Laser economics: periodontal therapy

Aug. 1, 1998
Since the introduction of lasers into dentistry in 1984, they largely have been economically unjustifiable. Other than the ability to market the laser internally and externally, there was little cost-justification for purchasing a laser. There was no single procedure that a dentist could do in sufficient quantities to pay the monthly lease and/or realize any appreciable return on the investment. Until now.

Robert H. Gregg, DDS and

Delwin K. McCarthy, DDS

Since the introduction of lasers into dentistry in 1984, they largely have been economically unjustifiable. Other than the ability to market the laser internally and externally, there was little cost-justification for purchasing a laser. There was no single procedure that a dentist could do in sufficient quantities to pay the monthly lease and/or realize any appreciable return on the investment. Until now.

In this article, we will describe a laser-dedicated and laser-required procedure that any reasonably competent practitioner can learn and perform safely and efficaciously. What is it? Laser periodontal therapy.

Prior to 1990, the CO2 was the dental laser of choice and availability for soft-tissue procedures, and still is for many procedures. It presents a problem treating soft tissue in the closed periodontal pocket because CO2 is highly absorbed by enamel and dentin. Also, it is transmitted through air or a hollow metal tube (waveguide), making access limited.

In 1990, a "free-running" pulsed (FR) Nd:YAG (neodymium: yttrium aluminum garnet) was introduced. It featured small, flexible, quartz fiber optics. Dentistry had the first appropriate laser-delivery mechanism, wavelength, and pulse profile to perform unique laser-periodontal therapies safely around the teeth.

Before we became involved with lasers, we were like most general dentists. We would perform "soft-tissue management," but, in most cases, stopped short of scalpel and suture periodontal surgery. When it came to periodontal surgery, we referred our surgery to a specialist. The problem was, and still is, that most patients refused to comply with traditional periodontal-treatment recommendations. Compliance has been reported to be as low as 3 percent!

The referrals also meant immediate loss of production revenue, and, most of the time, a significant delay in subsequent production revenue while waiting for the surgical recovery and healing to take place. But that was OK, since we didn`t have any alternatives to offer. But now we do.

The first (FR) Nd: YAG laser was suggested for use in periodontal therapy, specifically "laser curettage," in 1988. Laser curettage has been practiced in some form or another around the world ever since. The problem is that laser curettage has not been researched in the university setting under controlled conditions. Therefore, the successful attributes of laser curettage are not widely known or documented.

However, laser curettage has met the ultimate test of clinical success over the last decade, demonstrating improved clinical indices with patient acceptance and compliance. Some highly respected practitioners hold that "clinical success is the final test." But the economics of laser curettage (with some exceptions) have made it hard to cost-justify the capital-investment aspect of laser acquisition, training costs, and incorporation into the office routine.

With another laser-periodontal technique that has evolved over the past five years, we suggest that the laser can justify a high-end fee with advanced intervention and impressive results by performing laser ENAP (excisional new-attachment procedure).

For those dentists who wouldn`t consider periodontal surgery, laser ENAP gum therapy is nothing compared to flap surgery, because no flaps are made. How can deep pockets be treated? By inserting thin, laser fiber into the gum pocket and selectively destroying pathologic proteins, while leaving healthy soft and hard tissues unharmed. Ultrasonics with small perio-tips and subzero scalers provide access to and treatment of the hard tissues.

To cost-justify and profit from a laser would mean the dentist must have a unique and specific procedure that only can be accomplished with a laser. The procedure also would need to generate fees in excess of what a general dentist makes per hour of operatory time. Laser ENAP does this as nothing else can - not a camera, not even air abrasion. How?

The most profitable procedure that a dentist can perform in an hour is a single unit of crown and bridge. To illustrate, let`s say $500 per unit (adjust the fee to reflect your geographic area). Now subtract the cost of materials, the lab, and the assistant`s time to arrive at a net of $250 to $300.

Comparatively, one quadrant of laser ENAP - for the purpose of our illustration, let`s say $500 per quadrant - requires no materials, lab fee, or even an assistant for a net of $500. Also, the patient usually has three more quadrants of periodontal therapy to do. For most patients who need laser ENAP, four quadrants of therapy are required. For example, at approximately $500 per quadrant, patient revenue is $2,000. That doesn`t count the revenue from other dental needs these patients with newly saved teeth and a new appreciation for dentistry will generate. And you, their new "high-tech" laser dentist, will be happy to accommodate them!

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