Using the PerioLase® MVP-7™ and a microscope together

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. John Leitner, a general dentist in Grand Haven, Michigan. Dr. Leitner was born and raised in Grand Haven, earned his DDS degree from the University of Michigan, and after some time practicing in Pennsylvania, has been practicing in Grand Haven since 1990. Dr. Leitner, thanks so much for being my guest today.

Dr. John Leitner: Well thanks for having me, I’m happy to do this.

Marty Klein: Wonderful. You came to training on the LANAP® Protocol in 2008, so I’d like to have you first start by telling us your LANAP® story from the very beginning, your initial thoughts, how you first heard of it, and what made you incorporate it into your practice?

Dr. John Leitner: Well, before I got the laser, I became a member of AMED, and that’s the Academy of Microscopic Enhanced Dentistry, and we have a yearly meeting at that time was out in Arizona and different exhibitors are there at the meetings. I think the first year I was there, there are these guys with this big box. I think it was called the laser, something like that at the time. And I thought, “I don’t need that, I can’t use that, it’s too expensive.” I went through that whole mindset. I think on the second year that I went to the AMED meeting I got more serious about it ‘cause I went home and did some math and looked at my numbers for the amount of periodontal treatment I was sending out and I thought this makes sense to do this. And I wanted to provide that for my patients. I thought I could do it in-house.  So I think it was the second year I went back from the AMED at meeting. I thought, “Nope! I’m going to do this,” and never looked back since. So it’s been a great, as I say many times to my patients, it’s a wonderful marriage between the microscope and the laser, as far as treatment goes. I always say that you can only treat what you can see and the laser is so wonderful for opening up areas around teeth and with the microscope, I can really see exactly where that calculus is, what the problems are. So it’s been a great enabler for the laser in my practice.

Marty Klein: So I’ve asked that same question to everyone who’s been a guest on the podcast about how they first heard of it. And you’re the first person to have heard of it at a microscope meeting. Did you make that connection in your mind right from the start of how the two could work together?

Dr. John Leitner: No, no. I was still kind of a rookie with the scope. I’m kind of a slow learner. No I didn’t really, well I knew how the microscope helped me with so many other procedures, but I didn’t really understand how it would affect my ability to use the laser. On one of the classes, Dr. Gregg did have a microscope up there and that’s when I really the light bulb when I thought “Oh this this is this is really dynamic here.” So ever since then I do everything with the microscope and the laser has been I keep saying, “Give me a telephone, a hand piece, my laser, and microscope, and I can do anything in my office.”

Marty Klein: We haven’t on this podcast talked much about microscopes. I’m hoping you could really illuminate how exactly it works or rather how LANAP® is made easier for you with a microscope. You mentioned that you can only do what you can see. Can you tell me more about that?

Dr. John Leitner: I do remember in the class I was getting around the backside of 2 and 15 with no problem. I was sitting upright, I was comfortable. Other guys in the class were looking like, “Wait a minute. How do you get back there on the backside of 15 like that?” It’s just, you know, I’m comfortable, my stress level is way down because I don’t have to contort myself to see what I’m doing. It’s magnified and it’s well lit. All these different factors make a difficult procedure much easier to do, and I feel much more precise with my actions of what I’m taking care of.

Marty Klein: Would you call a LANAP® difficult procedure?

Dr. John Leitner: That’s a good question, because it depends on the patient. There are some times I’m really stressing to get things done accurately. Other times some patients are a lot easier. So it really depends on the patient, but as far as stress, it’s actually fun.

Marty Klein: What part of it is fun?

Dr. John Leitner: The whole procedure. I like the fact that people come back that have had periodontal surgery in traditional offices and they’re scared stiff to have the laser done. When they come back they said that was a piece of cake compared to having traditional periodontal surgery. So it’s wonderful because you know, you’re not hurting people and you’re doing a wonderful service. In my office we kind of tongue-in-cheek call it voodoo dentistry, because I still am amazed, even though all these years I’ve had it, the results that we get. I have not referred out one patient for what I call garden variety of periodontal disease since I’ve had the laser. It just, it works and I keep telling my patients it’s like a baseball being hit. The batter comes up, hits the ball, but he follows through. So we’re hitting the ball with doing the laser procedure, but you’ve got to follow through. The patient’s got to follow through and if the patient follows through, I can’t guarantee my work, but I have not had to redo anybody at this point. We’ve just had phenomenal results and it’s fun.

Marty Klein: So you came to training 2008 and I think I read that you did 60 cases in the first two years that you had it. So there must have been something that was a light bulb when you first got back to your practice to start pitching this to patients. Was it easy right away to treatment plan this?

Dr. John Leitner: Well, there’s always the question…I took over my father’s practice and a lot of people say, “Your dad didn’t say anything like that and you didn’t say anything about this beforehand, why are you hitting me with this gum problems I supposedly have right now?” So I certainly did have the typical usual resistance. As you learn new procedures, new protocols, you also learn there’s more going on with that patient’s mouth than you originally knew or thought. But I did get resistance. I had some patients that were not happy with the whole thing, as far as introducing it, like, “Oh, well, you know, I understand cavities, but I don’t understand periodontal disease.” People many times get very emotional in the chair about periodontal disease. Where if you tell them, “You are gonna lose a tooth because of cavities,” its “OK, fine,” but, “You going to lose all your teeth because you have periodontal disease.” That’s a different ballgame. That’s a different ball of wax, and people respond emotionally much different to periodontal problems than they do to caries, at least in my practice.

Marty Klein: You mentioned just then that you took over your father’s practice and you told us when you first came to training that one thing he said to you is not to be too concerned about caries, but soft tissue problems you really need to study and treat that. Has that advice help shape your practice?

Dr. John Leitner: Oh yeah, very much so. We’re very preventative as much as we can be. I live in the area where the dental IQ is pretty good and we do have fluoridated water. Certainly I do see cavities, certainly. People are keeping their teeth longer but then having gum problems as a result of neglect or bad advice or whatever. So, I do have people search me out on the internet, coming to my office specifically for the laser procedure. So people do seek me out.

Marty Klein: Yeah, I do hear that a lot. It sounds like you had a nice patient base, maybe a little bit harder to persuade to get LANAP® done, and then now you’re getting a lot of external referrals, or maybe just being a LANAP® dentist is helping?

Dr. John Leitner: That’s true. Quite frankly, the laser is so successful that I don’t have that much perio in my practice now as far as patients with periodontal disease. If I do have somebody, it’s somebody who’s been well informed about laser and has refused treatment. And that’s their right in my viewpoint to refuse treatment if they so choose, but they’ve been well educated. We’ve had some patients that after a period of time. “OK. Yeah. OK. Let’s do the laser. You’ve been telling me about this for 10 years now or whatever.” But most of the PerioLase® that I do now are new patients.

Marty Klein: Just on the whole – and you can get specific on a particular patient if you would like – but do the clinical results help? You’ve seen the clinical results, but have the patients themselves understood that this is a good solution for their periodontal problems?

Dr. John Leitner: It starts with the fact that they have minimal pain generally. So they’re very happy about that. I think it’s a whole-mouth procedure. I want to say a whole body, but that’s not really true. But it’s a whole-mouth procedure and between their mouth feeling better, less bleeding gums, their bite feels better… It’s been really kind of life changing for some of my patients.

Marty Klein: We talked about microscopes earlier but a couple of other technology points I want to hit on here. I know you use T Scan as well as JVA or Joint Vibration Analysis to help with precision occlusal adjustment and TMJ issues. Can you tell me a little bit about how that relates or dovetails with the LANAP® Protocol?

Dr. John Leitner: Well I feel very strongly I had a pretty strong occlusal basis as a lab technician. But I do think the occlusion is a huge part of the whole success of the procedure and I just felt that with bite paper I wasn’t getting the precision that I needed. When I found out about the T Scan, I actually think it was at one of the LANAP® classes I found out about T Scan. I thought, “Oh!  If I’m really gonna continue with my precision here this is something I need to use.” The T Scan and JVA for that matter… JVA is more diagnostic. The T Scan I use for actually treatment. But it’s really boosted my confidence in adjusting the bite and I think I’m getting better results with my LANAP® procedures long term balancing the bite with the T Scan.

Marty Klein: Well indeed, occlusal adjustment is an integral component of the protocol.

Dr. John Leitner: Huge.

Marty Klein: Let’s talk about other procedures. I know you’ve mentioned that you use your PerioLase® for a couple of other things. Can you tell me about that?

Dr. John Leitner: There’s hardly a day I’m not using the laser in some kind of mode. I really don’t do that many root canals in my practice, and I’ve not really used the laser for root canals, but I certainly use it instead of packing cord. I’ll ablate some of the tissue for crown preps or a really deep restoration that goes sub-G, and I can’t get a band on there. That really helps tremendously.

Marty Klein: So we’ll just wrap up here with a retrospective. Just looking back, you’ve been using your PerioLase® for 13 years, and can you remember what it was like without it? Or any final thoughts, I suppose, looking back being a LANAP® doctor?

Dr. John Leitner: Well I guess in a lot of different ways I do have quote-unquote a “high-tech” office, but the laser and the microscope certainly are the two main things that I’m constantly using. Gosh, I don’t know….without the laser…I hated the electrosurge. The laser is so much cleaner and easier and people don’t get as sore with it.

Marty Klein: Well, I would guess that the outcomes are wildly different also.

Dr. John Leitner: Yeah. Yeah. Yeah. Things are so much cleaner with the laser. I use a lot of… oh I’m sorry, going back to other uses. I use it a lot with extractions to help cauterize and clean the area. Whether I’m using bone grafting or not it really can help, especially patients that are on anticoagulants. I don’t worry about them bleeding all night long. So that’s one of the other big uses I use it for with extractions. I’ve used it on different infections that patients have come in. I’ve lanced and IND’d different lesions and I’ve used the laser with those issues. I even had one patient that had paresthesia from an extraction of a third molar that I had done years before, and we did some biostimulation with it and the feeling came back. I couldn’t believe that one, but that truly did happen. So I’ve used it for other things also. But no, I’ve really enjoyed using laser. It’s been a big part of my practice.

Marty Klein: Well, fantastic. I do have to throw in that biostimulation is an off label, or non-FDA cleared use, although I have heard so many stories just like yours there of nerve paresthesia coming back. I never get tired of hearing those. I do want to thank you for being a part of our podcast series and sharing your ParioLase successes. I also want to give a plug to your website. If any of our listeners would like to learn more about you and your practice in Grand Haven, Michigan. The website is mymichigandentist.com. I’d also like to remind our listeners that all of our podcast episodes can be found at lanap.com/podcast. And you can, of course subscribe wherever you download your podcasts. Dr. Leitner thank you again for being our guest today and sharing your story with me,

Dr. John Leitner: Thank you for having me!