Offering the LANAP® Protocol in a COVID World

April 19, 2021

Offering the LANAP® Protocol in a COVID World

Rebecca L. Wagner, DDS, MS


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. Rebecca Wagner, a periodontist in Chambersburg, Pennsylvania. Dr. Wagner earned her DDS degree at the University of Maryland and her MS degree in periodontology from the University of Michigan. In addition, she is a diplomate of the American Board of Periodontology, diplomate of the International Congress of Oral Implantologists, and a fellow of the prestigious Misch Implant Institute. Dr. Wagner, Thanks for being my guest today.

Dr. Rebecca Wagner:  Thank you. Thanks for having me on.

Marty Klein:  My pleasure. While on the podcast, we like to have our guests tell their LANAP story starting from the beginning, which, for you at least, deciding to purchase was relatively recently, in 2020. How did you first hear about LANAP and what were your original thoughts?

Dr. Rebecca Wagner:  I think I first heard about LANAP probably about six or seven years ago, because I belonged to North American Society of Periodontists. And it was something that I’ve wanted to purchase, I just I had follow through with some other issues. I was in the transition in my private practice and my professional life. So it actually didn’t happen, though, until beginning of 2020. So I purchased it and then I came to your program in March of 2020.

Marty Klein:  So in March of 2020 quite a lot happened and I want to get to that in just a moment. But first, just thinking back a little bit. As I understand it, the North American Society of Periodontists have quite a few LANAP users within it. Can you tell me about what they told you or what you have heard, or what made you want to give this a try for yourself?

Dr. Rebecca Wagner:  Well, essentially every single one of them said that it completely changed the way that they practice and changed their philosophy of treatment. When I would question them about, are they doing osseous surgery anymore? Most of them said they’re doing LANAP exclusively because of the results that they see. It seemed like, for lack of a better word, it was like this magic wand, and they were all talking about how great this was. I knew because they were trusted colleagues of mine, and I knew that I knew that it was just something that I needed to incorporate in my practice as soon as I was able to do so.

Marty Klein:  OK, so you decided to do it. Of course, none of us really were prepared for what would happen in March of 2020 if you live really anywhere on this planet. But you came to training right before a lot of things started shutting down in this country. So before we get to that, just the training experience was that, well, you tell me. What did you think of it? Did you feel well prepared to incorporate this into your practice coming out of training?

Dr. Rebecca Wagner:  Oh, absolutely. Coming out of training, especially. I felt the first day when we went in and we delved into really just the physics of the laser talking about quantum physics and energy of light. And really, you know, a lot of us as dentists and periodontists, we don’t really spend a lot of time… That’s something we had, maybe when we were in college. So it was nice as a just kind of refresh to go back to the basic science and really the review of all of the reasons why these lasers, particularly the Nd:YAG laser was different from an erbium laser or the diode laser and really kind of really understanding the mechanics and the physics behind that. I think it was really, really essential. Then our second day, when we do doing the clinical surgery on patients was just a great experience to be able to do it again; hands on, you know, putting everything together with what we learned.

Marty Klein:  So you’re coming out of training and everything shuts down around you. What was that like?

Dr. Rebecca Wagner:  Yeah, it was really difficult. I had while I was here, my son’s in college and the school, went into lockdown, and he had to come home and he lives three hours away from home. My daughter was in a car accident, and she’s in downtown Philadelphia in PT school. Then I couldn’t get home right away. My flight was cancelled, so I got home a day later. Then Pennsylvania shut down the following Friday. So my whole practice shut down then – I was shut down almost for about four or five weeks, essentially.

Marty Klein:  Well, certainly a buzzkill coming right out of LANAP training.

Dr. Rebecca Wagner:  I was pretty scared, to be honest with you.

Marty Klein:  Well, and it is an investment in your practice, and you’re looking to get some return on that investment, and now you can’t practice at all.

Dr. Rebecca Wagner:  I know. I was wondering how I was going to come up with a payment for it the next month, to be honest with you. But you guys were great. I had the financing company that I worked with, and they were great. They helped with, we got a delay, I had about a 90 day reprieve, which was really helpful. My laser came, and then I put it together in my apartment. I used to have five employees; I went down to one employee. So, there’s another challenge, but it gave me a chance. I spent a lot of time just working on the protocols that we had been given and just getting the systems in place. I went ahead and did some marketing letters. I spent a lot of time getting the COVID protocols together. Then I had a patient that really, really needed LANAP and decided to treat her in the middle of April because she had an abscessed tooth, she was diabetic, and she was a smoker, and her blood sugar levels were over 350 every single day. And I just said, “I’ve got to go in and take care of this lady.” So she was my first patient.

Marty Klein:  So tell me, then. Slowly but surely practices started to reopen. You got to reopen your practice and actually start marketing and using your PerioLase for LANAP quite a bit. So take me through the rest of the summer and or really, up to this point, we’re recording this now in February of 2021. So you’ve been using it a solid six months since the reopening. What happened?

Dr. Rebecca Wagner:  Well, the first person, really, that first patient was really just I think, just a tipping point for me to understand, really, and being able to communicate with my patients, how great this laser was and how effectively it was helping to treat patients because my first case was a patient of mine who had been at least 15 years. She was a smoker, like I said previously, and a type two diabetic, but she had become more noncompliant, and I actually hadn’t seen her for a year. So she came to me in February, just before I took the LANAP course, and I told her, I said, “You’re a great candidate. I think you’re gonna be a great candidate and I’ll call you when I come back.” So and then, of course, we were shut down. So I decided to use her as a great first case, and I had a whole day in my office to be able to treat her and follow up and things like that. But, like I said, her blood sugar levels were 350. She had an abscessed tooth, number 12 that had 18 millimeter probing depth. Most of her teeth had grade 2 mobility. She had advanced furcation involvement, so she was a chronic perio, stage four. Within two days I saw her 48 hours post op. She said to me, “I have absolutely no pain. I have no bleeding, have no pain.” And she was shocked. Then I just took her full-mouth series back in January, so that would have been about seven months post op, and we’re already seeing bone growth everywhere, particularly in the area of the extracting site where I didn’t do any bone grafting. I just treated with a laser for homeostasis and her blood sugar levels within two weeks were down to 150. She’s then stopped smoking, which is amazing. Seeing her as a previous traditional perio case and then her response not only with her tissues and her health of her tissues, but her own personal response and how she how she responded to treatment, and honestly, I thought her whole attitude about periodontal treatment and the way that she became much more compliant was shocking to me. I think she’d be my patient for almost 20 years and there were things that I could never get her to change, and so she completely turned around. But also, she said her mouth has felt never felt this good in her entire life, her bite feels amazing. That’s when I started to see as a common theme with my patients is how they would come in and say to me, I mean literally, I had yesterday a guy, he said, “I have never felt my bite feel this good in my life. I’ve never felt my gums feel this good. I don’t know what I don’t know how you would actually say this, but I don’t think I’ve ever said this before to you, Doc. But my mouth feels really, really good”.  I hear that time and time again their bite feels good. They had no pain whatsoever. Their teeth don’t hurt. They feel like their teeth actually move in the right direction, before they would feel their teeth moving. Their jaw doesn’t hurt. I haven’t had a patient who had xerostomia and her salivary gland started to work again and she started having normal salivary production.

Hearing that like I mean, that’s a consistent, consistent theme. So it makes it really easy to talk to patients again about the protocol and really understand about not violating the protocol. You know, not trying to say like, “Oh, well, we’re just going to treat this one area. You know, this patient just has a six millimeter pocket here and everywhere else are fours, and we’re not gonna really worry about I’m going to treat this traditional perio.” I just really started just talking to each patient and giving them my own experience and explain to them out for 25 years, I’ve done it one way, and I think I’m a pretty good surgeon. But seeing the way that these patients respond is really been a paradigm, a complete paradigm shift for me to the point that I don’t really ever want to do osseous surgery ever again. I just feel that I can really, honestly say to them that you’re not gonna have any pain, and I can say to them that I know that they are going to do better. I know they’re going to have less mobility. I go through them, I always give them both options. I go talk to them about it, when I explain it to them, I said, “You know, with traditional periodontal therapy, we’re gonna need to do your scaling root planing first, and then we’re gonna re-eval. Then we’re gonna come back, and then we’re gonna do osseous surgery. I’ll gently lift the gum out of the way and I’ll root plane and clean everything off, and I’ll gently put the tissue back,” I said, “But here’s the thing. At the end of the day, I’m going to take care of your infection with traditional therapy, but I’m not growing anything back. I’m not growing back your cementum, periodontal ligament, or bone. And if you want to have the opportunity for us to be able to actually regenerate your periodontal tissue, we need to do LANAP and it’s a full-mouth protocol.” So as a result of that, I’ve done a lot more quadrants of surgery, over 250, since I started this at the end of April last year.

Marty Klein:  You had you said when you first came to that BootCamp training that your practice was about 60% implant, 40% perio, how would you say it is today? Has that changed at all because of the PerioLase?

Dr. Rebecca Wagner:  Yeah, I think it’s I would say it’s probably at least 50/50. If not maybe more. I work four days a week, and so I do at least two LANAP cases a week.

Marty Klein:  OK. Have you used your PerioLase around implants to try to save implants?

Dr. Rebecca Wagner:  Yeah, I’ve done, I think I’ve done about 40 LAPIP cases. When I do that LAPIP protocol, I also do… So if they have an area of one isolated area where the implants failing, not only do I always take off the restoration, but I also do LPD everywhere else. So even if they only have maybe three or four millimeter pockets and there really isn’t evidence of infection, there’s still some gingivitis or I explain to patients, “I need to make sure that you’re completely disinfected.” So everybody’s getting occlusal adjustment and getting an occlusal guard, and they’re getting at least a laser pocket disinfection, in addition to the LAPIP. I don’t have much pushback on that because I’m explaining to them that really the idea of the way that this works in order for it to work in the LAPIP or LAR or LANAP is that we need to have complete full-mouth disinfection and has to be done really, within a matter of a few days. So I do all of mine as full mouth. I do all my LANAP full mouth for all my treatment, and that just works better.

Marty Klein:  Well, gosh, what started as incredibly poor timing to get trained with LANAP sounds like you’ve had quite a bit of success that has carried you through this COVID period.

Dr. Rebecca Wagner:  Yeah, absolutely. Absolutely. And the great thing is that with only having one person working for me for about six months, I learned to use the Isovac and I’m doing LANAP by myself. Until, I mean, I was able to hire another assistant in August, and then I have a second assistant that’s coming on board in a couple of weeks. But we were very short staffed, so I learned using the Isovac and being able to do full-mouth surgery all by myself. So it’s actually been that’s been a blessing too and my practice overall grew by 20% last year. So even though I was closed for five weeks, maybe patients weren’t doing as many things as full-mouth implants or full arch reconstruction, things like that. I’ve had a really good acceptance rate with patients accepting LANAP, way more than they would have ever accepted for traditional osseous surgery.

Marty Klein:  That is fantastic. I do have one final question, and that is that we are recording this at the lunchtime of your follow up training, Evolution 4, and I’m just curious what you think so far?

Dr. Rebecca Wagner:  I’m learning more again. You know, I had questions that, frankly, I think I’m down in the weeds just working really hard, and it’s nice to have some things are going to help me with my efficiency a little bit more and just give me time to step back and think about some new ideas for marketing. That was the other thing that I did kind of a bold move for 2020 is I invested right in the beginning of 2020 to do a brand new website, brand new blogs, and an SEO campaign. So the great thing about that was when all of COVID hit all of the costs for advertising, Google was cheap. So I was there already making a presence. So that’s been a great sort of, I don’t know, fallout from that.  I think it was a little bit gutsy for me to invest that much money in the beginning of 2020 and having that in the laser, but doing those all of those things, I think really, really helped. I have a lot of patients that come to me through Google search, actually, because I’m in a rural area and nobody else is doing LANAP where I am, and so they’re seeking me out for that.  They’re seeking me out because they don’t want to have traditional treatment.

Marty Klein: We are always so happy to hear success stories like yours. We’re happy to have you back for Evolution 4 today. I know you have a patient treatment this afternoon as part of your training, so we will let you go get to that. I do want to plug your website that you mentioned. It looks great, by the way, and that is, and to the listeners out there, If you have not yet subscribed to this podcast, please do so that you don’t miss any episodes. You can also find all of the episodes we’ve released at Dr. Wagner, Thank you again for being my guest and sharing your success with us.

Dr. Rebecca Wagner:  Thank you!