A periodontist’s perceptions changed

Transcription: 

Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Alan Bresalier, a periodontist in Westin, Florida. Dr. Bresalier studied at the State University of New York at Stony Brook, where he earned his DDS degree. He continued on to Boston University, where he received a specialty training in periodontics and earned his certificate of advanced graduate study in periodontology. He is also board certified, having achieved diplomate status with the American Board of Periodontology. Dr. Bresalier, thanks so much for joining me today.

Dr Alan Bresalier: Well, thank you, Marty, for having me.

Marty Klein: So I’d like to start by taking you back to prior to being trained all the way back to when LANAP® first came on your awareness. Can you tell me a little bit about how that first started and what your first thoughts were when you heard about it?

Dr Alan Bresalier: I had known about LANAP® for a few years, having received a number of promotional materials from Judy Nicol, my Florida representative from Millennium Dental Technologies. I would also see her at various dental meetings. We would make eye contact and I would politely pass by her booth, and I never gave her an opportunity to give me her sales pitch. I had heard about the high cost of the laser, and in order to find out any specific information on how it works, you had to purchase the laser first. My “ah-ha” moment came when I attended a LANAP® lecture at Dr. Steven Reimer’s Seattle Study Club. He brought in Dr. Chuck Braga, whom I believe was the second periodontist ever to begin using the Millennium PerioLase® Nd:YAG laser to treat his patients for periodontal disease. After viewing a number of his cases and seeing his incredible results, I knew that by the first morning break that it was time for me to jump on board the LANAP® train. I went up to Chuck at the break and introduced myself as a periodontist, and I told him that it was his job today to provide me with enough information to convince me to purchase the Millennium PerioLase®. At the end of the lecture, I already knew that I could no longer practice periodontics without this laser. At the end of the lecture, I met with Judy and signed the necessary paperwork to purchase the PerioLase® laser and begin my LANAP® journey.

Marty Klein: So if I may ask before that point, what were your points of skepticism as to why you didn’t make eye contact [with Judy]?

Dr Alan Bresalier: Oh, cost. I heard about the cost of the laser, and basically, the most expensive piece of equipment prior to that purchase, was my panoramic X-ray, which was $33,000. This is gonna be, like, four times the cost.

Marty Klein: Okay, Well, I will follow up on the cost in a little while, but I do want to tell your story in kind of chronological order. Did you have any laser experience up to that point watching Dr. Braga’s presentation?

Dr Alan Bresalier: Yes. I have been using a diode laser to perform frenotomies and minor gingivectomies, and that’s about it.

Marty Klein: Do you still use those?

Dr Alan Bresalier: You know what? Honestly, rarely. Now that I have the PerioLase®, it does the same thing, and I think more efficiently and better.

Marty Klein: All right. So you have now these high expectations, you saw the results that Dr. Braga was talking about in the studies, histological studies, etc. So, you might still have a little bit of skepticism going into training. Tell me about the training experience and how it prepares you to be ready to do LANAP® for yourself.

Dr Alan Bresalier: Well, when I first started using the Periolase®, like anything new, I was a little bit apprehensive about using the laser for the very first time, even though I feel that I had received excellent training and education from Dr. Jeff Dolgos and Dr. Ray Yukna. Fortunately, I chose the right patient and the right area to treat as my first introduction into treating periodontal disease with the laser. My first patient was one of my maintenance patients. They already had performed traditional surgery in the mandibular left quadrant. I had performed bone grafting with membranes, and I was able to save a severely involved tooth. She had a lot of faith and confidence in me, since the periodontist that she had seen before me wanted to take out her tooth and replace it with a dental implant. When I presented her with the opportunity for me to treat the maxillary left quadrant with the laser, she didn’t hesitate to allow me to use it. Needless to say, she had a 15 millimeter pocket on the distal aspect of her maxillary left second molar, also a tooth that the other periodontist was going to extract, and with the periodontal surgical treatment from my PerioLase®, I was able to reduce the pocket down to five millimeters; no bleeding on probing or gingival inflammation present at the one-year reexamination visit. She and I couldn’t be happier.

Marty Klein: That was one of your first patients, you said?

Dr Alan Bresalier: That was the very first patient, who I still follow, was 3.5 years ago. The very first LANAP® patient.

Marty Klein: So right out of the gate, your instincts are starting to be proven correct with what you were seeing at the lecture.

Dr Alan Bresalier: Yes, but let me tell you, I didn’t believe it at first. I still don’t believe it. And even today I can’t believe that what I’m doing works because it is so noninvasive. We were trained and educated, and I don’t want to use the word cookbook, but in a sense it is a cookbook. If you follow the protocol, the way we were trained. It works and it just it works unbelievably.

Marty Klein: Yeah, I think that’s an important point to make that it’s not just the laser. The PerioLase® gets a lot of credit, and it’s certainly a giant component of the protocol. But it’s the overall protocol and how it’s used that gets the results. Now I know that you do a lot of CE or continuing education. Can you take me back just for a moment to the training itself. It’s three initial days of CE training to start to use LANAP® and how that prepared you to start doing those cases to get those kinds of results.

Dr Alan Bresalier: Well, my LANAP® training was very intense and it felt like information overloaded at first. But I have to tell you that it was the most organized, thorough, and comprehensive learning experience that I have had, outside of my dental school and postgraduate periodontal training. I felt very confident that I was able to go out on Day 1 and began to treat my patients with my new high tech laser. Yes, I was a little apprehensive, but that’s usually the case with learning anything new and then going out and using it for the very first time. Millennium did a great job with my education into laser dentistry.

Marty Klein: I believe you said when you first came to training that you had hoped that the PerioLase® would make your life easier, and that was, like we said, about three years ago. Has that been the case? Has it made your life easier? Are you doing less traditional surgery than before?

Dr Alan Bresalier: Yes, the PerioLase® has made my life much, much easier. First off, it’s not as taxing on my body trying to see into the surgical area and the complex bony defects that may be present, while trying to hold out the flap, while the patient’s head is moving around, or the tongue wants to check out what we’re doing, or they’re a heavy salivator or a gagger, and there’s an extensive amount of bleeding due to severe periodontal disease condition. As far as doing less conventional surgery, I only treat periodontal disease cases with my PerioLase® laser today and have been. I have not done a traditional flap & osseous surgery to treat periodontal disease since I received my initial LANAP® training. There’s no need to. The Periolase® is incredible and does a wonderful job as long as you follow the protocol. Basically, I learned it, I follow it, I do it, and I see the results because of it.

Marty Klein: Wow. I just wanna go back to that statement, which is quite a statement, that you haven’t done any traditional surgery since incorporating the PerioLase®. Was that something that was the intention? Did you ever consider both versions or did it just work out that way because of the results?

Dr Alan Bresalier: Well, that was a major paradigm shift. I never expected to all of a sudden just say, “I’m not going to do traditional perio surgery anymore.” I didn’t believe it at first, honestly, I really didn’t, even though I bought an expensive piece of equipment. I really wanted to give the laser an opportunity to show me what it could do. Having experienced Dr. Braga’s lecture, I knew that if I followed the protocol that my results should be similar, because I’m using the same technology. Therefore, once I proved to myself that the laser works, there was no need to go back to traditional surgery. Traditional surgery is more invasive, you’re doing flaps, and you’re placing bone; additional costs, you’re putting biologics in, you’re using membranes. All this stuff actually costs more. So a quadrant of traditional surgery versus a quadrant of LANAP® surgery, LANAP® surgery is actually cheaper: more cost effective, less painful, has less post-op sensitivity, less space in between the teeth, and the patients are happy.

Marty Klein: So going back to your statement right at the beginning that it was too expensive.

Dr Alan Bresalier: Well, in reality, it’s not expensive. It just on the surface it looks expensive. But you get tremendous value for what you pay, and in a heartbeat. The only regret I have is I waited too long. That’s it. I mean, I didn’t wait too long because I’m doing it now and have been for the last 3.5 years, but I almost wish that I didn’t put the blinders on and had spoken to Judy sooner. It’s interesting. I found a piece – this was after I had finished my laser training and had purchased the laser. I found a piece that Judy had sent me probably a year or so before, and she says, “You don’t know what your patients are missing out on!” and I never forgot that she hand wrote that on the postcard, or whatever it was that she sent me, and I saved it. So obviously I knew there was something about it, I just I didn’t want to take the plunge. To me, it was probably more cost than anything else, but it was also the fact that I just didn’t know a lot about it, and I almost kind of just put my head in the sand.

Marty Klein: Well, speaking of patients and also return on investment, I understand your wife is your office manager. So I’m curious if you could speak for her just for a moment and relay what she thought from her perspective, maybe right at the beginning, or how she views the LANAP® Protocol after these last 3.5 years.

Dr Alan Bresalier: Well, she thinks that it’s great having a high tech procedure that we can offer our patients to treat periodontal disease with minimal pain/sensitivity. The things I described already: spaces between the patients teeth post-surgically, and the patients can’t believe that they’ve had a half mouth of surgery performed, and they really have no pain. I mean, I call every patient the night after the surgery, and they say, “Yeah, it’s a little bit sore, it aches,” or whatever. Then the second day, the day after the next morning, my wife will call them up and see how they’re doing, and they say, “Man, I have no pain. I can’t believe it.” So it’s just revolutionary. It is, really. It’s just changed my practice – a complete 180 degree change.

Marty Klein: Always great to hear. I never tire of hearing it. I did also want to find out if you’re using your PerioLase® for other procedures other than LANAP®, either for peri-implantitis treatment or any other value-added procedures that you could do with it?

Dr Alan Bresalier: Yes, I’ve treated a number of cases with incredible results like the treatment around teeth. It’s hard to believe the results of them seeing when I know that I’m performing a minimally invasive surgical procedure around the dental implants: not doing a flap, not detoxifying the implant surface with biologics, putting in bone graft material membranes, and just doing it with the laser and seeing the bone regeneration that we’re getting when I compare radiographs taken from day one to a year later, and it’s like, Wow! I can’t believe the amount of bone regeneration that we achieved. It’s incredible. And we saved an implant for the patient. I was recently in communication with one of my instructors, Dr. Allen Honigman, and I had sent him a before and after case of this particular patient, and he was pretty astounded by the amount of bone regeneration that we got, so it was neat!

Marty Klein: So in addition to LAPIP™, have you used the PerioLase® for other procedures in the office?

Dr Alan Bresalier: Yes, I have treated a hemangioma on a lower lip that the patient had for over 50 years. She had worked for an oral surgeon in the past, and he wanted to remove it, but he told her that she would have a scar left in place, so she never had it removed. She even went to see a plastic surgeon, but he told her that she may have a scar after he removed it. I showed the before and after pictures from my LANAP® brochure and she consented to have me removed the hemangioma. The treatment was fast, easy and painless, and the result was unbelievable. At the one month post-op visit, there was no hemangioma, no scar, and a normal-appearing lower lift. She was overjoyed. How often can you say that about a visit to the dentist? I also removed the melanotic pigmentation from the gingiva of a patient that was undergoing orthodontic treatment. She had short clinical teeth, and the orthodontist needed me to uncover the teeth to allow him to place brackets on the teeth. She also had severe dark melanotic pigmentation in her maxillary and mandibular gingiva. Once we increased the length of the teeth, we finished the procedure by removing the pigmentation with our PerioLase® laser. The result was incredible and the patient, her mother, the orthodontist, and I were ecstatic. I have also used my PerioLase® laser for soft tissue crown lengthening procedures, frenectomies, and orthodontic uncoverings of un-erupted or impacted teeth. In conclusion, I would like to thank Millennium Dental Technologies, Drs. Robert and Dawn Gregg, as well as their incredible staff, for their excellent educational experience and training that I received.  As well as to Judy Nicol, who never gave up on me, and my instructors, Dr. Chuck Braga, Jeff Dolgos, Ray Yukna, and Allen Honigman.

Marty Klein: Well, I do want to give a plug to your website. That is www.alanbresalierdds.com. So please take a look to find out more about my guest’s practice in Westin, Florida, and I invite anyone listening here to subscribe to the podcast, if you haven’t yet, so that you don’t miss any episodes. You can also find all of them at LANAP.com/Podcasts. Dr. Bresalier, you’re always a pleasure to talk to you. Thanks for taking some time out today with me.

Dr Alan Bresalier: Thank you, Marty. It’s been a pleasure.