Lasers in dentistry–the journey of an early adopter and innovator

Transcription: 

Dawn Gregg, DDS: Welcome to Dentistry for the New Millennium. I’m Dr. Dawn Gregg, CEO and training director at the Institute for Advanced Laser Dentistry. And it’s my pleasure to kick off this podcast series with a conversation with Dr Robert Gregg, founder of Millennium Dental Technologies, program director of the Institute for Advanced Laser Dentistry, inventor of the PerioLase® MVP-7™ for the LANAP® Protocol, and who also happens to be my heart and soul mate and celestial love of my life. Today we’ll be discussing how Dr. Gregg first became interested in lasers, how the LANAP® Protocol came to be, and how lasers have been such a transformative force in his life and the life of so many other dentists, including myself and our patients. So let’s get started.

Robert H. Gregg II, DDS: Thank you, Dr. Dawn. This is Dr. Robert Gregg and thank you for tuning in. I think my story is very different than many of the other podcasts that you’ll be hearing from. That has to do with how I got my start – I got my start very early in the history of laser dentistry. Actually, before it became a field of study in science and then clinical practice. My first exposure to dental lasers was when I was at Georgetown in the 1980s, and I had an opportunity to meet the futurist and trend analyst by the name of John Nesbit. He authored the book Megatrends: 10 Trends that are Transforming our Daily Lives, and that was written back in around 1985. You can still find that at Amazon. I was meeting with him with my father, a physician, on some of the trends that were going on in medicine at the time. He then turned his attention to me and asked me what I was up to. I said, I’m a dentist training at Georgetown and he said, “Ah, lasers, young man, lasers!” just like in the Graduate. So I went to NIH library, which was just up the road from where I was living on Reservoir Road in D.C., Georgetown and up on Wisconsin Boulevard. I looked through the very primitive database searches and printed out some articles on lasers in dentistry. What I was able to digest from the abstracts I read is that the continuous-wave Nd:YAGs, and CO2s, and ruby lasers at the time did not have a means to control the heat composition or heat deposited to the tissue. In other words, the tissue could overheat rather quickly. So that’s not something we wanted to adopt in any sort of clinical practice at the time. And it wasn’t, but I tucked that little bit of direction from John Nesbit into my clinic pocket and remember to check in on the science as it developed over the next decade.

Then, in 1990 a company called American Dental Laser developed a pulsed Nd:YAG laser and my thought process at the time where, hmm what do I do with my need to expand my clinical horizons, my technical skills? Because I am five years out of school, I was feeling pretty proficient about the great number of the procedures I was doing at the time. There was only intraoral cameras and this newfangled laser thing, so I did my due diligence. I looked at the benefits, the advantages, the cost for the camera, and I did this thing for the new American Dental Laser Nd:YAG, and after meeting with Dr Terry Meyers at one of his seminars, I concluded that this had so much potential – untapped potential – to do clinical dentistry in a very new way and actually changed the way I interacted with my patients in terms of how they might heal, how I might accomplish my clinical objective. Whereas a camera allowed me to interact with my patients, but it didn’t change the way I actually touched my patients. And to me, touching my patients was, and is, a very important clinical interaction. And while it’s great to have a camera for communication, I felt my communication skills where adequate. But my technical skills that laser could do was something brand new, and all sorts of new clinical possibilities were on the horizon. So that’s my earliest background and how I got into lasers. It was really my own curiosity. I wanted to know what John Nesbit knew. Years later in 1997 or 1998, I actually got to meet John Nesbit once again. He didn’t remember our initial encounter, but I did tell him the story that I just shared with you, and it really did bring it all full circle to me, in terms of that initial exposure in awareness, research, investigation with John Nesbit the trend analyzer.

Dawn Gregg, DDS: So that’s how your interest in lasers got started. So I’m sure everyone is curious. How have lasers impacted your professional career and your life?

Robert H. Gregg II, DDS: Well, after I did my due diligence, I was at a trade show and went to the booth for American Dental Technologies. This was August of 1990. The price of the pulsed laser alone at that time was $50,000. Now, remember, this is 1990. You amortize that forward, you can take a look at current pricings today. And in August of 1990, their sales rep wanted me to put a deposit down. And Terry Myers didn’t know the story until I told it to him some 20 years later, in order to get the sales rep off my back, I pulled out my wallet and I said, “All I have is $20 cash,” and she says, “I’ll take it.” And that became sort of mythology within the company that I was the lowest deposit amount in the history of their company.

Now, I had the same excuses as many doctors do. “I really need to go home and think about it.”; “I need to go and check with my accountant”; all of which were really not accurate. Maybe a little bit of the bookkeeper might show me what my cash flow was. But, having credit cards at that time was not an issue. But I did want to think about it some more. And I did and ended up signing a deal. I don’t remember exactly my methodology of payment, but again, that was August of 1990. And for those of you who don’t remember and maybe those to do, that was the rumblings of a war in the Gulf with Iraq. And at the time that did not impact my decision. But what came after that in February of 1991 was the Gulf War, the combat aspect of that war. And I remember I was on TV cable news station recording that night, on the 17th of January, wondering of missiles were going to be launched while we were taping, and indeed they did shortly after.

Now that was my first experience with uncertainty with new technology. I’ve had an uncertainty before in the practice, starting with the October 1987 stock market crash, one of the biggest we’ve had in our history, so I’ve been through a couple of economic disturbances. But what I found was during the time I bought in August of 1990, and through 1991, with the disturbance in the saber rattling and while the actual combat in the Gulf War, I was able to offer our treatment that other dentists competitors, if you will, couldn’t offer and something that patients want. That became very insightful to me. It became very economically important to me, that while many people were stressed and worried about what was going on 10,000 miles away, I was actively practicing. At that time, I was doing the earliest version of the LANAP® Protocol and offering a treatment that patients preferred over conventional technologies. So that’s where that awareness came in that I still carry today, and I still believe that those that have laser-based technologies, especially something that has research proven success, such as the LANAP® Protocol and LAPIP™, can offer their patients. And their patients, are very excited to seek that out and participate in (this treatment).

Dawn Gregg, DDS: So the LANAP® Protocol, as you mentioned, it’s a multi-step treatment approach. How long did it take for you to develop it and refine it? And were there any memorable “Ah ha” or breakthrough moments along the way?

Robert H. Gregg, DDS: Yes, there were many memorable critical moments. I have said in the past that I borrowed, copied or plagiarized the Navy syllabus Professor Ray Yukna had written for the conventional scalpel ENAP protocol. The difference was, I was using a laser, fiber optic laser, to replace the blade. It doesn’t really replace the blade. It actually acts quite differently in that it separates the diseased epithelial lining from the healthy connective tissue bed. But the concept is what I borrowed, and I also improved upon it by adding occlusal adjustment and some other things that were in the protocol that make it, well, elaborate extensively on the on the protocol. I’ve since had conversations with Professor Jon Suzuki, and he tells me it was perfectly acceptable to plagiarize from the Navy syllabus as it was, and is, a government document, and they don’t own that copyright. So that gave me some relief, although Dr. Yukna has told me since he didn’t mind, given what’s developed since. So, that was the start of the protocol. I was also at the time doing something called Laser Curettage, which was nothing like what LANAP® is. Now we refer to that as hygiene laser disinfection, or laser pocket disinfection because it’s nowhere near as thorough as the LANAP® Protocol is.

There was a period of time when I worked with Dr. Del McCarthy from around 1991, Excuse me in 1994, to 1998 where we tried to improve upon the results that we found in initial protocol steps that I developed. We tried adding bone graft material, bio active glass, antibiotics, paraffins, lotions and potions and various different sorts of regenerative materials and Emdogain. And we found that nothing, other than the patient’s own modified blood in the protocol, did the job of being antiseptic and also sealing the pocket with a stable fibrin clot. Nothing else improved upon that, and it’s interesting that I know that others subsequently have tried different protocols, and they’ve realized that it doesn’t help as well. There was a four-year gap between 1990 and 1994 when Dr. McCarthy joined with me in my practice and then another four years before we had basically expired every other option. And we realized what we were doing in the end in 1998 that we were just putting foreign material, foreign objects that the body had to deal with, do something with, in order to get around to the actual healing event, which we’ve now come to know is true periodontal regeneration. So there were a lot of fits and starts, even a detour, if you will as we tried these other enhancements that were not enhancements.

But then ultimately, in 1998 we had a solid protocol, and to date there has been no changes in the protocol. There may be slightly different ways of improving upon some of the technology used in the protocol. So, you know, maybe this scaler, or perhaps a that tip that we use on the LANAP® Piezo scaler. But the 26 steps in the strict and defined sequence of the LANAP® Protocol have not changed.

Dawn Gregg, DDS: So you have this new technology that must have been exciting for you and what you had to offer to patients. It must have been a huge difference in how you could treat your patients.

Robert H. Gregg, DDS: Yes, further elaborating on that, as I started to use this protocol in a more defined and typical manner of treating moderate to severe periodontal disease, that is, doing quadrant periodontal surgery. As I started to appreciate the patients and what they were going through, I wanted to ask them a lot of questions. I wanted to know how they felt, what it meant to them post operatively. What they felt during the procedure post operatively, and in the days and weeks that came later. And I was very interested and sincerely interested. Many patients are used to giving us canned answers when we ask them, “So how did you do?” And they usually say something like, “Oh, I did fine.” And they are just trying to tell us what they think we want to hear. So I would say “No, I want really want to know how you did, what you felt.”

Once I opened up that conversation, I was in for the shock of my professional career. I heard about how deeply moved these patients were to in some cases deep spiritual comments and feelings and experiences, very deep emotional feelings and psychological feelings that they shared with me. Many of the responses that I got from my patients were very unusual, very exceptional, and very in depth – at a depth of sharing that I was not used, and not had before. And they were oftentimes emotional, several times spiritual, other times psychological. And I was uncovering some history with patients individually, but as a group that have had periodontal surgery in the past conventionally with scalpel blades. And they were deeply traumatized by that and some of the comments and stories I can’t bring myself to share because they’re, uh, very intense. But it changed the way I perceived patients and my patient care and how I approached my patients. I can give some obvious examples of one patient said, “I was told that I would need my gums cut again after conventional surgery, and I told him I would never do that again. I’d let my teeth fall out.” That was a common complaint. But what wasn’t as maybe a common complaint is the depth to which they were averse to having any conventional blade surgery done again. Very emotional, very intense, and very moving for me. And that’s what really started, if you want to think about it this way, the no cut, no sew logo. It was part of an advertising campaign in print that I developed so that I could tell patients in an informational way what sort of periodontal therapy I was offering. I was offering them a no cut, no sew option, and that was very powerful to patients. That really spoke to the patients. It was meaningful to the patients. They wanted that because they didn’t want the other way.

So that’s really what transformed the way I thought about dentistry and my role in it, my technology that I had purchased. I had no idea that what John Nesbit had shared with me so many years before was gonna have that sort of transformational impact on my practice, on my outlook, and on the patients that I was caring for. So in talking about how the patients responded, reacted, felt about this procedure, I knew I had something that was extremely valuable, and I was able to build my practice to a very high degree of income and profitability like nothing else before, because there’s very little overhead involved, other than cotton rolls and some anesthetic other than the original lease purchase. And it was easy to calculate what my return on investment was against a single lease payment purchase.

So what happened after that was a long period of time where I was making a lot of money and feeling very good about what I was doing, and helping a lot of patients that would not otherwise get help at all. And that allowed me to sleep very well at night, knowing I was doing well by doing good to borrow Dr. Bruce Baird’s phrase. So that went along quite happily for a while until patients started to ask me and us, “What are you doing to share this with the rest of your profession?” And my response was, “Well, I’m just trying to do the best I can for my patients, and I don’t think the rest of the profession cares anything about what I’m doing or have that what I have to say.” And that was my standard answer. Then, there were two patients in short succession, within maybe a couple of months, that asked the same question. “What are you doing to share with this?” And “how could my sister in Philadelphia get this treatment?” And I said, kind of cavalierly, “Well, she could just get on a plane fly out here and we can take care of her. We’ve had patients come from all sorts of locales around the world.” And she said, “Well, my sisters paraplegic, it’s very hard for her to travel,” and I immediately felt like a like a jerk. And that happened a second time. And then I felt, well, I better think about how I can share this and really was not prepared to do anything such as that. I was not a researcher. I was not a writer. I didn’t write scientific articles, and I certainly didn’t know the publication process. So I really didn’t know how they would share this. And, uh, I think that’s probably… what happened after, is a story for another podcast. It is what happened when I did figure out how to communicate this to the profession and then what that unleashed. Once that challenge was accepted to share, that’s when all hell broke loose. That’s when everything started to go crazy. That’s when my life was never the same. It already been transformed by the patients and that was wonderful. But my life essentially hadn’t changed. But what happened after that? After the first Dentistry Today article, and then everything that followed that was changed. My whole life changed, that changed everything.

Dr. Dawn Gregg, DDS:  Well, I love a good cliffhanger as I’m sure everybody listening to this does too. So we have lots to share with you, so I hope you come back to us again. In the meantime, we have several other clinicians to have things to share with you as well. We have a subscription. We love to have you sign up and to hear what we have to share every Monday.

Thanks for listening. And we’ll see you next time.