seriously about hats it’s going to do for my practise and what’s the return on investment. I think that’s a very fair question. First of all we are going to look at the smaller picture procedure by procedure but it really does mouton up fast. Let’s look first of all at additional procedures. Things that you are currently doing but you can do a few more of those because of laser dentistry.
Let’s take the several 750 000 per year dental practise and let’s say that because of the laser faster procedures we can do additional restorative procedures two per day. Well how can you do that? Bomber obey we are working without anaesthesia so we don’t have that wait time .We can work in multiple quadrants instead of limiting ourselves to just one quadrant. There are many times that patients come in and I fill number 3, 4 , 19 and 30 all in one appointment and I centrally wouldn’t do that if I had to do that with anaesthesia. By deign two extra per day we can add $64 400 to this practise.
Proteomes and restoration, because we can do proteomes in one step without for more. If we could add one per week, one additional per week we can add $19 750 to this practise. An additional surgical extraction remember we talked about being able to do surgical extraction without having to lay a flap and remove bone. If we could add two of these per week we could add $27 900 to this practise.
Additional cosmetic veneer because f of the way we are able to do destroy and that wonderful help that a laser is in our soft tissue around our cosmetic work let’s say we can just do one , one extra peer week we could add 74 750 to this practise . Then by doing biopsies. Remember if you have a solution you see the problem and I told you we do a lot of biopsies because we are looking or things that need to be checked. If we can just add one per week we can add $23 350 to this practise. All together additional procedures, things that we are currently doing but we are just going to do a few more of them than we have in the past because of the laser , we could add $210 150 to this practise.
Now let’s look at new procedures. Remember we sort of addressed them in the beginning. Let’s not just send them out the door. I know that I have to use the specialist too and they are e things that we defiantly need to send to the specialist but they are many very basic procedures that we send out that we can keep in house. Again the $750 000 practise. If h you are not currently doing phrenecotmy and tongue tie releases remember I told you earlier that only 5% of the dentist out there routinely do these procedures . If you just add one per week you could add $23 550 to this practise.
Tongue tie release, remember every day, every way you will see some one occasionally that is tongue tied if you are looking for them if you have a solution to this problem. When the patient raises their tongue we get the classic valentine shape there and they can’t stick their tongue out very far past their lip. This is a very simple procedure. Its lingual phrenectomy. You place haemostats at the base of the tongue and then we cut on the side ops at the haemostat then we go back about 3/4 of an inch to an inch to release.
Then you let the patient move their tongue around and see if they can touch the roof of their mouth and of they can extend it out past their lip now and when you have gone back as far back as far as you thin you need to go then you can place your sutures. It is very important in this case to make sure… I ideally place 3 sutures so that you do not get any reattachment.
Here’s a very large mucus seal. I’m sure there are days that people come in your office and you see a mucus seal. If you’ve taken one out you know that they can be a little not hard to determine the borders so this one was incised using the laser. Again very little bleeding. Look at the size of this, very large mucus seal. Seven days later wonderful healing and I want you to notice something in the pathology report. Yes it was a mucus seal but look lateral and deep margins are free of legions indicating complete excision. That means we’ve gotten on there and we’ve got out there with the laser and we remove the mucus seal in total.
Ovate ponits
This lady now have a really beautiful smile. It didn’t look that way just prior to the bridge she has. It looked like this. For quite some time we encouraged her to take out the f tooth in the frond and consider doing a bridge so we took the teeth h out and to give us a better look we use the chisel tip of the laser to ovate our ponic size all the way cross to the front, we use the double embossment t on each side. This gave use little bit better, a little bit natural look for this patient and age her a prettier smile. Now she is interested in doing the remaining teeth in her mouth.
Every day dentist y certainly includes crowning bridge j and it includes eight packing chord or using a laser to trop around crown grips. We use the Easy Lays 9400, it’s wonderful. It has disposable tips instead of having to clean the fibre of the tops you can just use once and then throw them away. Here is a lower full mouth case where we would have to pack a lot of cord yet we didn’t pack a single cord. In fact we don’t have any cord in my oppotuires, we never use any cord.
It allowed us to make a nice impression and get good results with our rotation. For asius procedures, surgical extraction assert notes that for time to time your face with a case like this and sometimes we have to consider laying a flap and removing some bone to get a broken root like this out. With laser we can use this 400, 5000 or 600 micron tip, Boa Lays have a nice selection of tips. The longer ones work really well or this. We can go down around the root and break the attachment between the period ligament in the bone and the tooth and then we can either with forceps or with thin elevators , peritonea, elevate the tooth out of the socket without having to lay a flap .
Just another example of this I really think you will be quick to admit if this walked in your office you’re going to be thing in about laying a flap and you’re going to be thinking about removing some bones. Look at the bone levels on this .The tooth is us all the way down to the bone yet we still have a full sized root. Yet we were able to go in with a laser an uncover it and elevate it out without flap. That also works out very nicely if you’re going to do an immediate implant placement. Here’s a surgical extraction with the root amputation, a rather unusual case is a bridge on the upper right.
We notice on the radiographic examination that distal buckle root had been severed from the tooth, [Inaudible] decay and so we went in with the laser and just took the root out into having to lay a flap and this is the way it looked immodestly postoperative. A few weeks later we actually went back and actually used this second molar as a bridge abutment with just a medium buckle and the powerful roots. You can see it radigraphically and excuse the blood in the field but this is right after we cemented it in and cleared around it.
Now we got a nice bridge abutment without having to have out r patient have to have an implant or other processes there. An apical granuloma, between x-rays we found this root tip left behind, granuloma tissue around it. Incision with the laser, open up the window with the laser, clean out the area, palace some bone graph material and here it is BS shortly after that. I think this was one week later, on week or ten days later. Olio surgery with the graph, this particular tooth had to have indo. It had really low decay here to the media and we had to open it up and do a little bone crack in he are , re contour the bone just a little bit . All one with the laser. You can see after indo was done a build-up will material will be forward on the tooth because that’s where the decay when originally.
Here it is about 6 months lather and here you can see the restoration that we were able to place so we were able to keep the tooth by moving the bone level back , doing a little bone graphing in this area and it gave us great results.
Crown lengthening
In this particcualr case we will take it all the way though, you can see that we are in a cross bite here, interior open by a low tissue line on the literal insider and this later insider is wearied out. Just make a mark with the sharpie to see where we want to move the tissue line, move it back with the Boa Lays laser and then use the chisel tips for recon touring the tissue. Once we establish our tissue lien when we want to move the bone up so that we have 3, boiologiocicl width. When I say we do this flapless we use a gold pirate and we actually will go, well it doesn’t actually show in the picture but we will retract the tissue back a little bit so that we can actually see the bone underneath there so we are not on tally working blind but it does allow is not to disturb the filling on either side of the tooth and maintain a nice sharp point there. Just clean it up with the pirate and we apply a title l pressure, use ox fires gel, eye it applied here and I think this was one week later. We did not disturb the lingual side and a few weeks later we did our preps for 360 porcelain, we chopped with the dial wood laser, our temporaries are in place ad ten the finish product. We’ve got a nice height on our later incisor, we corrected the cross bite, we closed up the bite in the front so here’s your before and after. Lasers were very much an important part of this and we wound up with some beautiful results on this overly patient.
Crown Lengthen Open flap this is a case where we had a three unit bridge , the patient had a decay underneath the [Inaudible] , it was just completely decayed out from under the abutment so we had to make an decision here and we decided to do indo and a build-up pan it and then we reflected a flap and removed some bones so we could crowd lengthen and continue to use this as abutment.
Here is immediately post-operative. One week post opt and six weeks post up > we have great healing, we now have a biological width sufficient that we can put a crown. Now we will go back and remove the other abutment bad sod a new bridge for this patient. we had done some interior corn work and we won’t doo the back cupids but as you can see the tissue line dips way down so in other to keep a good look we wanted to move the tissue up a little bit and so we dotted it with a Boa laser move the tissue back to the new line we waited to open flap and then by using weather 400 to 600 micron tip and then with chisel tip we were able to move the bone back and then after 6 weeks healing we can go back in and do our restorations and get a more pleasing tissue line .
Cosmetics, this is a new brochure we have in our office that we hand out to our patients. I just want to introduce you to some of our patients that have fallen in love with their smile. I will explain that later. I don’t have any prompts I on this lady on my PowerPoint but you can see and all of cosmetics we have done some tissue reocontouring , tissue touch up before we place their porcelain work . This is a case and a very beautiful last. Preoptivlely she had some dark stain, discoloured teeth. She just wanted that to have a better look. There’s minimal prep veneers to help cover pup the dark staining and you can see out r end result. She was very please. Pictures of those case e will actually be in the LBI magazine this fall.
This is a great patient, a wonderful person that we just did a full mouth reconstruction and the laser played a big part of that. This is his bite. He actually does have lower teeth here, he just have an extreme over bit it’s what the lower look like and the upper. Actually tooth number 29 was fractured and we just decided too cut it done with a laser and do some mat and like a retro field except from the inclusion and put the tooth to sleep and let it stay in there rather than try to take it out. You can see that that the root remains underneath there. Also in the interior you just really dint have anything to support crown so we had to g o in and crown lengthen his teeth across the front t with the laser and here you can see immediately after we upper with his temporary [Inaudible] and on the upper there was someone teeth we just couldn’t save , we had to take them out , we had to do some crown lengthen then we were able to open up his bite. For once in his life in a long, long time he was able to see that he had teeth in his mount and when he smiled folks knew that he had teeth.
Up until then you really couldn’t tell that he had any teeth at all. So good patient, great case thanks to the lasers. One final case along that line is just there’s some great results from an interior aesthetic stand point with six porcelain crowns to restore smile for this excellent patient of ours, this wonderful guy. Now he is ready to do the lower and currently we have had to crown lengthen this tooth after we did indo on it so we are working on this case as we speak now.
Pulp autonomies can now be done without having to use former, to be opened up and be treated with the laser, dropped inside of the pulp chamber with the laser. We use a little MTA on top of that and then go ahead and place our restoration. When we talk about indo terbium chromium YSTG laser uses the radial firing tips and they are much provisioned for removing bacteria form the root canal system and also removal of the smear layer. As you can see on this photograph look at the dental tubes they’re wide open. 15% of root canals that GPs do each year require retreatment and generally it’s because of reinfection. 99.7% reduction in bacteria count is when a canal is sterilised with a laser.
The radio fire tips as you see into his photograph here have a unique being because of the angle on the tip it disperses the energy laterally at an angle and if you notice it comes to a very exact point. When the tip comes to a point like that no energy is omitted thrush the end of the top. At this case we do want it to go laterally. If it goes out the end it ocean gout the end of the root ad stimulate some apical bleeding.
Here you see an indo tip , one that’s a brand new one and one that’s been used one too many times. As you can see in the photograph it’s blunted and if we use one too long and it becomes too blunted like this then the energy can travel out the end of the tip, out the end of the root of the tooth and cause an apical bleeding. There are two different sized tips at 200 and 300 micron they fit east [toy down inside the canals. Here you see a tip in use and we can set working length by the rubber stop that you see on the tip.
Down on the canal you admit their energy on the way out to remove the smear layer and to get rid of any bacteria that may be present. When we look down in the canal after that this is what we see. You will see that the canal are really frosted looking, very clean and a wonderful environment. It gives us a better seal between the [Inaudible] and the tooth. We can actually open the tooth up for indo using the laser if we need to. Other times if it’s a really hot tooth and you go in with your hand piece you know that the vibration that you get from hand piece, woven though you have good anaesthesia the patients still feels it. If you have a really hot tooth like that one of the best thing you can do is to open the tooth and get you access with you laser.
We use conventional instrumentation after that and then we turn to the laser for cleaning. It removes the smear layer, only takes about 2-3 minutes and also we get micro agitation tip to help clean out the cancel. From this photograph you can see with the laser it in water as laser energy has admitted it, it cause bubbles and squeezes down inside the canal. I see little particles falling out all the time as it cleans. It does a wonderful job of cleaning the root canal system. Then we can turn to the laser drive for disinfection. It reaches out into the dental canals and destroys the hidden bacteria that might there. Reamer we are using a radio fire tip.
Let’s talk just briefly and give another examine of another thing we can use the laser for and in endeavonance for an apectomy. Teeth 9 and 10 and on the radiograph we see a rather large lesion inn association with the apices of 9 and 0 and in kHz radio graph you can see that we’ve complete the indo on both of those two teeth . We just measure up from the incision edge to locate the approximate apex of that teeth and we will make out incision using the laser. Once we have the incision and woe open up the indoor of the bone using the same laser tip and then once the window is complete us clean out the legion area and wee amputate the apex with a little slight beble for access.
After we do that we can use the laser to go to the end of the root of the teeth and take out the gutter putura or the material it might be using at the very end and then we can do a retriivabatye field using MTA. Following that we can use a brine graph, seek though the area and then we are finished. With the laser we’ve made our access with an incision, we’ve amputate the root, we’ve opened up the root at the end of the tooth. It’s just a great tool and here you eel postoperatively our legion as it started and post operatively here is the lesion after we did the apical.
This is one week later, six week later and 12 months later. One thing that I mention about this particcualr case is that this patient was an extreme diabetic so healing was even compromised by that fact and I think you can tell that we got wonderful healing in this case.
Now let’s talk a little bit abs tout soft tissue. The treatment of a respective legation, we could also use the same treatment for an after ulcer. you want to get to the legion why it is still in the vesicular state before it gets into the vesicular stage , when the patient can first feel it coming on this time to treat it .We treat the herpetic legion with the laser. We just fire around the outside and work our way to the centre covering all of it. We want to be sure when you do a good high volume suctions system and one of the better quality mass.
You can also treat an after sulphur inside the mouth with the sane techniques. We do quite a few biopsies in our offices. This a biopsies for the removal of a fibroid, it’s a very large none. We use soft tissue pick up forceps and soft tissue tip on the laser and an incision to remove the entire fireman and after tan we use chisel tip to go back and do the laser band aid. It says here to put a little oxy fresh gel on top of the legion and here it is 6 days post operatively.
One of the things that you see with the laser is that healing is just wonderful after using a laser, much better than if you use a blade or an electro surge. By the way the patient that you saw in the photograph here was 86 years old at the time this was done so I think that was pretty good healing for someone off that age. A Paloma on the tongue , again using soft tissue pick up forces and soft issue tips on the laser , we just go around and remove that and if you notice the absence of one thing here., the absence of bleeding . Even though we are working on the tongue which is just full of blood vessels we have little to no bleeding and these are not touched up photographs one we didn’t blot the tongue just before we made the photographs to impress you. This is the we way it really looked immediately after we removed the papilloma.
The laser candid, we put socket gel, oral pain gel on top of that and here it is 6 days later and you can see that it has healed up so well .It really a little difficult to even tell where the pap lama was before we took it off. I don’t know if you have this in your practise, I just want to mention it to you. You can purchase this through Henry Schein dental, it uses The Dental Pie 300, it’s a multi oral cancer screening device. We use it in urn I office it has a wide wave length that just helps to eliminate the mouth. The violet with speckle glasses will show up any kind of legions as a dark spot in the tissue and then you can help to differentiate it by the green amber light and it shows you the vasculature to the area that you are concerned about. A very concise vasculature probably means it so and a very diffuse vasculature is something that concerns.
This is a wonderful tool and I know that it goes hand in hand with laser se and we use it in our office routinely .We did do a training video for them and you can see that at abystintrimera.net.
Prenectomies
Again remember every day , very way dentistry we see people come in all the time with a Lowe attach phrenic or a diasoma between 8 and 9 and were phrenectomy is necessary and remember we see the problem if we have a solution to that problem . Here’s an ortadontist case, a very; low attached perineum removed with the laser. Again look at we do not see, bleeding. We do a pretty aggressive phenectomy and we have very little bit of bleeding when we do this. Post operatively several weeks after the fact look at what our attachment reoccurred I’m going to show you in the next series of slides how you determine where you can place your reattachment of the phrenic and we can put it exactly where you want it to reattach.
Here’s that phrenctomy step by step, also with the distraction of kea legion. Low attach premium again, soft tissue pick up forces in the laser. We do an aggressive phrenectomy. We’re going to take the entire little muscle out. Very little bleeding here. Turn it over and do the other side. Now we’ve removed the perineum and then we go back between the central insiders and actually cleanout. There is always that little area between the teeth where there is a lot of tissue attachment and the bone just sort of invigilate there. We’re cleaning that out there really good to make sure that we have all the fibres.
Then a very important step is to score the periostum. The way that we determine how we do that so we look at the junction of the removable and the attached tissue and where we scored the perisotuium there we will have a scar band and that scar band will determine where the phrenum reattaches. If you’ll just lock that in your in as we got through these remaining slides you wills eye that the phrenum actually goes back and reattach exactly to that spot. With these you could probably leave them open. I think we get better healing and also by placing sutures it prevents any kind of reattachment in there of the tissue.
Now it’s healed up from that but you still see that we have a little legion of here to the right and we will go in and remove this legion using the ablation process. Thad is a chisel tip and instead of sizing it and cutting it out we’re just going to ablate it away. The tissue is just taken down cell layer by cell layer until it’s gone and here it is a few weeks after that when it is healed up completely. Remember in your mind where we score court pereostum and this is where our attachment will go back to.
If you didn’t see this wonderful article in Dental Economics recently by Rodger Levin , the march edition I would encourage you to take a look at that and when you’re Dental Economic issue arrives this month be sure to take a look at our upcoming article, The $250 000 Smoked Ham. In the article it talks about the fact that we a general dentist refer out of our offices each ear, approximately $250 000 in production that we can do under our roof. It’s not the exotic, its everyday destroy that we are referring. In December the UPS guy comes and brings us that wonderful smoked ham and we are so excited because we have a $95 ham while we spent $250 000 of our practise.
I got this information from Charles Blair very recently. There’s 500 dental procedures that you and I do .The referral dentist does only 60 of those 500 procedures. Joe’s average dentist does 90 of the 500 procedures. The decathlon dentist does 120 of those 500 procedures so what I want to challenge you to do tonight is to go back and look at the number of procedures your routinely doing and if you are under that 120 mark by adding a laser into you practise you can became a decathlon dentist. So you’re training starts today. Also in the Dental Economic the September issue please look at my article don’t be a Sheep. We talk about how to differentiate your practise, how to separate your practise form others. When we come out of dental school sometimes we tend to follow the practise that is right in front of us and we do what they do. Let’s differentiate ourselves and laser is a great way to do that.
Perhaps in the Orthatribune you saw our article that talks about how lasers relate to orthodontist cases and things that we can do and upcoming in the fall there will be an article and LVI Vision The impossible is nothing which will cover a lot of the information that we talk k about tight . That was co-authored by Lorne and myself.
When the lark goes off in the morning are you really excited to get up and go to your office air would you rather just hit the alarm clock like you see in the picture? Do you feel you need direction for you practise? Lasers might just be the driving force that you need. I will honestly tell you that before 1998 when we purchased out first laser dentistry had really become really boring and I was experiencing burn out from it , the same thing all day long , every day .
In the 1998 we purchased out first laser which was Boa Lays laser and later on we purchased a Delight and a Versa wave and then the laser that we currently use which I think is the finest laser on the market is the Boa Lady MD Turbo . When you look at this picture GD black just think about all the changes that has occurred in our profession since these days. These are antique pieces that are in our witting area. Things have really come a long way since the old singer sewing machine, foot pedal driven hand pieces and belt driven hand pieces and then along amen air driven high speeds and now the modern appotoires that we have today and we can now take it one step further by the addition of a laser.
As we start tonight I want you to open your minds and erase any pre conceived notions you may have about lasers and dentistry whether good or bad. Just open up your mind to the concept tonight. The things that we say here could change your practise forever in fact they can possibly change your life.
I want you to differentiate your practise by jumping out of the dental fish bowl, not like every other practise that is out there. We want you to catch the concepts that we will present here and run with them and for those of you that choose to do that the rewards for your effort will be great. During the next 45 minutes we’re going to talk about nothing but lasers and more lasers. Lasers are all about solutions for everyday problems. You knee every day when you and I go into the office we are faced with one problems after the other, our patients bring us those problems and from those problems we have to be problem solvers, we have to have solutions. One of the problems we battle each and every day on almost each and every patient is bacteria and one of the things that you will learn tonight is that bacteria is every susceptible to laser energy .
You just don’t see the problem if you don’t have a solution. What if all you had in your armentary was to set up forces. What would you see on every [patient? Of course you would see extractions but what if you wades a hand piece and then maybe threw in lights and some instruments and some filling material then we can see a lot more problems because we have a lot more solutions. Then if we added an indo cabinet to our raptor now we can actually think about saving teeth by doing root canals. If we added a soft tissue laser, just think of the soft tissue procedures that we can do now. All of a sudden we more problems because we have more solution and ultimately if we added an YSGG laser, an all tissue laser now we can really see solutions to all the problems that priest present to us.
Did you know that only 5 % of general dentist routine lead to osseous and soft tissue procedures? Don’t limit your practise. Rumanian chromium YSGG laser is juts the tool kin the dental tool box but what a fantastic tool it really is and who would have thought that you just couldn’t run dental practise without a laser. There are three things that will shut my laser in my office down and one is loss of air, once is loss of vacuum and the other is loss of laser. Our patients are so oriented towards laser that they just would not want to have procedures done without one.
Let look very briefly and I do mean briefly at physics tonight. Abler Einstein certainly understood that the impossible was nothing. He talked about laser mathematically woven before there was laser. The word laser is an acronym for light amplification by stimulated emission of radiation. In the room that you are sitting right now you probably have some lights in, some ordinary visible light that is multiple wave lengths, non-directional and non-focused. With the laser it monochromatic and its collimated and its coherent light. It’s a single wave length of light.
The light energy that travels from the laser itself travels via fibre optic delivery system to a hand piece and then the energy is admitted at the end of a tip .When the laser energy leaves the tip it comes in contact with the tooth and it would either reflect , transmit , hit and scatter or be absorbed and the thing that you and I care about the most is the absorption . The 2780 anatomy of wave length is the peak absorption in water and hydroxyl appetite sow when we aim the laser at the tooth it’s looking for water. In enamel there is 3%-5% water, dentin have has 10% – 12%, carouse has 16%-18%. Maybe sometimes as high as 40%.
The more water that the tooth structure has or the tissue or the bone the faster the laser cuts. The more water it has the faster the laser will cut. That’s why soft tissue cuts faster than any other tissues. When the tip is aimed at the tooth it’s looking for the water molecules. The water molecule that highly absorb that wave length and as it absorbs it expands and eventually that water molecule will explode and when it does it blows off everything that surrounds it.
One blast from the laser will leave a crater that’s about 30 – 50 microns deep into his diameter of the tip that was used. Now let’s move unto some cases. Let’s look at operative dentistry. As we go through this bear in mind problems that you see each and every day in your office. Anybody ever see an area like this? Probably saw one today? The carious extends under the tissue, we have to move the tissue back. We can think about electro surge, we can think about retraction cord door we can think about a laser.
In this case without any anaesthesia we were able to move the tissue back, access the decay, remove the decay and place the restoration in a dry environment. All without anaesthesia, without packing cord in a comfortable four hour patient.
Class four
This patient fell on the asphalt in school. You can tell by the asphalt that is still left on the initial edge there. The mother brought this patient in unscheduled and we were able to clean the tooth up, prep it with a laser without anaesthesia and then send the child back to his mom. Unscheduled patient so we sent that young patient out looking just like they hid right before the accident and you don’t think we were a hero that because of what the laser was able to do for us and for our patient .
A class three
Take the amalgam out with a hand piece and turn to the laser for a nice prep. By the way we get a 50% stronger bond when we prep with the laser than we would if we prep with just burg
Class ones
We see class ones all day, every day in our practise and it’s so nice to be able to go in and do these without anaesthesia. Our patients really appreciate the fact from allusions such a and they can return to work or school or home without a numb lip.
I don’t know how many of you may use a diagnodent in your practise but a diagnose is also a laser and its works wonderfully hand in hand with the Boa Lays laser. We like early detection of the decay. 80% of the decay occurs in in the inclusion surfaces and with visual and bite wing we probably diagnose about 50%. In our practise anything that measures 20 or above on our diagnodent we fill. We like to fill it early that meets it a lot easier for us to do it without anaesthesia. By the way being even very conservative we do 80% of our restoration without anaesthesia.
Class two
When you are working on a class two you make sure you protect the adjacent tooth with the matrix band. This sis showing the Boa Lays turbo hand piece as it preps a class two. We are able to go through and do this without anaesthesia in most cases.
Now let’s talk briefly abound indo .Lets start by talking about direct pulp exposure, mixed incision and we receive a direct pull exposure in this case. As all of you know when you get a direct pupil exposure we can do a pulp cap but we usually expect in about 6 months, 12 months it will be going back and then variably do an indo on a tooth like that. With laser we can treat a direct pulp exposure a little differently. When we get the red pinpoint we can tune it brown using the laser. What this does is to sterilise the environment. Then we can place on top of that some MTA and then go ahead and place our restoration. You can see in the radiograph how deep the restoration was that we placed here. This has been two to three years now, post operatively and the tooth is doing very well.
Now why if we get a pulp exposure and we treat it with a laser is that going to be different than what we’ve done in the past .When we get the mechanical exposure we have no way of getting rid of the bacteria. Remember we talked about it in the beginning that lasers are problem solvers and so with the laser we can actually sterilise that environment before we seal it up with our restoration. That h why we see almost assuredly when we do a pulp exposure we will see success.
Lorne: We are going to go ahead and get started. Greetings to everyone .Thank you very much for attending. I want to thank you all of you for joining us this evening. We’ve had over 250 registrations as of this morning so I’m glad that I’m seem to be hitting on some topics that are of interest to many of you out there. For those of you that have been on our webinars in the past with me this one is just going to be a little bit different because we have just a ton of great info. We are going to speak for about an hour this evening. We’re going g to have at least 15 – 20 mixtures for questions.
I was talking with Don earlier and really neither one of us has to be done right at hall past the hour so we can probably go a little bit past that if we have more questions. Each of one of you should see a little box on your go to webinar control panel where you can ask questions. Just type it in , feel free to ask , make them throughout the lecture as you think about them but we’re really not going to have time to get to the questions until after we are done speaking .
By tomorrow I’m going to be sending you all a number of things you’re going to be getting a short survey as soon as you log out of this webinar .Please indicate on that survey if you want to be contacted for more information. I will be putting the webinar on the website so if you have to leave early don’t worry about it, you’re not going to miss anything. Also Amanda from my office will be sending you links to that for those of you who are on the call, you can get an hour and half of education credits as well.
I’m sure most of you know who I am already. I did practise as a periodontist for ten years, People know me as a digital dentist, I work with offices all over the country to help them make technology decisions and certainly lasers fall into that category. As many of you know when I’m put together these webinars I try to find topic that I think would be of interest to dentist . I get a chance to interact with many of my colleagues at trade shows and when the topic turns to lasers I find that many dentists out there are worried that laser just really have very limited uses. In my experience though and I have a lot of clients that are using lasers they’re telling me just the opposite , that their lasers get use pretty much every single day . One of the goals do for today was to dispel this notion that lasers are only useful for high-end procedures by highly trained dentist. In my experience probably a third year dental student can easily handle a laser.
We want to look at that, we want to look at the great h return on investments that you are going to get with lasers, look at some of the pricing as well because this really is a very affordable price. I really wanted to thank Henry Schein and Boa Lays from partnering with us tonight .They’ve really been a leader when it comes to dental laser treatment. At this point I’m going to go ahead and introduce Matt Hunt who is the director of laser sales of Hennery Schein Dental. He’s just going to say a few words.
Matt?
Matt: Thank you very much Lorne. To follow up on certainly your comments earlier we are very excited and we would like to thank all of you on behalf of Hendry Schein and certainly Boa Lays for certainly taking the time to learn more about using lasers in your everyday dentistry. As Lorne said I think in the past these have been perceived as maybe some kind of gadgets and or elite type of practise that are integrated them . That certainly not the case and we have very excited, Henry Schein again and Boa Lays to have Dr Wilson share a lot of his everyday application and or procedures that he uses. Thank you again for joining and I look for award to an exciting filled hour to go over all the everyday application that the lasers can do for you. Lorne?
Lorne: Thank you Matt I appreciate that. I’m absolutely thrilled to introduce Don Wilson who is going to be presenting the bulk of the webinar tonight .It will probably be safe for me to say that Don has begotten more about lasers Thant I’ll ever know. He has graduated for the University School of Alabama School of Dentistry. He holds both a standard and advance participant certification as well as educator status through the academy of laser dentistry. He is also an associate fellowship within the World Clinical Laser Institute. He has conducted about 300 laser seminars and is the director of laser education at the National Institute in Charlotte. I’m going to turn the screen over to the Don and have him take it away.
DON: Thank you very much Lorne and welcome to all of you tonight and it’s a pleasure to be with you. I appreciate the time that you are giving us tonight out of your busy schedule. I realise that all of you have lots of things that you need to do and it’s just an honour to have you on the webinar tonight. We will be talking about the impossible, it’s nothing, the reality of lasers for everyday dentistry and I would like to thank Henry Schein. It’s a pleasure to be associated with him and with my good friend Matt Hunt. Even though Matt lives in California he’s a great Alabama fan. He’s coming down this fall to be with me for the Florida game and it’s just a pleasure to be associated with him. Thank you Lorne for allowing us to be on the program and to Boa Lays. It’s a wonderful company and appreciate the fact that we are associated with such a fine laser company.
Also a commercial for the National Institute, we do teach laser education along with cosmetics at the Laser Institute and we invite you to come and share with us. You can look at the programs that are available at national instuitute.com.
Let me give each of you a pat on the back for joining and participating in the program tonight. Your practise is about to change if you take the things that we are about to present tonight and employ them into n your practise. Thank you for seeking out this knowledge. Whether you attest use it or not you are at least looking at laser education for your practise.
In 2010 we designed a new program the impossible is nothing the reality of laser and everyday dentistry and we are going to cover portions of that thigh. We have limited time but we are going to cover just a little bit of physics and then we will cover all the procedures that you see listed there and then we will talk finally about the return in investment.
Boa Lays is really the most complete family of dental layers and featuring the new I-Lays, the pocket sized personal laser that is production right now. The Easy Lays which I use every single day in my practise or soft tissue procedures we’ll talk about that tonight. The Water Lays Sing 100, which is an economy entry level hard and soft tissue laser and of course the Water lays in the turbo which is the one that we will focus on tonight. It’s for basic and beyond dentistry.
It only lasted 12 seconds and it only flew 120 feet on December 17th 1903 at Kitty Hop, North Carolina because until that moment flying with power was impossible but on that very day it became possible and you know what has happened since that point. If we determine something to be impossible out vision for the future is blind. Orville Wright was quotes as saying “isn’t it astonishing that all these secrets have been preserved for so many years just so that we can discover them “and that’s kind of the way I feel about lasers. What a wonderful addition it has been to our profession.
Lasers are not only used or a fad or off the radar or a just a niche in dentistry. We have just seem to tip the ice berg. There will be over 4000 lasers purchased this year by dentist .It is a very rapidly growing facet of our profession. Five out of a hindered dentist now routinely use the laser. Lasers are part of everyday, every way dentistry. We use our lasers all day long every day. It’s a fact dentist who own a laser produce 25% more than dentist who do not own a laser. For those of you who would like to get in touch with me and ask any questions following tonight’s webinar, you see my email there [email protected]. If you would just put in the subject line “reference something to laser” I will be glad to respond to you.
Our little part of the world is in the north west corner of the state of Alabama, Florence Alabama, the home of W.C Andy the popular blues, Helen Keller the first lady of all times with disability of not being able to hear or to speak , the famous Fames Studio that was the hit recording capital in the world in the 60s and 70s and Stewart Saint who many of you know because of his fame and Goth and went into British Open last year.
We are along the beautiful Tennessee River, it’s a very important part of our culture here and this is our office and I just wanted to share this with you so that you get a concept of the guy that’s talking to you tonight about lasers. We are just in my option an ordinary practise. We practise in a rural area and I think I’m a common everyday dentist. I don’t think we have anything that’s especially exceptional in our abilities so I want you to know that I’m an in the trenches dentist just like you guys .
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Our newest practise is Signature Smile. I’ll talk about the fact that later on we have had various practises through the years.
Everyday dentistry with the Boa Lays laser. We’re going to talk tonight about getting more patients, keeping more patients and growing more patients in our practise. I want you to understand this is not star was technology. I think through the years us as educators have kind of made lasers a little out there like it’s kind of an elite kind of thing. It’s really not, it’s something that every dentistry can do. This thing is not a laser sword.
Lasers do not make a bad dentist good but it will make a good dentist great. I would like you to ask yourself do you believe that doctors are really taking a serious look at laser technology these days. In dental town recently there was a survey and it was determine that 77% are treating pockets greater than 6 mm. Then it was determine 78% believed laser could be used for periodontal surgery but then it was discovered that only 18% reported actually using laser to treat perio. That means that there are 60% of the doctors out there who are seriously thinking about adding laser to their practise and I’m sure because you are on the webinar tonight you are in that 60%
Alcohol has the same effect on them directly when it’s taken in a form of cherry. We know that alcohol will penetrate the plaque. We know that it’s a wetting agent. We know that it penetrates, therefore, into the parasite, and by dissolving the acroflavein in it, we can take this protoplasmic poison straight into the body of the parasite.
The important thing about acroflavein 1 in 50,000 as a preventive used one to three times daily is that it’s not a tissue irritant, and it’s not, to a great extent, bacteriostatic. It has to be stronger than 1 in 33,000 in order to be bacteriostatic. The method we have our patients use it is to take one teaspoonful at the mouth at full strength, rinse it around the mouth for five minutes, spit out, and then don’t eat or drink or rinse for the next 55 minutes. Again, for the Torrens powder, pat it on the gingival margin, spit out all the excess, and then don’t drink or rinse for the net 55 minutes.
Other drugs that can be used for the treatment of parasites. Apart from metronidazole, tetracyclines are weakly antiamoebic. The dosage regime that we employ is two 250mg capsules twice a day, no milk products at the same time, obviously. This is continued for two weeks. At the end of two weeks, we usually examine to see if there’s parasites in the plaque. If there are parasites in the plaque or if the patient isn’t completely healed or if it’s been a very severe infection, then tetracycline 1g bid for another two months.
Another drug which is not yet completely proven is ativrin, another antimalarial, is effective most of the intestinal protozoa. We’ve used it in a couple of cases of resistant infections. In fact, ativrin, 1 tablet 3 times a day is more effective than metronidazole over 11 days with the paste. So, ativrin by itself seems more effective than metronidazole and metronidazole paste, but ativrin has unpleasant side effects.
One of the things we’ve tried to get rid of these protozoans is to go on an overkill and then to try to prevent reinfection during the convalescent phase which can last for a matter of weeks up to nearly a year.
Anybody who’s going to be prescribing any of these things should remember two things: One is the importance of a sound medical history and consultation with the physician if necessary. The second one is to be totally familiar with the drugs they’re prescribing. A compendium of pharmaceuticals is essential in this point of view.
Host: I’d like to have a little summary, again, of step-by-step process of handling a new patient. A new patient comes in, obviously the periodontal situation is very active. So, the first thing we’re going to do is tell the patient of a little bit of both the concept of parasites and say we should not prescribe anything without doing a proper testing. We could either test by using a microscope, a phase contrast microscope, to observe the amoeba, or else, we take a SAF kit to do the sampling. We take the sample, send it off to a lab. That comes back positive, you being highly suspicious, put the patient on a preventive mouth rinse. Tell me a little bit about your choice of rinse here, and the progressive treatments, maybe the mild case or the severe case just to summarize it one more time.
Dr. Lyons: Yeah. Okay, well, if we’re waiting for the results to come back, we put them on modified Torren’s powder once a day and a pretreatment rinse, which they use four to eight times a day. The reason for the fluctuation in time is sometimes they can’t keep it in their mouth for five minutes. Sometimes, they have to eat within the 55 minutes.
Modified Torren’s powder, of course, is the salt and baking soda combination which has been finely ground up. Some patients like to add flavoring to it like cinnamon. The preventive rinse is 1 in 50,000. The pretreatment rinse is 1 in 10,000. The pharmacist has a bottle of concentrate and just mixes it up using alcohol form the liquor store, which is diluted so that it’s 16%, and then he adds the flavoring.
Once, we have gotten our positive diagnosis or in the case of a severe infection, we use a pretreatment rinse to get the numbers down. We then go ahead and watch as the patient is being treated with the drug and with the paste. We got to continue with the modified Torren’s powder.
Sometimes, the patient will develop a severe reaction medically, and because of their general symptoms, they have to discontinue treatment. Very occasionally, the worst complication that we get is basically a herpetic stomatitis. If the patient develops a herpetic stomatitis and I think we have three cases in 700, what we do there is we take the patient off all medication. We get them to continue with the rinse frequently, to use modified Torrens powder (to take 3 teaspoonfuls in 4 ounces of hot water and use that as a rinse), to stop toothbrushing entirely, and to use modified Torren’s powder on their finger.
After about 5 days, it will subside, by which time the patient will have developed some sort of skepticism for the treatment so they need a little bit of hand holding. Then, they retake treatment, and when they retake the treatment, surprisingly, another herpetic stomatitis does not recur.
We’ve had one or two problems with urticarial. Generally speaking, the urticarial response ceases immediately when medication is discontinued, and this can be controlled with the use of antihistamines. However, with antihistamines, because we think they affect the metabolism of the parasite, will also slow down the rate of uptake of the drug, and therefore, prolong treatment.
In one case with urticarial, we suspect that there might be something like Endolimax nana in the patient’s system, and this is why he’s developing the responses that when he took the metronidazole, the other parasite was not as affected by the metronidazole as Entamoeba gingivalis. Therefore, this other parasite overgrew, and it therefore, developed this problem as a side effect of treatment but not as a side effect of the drug.
Host: That summarizes the treatment. After the treatment has been done, what do you follow up?
Dr. Lyons: As far as follow up is concerned, the most important aspect is home care on the part of the patient, and this involves the usual regime of home care which is effective for that patient coupled with the specific antiamoebics that we’ve previously mentioned, the modified Torren’s powder, and the acroflavein 1 in 50,000 mouth rinse. We have patients in the high risk category group using the mouth rinse anywhere from four to six times daily, normally one to three times daily and using the modified Torren’s power once daily or as they feel they require it.
The medical implications are largely speculative, but they’re based upon clinical obsevations of dental patients where there is a correlation oral parasites and systemic disease and a clue as to what parasites may be related to other diseases and an indication that this demands much more careful investigation. As far as dentistry’s concerned, I really do feel, from the research that has gone on in Russia, in France, and Germany, Spain, and Italy, and in the United States back in the 1920s and the early part of the Depression, that the case has been proven for the pathogenicity of Entamoeba gingivalis, and that many of the cases that we see in the mouth should really be classified as oral amoebiasis.