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Dental lasers have fully come into their own-but many dentists continue to balk at lasers. Here’s why bringing laser technology into your office can pay off-and help your patients.
It was 1996. The music was grungy, and the rumor was a dot-com economy would make us all millionaires. Technology was still just beginning to transform our analog world, even in the dental practice. In Northern California, Dr. Michael Miyasaki, DDS, was working with his first laser in the dental practice, a medical laser brought over to use in dentistry.
“They were big, overpowered and way too much for what we needed, but they were lasers, so we were excited,” Dr. Miyasaki says. “But we didn’t understand how best to use them.”
Fast-forward to 2017: Many clinicians now understand how best to use lasers. In fact, today’s lasers have a much simpler user interface than before and are designed for dental professionals to deliver a predictable and effective patient outcome.
But despite the evolution of laser dentistry over nearly 30 years, the dental community has its fair share of skeptics about its use. Some argue that it’s a gimmick or a marketing ploy to disguise a dentist’s lack of clinical skill. Others say the cost of entry is just too high-and that the ROI on lasers just isn’t there once the initial investment is there. However, early adopters say that is not true, laser dentistry is here to stay, and that it is great news for a dental practice’s bottom line. We spoke with several industry experts to learn how laser dentistry has improved revenue for clinicians. Here’s what they had to say.
1. Laser dentistry condenses procedure timelines by avoiding injectable anesthetic and reducing the need to manage bleeding.
In the past, two alternatives existed for things like soft tissue re-contouring and ablation, a blade or an electrosurgery, Dr. Miyasaki explains. Both require an injectable anesthetic. Using a scalpel also requires managing the patient’s bleeding. Lasers get away from the injectable anesthetic and prompt minimal bleeding, making same-day surgery and prep feasible.
“I had a patient in today for some gingival contouring, and I didn’t give him an injection; I just put some topical on the tissue. When we did the gingivectomy, he was fine with it,” Dr. Miyasaki says. “It’s a kinder, gentler way of doing dentistry.”
Dr. Jeff Rohde, MS, DDS, practices in California and uses lasers for his soft tissue surgeries also, which he describes as anesthesia-free and blood-free. “So, let’s say a 6-year-old comes in and has this flap of tissue over an erupting molar,” he says. “I just laser that little thing off. I don’t have to numb her up. There’s no bleeding, and she’s out the door. I would never have tried that before.”
Dr. Sam Low, DDS, MS, MEd, agrees that laser dentistry is a less traumatic way to do dentistry, especially for young patients. While local anesthesia is very safe, it can cause soreness. He sees laser dentistry as a way for parents to spare their children negative emotional experiences. “As a parent, do you want your child to undergo the local anesthesia aspect-the stress, the crying, the anxiety-versus seeing a practitioner who can do restorative dentistry without local anesthesia?” Dr. Low asks.
Dr. Low, who is also the chief dental officer and vice president of clinical and dental affairs for BIOLASE, says that some practitioners who have fully embraced laser dentistry use the laser almost on every single patient. “Part of that is the ability to do restorative dentistry, especially with children, with minimal local anesthesia,” he says.
2. Laser dentistry adds production for routine procedures to regular hygiene visits.
A regular hygiene appointment with an exam, bitewings and prophylaxis typically bills around $200. Many times, the dental team identifies issues like decay.
Dr. David Stinchfield, DDS, describes his private practice in Washougal, Washington, as technology-driven. He began using lasers 10 years ago with a laser and now uses the Solea® all-tissue laser (Convergent Dental) for both soft- and hard-tissue procedures. He appreciates how he can quickly perform fillings with his laser for decay identified in the hygiene appointment, adding additional production billing to a standard hygiene visit.
Because Dr. Stinchfield can fill a tooth without needing to numb the patient, he can take care of restorative procedures like this in as little as 15 minutes-for two fillings. That additional production adds another $300 to the visit. Best of all, the patient doesn’t have to return to get the dental care he or she needs.
“That very quickly increases your return on investment for that technology if you’re doing that on a daily basis,” Dr. Stinchfield says. “Even if you just do that once a day, it will add an extra $300 a day with only 15 minutes of your time.”
Next page: Efficiency and fewer referrals ...
3. Laser dentistry retains procedures in your office that you would have otherwise referred.
Clinicians who practice laser dentistry keep procedures in their office that they would have otherwise referred out. It is not only good for revenue, but patients also appreciate it.
“This is going to get touchy because I am a periodontist, but I’ll be the first to say to you that patients do not want to be referred,” Dr. Low says. “Patients want convenience. So, they will say to the doctor, ‘Are you sure you can’t do that? I know you can do that.’ Or they’ll say ‘I heard about this. Can you do that?’ If you are well versed in lasers, you can say ‘Yes, we do and I’ve done several of them.’”
Dr. Rohde has used soft-tissue lasers since 2008 and has used the Solea for the past three years. He does a wider variety of procedures now that he incorporated the hard-tissue laser. From cutting soft tissues for surgical procedures like fibroma removals to hard tissue crown lengthening, the laser enhances what he was doing already and gives him the confidence to do more. “I have more CDT Codes that I can bill based on the fact that now I have this tool that allows me to,” Dr. Rohde says.
Dr. Robert Gregg II, DDS, co-developed his company Millennium Dental’s PerioLase® MVP-7™, a pulsed Nd: YAG laser. He believes the introduction of laser dentistry can open whole new areas of dentistry. For example, the LANAP® protocol for the PerioLase has FDA clearance for full-mouth true periodontal regeneration, allowing general practitioners (GPs) to treat periodontal disease without traditional surgery. “GPs now have a brand-new revenue stream because they never treated perio before. They are revenue positive with just one full-mouth case per month, without needing expensive growth factors or biologics. It’s all upside,” he says.
4. Laser dentistry facilitates improved efficiency in your standard procedures.
In a practice, time is money. Dr. Miyasaki, who has been using lasers for most of his 30-plus year dental career, explains saving time is a great way to boost revenue, whether that means you can see more patients in a day or have more comprehensive appointments with the patients you do see. He uses his laser every day in his practice in Sacramento, California, and for nearly every procedure he does in his practice.
Dr. Miyasaki now approaches his crown preps differently than in the past. Instead of packing a cord, he does a trough during his preparation to gain a physical separation between his hard and soft tissue margin. “Then, I can pop my impressions and usually get my impressions pretty predictably,” he explains. “That saves me a lot of time and lot of money.”
When Dr. Miyasaki teaches laser courses, some doctors argue that blade and electrosurgery are faster than a laser. Dr. Miyasaki reminds them to look at the overall picture and the healing time involved. Dentists wait for the injectable anesthetic to work. In the case of a gingival re-contouring with a blade, dentists spend time managing the bleeding. Then, one must let that tissue heal up before the crown or veneer preps, so there could be another visit involved for the patient. A simple procedure can end up being drawn out to a month.
“If I use a laser, I can do my contouring and my preparations the very same day knowing that the patient is not going to bleed significantly. It saves us all a lot of time,” Dr. Miyasaki says.
Dr. Stinchfield agrees, estimating that he treats fillings anesthesia-free in 90 percent of the cases because you get an analgesic effect from the Solea laser when using it on the tooth, eliminating the need to wait for the patient to get numb. He sits down and immediately starts treating the patient’s tooth with the laser.
“There’s not five to 20 minutes of dead time where you’re waiting for anesthesia to kick in. Within that time, you already could have had the procedure completed and the patient dismissed,” Dr. Stinchfield says. “So, there’s an efficiency factor there for sure.”
Dr. Miyasaki thinks many times doctors do not realize all the benefits they will have when they first start using a laser, but that over time they see how ubiquitous its use becomes, from soft tissue management to disinfecting the sulcus to removing diseased tissue. “Unlike a blade or electrosurgery that will just cut any tissue in front of it, the lasers are attracted to tissue that typically has more pigmentation, that is darker and more necrotic,” he notes. “And so, I always tell the doctors the laser is tissue selective so you can use it for a pulpotomy, a biopsy, for troughing and a gingivectomy.”
Dr. Miyasaki adds that using lasers in esthetic cases make it easier than any other instrumentation out there. “If your Class 5 restoration goes subgingival, you can use a laser to remove the tissue, place the restoration and that tissue will just heal back right where it was before you lasered it,” he explains.
However, efficiency doesn’t only apply to the time it takes to perform a procedure. Healing can be more efficient also. Dr. Rohde describes his practice as technology-driven. He uses the latest technology not only to create efficiencies, but also to provide an improved patient experience. He gives the example of a surgical removal of a minor fibroma. With the laser, the procedure takes 30 seconds with no bleeding. “Before the laser, I’d had to make an elliptical incision and then carve this bowl out from it and then suture it closed,” Dr. Rohde says. “And the patient is in pain for two weeks versus being 99 percent healed in four to five days with the laser.”
Next page: Expansion of offerings ...
5. Laser dentistry expands what procedures you do that you never considered in the past.
Dr. Low says lasers open opportunities to perform certain procedures that you didn’t before lasers, procedures the patient didn’t know could be done. “One perfect example is what we call esthetic crown lengthening,” Dr. Low says. “Patients come in with ‘gummy smiles.’ When they smile, their teeth look gorgeous, but they’re very short. This condition is especially prevalent after orthodontics.” He credits the laser with giving clinicians the confidence to tackle the procedure because the laser eliminates the blade and related bleeding while improving the precision. Moreover, Low says many of the lasers today are more user-friendly, often to the point of pushing a button-what he calls “buttonology”-to get the proper settings for the procedure. The BIOLASE Waterlase Express™, for example, also includes an accompanying HD animation that plays on the laser’s touchscreen to demonstrate step-by-step for clinicians how to perform many laser procedures. “Buttonology is very, very important in laser dentistry,” he says.
Dr. Stinchfield always did a multitude of procedures in his practice. However, he acknowledges that lasers can expand what’s possible for those clinicians whose repertoire has more focus. From crown lengthening to frenectomies to periodontal deep pocket treatment, the laser makes it easy to manipulate the gum tissue and bone.
“Some people aren’t comfortable reflecting a flap or doing any type of crown lengthening,” Dr. Stinchfield says. “But with the laser, it’s just so clean and so predictable that it can add that procedure for somebody.”
6. Laser dentistry frees up time in a full schedule to grow your practice.
Most clinicians want to provide excellent patient care while growing their practice. However, if you have a full schedule from 8-5, how can you grow your practice?
“You can open Saturdays, but no one wants to do that. People value their weekends,” Dr. Rohde says. “You can work until 8 p.m. You can compromise the quality of what you’re doing. Instead of doing one-hour cleanings, you zip the people in for 30-minute cleanings. But no one wants to compromise the patient experience that way, right?”
Lasers allow dental professionals to be more efficient and get more dentistry done in any given unit of time. Dr. Rohde had a woman who needed four fillings, two on each lower side. Using anesthesia and a drill, Dr. Rohde explains, would have meant two separate 30- to 45-minute appointments of numbing, drilling and filling, with two hours of numbness afterward. With the laser, he didn’t do any numbing or drilling for this case, and he was done in 20 minutes.
“I just did twice as much work in half the amount of time,” Dr. Rohde says. “And I don’t have to have her come back for that second slot that would have been some other time in the month, so now I’m putting a CEREC or another two-quadrant, three-quadrant procedure there.”
“One of the things that’s not understood is that for the things that you would charge out for like fibroma removals or gingivectomy surgical procedures, it doesn’t matter if you use a scalpel or electrosurgery or laser,” Dr. Miyasaki says. “As long as you do the procedure, you can bill out for that procedure whatever dollar amount. But if you’re doing that procedure, you can do it quicker and more predictably with the laser.”
Next page: Evaluating the ROI ...
7. Laser dentistry provides a more straightforward return on investment than other capital expenses.
Dr. Gregg thinks that investing in a laser is different than investing in other types of capital equipment. “This particular business model is not capital equipment; it’s a treatment protocol,” Dr. Gregg says. “It’s not like getting CAD/CAM where you’re replacing one set of expenses with another. This is a pure profit play. It’s the sort of thing with no down side.”
In the case of the PerioLase, the laser introduces a new treatment, one the dentist isn’t doing already. That means it isn’t replacing any expenses the practice already has, which is different than purchasing a CAD/CAM system. “Well, I have $X number of dollars I spend when I send my impressions to a lab,” Dr. Gregg explains. “Now I buy a CAD/CAM, and instead of sending my stuff to a lab, I make it myself. So, the cost that I spent on my lab guy I’m now spending on lease payments with the CAD/CAM. On top of that, I’m now the lab. So, I’ve added to my cost and time.”
Dr. Rohde uses the Solea and feels the same way about the production he gains from the laser. “Even though we gained the expensive laser, we’re doing more of these types of procedures per day,” he notes. “I mean, we’re probably doing five or six additional procedures per day for each of the lasers that we have. So that could be a procedure we couldn’t do before, that physically I didn’t have the tool to do.”
“There’s a direct fee that we can charge for a procedure, and there’s also the time savings,” Dr. Miyasaki says. “If the clinicians looked at both of those factors, they would understand there is a very good return on the investment in something like a soft-tissue diode laser.”
8. Laser dentistry increases patient acceptance rates.
Patients balk at traditional periodontal surgery, even when the need is dire, because of the fear and discomfort associated with traditional gum surgery. Dr. Low says that occurs because traditional periodontal surgery is not patient-friendly. When a fellow passenger invades his space on an airplane, Dr. Low jokes that watching gum surgery procedures on his laptop is most effective at helping him reclaim the armrest. “If you go on Google, periodontal surgery is generally not something that you want to watch on a full stomach,” he laughs.
“And that’s what our patients are watching,” Dr. Low continues. “If I tell a patient they need periodontal surgery, what do you think they’re going to do that night? They’re going to go into periodontal surgery on YouTube, and they’re going to say, ‘My god! That’s what he’s going to do to my gums?’ It becomes very important that we do minimally invasive procedures if we want patient acceptance. And that’s where laser dentistry shines.”
Dr. Gregg estimates that the acceptance rate for traditional perio treatment is only 30 percent, but acceptance rates jump to 90 percent with the laser. “And I’m talking specialists, as well as GPs,” he says. “Specialists are seeing their case acceptance go up the roof. And it’s not a greed-based protocol or a value opportunity. It’s needs-based.”
Next page: What patients really think ...
9. Laser dentistry improves the patient experience.
Dr. Stinchfield appreciates the convenience the laser affords his patients in need of treatment. Since the Solea does most procedures with no anesthetic, patients could enjoy single-visit resolution to many of their dental care needs, eliminating the decision process about whether to have the treatment or finding time in their schedule for a follow-up.
In addition to patient convenience and lack of anesthesia, laser dentistry improves other parts of restorative dentistry, particularly in fillings. Lasers handle fillings vibration free, a feature that Dr. Stinchfield’s patients appreciate.
“There is no vibration in your mouth. All you hear is a little bit of water and air blowing,” Dr. Stinchfield says. “I see people white-knuckle it in the chair when you’re giving the shot, and when you put that drill to the tooth, it rattles your entire head. So even if you are anesthetizing, I think laser dentistry is a huge service for being able to treat something without all the vibration and noise.”
Laser surgery also improves the patient experience for periodontal surgery. Dr. Gregg’s LANAP protocol was developed to be an alternative to scalpel blade surgery.
“We’ve expanded the market for both dentists and patients to get a treatment that patients need and dentists are very happy to provide because laser technology in LANAP is physically easier on the body than conventional cutting and sewing and bone grinding,” Dr. Gregg says.
“Lasers do not fix things; lasers manage things,” Dr. Low observes. “Lasers remove the stimulus so that the body can heal itself and that makes it so much more receptive to patients now.”
10. Laser dentistry inspires word-of-mouth referrals from your patients.
Dr. Rohde credits part of laser dentistry’s benefit to his practice revenue to things he can do now that he couldn’t in the past. But the other part is having more patients on which to do laser procedures. Many of these new patients come from referrals.
“It isn’t just lasers; it is any technology,” Dr. Rohde explains. “If I can create a great experience for someone by investing in technology that distinguishes our practice from other places and then that gets people to refer by word of mouth, there’s nothing better than that referral. There’s no advertising that can trump that. And I think most people would agree with that.”
Dr. Low agrees, adding that it is incumbent on the doctor to communicate and demonstrate the benefits of laser dentistry for your patients. “If you do the song and dance right marketing-wise, patients will refer family and friends,” he says. “Before you know it, you will get internal marketing without having to do unprofessional, external marketing.”
As an early-adopter, Dr. Stinchfield thinks the cutting-edge element of laser dentistry can create buzz about your practice. He lives in a small community, and people who have heard he treats patients’ teeth with a laser and can do fillings without anesthesia routinely approach him to hear more. As lasers become more prevalent, he believes word-of-mouth advertising benefits will only get better.
“I honestly believe as we go into the future, technology will be getting better and better, and laser dentistry is going to become more and more common,” Dr. Stinchfield says.
Dr. Rohde believes most people don’t like going to the dentist. When he integrates technology, he looks for equipment that makes it easier for people when they are in the chair. Since Dr. Rohde first incorporated lasers, laser dentistry has done that for many of his patients. He uses testimonials on his website from actual patients who have had a changed dental experience.
“That’s what’s exciting about where this whole category is going,” he says. “It’s upping the ante about what it means to take great care of people.”