March 8, 2021

Why is the LANAP® Protocol A Full-Mouth Protocol?

Jin Kim, DDS, MPH, MS

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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. Jin Kim, a periodontist in Diamond Bar, California. Dr. Kim began his dental schooling in Australia at the University of Sydney, including an advanced degree in pathology. He continued at UCLA for his master’s degrees in public health and oral biology and a specialty training program in periodontics. He’s board certified by the American Board of Periodontology and the American Board of Oral Implantology and Implant Dentistry, making him a unique and rare dual board certified specialist. Dr. Kim, thank you so much for being my guest today.

Dr. Jin Kim:  Oh, thank you very much, Marty, my pleasure.

Marty Klein:  You first came to training on the LANAP protocol almost 10 years ago in 2011. Now, I understand it wasn’t a quick and easy road from when you first heard about LANAP to getting trained. So I’d like to give you a chance to tell your story how that happened.

Dr. Jin Kim:  I must have been a very unique situation. I was trained in periodontology specialty at UCLA, where I kind of got to know the founders of Millennium and the device earlier on. I think two things were unique. One was the fact that in general the periodontal community was not very receptive to lasers in general. So with my training and background, I too was skeptical. Does the laser really work? You know, what is it about this? There was one aspect, but the other aspect was earlier on when Millennium first brought out the device, I think the marketing strategy, let’s say, didn’t go down very well with established periodontal community. Let’s just leave it at that. So a lot of periodontists had a little bit of animosity, hostility to this device, so that sort of arbitrarily kept me away. It really wasn’t until I saw a considerable number of clinicians who I have total respect [for], my mentors and my colleagues, who were practicing in the so-called trenches and actually doing the treatment. When I visited one after another and after, say, about half a dozen of these clinicians who were the true pioneers, and I said to myself, “This cannot be ignored. This is truly a substantial significant tool that we can use to help our patients.” So that’s when I jumped on board.

Marty Klein:  I see. So it was a bunch of colleagues, then. In the in the decade that followed, have you noticed any change in the overall profession’s attitude towards the PerioLase?

Dr. Jin Kim:  I think it’s definitely changed, and I don’t know whether it’s fully accepted at this point. I mean, the numbers tell the story. The significant number of periodontists are using this method. There will always be die hard opponents, for one reason or another. I think some of the reasons some people that oppose it is sometimes cost. Sometimes the fact that they have to go get the extra training, there could be other, you know, reasons that’s not necessarily philosophical in nature. And some people still argue that is there enough evidence and that’s a typical periodontist talk. But in general, I think it’s becoming more and more accepted in the periodontal community.

Marty Klein:  Now, had you used any other lasers prior to coming to training?

Dr. Jin Kim:  Yes, I have been using a diode, but for different reasons. Not for periodontal therapy, for simple hemostasis, for tissue trimming, the sort of thing where diode is actually indicated for. But I never really thought of that as a solution for periodontal therapy until I got into PerioLase.

Marty Klein:  So you signed up for training back in 2011, and you have quite a history in dental education. You’ve led the West Coast Study Club for quite some time. So can you comment on the education that you received specifically for LANAP with the training?

Dr. Jin Kim:  Sure. You know, all my career, I’ve always been wholeheartedly involved with continuing education and dental education in general, teaching at the universities. I teach continuing education courses, participate in conferences, you know, that’s just part of my life. You know I think Millennium and the PerioLase has done something incredibly worthy in order to establish the fact that this is evidence-based material, and in order to make sure that the new users who are relatively new to this whole thing, including lasers, got the proper training, I know that they placed emphasis on rigorous training programs and, you know, kudos to them because I felt that my particular learning experience was extremely smooth, with very profound teaching and some nice mentors. That rigorous training over a period of three sessions and allowing the clinicians to go step by step, I think, was a very, very well thought out method that worked very well.

Marty Klein:  You mentioned there a couple of your other teaching credentials, and how this is just almost a lifelong passion for you. Now, this last year with COVID-19, it was quite a challenge I’m sure in the educational field. Have you participated in all in dental education over the last year? I’m curious your perspective on how that’s changed things.

Dr. Jin Kim:  Well, I think, you know, if COVID has done anything to the dentist mindset is clearly done two things. We are starting to accept our dentistry, which I’m getting into. I think we will start to do more treatment conferences, consultations, follow-ups over video monitors, which is a great thing, but it left a profound mark in the continuing education. Prior to this, and although I’ve given, you know, hundreds of hours of lectures and programs each and every year, this was the first year that I really did a significant amount of webinars and online teaching and we all learned, I think collectively all the clinicians have learned how to do it. I personally learned as somebody giving these programs find out, what to say, what not to say, because we don’t get that personal feedback. So how to make sure that the contents worked online? It’s always a good learning experience. And now I guess everybody became experts in Zoom and all sorts of online content.

Marty Klein:  In a way we might never go back.

Dr. Jin Kim:  That is true. There are some goods to that, too.

Marty Klein:  So I want to come back to your LANAP story and back to after you were trained and some of your experiences with getting the PerioLase into your office and starting to use it yourself. After quite a road getting to that point, did you start to see some promising results?

Dr. Jin Kim:  You know, I probably had much more anticipation than an average clinician who went through the same thing because I was really eyeing this for a very long time, and I was imagining how cases that I was actually treating in a conventional way how that would have turned out if I would have applied this laser. I went through a period of time when I was just imagining things like that. Then when I actually jumped right in I was for a while doing some parallel kind of studies, so to speak, because I was doing certain cases with laser certain cases without trying to get a feel.

The bottom line is, there’s clearly a place for LANAP I don’t think LANAP solves all the problems. I think that if somebody claims that that’s a little bit of, uh, exaggeration. There’s still some places for flap and osseous and bone contouring. So in my practice is working out great, because the tough cases that does require things beyond laser, there’s always a place for that. But the vast majority of the patients who do utilize LANAP truly benefit from it. I think the first thing they say is, especially the patients who actually had the unfortunate experience of having had the traditional surgery in the past, they would jump in joy as to how this was less dramatic and much kinder. But even for the ones who had never sat through surgery before, people come in with some knowledge and some perceptions as to what to expect. When they are given the news, that laser may be the treatment of choice for them, I see many patients just expressing the joy and relief that they don’t have to go through much more tougher surgical procedures.

Marty Klein:  And you must now have some patients that you first treated with an LANAP almost 10 years ago. Do you follow any of them? Do you see the longer-term results?

Dr. Jin Kim:  Absolutely. Periodontal therapy is periodontal therapy. There are cases that are successful. There are cases that drag on. There are cases that fall apart. That is, I think, independent of laser versus traditional methods. So I do see, you know, to be fair, I do see that equal proportions in the two modalities. However, I must add, since patients do not go through as much traumatic experience, they are more receptive. They’re more… What should I say they? They like coming into the office more. Earlier on, whether it was my lack of experience or just the nature of the brutal surgery, a lot of the patients in my office had one side of their mouths treated, never to come back for the other side.  When we when we followed them up and bug them with phone calls and letters and so forth, and when you finally tracked them down, they would admit that, “Nah, I really can’t go through that because it was uncomfortable. It was horrible.” We do hear some of that. Of the ones who are in maintenance, I do have a significant number of patients who had only one side surgically treated on the other side non-surgically treated. Now, by the time I got the laser fully involved, most of the patients I actually was able to follow up. I got caught up and said, “Hey, there’s great news. We don’t have to do invasive surgery. We can do very noninvasive surgery and let’s treat the other side.” So there are quite a few lucky patients who had gone through that. Now I guess that is truly the hallmark of the result, because I mean I don’t have a great number, but I have a handful of patients which really had conventional surgery on one side and laser LANAP on the other side. And I must say the result in the outcome is equal, if not better, in the laser group. So you know, that would be my joyous report of those findings.

Marty Klein:  You can’t evaluate any system or procedure if the patient isn’t willing to come in and do it.

Dr. Jin Kim:  That’s true.

Marty Klein:  I should also point out that the LANAP protocol is a full mouth protocol. So in your case, you mentioned that you had some previously treated patients. But for those who are listening now, LANAP is full mouth.

Dr. Jin Kim:  Yeah, and I do want to mention that again, Marty, because I think that’s one thing that the LANAP training has done, which I think that they should get the credit for. We know that periodontal disease is an infection of the mouth, of the human being, of the subject, not a particular area, not an arbitrary section or quadrant. But in practice, that’s the way we’ve been practicing for a number of reasons: Sometimes it’s the third-party reimbursement, sometimes it’s the money, but many times it’s because it’s uncomfortable, so you divide up the painful episodes over time. But, you know, bugs aren’t going to hide in one particular area and wait to be treated in the other side. The mouth is a unit of infection. So with the laser, because it’s the protocol that was put forth, because it is less traumatic and less invasive. We are able to do full-mouth protocols, which I love. So 10 years ago, I switched pretty much to full mouth protocol on all periodontal disease categories. I simply don’t look back because the patients are truly benefiting, the outcome is much more significantly positive, and everybody’s happier. So yes. Some of the exceptional cases I did were partial mouth sort of experimental, if you want to call it that. But today, when the patient comes in with disease, we don’t make exceptions, we tackle it full mouth, head on.

Marty Klein:  Excellent. Excellent point. I want to switch gears a little bit to implants. You have many credentials when it comes to implants and peri-implantitis. So I’m curious to hear from you how you’ve folded in the LAPIP protocol with the PerioLase to treat peri-implantitis in your practice.

Dr. Jin Kim:  Yes, that’s a very, uh, are you sure you want to start the topic because we’re going to be here for another eight hours?

Marty Klein:  Well, I can be more specific. How do you decide to use your PerioLase versus other modalities?

Dr. Jin Kim:  Great point. You know, up until this point, and still we really don’t have a perfect solution to peri-implantitis or bone loss around existing implants. That’s an area that still needs to be investigated and tackled and so forth. But when it comes to implants, I mean, I have a very simple rule: If the implant loses bone, you take the implant out. When do you take them out? A clear indication is, if it’s not your implant. If it’s your implant, you’re going to do everything possible to try to gain attachment and get it stabilized. If it’s somebody else’s, I mean let’s be frank, it’s a lot easier to say, “Let’s start over,” and many times that is the case. So when laser, when the Nd:YAG from PerioLase was able to explore, “Can we reverse the bone damage around dental implants?” I was naturally very excited, and once the LAPIP protocol became established and was put into place, I am actually seeing significant changes. Now, my golden rule is if it’s something that’s not going to be maintained over a significant period (and arbitrarily, let’s say five years), if the patient and I are going to regret after five years, then we got to take a more definitive action, such as replacing the implant. But if it’s something that I feel firmly in five years, if I can turn this around so that the clinical outcome will be more stable than where we are, then I do apply the LAPIP protocol. And it does work fairly well in my hands, and I think I am not the only one they can say that. I think by now we have quite a significant number of clinicians across the nation across the globe, in fact, doing the LAPIP protocol. So I don’t think I have to go into the details of the success. But there is clearly a place for Nd:YAG in the main management of bone loss around dental implants.

Marty Klein:  OK. Now you are pretty well known in LANAP circles for a video that you made of spirochete. You have, of course, a background in neurobiology and advanced degree in pathology. So I’d like for you to give a little behind the scenes if you will first. Maybe just explain what the video shows and then why you decided to make it?

Dr. Jin Kim:  Sure, yeah. You can easily find a video on YouTube. Just search for Jin Kim Laser, and you’ll probably hit that. It’s basically one day…We do phase contrast microscopy on a lot of our patients, and it’s a powerful educational tool because we take a scraping from their plaque around the gums and put it on a microscope slide right in front of their eyes, and we put that onto the big screen, and it’s a fascinating thing. The patients see these crawling bugs crawling, spinning, swimming on the screen. In fact, I had one patient who literally ran out after seeing that, so that can’t be a practice builder. But by and large, patients tell me that, “That’s bugs from my mouth? Doctor, help me! What can we do?” So we’ve had quite a few patients go through that sort of awakening experience. One day, my assistant I got bored I guess, so patient left and there’s a slide still sitting there and said, “What if I zap that with the laser like we always do? Let’s see what happens.” So we actually got the laser to that room and started working, and I got my assistant to film it with video with my iPhone. So this little video clip became sort of an instant hit.  You see this picture, these tiny micro microbes, especially the spirochetes and the more active ones that are spinning and swimming and erratic fashion, which is very typical of these bugs. And then when I run the laser over the slides, you know, directing the energy directly at them… instant death! And then you see calm of these dead bodies literally floating in the media. It’s a pretty fun video, so take a look at it. You will enjoy it.

Marty Klein:  It is. Now, I’m not a clinician myself. So as you mentioned as a, I’ll just call myself a patient, it’s very obvious you have the bugs and then you don’t have the bugs, so it waters it down so someone like me can understand it. I do have one other topic, and I will let you go, and that is that your wife is a general dentist, and I’m curious if she refers LANAP patients to you or how aware she is of the protocol.

Dr. Jin Kim:  She’s not on my good list anymore because she doesn’t refer anymore. It’s because she stopped practicing. In fact, she closed, she sold her practice. We’d been practicing, oh boy, for quite some time! She had her own independent practice. She’s in my practice helping me with other things, at this point. We built a digital lab together, so that’s her role at this time. You know, her and many other general practitioners 10 years ago, when I switched and brought in the laser, word got out, and a lot of the clinician said, “Hey, I’ve got a tough case, but I hear you have laser.” So people have been sending and that that that has been very helpful for the patients. But interestingly enough, you know the latest trends has been it’s been more driven by, should I say, direct consumer response because people are googling finding out “I have gum disease, but I don’t want to get conventional surgery. Who can I go to?” We do see quite a few number of patients, that I didn’t see in years past, that are coming in knocking on the door saying, “I hear you do laser. I’m here for that,” rather than coming in through dentist referrals like we had in the traditional past. So that’s becoming a bigger part of the practice as we go day by day.

Marty Klein:  Wow. You know, I have heard that from so many other clinicians to that more and more patients are coming in almost demanding it or asking for it by name. So that’s a trend that I’m sure will only continue.

Dr. Jin Kim:  Yeah, and that’s happening a lot more in dentistry in general. And I guess in the medical field, they call it the Rogaine Syndrome. It’s the bald-headed guy walking in and saying, “Doc, I need Rogaine,” you know, and that’s how the name got stuck. But yes, you’re right. dental implants, complications from implants, laser, a whole bunch of things, sleep apnea treatment, we do cosmetic enhancements, a Pinhole gingiva augmentation…All of these things that we’ve offered today it’s incredible how its consumer-driven and in this day and age of social media, especially during the COVID period when people are locked down and all they do is just stick their finger on their phone and research things. This is a phenomenon we’re going to be living with.

Marty Klein:  Excellent point. Well, I do want to thank you for taking the time out to speak with me. But before we go, I’ll give a plug to your website. Drjinkim.com. And for anyone listening who’s not yet subscribed to this podcast, please do so or visit us at lanap.com/podcast. All of the old episodes are there. Dr. Kim, again, it’s been a pleasure to speak with you. And thanks for taking some time out of your afternoon to speak with us.

Dr. Jin Kim:  Marty, the pleasure has been mine. Thank you very much.