Case studies on waterlase in today's dental practice (2)


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Case studies on waterlase in today's dental practice (2)

  1. 1. Shareef Mahdavi ■ President ■ SM2 ConsultingCase Studies on Waterlase in TMToday’s Dental PracticeInvesting in Your Patients and Your Practice
  2. 2. A Tale of Waterlase MD Two Practices TM Case Study A s a dentist, have you ever wondered what it would be like if you could start all over again and build your dream practice based upon all you have learned over the years? Well, that’s exactly what Robert “Bo” Turnage, DDS did… after 23 years in clinical practice. His story offers significance for newly-Robert “Bo” Turnage, DDS minted dentists, established practitioners and older Friday Harbor, dentists verging on retirement. Washington After graduating from Loma Linda hovering at 80% of revenue. “My in 1982, Dr. Turnage purchased philosophy was that pumping more a small practice in Palm Springs, patients through the system would lead where he and his family lived for the to greater financial success. I had to next 10 years. With his wife and 3 work my tail off to keep the practice small children, he decided to forego on track and profitable.” What kept California’s fast-paced lifestyle and him up at night; however, were dual relocated to Ellensburg, Washington, “nagging thoughts.” His kids were a rural community between Seattle nearing the end of high school, and his and Spokane. Dr. Turnage bought an wife and he thought about relocating aging practice and spent the next 13 to their eventual retirement community, years building it into the largest dental “somewhere we could truly enjoy practice in the area. “We were ‘crazy natural beauty each and every day.” busy’,” recalls Dr. Turnage who, with At the same time, the pace of work was a 12-person staff, saw from 35 to 50 very stressful, even in a rural setting. patients a day. “We had 6 operatories “There had to be a better way.” and an in-house lab. But we also had Against the well-wishes of friends, old-fashioned equipment, including they decided to up and move once banana chairs, traditional radiography, again, to Friday Harbor, a community and air-driven handpieces.” in the San Juan Islands north of Over the years, his rural practice Seattle. During repeated visits to grew to production of $120,000 per Friday Harbor, they would ask locals month. “Not bad,” said Dr. Turnage, where they went for dental care. “What but his high-volume practice generated we heard consistently was, “can you tremendous overhead, which was get back to Seattle?” The Turnages2
  3. 3. Old Practice New Practice Description “High Volume, High Overhead” “Fewer Patients, Better Care” 6 operatories 3 operatories Structure 13 staff 4 staff No. of Patients per Day 35-50 8-10 No. of Work Days per Week 5 4 Monthly Production $120,000 $81,000 Time to Accomplish 10 years 5 months Overhead 80% 65% Typical Monthly Net Income $24,000 $28,000 Outlook Mature, Stable Infancy Table 1 – Turnagesaw this as an opportunity to bring a digital x-ray units and Pano, microscopesunique presentation of dentistry to and ceiling-mounted flat-panel TV/the community of 7,000 year-round monitors. “We took a risk, not knowing “Utilizing the laser, I can offerresidents that grows to 22,000 in if and when patient acceptance wouldsummer. Starting from scratch, Dr. be there in a relatively small community. better care to fewer patients.Turnage began to design a dental It was more expensive to start frompractice from the ground up. scratch, but I wasn’t handicapped by It’s a controlled environment They decided on an elegant harbor- outmoded equipment, systems or bad that also gives me freedom toview setting with Asian and European habits built in to an existing practice.”antique furniture, dramatic lighting and Indeed, the risk is paying off. enjoy a more relaxed lifestyle. Ilots of art. “We wanted patients to feel With only a small sign outside theirlike they had walked into a high-end building and four “conservative” no longer feel like I’m going tospa in Dallas or New York.” Next, they announcements, the practice isdecided to make high technology the attracting both high-end and working have a heart attack.”focus of their practice as well as the class patients. “We have not onlydifferentiator in the community. “We attracted ‘dot-com millionaires’, butalso wanted patients to feel that they also long-time residents who are incould get the highest level of care many of the service industries. Wewithout having to travel.” To accomplish also kept our fees reasonable tothis, they started by purchasing a laser. create even more value to our high-“The Waterlase MD TM has become the tech approach.” They opened theircornerstone of our high-tech patient doors in May 2005 and business hascare approach,” noted Dr. Turnage, exceeded expectations. After 5 months,who has also employed an additional they are averaging 53 new patientsBIOLASE LaserSmile TM diode laser, per month. Production is at $632 per Investing in Your Patients and Your Practice 3
  4. 4. A Tale of Two Practices (continued)Both staff and patients enjoy hour and growing steadily. In contrast The reduction in overhead creates to the high-volume rural practice, Dr. net income that far exceeds the lower the benefits of the laser. Turnage sees 8-10 patients per day volume of patients. “Utilizing the laser, utilizing a smaller and simpler structure I can offer better care to fewer patients.“My staff really appreciated that leverages technology. The lower It’s a controlled environment that also overhead (now at 65% which includes gives me freedom to enjoy a morethat the ‘old dog’ was willing some equipment financing) has allowed relaxed lifestyle. I no longer feel like more money to drop to his net income I’m going to have a heart attack.” The to learn something new. line with only two-thirds the production Waterlase MD technology has greatly required by his old practice (See Table 1, contributed to this being possible.It motivates them to achieve Figures 1 & 2). “The ability to practice dentistry with a higher standard.” Figure 1 Average Hourly Production and Revenue per Patient Visit New Practice vs. Old Practice $800 $700 $714 $600 $633 $500 $400 $405 $300 $200 $100 $24,000 $0 Old Practice New Practice Hourly production Revenue per patient visit4
  5. 5. For others like me who have been in practice for 20 plus years, the laser gave me a new sense of pride in my profession as well as the ability to offer better patient care.”a laser is hugely different, better and took some time to learn, but it’s a lot Figure 2more fulfilling.” From bleeding control, more fun, it can do things I had never Average Monthly Productionto treatment options, to post-op pain thought possible and I now make them vs. Net Incomecontrol, to periodontal, endodontic, part of my everyday practice.” with the Impact of Overheadsurgical, and restorative procedures, Dr. Turnage says his experience $140,000Dr. Turnage is doing things that starting over, “where no one knows yourpreviously often required referral to name,” has helped debunk his previousa specialist or simply were much less belief that a successful practice depends $120,000predictable. “Using the laser means heavily on longevity in one community. $120,000fewer complications afterwards and “I now have time to do the simplemuch less post-op pain.” but important things,” which include $100,000 Both staff and patients enjoy the developing a personal relationshipbenefits of the laser. “My staff really with each patient, lunch with his wife, $80,000appreciated that the ‘old dog’ was a phone call to his son at college, or $81,000willing to learn something new. It extended staff meetings to review issuesmotivates them to achieve a higher and opportunities. His advice to other $60,000standard.” And patients, who are dentists can be applied to new andhearing about this laser around established practitioners. “For the new $40,000town, quiz the staff before seeing dentist, you now have the opportunity tothe dentist to get the inside scoop. go ‘high-tech everything’ and you shouldThey ask questions like, “If the laser do so. The improvements in efficiency $20,000 $28,350 $24,000gets bumped while the doctor is and effectiveness are incredible. Forworking, will it cut off my tongue?” others like me who have been in practice $0The reaction from other local dentists for 20-plus years, the laser gave me a Old Practice New Practicehas been mixed: “Some embrace the new sense of pride in my professionlaser and recognize its potential while as well as the ability to offer better Gross Productionothers seem skeptical that it could patient care.” And he wants to serve asbe applicable to their style practice.” a role model for dentists contemplating Net IncomeOne informal metric has been the retirement: “I am determined that when Iincreasing frequency of the faxing of retire, my practice will be technologicallypatient release forms to other dentists, current for the new dentist.”which is occurring multiple times each With a view of the harbor from bothday. “Patients are actively seeking this his home and his office, Bo Turnagetechnology!” exclaimed Dr. Turnage, has turned his dream into reality, with awho likens his new practice to switching five-month old practice literally “in itsfrom driving a Cadillac to being in the infancy.” And he’s certainly proven toseat of a Formula One race car. “Both himself that the third time around isare automobiles, and the new one the charm! ■ Investing in Your Patients and Your Practice 5
  6. 6. Take this job Waterlase MD Case Study TM and Love It! B y the end of 1999, Dr. Bruce Cassis had spent 19 years building a successful rural dental practice in Fayetteville, West Virginia. “Being of service to people in a positive way” is how Dr. Cassis describes his philosophy. But he was also exhausted enough by the daily routine to admit “this job stinks!” and instruct his staff “don’t ever schedule another kid in my office!” Dr. Bruce Cassis Fast forward to 2005...Dr. Cassis has Immediately, however, he began Fayetteville, had his Waterlase TM since late 2000 and generating more revenue and West Virginia work life is described differently: “I’ve procedures with the laser. “We never been happier or more satisfied introduced it to patients whether we as a dentist. My TEAM — they’re not were going to use it on them or not. staff — looks forward to work every And as a practice, we used the laser as day and we have no more long faces. a business opportunity rather than just “I believe that laser And I’m doing the best kids’ dentistry open the door and see what happens.” imaginable.” In fact, his office has As shown in Figure 1, net collectionstechnology will become become a long sought after place of have more than tripled when comparing employment in the community. calendar year 2004 to the same year in ‘the standard of care’ What happened? “The laser 1999. And 2005 is shaping up to be a in the next 5-7 years. changed everything,” Dr. Cassis stated record year with production forecast at emphatically. Early in 2000, Dr. Cassis $2 million, putting Cassis Dental Center The laser is much more attended a lecture on dental lasers in in the top 1% of practices nationwide. Charleston led by Dr. Bill Chen. “I got What might be surprising is thataccurate and can pinpoint it immediately as I was really interested Fayetteville, West Virginia has a in soft tissue applications. My cousin population of 2,000 people. The tissue much better than Steve (an ophthalmologist) had long practice draws from 3 counties and been using lasers for eye surgery and has an active patient base exceeding a burr.” asked ‘can’t you use a laser in the 5,000 people. “We are well known mouth?’ Here I am using scalpels, which for pampering our patients, who I didn’t like because it’s painful for the are everyday, hardworking people,” patient and full of complications.” He commented Dr. Cassis. His patients made his decision that night and was range from two years of age to 102. the only one of twelve attendees to This is in keeping with his practice invest in a laser. “Like my colleagues, I philosophy of a “lifetime of care” for was initially thinking about ‘cost’ more people’s oral heath. The practice has than ‘ROI’.” taken the time to understand local6
  7. 7. Table 1 – Cassis – Change in Procedure Mix & Production 1999 vs. 2004demographics and employment trends. % Change $ Change CDT Code # in 1999 # in 2004Dr. Cassis noted that 75% of residents Volume Productionin his county own their homes; the 2330 Resin 1, Anterior 54 108 100% +$6,710practice has also successfully connected 2331 Resin 2, Anterior 34 72 111% +$5,947with employee groups in the area. 2332 Resin 3, Anterior 32 59 84% +$7,065Creating affordability through patient 2335 Resin 4+ Surface, Anterior 25 30 20% $3,149financing vendors such as CareCredit 2380 Resin 1, Posterior 11 1 –91% –$692(Costa Mesa, CA) has also had a major 2381 Resin 2, Posterior 14 3 –82% –$790impact. “We have figured out ways 2385 Resin 1, Posterior 187 413 120% +$44,709to find money for people who desire 2386 Resin 2, Posterior 160 31 –81% –$17,651our services. This is a huge part of our 2387 Resin 3, Posterior 50 240 380% +$36,035revenue.” 3426 Apecoectomy 2 10 400% +1,231 Dr. Cassis has closely documented 4211 Gingivectomy 5 16 220% +$2,178the types of procedures and frequency 7110 Extraction 120 194 62% +$12,224with which they are performed. As 7210 Surgical Extraction 26 74 184% +$10,329seen in Table 1, there has been a 7280 Surgical Access Unerupted 5 2 –60% –$654dramatic shift in the procedure mix 7286 Biopsy Soft Tissue 1 10 900% +$1,673since implementing the Waterlase. His 7340 Vestibuloplasty 2 3 50% +436experience has led him to work both 7960 Frenectomy 6 23 283% +$5,554as an instructor for BIOLASE as well 4240 Gingival Flap Procedure 0 3 NA +$1,494locally as part of West Virginia’s RuralHealth Education Partnership. In that “If you understand a half a dozen This story is part of the messageprogram, dental students from West basic concepts, you can use the laser that Dr. Cassis wants to get out toVirginia University’s Dental School come immediately with a live patient.” What dentists everywhere. “I believe thatthrough for a six-week rotation. Dr. impressed Dr. Cassis even more was laser technology will become ‘theCassis gives them a half-day training the response of his student: “It was standard of care’ in the next 5-7 years.session specifically on the laser. His awesome. I did the same things I do at The laser is much more accurate andmost recent student was trained in school with the drill. The patient asked can pinpoint tissue much better than athe morning of her first week and me, ‘have you started yet?’ after I had burr. I’d jump all over this if I were andoing laser dentistry in the afternoon. completed the procedure.” older dentist, as it makes procedure easier to do. Younger dentists have theFigure 1 opportunity to really change the courseBusiness Performance 1999 (no laser) and 2004 (with laser) of their career.” In fact, colleagues who$1400 were referring patients to him because the laser could solve the problem are$1200 $1,300 now investing in their own unit. “This is good, because it raises the level of care$1000 in our community.” $800 Dr. Cassis is grateful for what the Waterlase has done for his practice and $600 $697 his patients. “On behalf of the eight people who work here – our TEAM - I $400 476 can say that the laser has changed each $411 $302 of our lifestyles by helping us be more $200 253 $233 successful at what we do.” Looking $145 back at his decision to get into laser $0 New Patients Net Collections Average Production Average Production dentistry, he offers this conclusion: “I’m (thousands) per Patient per Hour a much better dentist than I was six 1999 2004 years ago.” ■ Investing in Your Patients and Your Practice 7
  8. 8. Dentistry: The Perfect Combination ofWaterlase MD Case Study TM Surgery and Art L inda Kronick, DMD is one of those dentists that you just want to get to know better. With a family practice in Norwich, Connecticut that focuses on high tech dentistry, her passion for the profession is a reflection of how she lives:“I love people and want to make them happy.” As a young adult, Dr. Kronick saw in the laser was showing up in daily dentistry as a means of combining two in her expanded use of the WaterlaseLinda Kronick, DMD strong areas of interest: surgery and art. MD with her patients. With a focus Norwich, Growing up, in the same town where on restorative dentistry, she is finding she now practices, Dr. Kronick spent the laser much more efficient in doing Connecticut time learning how to paint and also minimally invasive composite resins worked in a surgical practice. and she routinely uses it for troughing, She first learned about dental lasers in lieu of packing retraction cord, prior while working in the surgical practice to final impressions for crown and observing CO2 lasers being used in bridge procedures. “Doing additional general and oral surgery. She eventually procedures, at the same visit, in the had the opportunity to take courses and same or different quadrants are made see exactly how the laser could work easy with the Waterlase MD. Patients with both hard and soft tissue. “I was are grateful to have one visit rather spellbound and knew I had to have this than several to complete their dental in my practice.” treatment. That’s a plus for everyone, In late 2004 she made the decision doctor and patient, in this busy world.” to purchase the Waterlase MD TM In addition, she is doing periodontal (BIOLASE, San Clemente, CA) and had procedures that she used to routinely it installed to start the New Year. “It’s refer out. “Four perio procedures, that blown my expectations away,” noted she performs routinely, have generated Dr. Kronick. “There is so much that I’m $38,000 in additional revenue so far, doing and so much more to learn.” As and I’m just getting started (see Table her experience and expertise grew over 1: Periodontal Procedures Performed several months, Dr. Kronick’s confidence In-Office).” With the ability to do crown Table 1 – Periodontal Procedures Performed In-Office via YSGG Laser DPT Code Crown Lengthening 4210 Gingivectomy 4211 Mucogingival Surgery 4299 Laser Assisted Scaling 42508
  9. 9. Figure 1 – Monthly Production, 9 Months YTD, 2005 vs. 2004 YTD Revenue such as the WCLI (World Clinical Laser 2004: $614,000 Institute) and meet other dentists who$120,000 2005: $753,000 Growth 23% will share their laser experiences with 2004 2005 you. You will learn a lot, because the$100,000 lecturers are approachable and aren’t $80,000 ‘prima donnas’”. Dr. Kronick speaks with authority here, as she lectures to $60,000 dental students at the University of Connecticut School of Dental Medicine $40,000 on restorative procedures. Has the Waterlase MD been a $20,000 good investment? Dr. Kronick offers an unqualified “definitely yes” on $0 Jan Feb Mar Apr May Jun Jul Aug Sep multiple levels. First, she paid off herlengthening procedures at the same laser. “They love raving about it to laser via additional revenue withintime as crown preps, “one can impress our patients,” added Dr. Kronick. The 6 months of purchase. Second, thisimmediately following the surgery with practice philosophy has always been device compares favorably to otherunparalleled accuracy. My lab could not to take time to educate patients and opportunities available to dentists.believe the clinical results.” explain what the different technologies “This laser allows you to increase Indeed, the data from her practice do for them. “Our patients see the revenue much more than with anyindicate that the laser has been the benefit and are just amazed at how whitening system being promotedmain reason for growth this year. As much better the trip to the dentist to you right now,” commented Dr.shown in Figure 1, monthly production can be.” The influence of the laser on Kronick. Third is the professionalis up 23%, with several months over referrals has also been significant. Year development. “You will challenge$100,000 in revenue. to date, the practice is seeing 33 new yourself and you will learn more.” Her hourly production has increased patients per month, almost double from Her final advice: “Call one of us andover $200, from $661 to $863. While the average of 18 new patients for the see what we are doing! The Waterlasehourly production is up 31%, hours same period a year ago (Figure 3). Two- MD has helped me grow tremendouslyspent on the job are down 6% (see thirds of the new patients are coming without having to get bigger. I haveFigure 2). “I’m working smarter per from referrals, with the balance from even more time to enjoy life and wanthour,” notes Dr. Kronick, who has a small amount of advertising (yellow my colleagues to have that sameworked fewer hours this year. She has pages, radio) that has been constant experience.” ■used the extra time to learn more about over the years. “My phone now ringsthe capabilities of the Er,Cr:YSGG laser. off the hook every day.” Part of this Figure 2 The response from her patients has can be attributed to the mothers of New Patients per Monthbeen similar in impact. “Patients are young patients: “Kids love it, and their 9 months YTD 2005 vs. 2004thrilled because the laser makes their moms go running back to day care anddentistry quicker, cleaner, and more schools and tell other moms,” Kronick $120,000 33precise. They go ‘wow’ when I tell them mentioned. 30there’s a good chance they’ll have no Was it difficult getting started?needle, no pain, and no post-operative “Like anything worth pursuing, there’snumbing or swelling. And they are truly a learning curve. You need to give 20grateful that I’m taking less of their yourself permission to take extra time 18time and don’t have to refer them to a and to make mistakes. At first, you needspecialist.” to be the student before you can be the 10 Dr. Kronick has the full support of her teacher.” Dr. Kronick also has advice forstaff, many of whom have personally new users of the Waterlase MD: “Takeexperienced dental work using the advantage of the fabulous meetings 0 2004 2005 Investing in Your Patients and Your Practice 9
  10. 10. Excelling in theWaterlase MD Case Study TM Mainstream T ake a drive through Bensenville, Illinois and you will find yourself in Middle America, both literally and figuratively. A suburb of Chicago located not far from O’Hare Airport; Bensenville is where Dr. Mark Stasiulis has been practicing dentistry for the past 24 years. Far from the glamour and glitz of the Magnificent Mile in downtown Chicago, Dr. Stasiulis views his facility as representative of the typicalDr. Mark Stasiulis dental practice in the U.S., performing “bread and butter” Bensenville, dentistry. “We don’t look anything like those high-image Illinois places you see in the dental trade publications,” remarked Stasiulis. His patients, however, appreciate the high-tech and high-touch approach to dentistry taken by their dentist, a solo practitioner who does much of the work himself. Over the past decade, he re-engineered (BIOLASE, San Clemente, CA). That was his practice to incorporate new in July 2001. Now, nearly 5 years later technology. The journey began in with the addition of a LaserSmileTM diode 2000, when he took a course on micro laser (BIOLASE, San Clemente, CA) dentistry. This led to an investment in Dr. Stasiulis has a wealth of experience an electric hand piece, Diagnodent with the lasers and how they have caries detection unit, and air impacted his practice. “They filled abrasion system. His production grew a void in the type of care I wanted immediately by 27%. “The Diagnodent to offer,” he said. “My days are so unit really convinced me that early much better knowing that I use these diagnosis of the decay process led to lasers to solve problems that present more conservative early treatment.” themselves on a daily basis...from The air abrasion system with its promise desensitizing sensitive roots and painful of conservative preparations with no Aphthous ulcers in less than a minute, need for anesthetic seemed perfect to the advanced surgical procedures for these types of restorations. Dr. many of which require only topical Stasiulis was frustrated by the dirt and anesthetic. I have performed so many dust created by air abrasion and how restorations with the minimal use of it irritated his breathing. The following additional anesthetic that they have year he purchased a Waterlase TM laser become routine.” Pain management10
  11. 11. “Learn to use this laser, it will Figure 1 – Gross Production, Average Charge per Procedure 1996 – 2005 improve your bottom line and it $600,000 Acquires $180 Gross Production Waterlase (July, 2001) also is a heck of a lot of fun.” $500,000 $150 Average charge/procedure Average Fee Per ProcedureGross Production $400,000 $120 $300,000 $90 $200,000 $60 $100,000 $30 $0 $0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 with the lasers has been a great the contrary, he has used the laser to laser dentists gain confidence and marketing procedure in his practice. market “internally” and builds upon proficiency in use of the technology. ”The LaserSmileTM diode laser is the relationships with existing patients. “I am self taught, which was necessary used daily to deliver ‘low level laser The Waterlase has allowed him to do five years ago because the collective therapy’ that relieves many painful advanced procedures and eliminate experience was somewhat limited. It’s dental conditions.” As one patient who the return trips for many of his patients. much easier today, with many more received laser treatment for facial pain “They love the convenience as well courses, materials and laser-based said, “It’s a miracle”. as the higher-tech approach.” Not colleagues that allow us to learn from “Our patients’ perception seems to surprisingly, new patients travel from one another.” be that we are using state of the art 1-2 hours away because they’ve been He added that it is essential for new technology to give them less invasive referred by enthusiastic patients. users to “stick to the bread and butter” treatment for their dental needs. The Beyond revenue and new patients, procedures that are easier to do and hardest question I have to answer is the effect on his practice can be seen will help gain confidence. According why more dentists don’t use lasers”. in both the types of procedures he now to Dr. Stasiulis, all classes of decay, The lasers have dramatically impacted performs (see Table 1) and the average soft tissue work such as gingivectomy, his patients’ perception of dentistry charge per procedure, which has grown frenectomy and cosmetic gingival and of him as a dentist. “My practice from $89 in 1996 to the $150-$160 recontouring are all good procedures and what we do cause our patients to range in the past year. to start with. “One mistake new users believe that their friends need to know Dr. Stasiulis spends part of his time make is that they want the laser to do about what we are doing and why we as a trainer and teacher to help new ‘everything’, which is unrealistic of any are different.” Using 10 years of data from the Figure 2 – Advanced Procedures Performed 1996 – 2005 practice, one can see the impact 200 Pre-Waterlase: Average = 143 With Waterlase: Average = 185 that the lasers has made on a host of financial variables. Annual production 180 has nearly doubled from $279,000 in the late 1990s to $529,000 with four 160 full years of laser usage (see Figure 1). The average number of new patients 140 per year has grown 29% over the long term (see Figure 2), “an appropriate 120 amount”, says Dr. Stasiulis, “for a stable 0 practice that does no advertising.” To 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Investing in Your Patients and Your Practice 11
  12. 12. Excelling in the Mainstream (continued)technology, even one as remarkable as quantum leap forward from my original when broken down into athe Waterlase.” However, on a recent Waterlase. It delivers better custom daily amount.”training day a new user (Dr. Mark control over desensitization, restoration It is this type of analysis that,Bancroft) performed a vestibuloplasty procedures and unbelievable soft tissue according to Dr. Stasiulis, is what willas his first laser procedure under Dr. capabilities. This is the unit of choice create a “tipping point” in dentistry.Stasiulis’s watchful eye. “I was so proud for dentists to incorporate into their “Awareness of lasers in medicine andof this dentist that embraced the treatment regime.” in dentistry simply amazes me. Patientsnew technology and performed this Aside from managing the learning are being exposed to laser-assistedprocedure like he had been using it for of the technology, Dr. Stasiulis comes dental treatment through the media.years; by the way, with no anesthetic across colleagues every day who are They are looking to our professionexcept some topical.” just unsure if the investment makes for this type of treatment. Currently His results bear out this experience, financial sense. “On the first day I used only 5-6% of dentist utilize lasers inas the number of advanced procedures the laser, my wife made me keep track their practices. I would recommendperformed has increased dramatically of the procedures I couldn’t have done all dentists considering adding laserin the 3rd and 4th year since first that day without the use of the laser to treatment into their practices to readacquiring the Waterlase. “It takes time see if it would pay for itself each day. the best seller Who Moved My gain the confidence and get good On the third day, she told me to stop There is a paradigm shift occurring inenough to do the procedures taught keeping track. She saw it was clearly dental treatment today. It’s great to bein the advanced courses. All users paying for itself right from the start.” part of this movement toward minimallywill advance their utilization to their He added, “Doctors view this as a invasive dentistry.”individual comfort zone. The list of $75,000 investment, which is wrong. Dr. Stasiulis’s’ enthusiasm for theprocedures I don’t do is much shorter This is a $90 a day decision: The right laser is buoyed by the fact that hethan the list of those I can.” Dr. Stasiulis question is, ‘can I perform $90 of treats blue-collar workers as well asrecently added the new Waterlase additional laser treatment each day?’ CEOs. “My practice isn’t fancy, but IMD to his practice. “This new unit is a in order to offset the lease or loan cost wanted to give mainstream America cutting-edge technology when it came to the care of their teeth and mouth.”Figure 3 – Advanced Procedures Performed 1996 – 2005 The impact on his patients and his120 Apecoectomy practice has been nothing short of Gingivectomy per Quadrant remarkable. My patients love it, and Gingivectomy per Tooth my production and profitability (65% of100 Crown Lengthening revenue) have increased. The laser has been a technology investment that has Free Soft Tissue Graft 80 made money and improved customer Osseous Surgery satisfaction. I rarely see this in dentistry Frenectomy 60 Acquires Desensitization with other devices being promoted to Waterlase our profession.” Pulpotomy (July, 2001) His final words of advice to those 40 I&D who are “on the fence” about laser Vestibuloplasty technology: “It doesn’t matter what 20 Fibroma kind of practice you have. Learn to Operculectomy use this laser, it will improve your Aphthous Ulcer Treatment bottom line and it also is a heck of a 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Guided Tissue Regeneration lot of fun.” ■ 12
  13. 13. In MyOwn Words Waterlase MD Case Study TMT he final case study in this series is somewhat different. Prior to my interview with him, Dr. JonathanBregman wrote an essay precisely describing how lasertechnology has changed his practice. Rather than re-write,I chose to keep the text purely from his perspective as adentist. Following my introduction, I will turn over the pento him and allow you to hear his story…in his own words. Dr. Jonathan BregmanJonathan Bregman of Durham, North 2005 and says, “This laser has literally Durham,Carolina will be celebrating his 30th changed the way I do dentistry with North Carolinaanniversary as a dentist this year. He almost every procedure I do. That’schose the profession at age 19, wanting amazing to me.” In fact, one of histo help people improve their health patients is the dentist whom he boughtand noticing that dentistry had a clear his practice from 10 years ago. “Hebeginning, middle, and end to the told me that if this laser had beeninteraction with patients. As part of a around when he was in practice, hecareer goal, he wanted to make sure would never have left dentistry.” Thatthat anyone who sat in his dental chair testimonial, from a dentist-as-patient,would have a positive experience. After is part of what drives Dr. Bregman’sfollowing laser technology for about passion about laser dentistry. ”If I madefive years, he decided to purchase the no additional money using this, it wouldWaterlase MD TM last year after hearing still be worth it.” Here’s his story:about BIOLASE’s next generation ofadvanced dental laser technology. How has the Waterlase MD“I’ve taken thousands of hours of CE changed my practice?over the years and don’t ‘jump in’ but It’s all about better and morereally evaluate what I learn,” remarked comfortable patient careDr. Bregman. “I was excited aboutwhat this could do for my patients. For almost thirty years of practice IOnce I did the hands-on clinic at a have focused on caring for patients indental meeting, I was convinced that an excellent way. That translates notI needed to purchase and integrate only to the technical dentistry I performthe technology into my practice.” but also to the care of the patient asHe acquired a Waterlase MD in early a human being. This new technology 13
  14. 14. In My Own Words (continued)allows me to do so many procedures margin to the bony crest) done 1. The class V restoration at or belowin such a way that the patient sits up with the laser as a single visit the gingival crest: I can quickly andand says, “I cannot believe what you followed by restoration after the easily remove the tissue to exposehave just done for me.” They say this laboratory completes the case decay, create a dry and clear field,because: versus temporization, referral to then place and finish a much better1. They did not have a needle ( one of specialist, surgical procedure, 6-8 restoration. All of this is done with the main reasons that many people weeks healing, return to my office no chemical local. I need only do not seek dental care) for re-preparation, impression, topical for the soft tissues. The laser new temporization then finally the serves to numb the hard tissues. NO2. The procedure was quick and easy restoration placed needles, retraction cord, hemostasis, for them no ‘fighting the tissues’ required! 7. Gingivectomy procedure around3. They experienced no discomfort orthodontic brackets done with 2. The removal of a crown, previously4. They left without a numb lip topical anesthetic in just a few placed filling, deep decay: I can minutes compared to local quickly and easily can remove tissue Post treatment, there has not been anesthetic with needle, blade tissue to gain a dry field for the placementone patient who has mentioned any removal, packing to cover tissues of the restoration or impressiondiscomfort from a soft tissue procedure and perhaps a return visit.that I have done over the last ten 3. The seemingly shallow Class Imonths of using the Waterlase MD. 8. Any procedure that I would have restoration with a tooth that hasThis has been accomplished due to a previously used a blade to open a a ‘little stick’ on the occlusal thatnegligible zone of necrosis around the soft tissue flap versus the precise turns into a deep area of decay: Ilasered tissue and the sterilization of cutting and sealing off of the area can quickly and easily use the laserthe area with sealing of the blood and with the laser. to numb the tooth in advance so thatlymphatic vessels besides the nerve there is no worry about that deep 9. Frenectomy both labially andendings. With minimal to no swelling area causing the patient a painful lingually done with only topicalor discomfort, that is such a major plus! reaction. In the past, doing that anesthetic and a laser bandageHere’s a short list of what I’ve been able procedure without local anesthetic to stop bleeding versus a localto accomplish with the laser: because it appeared to be’ just a anesthetic needle and sutures.1. Crown and bridge using troughing very shallow cavity’ would cause a versus a retraction cord 10. Aphthous ulcer treatment previously difficult and stressful situation to not able to be done in my office is occur for the patient as well as the2. Class V using laser removal of soft now done in less than a minute with dentist. No longer true with the laser. tissues versus a retraction cord the laser. Pain is completely and 4. Children love the experience:3. Biopsies using a laser bandage and immediately gone. The healing takes Quick, easy, painless way to do topical anesthetic versus local and place in 2 or 3 days instead of 7-10. all soft tissue and hard tissue sutures procedures without “the shot” ordeal Predictability4. Operculum removal in conjunction for the patient and dentist. One can Pre Waterlase MD I would approach rely completely on laser numbing with restoration of a tooth procedures that would cause me to for everything from placing routine5. Cosmetic re-contouring of the wonder just how things would turn out restorations to pulpotomies. Using gingival tissue around anterior teeth or how I would get a great clinical topical only, the child experiences with topical versus local and a blade result if I found ‘x’. Now, with the no discomfort at all during or or electrosurgical tissue removal Waterlase MD the stress of dealing after any soft tissue procedure. A with “the unknown” is dramatically common example is removal of an6. Closed bony crown lengthening decreased. Thus the enjoyment of operculum on a molar that needs to in conjunction with routine crown dentistry has been enhanced or be restored. In a matter of moments, and bridge procedures to create restored with the following procedures. the dentist can have a dry and clear ideal biologic width (3mm from 14
  15. 15. field to visualize the distal groove of many of these same procedures in a asking about the new “needle- the tooth to either remove additional much more time efficient manner less” technology. Over these past decay or seal that area. Parents love because there is no need to place ten months, we have seen more the fact that they do not need to and then wait for a chemical and more new patients coming watch over their child to insure that anesthetic effect prior to starting. into our office for “laser dental they do not accidentally bite a numb Also, I can work in multiple care” and many existing patients lip…because there is no numb lip! quadrants very easily. Quickly and accepting either new or previously easily gaining and maintaining a dry recommended care due to the5. A perfect crown and bridge and clear field for hard tissue advantages of dental lasers from the impression can always be procedures saves a huge amount of patients’ viewpoint as mentioned accomplished: Troughing and time and allows for better quality previously. hemorrhage control if needed is dentistry. Soft tissue procedures take achieved using the Waterlase MD, Dentistry is just more only a few minutes with no return which makes this aspect of dentistry enjoyable to do! visit needed (see Table 1). so easy and stress free versus Adding up all of the pluses mentioned retraction cord and hemostasis. 2. Additional procedures: Some of above, having my Waterlase MD the procedures I am doing that I6. The fearful patient: the dentist makes every day more predictable, was not doing prior to getting the knows that he/she can perform most enjoyable and less stressful. Also, each Waterlase MD are: routine procedures quickly, easily, day is more profitable. I use my laser and painlessly without the dreaded a. Biopsy with almost every patient. They love ‘needle, drill, numb lip’. it, and I love it. After all, it is really all b. Bony Crown Lengthening about the patient and their comfortProfitability c. Soft Tissue Crown Lengthening both physically and emotionally. TheDue to greater efficiency and d. Aphthous Ulcer Treatment Waterlase MD has provided me aperforming many procedures that I had tool to meet my patient’s needs in e. Herpetic Lesion Treatmentreferred out of my office in the past, I a better way each day. After almosthave paid for my Waterlase MD many f. Laser Root Desensitization thirty years of clinical dentistry, my lifetimes over each month. Here are the and the way I deliver dental care has g. Labial Frenectomyareas where I have achieved greater been dramatically changed throughprofitability: h. Lingual Frenectomy this technology. Most importantly, the Waterlase MD has changed, in such1. Efficiency: For many years now, I 3. Practice builder: Even after just a positive way, the way my patients have performed most procedures in a few weeks of performing dental experience dentistry. my office quickly and with great care. laser procedures, we began to Dr. Bregman’s story is typical of Using the Waterlase MD, I can do have new patients calling our office dentists who acquire and come to enjoy what the laser does for their practiceTable 1 – Procedure Times: Before & After Waterlase MD of dentistry. “Many dentists still know nothing about this technology,” added Procedure Pre-laser Waterlase MD Dr. Bregman. “I want to spread the Occlusal Filling 30 minutes 15 minutes message that they should learn about Crown and Build-Up 75 minutes 60 minutes and adopt this technology and not Soft Tissue Biopsy focus so hard on the cost. I believe in 30 minutes 15 minutes (stopped doing and now does via laser) that old adage, ‘do what you do well in Facial Class V Filling with caring for your patients and the money Sub-Gingival Involvement 30 minutes 15 minutes will follow’. That has never been truer (time to perform two fillings) than what I have experienced with Gingivectomy the Waterlase MD technology in my (around three teeth) 30 minutes 10 minutes practice.” ■ Investing in Your Patients and Your Practice 15
  16. 16. Postscript from the Author:As a researcher, what I found most interesting during the interviewprocess was the professional passion that was displayed by thesedentists. They were not saddled by the burnout mentality whichis so typical of dentists after being in practice for 15 to 20 years.To the contrary, these users of Waterlase technology have anenthusiasm for work that probably exceeds their first days out ofdental school. Their incorporation of laser technology has positivelyimpacted them emotionally as well as financially, and there is a joythat’s been expressed in the impact they are having on patients,including those who have been previously fearful of dentistry orthose who are naturally challenging to work with, such as children.At their core, these dentists are amazed at how the laser hastransformed the way they deliver dental care to their patients andwant others in their profession to understand just how significant achange the laser can make to one’s practice and one’s person.About the Author:Shareef Mahdavi has spent the past twenty years working in seniorsales and marketing positions with manufacturers of new medicaltechnology. During that time, he was responsible for launching thelaser technology used for LASIK, helping the procedure to becomethe single-most performed elective surgery procedure in the U.S.As President of SM2 Consulting, he advises medical devicecompanies and providers on ways to increase market adoption ofnew technology. As a consultant to BIOLASE,TM he is researching andwriting a series of case studies to better understand the impact ondentists who have integrated the Waterlase MDTM technology intheir practices. Shareef lives with his wife Renée, and their threechildren in the San Francisco Bay area. You can reach him at SM2consulting’s website, which is © 2006 SM2 Consulting. All rights reserved.BIOLASE, WATERLASE MD and LaserSmile are registered trademarks of BIOLASE, Inc.All other trademarks are trademarks oftheir respective holders.