When Scalpels Become Unacceptable

January 11, 2021

When Scalpels Become Unacceptable

Dan Indech, DDS


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. Dan Indech, a periodontist in Phoenix, Arizona. Dr. Indech graduated from the dental school at University of Western Ontario in London, Canada, and received a Certificate in Periodontics at the University of British Columbia in Vancouver, Canada. He is currently studying to become an IALD Certified Instructor. Dr. Indech, thanks so much for being my guest today.

Dan Indech, DDS:  Thanks, Marty, for your kind introduction. I became a periodontist to help patients fight gum disease and keep their teeth for a lifetime. I’ve seen and done a lot in the 30 years I’ve practiced: 12,000 implants and more osseous surgery and tissue regenerative procedures than I can count.  For that unacceptable percentage of patients that signed up and let me do their treatment using a traditional approach, I’ve seen great results all the time. I’ll be the first to admit that I’ve seen mixed results and post-treatment challenges, including infections, slow healing, and other procedural disappointments. But for me, the most upsetting part was hearing my patients complain incessantly about post-op pain, gum recession, food impaction, and altered appearance. I found myself lost and continually asking, “Is this the best I can do for them?” I looked at the PerioLase in 2000. I resisted because the AAP, the American Academy of Perio, didn’t endorse this approach. I came and looked again in 2012, and I almost jumped in, but I got cold feet. It wasn’t until 2019 I finally got in the game, I couldn’t resist. I heard a lot of positive reports of terrific outcomes from colleagues that are LANAP-trained clinicians, including both of my undergrad and graduate mentors. Patients were asking for it. You know, they’d hang up on my schedule coordinator when she responded that we didn’t offer this approach, and if they did come in for a consult many declined surgery, instead seeking nearby LANAP clinicians. This was really discouraging for me, and it made me question my approach.

Marty Klein:  So you mentioned in there that it was patients that were calling. You had heard about LANAP it seems for several years, but the AAP, American Academy of Periodontology, was also one of the organizations kind of holding you back. So a couple of questions in there, have you noticed a change in the perspective of your peers? And have you noticed an increase in your patients asking for LANAP by name?

Dan Indech, DDS:  That’s a really interesting question. Early on I worried that if I used the laser and patients didn’t get better or something bad happened, the AAP wouldn’t have my back and I could get stuck in a legal entanglement. But I found that as this discipline has evolved, the AAP couldn’t possibly ignore the landmark science that has been produced, not to mention the FDA clearances. You know, there will always be those that resist. But look at the stats: 35% of the AAP members have adopted this approach, and many of the leadership group of the AAP are LANAPers. Dental schools and Perio residencies are slowly but surely coming on board. But most telling is that when I look around the seminar hall of BootCamp, and I’ve attended five times, the room is dominated by periodontists and enhanced by General Dentists and other specialists passionate about periodontics or struggling to manage peri-implant disease. That tells me this method is here to stay, and it’s gaining a lot of traction, especially among us resistant, evidence-based, needy periodontists. Unfortunately, though, progress leading to widespread adoption and acceptance takes time. We’re getting there, though.

Marty Klein:  So LANAP is on the map, then more and more, I’m curious if you had laser experience prior to learning this procedure and if that made a difference in terms of your ability to start doing it yourself.

Dan Indech, DDS:  So many years ago, and it was more out of necessity, I bought an inexpensive diode laser, and it had instructions but no training.  I did this so that I could honestly answer, “Yes,” when I was asked if we use lasers in the practice. I didn’t understand at all what I could do with it, and I really didn’t end up using it much.

Marty Klein:  Now you mentioned earlier as well, coming to training five times. I should say that some of that has been part of your instructor training, and we’ll get to that in a moment. But when you first came to training to first learn LANAP for yourself and you went back to your practice did you feel comfortable right away treating patients with LANAP?

Dan Indech, DDS:  Great question, again Marty. I got to say Millennium and the IALD, they really keep their promise to provide a world-class educational experience. From the minute you take the so-called leap of faith and sign on, until that coin ceremony at the end of E5, you’re taken through this academic, thought-provoking journey with VIP, red carpet treatment. The instructors really make you question your knowledge and your beliefs, but it’s done in this warm, safe, nonjudgmental, collegial atmosphere. The support team is just so awesome. Even during the pandemic, I felt really safe at the center. You treat your first patient under close supervision with their hand on yours, and you see your patient a day later to observe their healing. More than not, you hear from them how well they’re doing and how little it hurt. The whole program is just so impressive. It’s extremely well thought out, and it caters to adult learning. They also provide this plethora of resources. They simply asked you to be open to evolving your thought process. The instructors make themselves available for ongoing clinical support by phone or email or text message for every doctor that goes through the training.

Marty Klein:  So you have come out of training now, you’re back treating patients in your home practice back in Phoenix. Tell me a little bit about the learning curve in using the technology based on everything that you’ve learned during the training program on your own patients with your own hand and how that starts to unfold.

Dan Indech, DDS:  So there’s definitely a learning curve, but I was committed to getting over that hump to the other side. Millennium brings you along safely. They provide a solid education, and they put training wheels on initially to protect the patients as you gain experience. I’ll be the first to admit, though, and own that I did cause a few healing challenges, and I’ve seen some treatment shortfalls. But I’ve learned from them, and it’s much easier to have a patient accept another session of LANAP or LAPIP to get the desired outcome. Good luck trying to get a patient that has just undergone flap surgery to do it again.

Marty Klein:  Yeah, I was gonna ask a little more about your patients and their responses to treatment. If it’s easier to motivate them to proceed with this treatment, it sounds like certainly it is.

Dan Indech, DDS:  Getting patients to sign up and agree to having periodontal treatment has never been easier. For many patients, treatment using a laser versus a scalpel and suture is really the primary, and sometimes the only, reason they’ll agree to proceed. Once we’ve conquered their fears and their resistance, they usually find a way to take care of the fees that are associated with treatment, especially when you compare their investment relative to the cost of say an all-on-four reconstruction or even individual or segmental implant-retained restorations when were forced to give up on their teeth. You know the results are really mind bogglingly good. I can predictably stabilize their disease in one or two treatment appointments. I’m seeing clinical and radiographic responses beyond expectation and beyond anything I could achieve with traditional approach. What really speaks loudly is that I haven’t laid a flap to treat periodontitis since the day my laser was delivered. This complete paradigm shift, it’s a common theme with other adopters, and it should resonate among you that are considering this. The patient response following treatment is also really positive. I get them healthy. They don’t suffer or complain nearly as much. How can you argue with that? They promote me, they promote my approach, and I get a lot of five star reviews. Overall, it’s been a win-win. My only regret is that I waited so long.

Marty Klein:  We do hear that one a lot, I must say.  I believe when you first came to BootCamp, just the first three days of training, you mentioned as you were introducing yourself, you were looking for something to recharge your practice for the next chapter of your career. Has LANAP done that for you?

Dan Indech, DDS:  You know, when I came to BootCamp, I was still somewhat skeptical. I sat in the lecture hall that morning and I remember thinking, “What have I done?” Boy, I was wrong. It’s been a total game changer for me. I’d say about 200 LANAP cases later, many LAPIP cases, and VAPs every day, using the parallels has not just given me a renewed sense of excitement and accomplishment in my everyday work, it’s really transformed the way I treat periodontitis and peri-implant disease. It’s changed my trajectory, and it’s been a better late than never career defining maneuver for me.

Marty Klein:  Happy to hear that you mentioned you’re using your PerioLase MVP-7 for LAPIP and VAPs. LAPIP, of course, being for peri-implantitis, and VAPs, which stands for Value Added Procedures, or other procedures that you can use your PerioLase with. So you’re getting a lot of versatility, it sounds like, out of your PerioLase.

Dan Indech, DDS:  My PerioLase is on, and it’s ready to go all day long. Aside from LANAP and LAPIP, I use it during my extraction procedures, for congestion and hemostasis in soft tissue grafting procedures. I can treat patients without them having to stop anti-coagulation medication and feel confident treating medically compromised or elderly patients that may struggle to recover from traditional surgical treatment by using this minimally invasive, tissue- and tooth-sparing, easier-to-recover-from approach. My hygienist, who is a certified PerioLase LPD provider, Laser Periodontal Disinfection or Laser Pocket Disinfection, offers it to every patient at their maintenance care appointment. These days, our biggest challenge is sharing that machine, and I’m looking to add a second one to the practice so that we don’t have to compete for it.

Marty Klein:  We certainly have had many customers do just that, add a second PerioLase for their hygiene area. You talked just then about quite a few patient benefits. Do you find that using your PerioLase for these procedures is also easier on you physically compared to conventional methods?

Dan Indech, DDS:  You know, Marty, doing traditional gum surgeries is a grind; it’s physically, mentally, and emotionally demanding, both for the patient and for the clinician. In contrast, when I use the laser, it just sit back comfortably. I have a much more relaxed patient under me, and I proceed efficiently through the many steps of the protocol. Using the laser is like probing, I gently walk it around the teeth, and I paint the periodontium with energy that comes out of the tip. I understand what that energy is doing, and I can see and feel where I am at all times.  I’m able to control the settings to deal with the variations from one patient to the next.

Marty Klein:  Certainly a different tactile sensation, I’ve heard that from many clinicians over the years. I do want to ask one last area, and that is regarding you becoming an instructor. You were finished with your Evolution 5, or the final day’s training, mid 2020 and jumped right into becoming an instructor candidate, learning to become an instructor for LANAP and the associated protocols. What made you so motivated to take that next step to start the process to teach others?

Dan Indech, DDS:  You know, Marty, there’s no question that I’ve seen the light, and I’m really passionate about all of this. I’ve been looking for something like this for a while, and it’s really a good fit for me. Becoming an instructor has given me the opportunity to continually be immersed in this discipline, and at the forefront of this exciting revolution in periodontics. As an instructor, I will have an even greater privilege of being able to share that knowledge and enlighten colleagues that attend BootCamp and beyond. For me, this is very rewarding.

Marty Klein:  Well, your enthusiasm certainly does shine through, and we look forward to you completing your instructor candidate program, which should be here in the next couple of months. I do want to plug your website for anyone who would like to learn more about you and your practice in the Phoenix, Arizona area. That’s http://www.desertridgeperiodontist.com. I’d like to invite the listener here to subscribe to this podcast if you have not yet done so. All of the podcasts are available at Lanap.com/podcast. Dr. Indech, thank you again for taking some time out to share your experience and expertise with us.

Dan Indech, DDS:  Marty, thank you for the opportunity to share.