The art of perio

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. David Goteiner, a periodontist in Chester, New Jersey. Dr. Goteiner earned his DDS from Columbia University and completed a three-year research fellowship in periodontology and oral medicine at Harvard University. He currently serves as a clinical professor in the Department of Periodontology, as well as Oral Medicine, at Rutgers University, among many other accomplishments. Dr. Goteiner, thanks so much for being my guest today.

Dr. David Goteiner: A pleasure.

Marty Klein: On this podcast, we like to have LANAP® clinicians start by telling us the first part of their LANAP® story. Now, in your case, I know that Rutgers actively teaches postgraduate periodontal students LANAP® as part of their program, and you were trained initially in 2015. Was your training related to that initiative? And if so or if not, how did you decide to get trained?

David Goteiner: Well, just to correct you. I got my training in 2014. But I must tell you that one of my former graduate students, who I now I consider my teacher, Dr. Lehrman, who practices in New York, when he graduated, he thought that periodontics, as it was practiced at that time, was a bit behind the times and so he took the LANAP® training. He and I, for some 5 to 7 years traded cases in which I did my classical surgeries and he did his LANA®P therapies, and it seemed that we were both getting good results. But his patients suffered less discomfort. It was for him at least, I thought, a more predictable procedure and that it was much easier to do in terms of stress for both the patient and the clinician. So I decided to do the course in 2014. When I had done the course and I had about a year behind me, I asked the chairman if he might consider applying to Millennium to start teaching the course at the university, which we did. I believe we started in 2017 or 18 and have not looked back since then.

Marty Klein: I see. So your involvement with LANAP® predated Rutgers involvement?

David Goteiner: Absolutely.

Marty Klein: And did you start seeing the same results that you had previously seen from Dr. Lehrman after you got trained?

David Goteiner: Well, the answer to that is yes and no, I am not as talented as that gentleman.  It is like any other thing that you do or do well, it requires a learning curve.

Marty Klein: Now your private practice website is ArtofPerio.com. I’m curious how you decided on that URL.

David Goteiner: I have an art gallery. I paint for enjoyment and I sell my work. I also give it away. And so my wife had suggested that I combine the two and call it Art of Perio.

Marty Klein: I noticed, too, in your background that in addition to your role at Rutgers, you have hospital appointments as well. And I’d like to hear a little more about that as a periodontist your role in the hospital?

David Goteiner: Yes, well, I am now an attending emeritus, so I do not have privileges there. I gave it up a few years ago because I picked up more time at the university. So my role there is now just giving didactic courses and, on occasion, attending meetings.

Marty Klein: Now you had mentioned the ongoing training of residents at Rutgers. Do you have involvement with that program? And either way, what are your thoughts about new periodontists coming out of school with LANAP® as a part of their curriculum?

David Goteiner: I do not have any involvement with the didactic portion because I am part time, but I do have involvement with the clinical portion and treating patients at the university. Am I a believer in the fact that students should be exposed to all forms of therapy that might assist the patient in becoming healthier? The answer to that is absolutely yes.

Marty Klein: And one of the areas that you teach is oral pathology. That is really critical to what we do with the PerioLase® and reducing bacteria. As a professor in that field, I’m hopeful that you can expand on your take on the ability of the PerioLase® to reduce bacteria in the mouth.

David Goteiner: That is a legitimate question. The PerioLase® can sterilize a pocket to a great degree, but you can expect it to re-populate. It is an easier way to do it than to do scaling and root planing, an open-flap surgery, or open debridement. What counts once you’ve sterilized the pocket is maintaining a healthy environment. So in those terms, I think that it is the less stressful on both the patient and the clinician in gaining that goal, than it would be to do the more aggressive kind of therapies.

Marty Klein: We have listeners who some are patients, some are doctors who are not yet LANAP® trained, or maybe don’t understand a lot about lasers in dentistry. I’m curious if your perspective and background on the different laser wavelengths can help to explain to some of our listeners who might not understand what separates the Nd:YAG type of laser from others. The PerioLase® MVP-7™ is, of course, an Nd:YAG laser. So could you tell us a little bit about the differences between lasers or what separates the Nd:YAG?

David Goteiner: I need to tell you, that’s one of my weak points, but I will share what I understand is that the 1064 wavelength is attracted to both pigmentation, which is an essential component of pathologic bacteria and inflammation, which is an essential component of periodontal disease, and that it is much more effective in treating those two, or the energy tends to lodge in that area. Whereas with other ones that they’re attracted to water or various other sorts of tissues.

Marty Klein: And over time have you seen the acceptance of lasers and periodontics exchange?

David Goteiner: I don’t have my pulse on the establishment per se. And the answer to that is that I have been, from former students, getting a lot more call to asking me about the system and what I thought about it. So I would say from a very small niche where I reside, the answer is yes, is it is becoming a more acceptable form of therapy.

Marty Klein: And lastly you participated in a study with one of the residents there at Rutgers, Dr. Strauss.

David Goteiner: Yes

Marty Klein: It was regarding the Nd:YAG laser and the treatment of peri-implantitis. So I’d like to hear a little more about that study and maybe what some of its conclusions were, if it is completed at this point.

David Goteiner: Well, we have just had our first paper – it’s divided into three parts – we just had our first paper accepted by the International Journal of Periodontics and Restorative Dentistry. We’re working on the second part, which is some different forms of data that we’re looking at in terms of age, sex, socioeconomic conditions, and a third portion, which is on the proteins involved in peri-implant curriculum fluid such as MIP one, interleukin one, alpha and beta, and interleukin 10. Those results, the latter, are not yet studied, but the first two are. So I will tell you the results are very nice, they tend to be a bit disparate. Statistically, there was no difference between those patients that were treated with lasers, versus those patients that were treated without the laser. However, there were individual cases that had remarkable results. We have to look further into the data to understand why we got certain responses. Also understand this, we took a lot of cases at the school which would not have chosen to have been treated and we included them in our study.

Marty Klein: And you mentioned that it’s been accepted for publication, that’s not yet available yet. So this is something that’s coming in the future?

David Goteiner: Correct.

Marty Klein: Okay, well, we will look forward to that and hearing updates about the remaining portions of that study. I did want to again point out for anyone listening your website, which is artofperio.com, for those interested in learning more about Dr. Goteiner and his practice. And if anyone listening here has not subscribe to the podcast, please do so, so that you don’t miss any episodes. All of the podcasts are available at lanap.com/podcast. Dr. Goteiner, thank you so much for taking time out of your day and sharing your expertise with us.

David Goteiner: Oh! My pleasure!