An oral surgeon & a GP’s team approach with the PerioLase® MVP-7™

Transcription: 

Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, training manager at the Institute for Advanced Laser Dentistry. My guests today are husband and wife team doctors, Max and Cerisa Moncayo. The former an oral surgeon and the latter a general dentist, in Pacific Palisades, California. Dr. Max Moncayo was a commissioned naval officer and earned his dental degree at UCLA and continued his oral and maxillofacial surgery residency at the Walter Reed National Military Medical Center in Bethesda, Maryland. He currently serves as faculty at UCLA and is board certified both by the American Board of Oral and Maxillofacial Surgeons and the National Dental Board of Anesthesiologists. His wife, Dr. Cerisa Moncayo, earned her dental degree at USC and also served as a naval officer stationed with the marines. Drs. Moncayo, thank you both for joining me today.

Max Moncayo: Thank you Marty.

Cerisa Moncayo: Thanks for having us.

Marty Klein: So there’s a lot I want to get to in your respective practices. But first just for our listeners here, will you give us a synopsis of how you met and how your practices started together? Was it because of the Navy connection?

Cerisa Moncayo: Yes, it was actually. We were both stationed at 29 Palms Dental Clinic on the marine base. It was a pretty large clinic with about 12 general dentists and Max was one of a handful of specialists, and we met there during our last tour in the military. When we got out of the military, we settled in West Los Angeles and found this opportunity for this amazing practice here in the Palisades. We set it up as, kind of essentially two sister practices, a general dentistry practice and sort of a sister oral surgery practice. We’re here full time and serving in this community.

Marty Klein: OK. So I want to get to now how LANAP® came into the fold? I know you both trained together in 2018. So how did it first cross your radar, so to speak? And then what was the sequence of events to choose to both get trained?

Max Moncayo: Yeah. So it’s funny story actually. We went to an opening of another office around the corner and you know, practicing in West LA, it’s sort of a dog-eat-dog world out here. It’s very, very competitive. What’s interesting is, you know, I love working with periodontists because they’re always so helpful, and they’re always so kind. I actually enjoy working with periodontists more than even oral surgeons. But this periodontist in particular that we’re visiting, he was so enthusiastic about his PerioLase® and the training that he received. He was showing us all these x-rays, and just talking about all the training that you have to go through and get certified. As he was giving me all this info, I thought, “Wow this is great information and what’s stopping us from a multi-specialty office of you know getting the dentist here trained and myself getting trained on it and then we can offer everything all under the same roof without sending out to a periodontist ever.” So in a way he sort of, I don’t think he was expecting us to run with the information that he gave, but it ended up being very enlightening. After we decided to purchase the PerioLase® and go through all the training, I mean, there’s been so many benefits of having it that it really is beyond what we initially even purchased it for, and we’ve just been so incredibly happy with it.

Marty Klein: I do find that interesting that the main person who referred you was a periodontist yet neither of you are periodontists. How did you foresee the adaptation to working with the PerioLase® in both an oral surgeon practice and a GP Practice?

Max Moncayo: Yeah. Yeah I mean that’s the beauty of it. You go through the training and you can fully basically just treat all sorts of perio defects, and just bring it into your regular general dental office. So having a multi-specialty office, being able to do all that perio work under your roof, it really adds so many extra procedures that you can actually charge out for and really increase your depth and knowledge and also your patient base all under the same roof. So it’s extremely helpful. Like I said, that was just one aspect of why we are interested in it, but we ended up using it for so many other things, and it’s become so crucial in our day-to-day practice that I couldn’t even imagine working without it now.

Marty Klein: So I want to come back to specifically the oral surgery practice in a moment. But first for Cerisa, what is the balance between doing the LANAP® full-mouth periodontal surgery versus other uses, or value-added procedures, in your practice?

Cerisa Moncayo: Great question. You know, it is fascinating because for the value-added procedures, I feel like it’s very heavily swayed for me to use it for other things other than LANAP®, even though I know the PerioLase® and all its research supports that full-mouth protocol and we do use it for that. But in terms of general dentistry, I mean we have our laser, actually both of our lasers, on pretty much every day for other procedures anywhere from restorative procedures to help with gingival retraction, low-level laser therapy, like biostimulation and so many other things. So it’s just been really helpful even for our hygienists. We have a couple hygienists who went to the hygiene training. So they use it almost on a daily basis as well for pocket disinfection and laser assisted regeneration for just more localized sites. So in terms of a general practice, we use it extensively for procedures other than LANAP® full-mouth protocol. And for that reason it’s just really helpful and it’s been really a huge benefit for our patients. The patients love it too. The idea of using a laser is something that is not very daunting to a patient. There’s just something very relatable that patients don’t view it as a scary procedure no matter what you’re using it for. So it’s been extremely useful.

Marty Klein: I’ve heard that referred to as a “magic” word in terms of softening of patients, perhaps, reluctant to proceed with a certain treatment.

Cerisa Moncayo: Yeah, definitely. It’s sort of like a no questions asked. Like, they kind of just understand the technology even though they don’t really. There’s just something very user friendly and very gentle and very minimally invasive when it comes to lasers that there’s so many applications outside of dentistry that people understand. So, yeah, exactly. It’s great.

Marty Klein: Sure, if you can get the clinical result that you want. I mean, I understand patients will accept the treatment, but you have to be satisfied with it from a treating clinician yourself as well. Is that the case?

Cerisa Moncayo: Definitely. Yeah, definitely.

Marty Klein: I want to move back over to Max as an oral surgeon, and I should point out that you are the first oral surgeon that we’ve had as a guest on this podcast. So I do want to pick your brain a little bit in terms of integrating a PerioLase® into your practice and how you found that you primarily use it.

Max Moncayo: Yeah. So I mean with the increase in cases of peri-implantitis that I’m seeing throughout my day-to-day practice, I wanted to get something that works extremely well for peri-implantitis but also is not very invasive to the patients. So having this to offer that to the patients for their peri-implantitis has been really a game changer in our office. Again, after I went through all the training there’s so many other things that I use it for and I like I was saying I use it almost pretty much on every surgery. Even, let’s say, wisdom teeth, I take out wisdom teeth and then I’m always using it on the LANAP® hemostasis settings for the lower extraction sites. I’m using it for upper extraction sites. And then at the same time I’m also getting the biostimulation and I’m also decreasing the inflammatory mediators. So patients not only do they have, I mean, I haven’t seen a dry socket here in this office in years, ever since I started using this. Then also the patients just have way better postoperative course, way less pain, way less swelling since I started using that. The beauty of it is so many patients these days are on blood thinners, there on the Xa inhibitors, thrombin inhibitors. I don’t even need to be concerned about them stopping that or what they’re clearance is. I just say, “Just keep doing your meds, come in” and I know without question that I’m gonna be able to get hemostasis because I have this in my arsenal.

Not only is it a great way to get hemostasis in these patients, but I don’t need to worry about just cooking the tissue. I don’t need to worry about causing nerve damage. If the inferior alveolar nerve is exposed, I could still laser right over the top of that and it’s going to selectively just target the blood and not do any nerve damage. So that’s the beauty of that. I’ve used it extensively on a lot of my TMD patients, my Myofascial pain patients. They come in and I’ll start using biostimulation before even the Botox sometimes, or I’ll just use biostimulation alone and they’ll walk out of the office like, “Wow, you know, I feel so much better. The pain is so much less than when I walked through the door.” And so it’s just so incredibly beneficial in so many ways. So after I went through that training, it really opened my eyes.

Another thing that, you know, I still can’t figure it out and I don’t think anyone can really figure it out is, numb lips from the paresthesia that we get from third molars. It’s so great to have something that I could tell the patients, “Hey, you know what, just come in, let me try this. I’ll do a little biostimulation with this laser, it’s not going to be painful and we’ll see if it helps alleviate some of your paresthesia,” and it always seems to work. And I don’t know why it works. Every expert I’ve talked to, none of them really have a good explanation, but it does work. I don’t know if it’s just purely mental and the patients they automatically feel like the paresthesia has been relieved. It works so often that there must be more to it than that, and the depth of penetration of bone relieving the inflammation around the nerve. I mean all those things come into play but having something in my arsenal to treat paresthesia is so helpful. Especially in such an area like West L. A. Where you know the patients are very demanding. There’s a lot of competition. You need to be able to offer something that’s gonna make the patients very happy and make sure that you have very few complications post operatively. So some of those value-added procedures have just been a game changer in our office.

Marty Klein: I hear stories like that all the time of nerve paresthesia being reversed and the TMJ that you talked about. I do need to say from our end that biostimulation or photobiomodulation is an off-label or non-FDA-cleared use. I did want to circle back though:  one of the original reasons that you said you saw the PerioLase® as a potential benefit for your practice was implants. And I wanted to ask if you do find yourself using it around implants and if so, what have their results been?

Max Moncayo: Yeah, I mean, definitely my peri-implantitis cases. I’ve gotten some excellent results. The main thing is making sure that you have good keratinized gingiva. If you have good keratinized gingiva around the implant, even in the setting of peri-implantitis, I mean this is gonna work. If you follow the protocol, if you take the time, and that’s the thing that a lot of people I don’t feel do correctly. They don’t go back to their training and really take the time to do it right. This stuff does take time and you have to be patient. Let the laser do its work. But if you follow the steps correctly that you’re given in training it does work very effectively. But not only do that, but I also use it for my immediate placement of implants. I’ll you know extract the teeth and then I’ll go around the adjacent teeth. And then I’ll also decontaminate the extraction site with the Nd:YAG. I mean the success rate of our immediate implants is, I can’t tell you one last time we had a failure on immediate implant. I feel a lot of that is contributed to the fact that we decontaminate that area so well with the PerioLase® before even using any of the implant drills. So that has really been a benefit also.

Marty Klein: That’s an angle we don’t hear very often. So, I’m glad you pointed that out. I have one last question here and that is that you both came to training in 2018. You purchased one PerioLase® between the two of you, earlier you made a reference of our PerioLases, plural. I believe that means you purchased a second one and additional to that you had an associate trained in the GP practice. So I’m just, I can maybe fill in the blanks there, but I’d like to hear from you what led to expanding your offering, so to speak, in those ways.

Cerisa Moncayo: Well, just, I mean its utility, really. Just practically, when we have multiple providers in the same suite who needed it at the same time, because again, a couple of our hygienists are trained in it. So sure, we could just wipe it down and then roll it over to the other room and you know, just kind of time it. But there were many instances where we thought, “wow, it would be really, really helpful to just have two because we need them both right now in room four, [and] in room six.” So that was that was a big reason for it, really.

Max Moncayo: Yeah. And then, I mean when we decided to get a new associate and her seeing all these uses of this laser and not having experience with it, we really thought it would just increase her depth of knowledge by going through the training. Then just seeing how helpful it is for us and using that into her daily practice, and she’s just been so grateful for that. It really is a game changer for so many things that we struggle with every day, especially in general dentistry. Like I was saying, the isolation needing a little bit of crown lengthening. There’s just so many things, but then also having another provider in here that could do four quadrants of perio treatment at the same time. We can just expand our office to offer so many different levels of treatment and just increase the satisfaction of all of our patients, all under the same roof. So it’s really just been such a great asset to have in our office.

Marty Klein: Well, we sometimes refer to the PerioLase® as a Swiss Army knife, and it’s gratifying to hear from a provider or providers that seem to use it like that. So I want to wish you both continued success and also give a plug to your websites, which are beautiful by the way, there are two of them. The first is www.palisurgicalarts.com. And the other is www.thepalidentists.com. I’d like to invite any listener here to subscribe to this podcast if you have not done so, or all of our previous episodes are available at LANAP.com/podcast. Drs. Moncayo, thank you both for taking the time out of your day to speak with me today.

Cerisa Moncayo: Awesome. Thank you for having us Marty.

Max Moncayo: Thank you, really appreciate it.