by John Jameson, DDS
This month, Dr. Jameson interviews Dr. Gerald Bittner, Jr., a noted authority on clinical and aesthetic uses for lasers.
Dr. Jameson: Let's first talk about the history of lasers and their evolution in the dental practice.
Dr. Bittner: I first used an Nd:YAG, which at the time was a great laser for tissue work, hygiene debridement, desensitization, etc. It was truly a pulsed laser. With the varying frequency of pulses, you could use the laser almost without anesthesia.
Later came the diode, an excellent laser for tissue work. It's still a valuable tool for densensitization and removal of lesions; however, because it has a hotter current, anesthesia must be used.
The newest generation is the YSGG laser, which is actually a proprietary patent of Biolase — their water laser. This is the newest and most versatile laser on the market. It can be used for both soft tissue and hard tissue work. It has an infinite number of settings, and can be used for caries removal, or even tooth structure removal. With this particular laser, 95 percent of cases require little to no anesthetic.
Dr. Jameson: Practitioners recognize the value of these lasers, yet have few guidelines on how to incorporate their use into the fee structure of a practice. How can they effectively determine what fees to charge when using this technology?
Dr. Bittner: Technology must pay for itself. We don't really sell procedures for a living; what we sell is our time. And what these units have done for me — whether it's the YAG (in the early years), the diode, or the erbium water laser unit — is save a tremendous amount of time.
The tissue response with lasers is incredible. I never use cord when prepping for a crown, because I use the laser to trough the area before I take an impression. With a laser, the work is meticulous and exact. Every impression comes out perfect the first time; there are no retakes. When I place that crown, the tissue is completely healed. Lasers are just phenomenal time savers.
Some dentists add a separate "laser fee" to a pre-established fee schedule, much as new car dealers add certain fees to the original base price of a vehicle. What I find, however, is that the significant time savings decreases my fees internally. When using cord during a crown prep, I usually have to wait five to seven minutes before taking a final impression. If there is seeping, I have to take it again and wait for it to develop, when I could instead be doing another procedure. Lasers prevent all of that; the time savings alone helps recoup their cost.
Laser use also allows dentists to expand the services offered to patients. Procedures they normally would refer out — such as gingival debridement — can be incorporated into their practice and are a huge source of profit. Plus, after scaling and curettage with a laser, the result is a patient with no bleeding, no post-operative sensitivity, and a very grateful attitude! The public relations factor of a patient who expects extreme discomfort, yet has virtually none, is invaluable.
Doctors can also use lasers for biopsies, or other procedures previously referred to the oral surgeon. With a laser, doctors can remove these types of lesions virtually in seconds, with zero bleeding and zero post-operative pain. The potential is nearly infinite.
Dr. Jameson: It sounds as though lasers not only have tremendous profit potential from the additional procedures they allow us to perform, but are also are a terrific marketing and public relations tool. Satisfied patients tell friends and family about the remarkable services you provide, while new patients are attracted by the state-of-the-art, technologically advanced practice.
Dr. Bittner: Absolutely! Patients see the lasers, and are amazed by the quick, almost pain-free results. I recently had a patient come in for a frenectomy. He was frightened to death! His friend had a similar procedure performed and told a horror story of pain that lasted three weeks. Imagine my patient's relief when he had minimal pain and was completely healed within five days!
This technology generates an enormous amount of goodwill. Satisfied patients become our emissaries, and brag about the practice and the marvelous technology it uses. I get an enormous number of referrals just because of the equipment itself.
Dr. Jameson: One area you have particularly focused on is aesthetic restorations. Many doctors have quit using them in their primary treatment mix, or have reverted back to older techniques because of post-treatment sensitivity. How are you using laser technology to eliminate this problem?
Dr. Bittner: With the Erbium YSGG water laser unit, there is no post-operative sensitivity, because it actually removes the smear layer. Even if I use a handpiece on a particular tooth, I will go over it with the laser and more or less sterilize the area. The result is zero post-operative sensitivity.
This laser can also desensitize a tooth that does not have a restoration, but may have dentinal sensitivity. It has a "mummifying" effect on the nerve and eliminates the sensitivity. There are no micro fissures on the tooth from a handpiece, there's no smear layer — so, no sensitivity!
Dr. Jameson: The FDA has approved lasers for use in specific areas; however, as clinicians, we are finding even more uses for them. Lasers are being used in treatments not even considered by the FDA during the approval process.
Dr. Bittner: You're absolutely correct. I'm finding newer and better uses for lasers every day — the potential is limitless. As practitioners, we have the latitude to use an instrument in whatever capacity we feel reasonably certain will produce the results we need.
This technology is like a wave, and practitioners have a choice: they can either ride the crest and sail into this new era, or they can hover along in the trough and never fully experience the ride!
Dr. John Jameson is chairman of the board of Jameson Management, Inc., an international consulting firm. Dr. Jameson lectures internationally on high-tech dentistry and its integration into the dental practice. He provides research for manufacturers and marketing companies. Dr. Jameson may be reached at (580) 369-5555 or by e-mail at [email protected].
