Using the PerioLase® MVP-7™ to Treat TMD

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. Sathish Palayam, a general dentist in New Bedford, Massachusetts. Dr. Palayam received his DDS degree from the University of Colorado and has been a LANAP-trained clinician since 2013. Dr. Palayam, thank you so much for taking the time out to be my guest today.

Dr. Palayam: You’re welcome.

Marty Klein: So you first trained on LANAP and the PerioLase almost a decade ago. Do you remember how you were first exposed to LANAP and the PerioLase and then what factors led you to get trained?

Dr. Palayam: Yeah, so when I was in school, my chair for perio was none other than Dr. Yukna, who is the pioneer of laser dentistry today. And as I was seeing him unfold, a lot of his research that he had talked about, and in particular, I was intrigued with his treatment to, you know, abscessed ulcers and other dynamics of periodontal procedures. And as he was doing more and more of those, I was like, I really want to do this. So I got into his so-called umbrella. I started to know more about it and to the point where I told Dr. Yukna and I want to do it, and that’s when he said, okay, you gotta go to get into a BootCamp. And I signed up, I bought the laser, I got into BootCamp and I did evolution one through evolution five, and I went back to go and get more of my training done. That’s how it all started.

Marty Klein: So it was really a one-person referral. I mean, granted, he is a, he did one of the histology studies and is certainly luminary in the field, but you took his word for it and just jumped right in. Did you have any laser experience before that at all?

Dr. Palayam: None.

Marty Klein: Were you cautious or skeptical whatsoever or not so much?

Dr. Palayam: I was a little skeptical about the results at that time. There was just a few LANAP users. This is I’m talking 2006, 2007, and it was just evolving as one of a comprehensive treatment protocol. But as I said, you know, I really respect Dr. Yukna’s work and I’ve seen him very closely and very dearly and all he wanted is the best for me. So I think that getting to know about a little bit about lasers and particularly having him stamp on the fact that this is a very successful protocol, really wanted me to get into this.

Marty Klein: Now, did you expect to use the PerioLase primarily for LANAP full-mouth protocol, or were you already interested in the other applications perhaps of the Nd:YAG laser?

Dr. Palayam: Great question. So obviously the main go-to was a LANAP protocol, but I really like, I was intrigued with all of the other adjunct therapies that, this machine or this technology would help us get done. So a little bit about anesthesia-free dental procedures, like restorative procedures, simple, plastic procedures. And the biggest one of all of that was the TMJ. And I was like, okay, you know, this is something I really, really need to get into and see how this works out.

Marty Klein: Well, I definitely want to talk more about TMJ in a moment, but just to bridge the gap between training, you said you came to the first three days you started using it yourself. How did you get your feet wet? What were the clinical results that you started seeing in the immediate couple of first years?

Dr. Palayam: You know, what was I was fortunate about the fact that the Boot Camp was, so successful and I had real big names in my BootCamp in 2013, very big names. I was like, whoa. And I’m like, just one of the three general dentists was attending the Boot Camp. And the rest of them were periodontists and oral surgeons and everything. I was like, there’s big names out there. There’s something of value with this machine. So went back and I started using it and I was like, this is, this is easy. You know, this can be done. You gotta just trust the technology. And once you trust the technology, it’s gonna give us some success. From that point on, I started with doing multiple full-mouth cases. And I think when I was back in the second [training], and there were some very high-end questions, not just from me, but from all the other attendees, and they were all specialists and they were like, wow, this is really a game changer from user perspective and a lot of positive patient feedback, you know, they were like, wow. Now this is so much far from the barbaric procedures that they were exposed to, especially with traditional periodontal surgery. And I felt like, you know, this is like, they probably would do it another time. And then the second time, I saw more and more patients signing off on this treatment plan. And that’s really what I saw after the first BootCamp. And as they rightly said, like, you know, patients are gonna be less traumatized, I would say least invasive procedure and probably comparable results with traditional. And then of course you would see those radiographic evidence of procedures done after six to eight months, but soft tissue wise, I would see immediate results and patients would be like, wow, my, I feel my teeth already tightened up everything. I’m not bleeding. My gums are not bleeding anymore. So we would see those quick transitional positive results within the first step, few weeks itself.

Marty Klein: So, your expectations were fulfilled, at least your initial expectations. So I want to get into other ways that you have used the PerioLase you’ve already seen great one LANAP success at this point. I did see on your website that you combine LANAP with CBCT, or cone beam, computed tomography. Tell me more about how those two go together, if you would.

Dr. Palayam: You know dentistry has really evolved over the years, right? I mean, CBCT has become an integral part of my practice and starting to compare CBCT-based protocol, especially periodontal diagnosis or any kind of diagnosis for surgical procedures. I see the advent of a proper diagnosis, and I would say a bullseye view of how the treatment is gonna be, and the outcome can be. And when you are introducing other adjunct and like LANAP lasers, and you do a postoperative CBCT, especially a year, year and a half after your first time, you’ve used a LANAP protocol, you are starting to see a mountain of bone that’s starting to get formed. You know, there is proper evidence, more radiographically, and that supports all of the scientific data. That’s been out there with respect to this procedure. And that’s why I felt like sometimes when you take a single periapical radiograph, the angulation matters position of the tube matters how the assistant took the radiograph matters, but CBCTs can be pretty effective and you can really overlay the pretreatment dicoms to the post-treatment dicoms. And you see pretty significant algorithms that are out there that shows you the growth of bone. And that’s pretty convincing to the patient as well.

Marty Klein: Yeah. It’s easier to see for sure. If you can really see it in real time.

Dr. Palayam: So true.

Marty Klein: So you gave a lecture at one of the LANAP study clubs, and this is now getting back to TMD because that was the subject of your lecture. So I’d like to get into that area a little more, both how you started to use the PerioLase in that area and then how that study came to be.

Dr. Palayam: Yeah. So the first part was, it was actually the AAP convention, and I was asked to talk about TMJ because that was a growing concern and a growing protocol. And there’s not much information out there. And that’s when I was like, okay, I need to put a good slideshow together because I had started to gather later a lot of data by then probably far close to 34, 35 patients that I’ve been following through my, in my practice. So that being said, we understand that a Nd:YAG laser has an affinity towards inflammation or inflamed tissues. We also understand the concept of photobiomodulation or biostimulation, but then how do we put it all together? So every time you spoke to a chiropractor or a PT or any of those professionals, they would use some sort of laser to really alleviate pain and discomfort for pain patients, whether it’s back pain, back spasm, neck spasm, any kind of spasmodic conditions. And I was like, okay, so what can we do to put the same principles into our most advanced concern, which is a TMJ pain or TMD, which is a temporomandibular disorder. There’s not been much done in this category of our treatments. And that’s when I start to introduce either a hybrid technique or just exclusive for biomodulation. And I started to biostimulate patients coming in with excruciating pain and leaving the office with, you know, maybe minimal to no pain. And I was like, what is this magical? Or is it just coincidental? And I started to say that, okay, we gotta do more and more of those patients. And I would start to, biostimulate my staff, I would start to biostimulate my family. And I was like, this is real, you know, and this needs to really get to the point where we need to record some data, do some research and come up a set protocol that’s successful. And that could be used in pretty much every clinician’s hands

Marty Klein: Sounds like before, the options were limited. I should also point out here that biostimulation or photobiomodulation are not an FDA-cleared use for the PerioLase, but certainly one that many clinicians are using. And I’d like to hear more from you from the patient’s perspective, how it works, what is the patient’s perspective on the treatment? Is it a one-time treatment?  Is it a regular thing?

Dr. Palayam: I’d like to answer your question in two parts. The first part was how you talked about there really is not much out there treating TMJ. So basically it’s palliative. You either manage that pharmaceutically. You’re talking about ibuprofen. So you’re talking about gabapentin, you’re talking about serious other agents and all also, you’re talking about using an occlusal guard. You’re talking about Botox injections, things like that. But, you know, as we know, Botox injections have a shelf life, they can sustain their effects for maybe first few months and they gotta go back and get it done. The fact here is that it’s a non-invasive, non-contact mechanism and the beauty of this protocol is its immediate effect. I’m talking literally in what, 15 minutes. So you can imagine that this is a treatment where the laser is on steroids and the, in the literal sense where using that light to treat the inflamed site, and immediately you could see the muscles that respond treatment, how often you would get that kind of relief. The only way to do it is to basically use local anesthetics to numb the patient. But you are just, you’re treating the surface of the problem. You’re not even treating the core problem, which is inflamed tissues. And this Nd:YAG laser in particular has an affinity at the vain that we use it at has a deep penetration to the point where it goes to the core of the muscles to reverse the biochemistry there, to be helping the patient. So patient comes in, we diagnose the problem. We are telling them, look, you know, we are using this non-contact procedure. We go, it’s going to be a good, maybe 45 minute procedure. And once we have identified those trigger points on either side of the jaw, we start to biostimulate them and I am not changed or modified much of the protocol because believe it or not, every single time it has worked. Every single time we do a pain scale study. We have the patient explain to us where are they at with respect to pain. And when people come into the office with eights and nines and tens out of a 0-10 pain scale, they’re walking out of the office with twos and threes with better mobility of their jaw bone, with their better opening of their jaw. And they’re like, wow, this is this really happening. That’s the kind of reaction I get all the time. And the better part of it is once you have met the patient for consultation, you’ve explained them the whole protocol. You’re not even in the operatory, the next few appointments, you’re actually having your staff members do it because you’re training your staff to set up the protocol. You just say, hi, how are you doing today? They’re like, oh, it’s much better than the day I walked in. Here we go. Sonia’s gonna be in the operatory. She’s gonna help you to leave some more pain of yours. And there we go.

Marty Klein: Sounds like there’s really no downside. And, and I didn’t even think of that last part. It’s not a surgical treatment. It can be done with an apparatus to keep it at a safe distance, and you haven’t resected anything. There’s no invasive anything about it. And yet you’ve seen it have profound effects. That’s fantastic. Are there any other ways that you’ve used the PerioLase?

Dr. Palayam: Yeah, biopsies, fibroma removals, excisional biopsies. I have done carries removal with [it]. I have used [it] for removing pigments, like deep pigmentation procedures. I have used [it] as a blast technique, especially when I’m placing the implant or something. As soon as I’ve done my osteotomy, I go with the laser to decontaminate the site, if you may. Let’s see. I mean, I can go on and on. I mean, I, one thing for sure is that I’ve squeezed that technology to its max capabilities. For sure.

Marty Klein: Maybe Dr. Yukna undersold the PerioLase!

Dr. Palayam: I guess so. Yeah.

Marty Klein: Well, I appreciate you telling us more about how you use your PerioLase and especially the good work you’re doing with the TMJ procedures. I do want to give your website a plug for anyone who would like to learn more about your practice and that’s www.aarohidental.com. If you are listening here and you have not yet subscribed to the podcast, please do so anywhere you download your podcasts, or you can listen to any of the previous episodes on our website www.LANAP.com/podcasts. Dr. Palayam, thank you again for being my guest today.

Dr. Palayam: Absolutely. My pleasure. Thank you.