Howard: It is just a huge honor for me today to be podcast interviewing Dr. Harvey S Shiffman DDS who is a general practice at the laser Dental Center in Boynton Beach Florida. He's a graduate of Georgetown University School of Dentistry and completed a general practice residency at Georgetown University Medical Center with an emphasis on treating medically compromised patients. Dr. Shiffman completed certification with the Academy of laser dentistry in three types of laser system and was recently awarded a fellowship in the Ald. He is personally involved in the use and development of cutting-edge technology and has performed tens of thousands of laser dental procedures over the last 18 years. Dr. Shiffman is an instructor for the academy of clinical technology, he's most recently lectured at the rocky mountain dental conference, Seattle Study Club symposium, Yankee Dental Congress, Americans sleep and breathing Academy the Greater New York Dental meetings on advances in laser dentistry and the 2018 Laser & Health conference in Slovenia. Dr. Shiffman is an adjunct professor in the department of prosthodontics at Nova Southeastern College of Dental Medicine and most recently was awarded the expert lecture status from the laser and health Academy. Hey thank you so much for coming on the show today how are you doing?
Harvey: I'm doing great thank you for the invitation.
Howard: So be honest when you lectured in Slovenia did you think at least twice that you weren't ever gonna leave and come home back to Florida?
Harvey: No Slovenia is a beautiful country you know it's wedged in between Italy and Croatia and beautiful beautiful country.
Howard: No I know I love it I remember my lecture did Venice I took my son my oldest son Erik and we actually rented a car and drove all around there and Croatia and lectured in Albania and what all I keep thinking of is that when you look at the Adriatic Sea on the one side is Italy and all that land on the ocean is like a million dollars an acre and then you cross and it's like ten thousand dollars an acre and I thought to myself my gosh Eric we should stay here and buy up all this land on the beach and then when you're my age it'll all be million dollar an acre condos and resorts that's any dentist listing this in Europe man go to Albania go to Slovenia and Croatia is just amazing but so I'm just gonna I'm gonna hit you with the hardest question this is dentistry uncensored we don't pull any punches, she just graduated from dental school four hundred thousand dollars and debt. I mean you're there Nova that's a hundred thousand a year I'm here in Phoenix on Midwestern and glendale's one hundred thousand a year, A.T. Still hundred thousand a year. So she walks out of school four hundred thousand dollars in debt and she says my god if I buy a laser that's another hundred thousand dollars, if I buy a CBCT that's another hundred if I buy a CAD cam that's another 100. When you're coming out of school four hundred thousand dollars in debt can you really afford a hundred thousand dollar laser?
Harvey: Well I mean it depends on what you want to do with it and and what kind of dentistry you want to practice, you know if you're looking to set up a practice which is very forward moving progressive then you've got to embrace laser technology of some kind these days. People that are coming into the office or searching us on the internet they're they're looking for high technology and lasers are part of it.
Howard: So do you consider well I have a friend who is a and I know you're thinking Howard doesn't have any friends but I got one and he's a podiatrist yeah a foot doctor I was getting confused with piedadontist and he advertises laser foot surgery, laser foot surgery and he just thinks it's he he only bought his from marketing he said that is the thing people when you tell someone they need a cortisone shot in their foot they immediately start wincing, just a thought I'm a imagine your foot sore and you're here to go to some he's gonna stick a needle in your sore foot but he thinks that the the laser for him was ten times more about marketing that was even clinical podiatry. Do you see laser dentistry as more of a marketing play or an actual treatment play?
Harvey: I mean we use our lasers we use the Fotona LightWalker laser which has two laser wavelengths in it one is for hard tissue one for soft tissue. So we use that machine all day long on every single patient that comes in to the practice our practice is laser focused. So is it marketing part of it is because we get a lot of patients that come in you know see more YouTube videos and the videos we have on our website and everything and they're searching out these procedures because they know it is gonna be less bleeding, less discomfort, it's gonna heal faster and all these positive aspects of laser dentistry. So it's a it's a combination of both things together for sure.
Howard: So out of all the way and by the way this is not a commercial even though the one of the biggest wings in that company is Keith G Bateman and I'll never forget his name because his initial or the KGB so every time I see him for last 30 years and he asked me a question I'm like is this being recorded for the KGB but anyway that's our 30 year running joke but of all the lasers and this is not a commercial Keith Bateman didn't ask me to bring you on or I called you, you didn't call me but of all the laser systems why did you pick Fotona and the LightWalker system?
Harvey: Well I mean I've been using lasers for 18 years so obviously you know I've had a lot of experience with different companies and different you know machines different wavelengths of laser. So every time I was back in the market I would research all the machines I would test them, see what they could do and for the last about 10 years I've been a Fotona user because of the you know the strength of the company the machine what it can do. I mean it can really do more than any other laser that's on the market conservatively speaking okay well that's my choice.
Howard: 25% of my viewers are still in dental kindergarten school like over at Nova, you said it's a hard tissue and a soft tissue, go into more detail on that. Well what is a laser that only does soft tissue versus a laser that does hard tissue and soft tissue?
Harvey: Okay I mean a soft tissue laser is typically a diode or something similar to that where you're doing gingiva ectomies, gingiva plasties, you know treating soft tissue lesions. A hard tissue laser is going to be able to do restorative dentistry crown preps if you want, you can cut bone with it any kind of tooth structure with it when you have the two combine together you've got the best of both worlds because you can do full osseous periodontal surgery where you're cutting and treating soft tissue and you know recontouring bone and decontaminating bone at the same time. So a lot of different uses you know when you have the two wavelengths together in the machine and the only one that's got those two wavelengths is the Fotona LightWalker.
Howard: That's the only one that has that for hard and soft?
Harvey: That's got the two wavelengths in the same box basically is the Fotona LightWalker correct.
Howard: So the only dental laser that has the hard and soft tissue wavelengths in one machine is the Fotona?
Harvey: That's correct I mean some of the other machines you can use the wavelengths that are there to cut hard and soft tissue but we have two dedicated separate laser wavelengths to do those procedures.
Howard: and by the way laser is an acronym standing for light amplification by stimulated emission of radiation and the first laser was built 1960 by Theodore H Mayman at Hughes research laboratories by none other than Howard Hughes so that's what I have the most common in with lasers is my name is Howard.
Harvey: Their you go.
Howard: and by the way I gotta tell you somethin bout Howard Hughes remember that movie what was the movie that he did was an avatar what was the, Aviator and I went and saw that movie and you won't believe this happened. It wasn't even a couple of days later a patient of mine came in and I just mentioned that I really liked that movie on Howard Hughes aviator and turns out he's was a retired man born in Nogales, Arizona who worked with Howard Hughes and he thought that movie was the most well done I mean that he thought it was a historical docudrama movie and when they were coming out with a movie he thought they're never gonna get Howard Hughes right and if Leo he said Leonardo DiCaprio just nailed the entire movie. So lasers started in the Howard Hughes research laboratories in the sixties I was born in 1960 I was born in 62 they've come a long way since you and I've got out of school.
Harvey: Oh absolutely absolutely yeah I mean the the some people say to me you know you must be an early adopter but my mentors were the early adopters, you know the people that I learned from you know back in using lasers back in the 80s and doing periodontal surgeries and all kinds of things with them and just move forward from there.
Howard: So go into more detail you said it's the eye it has two wavelengths dedicated one for hard when were soft what are those wavelengths and how are they different?
Harvey: The the soft tissue wavelength is neodymium YAG or nd-yag and that strictly soft tissue we also use it for what's called photobiomodulation to help healing stimulate cellular energy and that type of thing and then the erbium YAG is the other wavelength that can be used to cut soft tissue, hard tissue, tooth, bone. We use it for snoring and sleep apnea treatments for facial rejuvenation treatment lip plumping all kinds of things it's a very diverse machine.
Howard: and they'll talk about the hard tissue and and tooth versus bone.
Harvey: Well we can with with the newest machines we can cut teeth as fast as a high speed handpiece you know we can cut bone to your eye removal, wisdom tooth extractions without using rotary instruments that can you know microfracture or a damaged soft tissue. So very very safe much more gentle for the patient less post-op pain let's post-op bleeding you can coagulate with it a lot of a lot of different options.
Howard: One of the most interesting podcast, I've already podcast had five dentists who are no longer with us Dennis T Myers, Ivan Kirchner right here in my backyard in Scottdale, Robert Ibsen and the founder of DenMat, Carl Misch who needs no introduction but one of the most interesting ones was Fred Margolis out of Chicago who was really considered by many the pioneer of bringing lasers to pediatric dentistry and he used to even said on this podcast two or three years ago before he passed on that he couldn't believe that pediatric dentists didn't use a hard tissue laser he said my gosh at the time it takes you to get a child numb he could and have to give a shot which is not very good and fun, he could do the holding procedure but he said again back to marketing the mothers you know the average female Homo Sapien grade a monkey will talk to five other people for every one time a man will and it crosses all of the greater apes and she said he said when those moms would see that he didn't give a shot and we do with the laser that she would go out and tell everyone. He just thought it was the biggest practice builder ever had do you have you witnessed that effect?
Harvey: Absolutely are our patients because we used a laser on every single patient in one way or another either to relax their muscles after a long procedure or to pre numb them with the laser before we give an injection if we have to or fillings without injections, they go out and they tell all their friends and family and we get a lot of our referrals come directly from our patients so absolutely be firm believer.
Howard: Did you ever meet Fred?
Harvey: I knew Fred very well through the Academy of laser dentistry and he was a pioneer and a true gentleman.
Howard: Yeah he was he was a class act man r.i.p Fred we're still talking about ya and it's been three years. Do you see where you're at you're in a Boyden beach florida do you see a pediatric dentist using this?
Harvey: Not too many an in our area, my area is we're probably about 75% geriatric where we are in South Florida. So there's not a lot well this piedadontist around but there are no piedadontist locally to us using lasers that they really should you know I've got a lot of colleagues piedadontist that are using the photo no lightwalker laser and and their patients absolutely love it so no shots which is a huge no drill sound and no shot the thing that people fear the most
Howard: So would you almost consider yourself a geriatric dentist then?
Harvey: I guess so I guess so because the majority of our practice is geriatrics you know reconstructive dentistry, parep, endo, facial rejuvenation, all those types of things.
Howard: and how much does this Fotona, named after Photon, so it's fotona it's pronounced fotona?
Howard: After the light photon. How much how many times how much does it cost and how many times a day would you say use it?
Harvey: Well the machines are around eighty thousand dollars I mean obviously I'm not a sales person so I can't tell you exact numbers but it's in that ballpark and if we see 10 to 15 patients a day then 10 to 15 patients have the laser used on them in some way. Whether like I said it's treating sore muscles after a long procedure pre numbing before an injection to make the injections more comfortable we can give palatal injections after laser pretreatment that are almost totally pain-free which is pretty amazing so pretty much on every single patient.
Howard: So using the soft tissue laser on the greater palatine and numbs it up so that when you give an injection it's less uncomfortable?
Harvey: Yeah we use it for infiltrations, for palettes, for blocks, anywhere we're going to give an injection we pretreat it with the the neodymium YAG laser and then inject right into that spot and 85 to 90 percent of the time the patients feel absolutely nothing and with no side effects from topicals, so no swap.
Howard: Yeah so start talking about the all the different things you use it for, did it replace packing cord for you or not really?
Harvey: I would say over 50% of the time it does it just depends on the tissue but we do troughing with it you know ginger ectomies, tissue recontouring for smile design. We're very big on treating snoring and sleep apnea with the laser and and facial rejuvenation we've got a procedure called smooth lays that I actually hold a trademark on and it's facial rejuvenation all done from inside the mouth. So we're tightening collagen we're stimulate stimulating new collagen formation with the snoring and sleep apnea we're preventing the collapsibility of the of the airway by stimulating new collagen you know in the soft palate the uvula and that's all done with the same laser just you know different hand pieces that are adapted to it and like I said we do a lot of periodontal surgeries with it, we do procedure called pips sweeps which is for endodontics and you know pretty much anything you can do in dentistry we can do with a laser and it's more comfortable when patients are happier when they live
Howard: You said pip sweeps?
Harvey: PIPS, photon induced photoacoustic streaming and there's a new modification of that called sweeps and it's laser activated irrigation in the canal system to kill bacteria, remove soft tissue in the canal system in areas where files can't even go pretty pretty amazing. Then I saw a lecture by a gentleman by the name of Mark Colonna over 10 years ago and that's when I bought my first Fotona laser when he was talking about the antibiotic applications of it.
Howard: and so you do your regular endo and then the very last part of your cleaning and shaping and is this pip sweep?
Harvey: Well we in between each file you know just like you would irrigate after each file or each succession of files we go in with the laser and do the photo or the photon and activated irrigation and we're getting a much cleaner canal, bacterial kill is higher. You know it's all proven by research so very very very efficient low-cost system you know as far as you know any disposables or anything.
Harvey: Wow um do you think this is going to take off more with endodontists?
Harvey: It already is you know we've got a lot of endodontists using the Fotona lasers and more and more of them over time because I see them in the you know in the training programs coming through a periodontist also.
Howard: and Mark Colonna I'm with the Montana Center for laser dentistry he's doing this too?
Harvey: Yes he was one of my one of my early mentors.
Howard: iIs there right, well you tell them to come on the show and follow you that'd be a great one-two punch.
Harvey: Sure I'll talk to him
Howard: Yeah and so the one thing when you talk about our facial rejuvenation and then earlier you said you were 70% and you know senior citizens geriatric I really had my mind blown when I went to New York and spent a day or two with Larry Rosenthal because when I was a young kid I thought cosmetic dentistry was for like supermodels turns out that supermodels are already beautiful and gorgeous and what Larry was focusing on is he realized that 80 year-old women would give you what would do anything to look like they were 70 again and my gosh his entire practice when I mean was charged in all these amazing cases of cosmetic dentistry but they were all older ladies and in fact he said he said the biggest one-liner closing sale is uh my gosh I can make you look 65 again and these 75 year old women would start dumping out their purse. Do you see facial rejuvenation more with older women as opposed to older men?
Harvey: Well we I would say probably 80% of our rejuvenation patients are female and 20% or male and you know when we first started doing it years ago it was it was a hundred percent female but that's starting to shift because we can actually conservatively turn the clock back on how these patients look because I mean I've spoken to so many dentists you do a beautiful set of anterior crowns or veneers and give the patient the mirror what's the first thing they do, they either fix their hair or they look and they go I hate this you know wrinkles sagging lines on their face. So using the the smooth laser procedure we're able to turn the clock back a good 10, 15 years for this these patients and we can actually prevent wrinkle formation by keeping you know young collagen stimulated in the patient's skin all from inside the mouth.
Howard: So that means you're gonna create a course on double down on the smooth lace procedure for me, just say yes.
Harvey: Sure, sure absolutely
Howard: Really, would you do that?
Harvey: Yeah of course.
Howard: So talk me through it how do you use a laser what is the smooth lace procedure and how does that work, what are you actually doing?
Harvey: We're using the the neodymium YAG laser the the soft tissue laser to preheat the tissue and then we follow it up with a proprietary handpiece with something called smooth mode technologies it's a burst of six pulses in 1.5 seconds and what that does is it pumps heat into the tissue creates something called a heat shock which stimulates collagen conversion tightening of collagen and then stimulates the fibroblast cells to start forming new protein that's formed into new collagen. So it's we're down working on the cellular level with this stuff.
Howard: and if you did 100 senior citizens how many of them would think they it was a success and notice a difference?
Harvey: Hundred percent of them.
Harvey: I mean they all need multiple treatments and depending on the loss of elasticity of their skin you know we treatment plan them based on that too and and once we get about three-quarters away through their treatment they start to see the difference they feel the difference in their face elasticity wise you know sagging starts to tighten up, bags underneath the eyes start to tighten up it's it's pretty amazing stuff and definitely rewarding when you show the patients their before and after photos and they can really see you know the changes that have happened.
Howard: So is this a one treatment or is this a series of treatments I mean is this a one...?
Harvey: Its a series of treatments, yeah smoothlase is pretty much age based so 50 year old would typically need five treatments 60 year old six treatments etc. You know and then we modify that a little bit if they've got a really significant loss of elasticity a lot of sun damage if they were smoked or kind of thing so and then preventative treatments to prevent wrinkles usually two treatments and patients in their 30s and 40s are having those done.
Howard: What I've been doing is instead of trying to look younger I just tell everybody I'm ten years older I just say oh I'm 72 and they go damn dude you look good and so then is this a combination thing, are you also a Botox dentist?
Harvey: Well we do offer our patients Botox and dermal fillers and we'll use these things in combination you know as necessary. The majority of my patient pool down here in Florida doesn't want to have artificial materials injected, some of them do and you know we combined the smooth lays procedure with you know Botox and fillers sometimes or we used a platelet-rich fibrin and we inject that you know so more natural than artificial materials. So we have options for all different patient requests.
Howard: and how much do these our treatments cost?
Harvey: Well a seventy-year-old is probably looking at close to $7,000.
Howard: No kidding, $7,000 70 so so it would be seven treatments so $7,000 would be $1,000 a treatment seven times?
Harvey: Yeah that's that's the high-end okay so anywhere from about 4900 up to about $7,000 depending on your skin type.
Howard: Well and how does someone learn something like this? You teach a two-day course on this or something?
Harvey: Well I'm pretty much the developer in the United States and I teach the training courses and we have a two-day program that includes the nightlase, snoring and sleep apnea reduction therapy and the facial aesthetics is the is the second day of the program.
Howard: and where does someone find the dates of these events?
Harvey: Through fotona.org on the website there's an educational area that they can go to and find the training course schedule.
Howard: Okay let me see I think it's fotona.com so if you go to fotona.com the workshops that would be out there one of the under events training and workshops okay I'm finding that and
Harvey: Yeah you have to go into the dental section, Fotona also has dermatology and gynecology urology lasers so they're not just in the dental market.
Howard: Okay which ones are best market aesthetic dentistry gynecology or surgery what's your best on success?
Harvey: It varies all over the world, I mean you know if you would have asked me five six years ago it was dentistry in the United States but now the aesthetic division is really booming in the US. You know I mean dentistry is too but aesthetics is success and dermatology are selling like crazy.
Howard: So let's just take these one by one, let's start with a nightlase therapy how it says on the website for Fotona nightlase therapy is a non-invasive patient friendly laser treatment for increasing the quality of the patient's sleep how does that work how does a laser on help with sleep?
Harvey: Well nightlase is a non-surgical treatment so what we're doing is we're prevent we're preventing the collapsibility of the airway. Sleep apnea snoring is is from loss of tone of tissue in the back of the throat the base of the tongue the anterior tonsillar pillars, so we're re establishing new, more elastic collagen and tightening the existing collagen that's there and we're reducing the collapse ability and you know we've proven that through research studies with various different modalities and you know very very successful procedure all and tens of thousands of cases all over the world that have been done since 2011.
Howard: and another you know you and I have seen you know I always say there's nine professions and the one that changed the most in the 31 years that I practice since I 87 was periodontist and my gosh when I got out of school and I was little it was always four quadrants of surgery then 10 years later everybody thought you know what that doesn't work you're gonna treat this gum disease with forceps and they start extracting all these molars and replace the implants and then about ten years after that they started realizing that my gosh forty to sixty percent of these implants have peri-implantitis after five or nine years. So what are your thoughts on using this as for peri-implantitis and there's another laser LANAP that talks about this to. Are you using yours for peri-implantitis?
Harvey: Yes yes we are the the erbium laser can actually clean and detoxify the titanium surface of the implant without doing any damage to the factory surface and you can get bone regrowth regeneration onto the implant surface and then we used neodymium YAG wavelength which is in the millennium laser also and we use that to detoxify the soft tissue around the implant for reduce the bacterial load and stimulate you know more rapid healing with that wavelength also but the erbium successful at cleaning the implant surface and the bone.
Howard: Well this is Dentistry Uncensored so i'm going to have to at least throw it out yeah well then what would be the difference of doing it with a photon of laser versus the LANAP laser?
Harvey: Well the Fotona laser has the hard tissue wavelength so we can actually clean the surface of the implant without doing any damage and we can clean and detoxify, decorticate the bone defect around the implant to place graft materials, biologics you know membranes whatever you'd like to put in there. So their are two totally different approaches.
Howard: A lot of people say that laser assisted tooth whitening is a gimmick not science do you agree or disagree?
Harvey: Well I mean I disagree because you know we do it when we do it with the erbium laser very different than using a diode laser where there are no pigments that absorb the energy and the in the gel like with a diode laser. We're actually only micro heating the water molecules in the gel itself on the surface so there's no significant heat penetration into the teeth and we do see you know a better longer-lasting whitening effect then you know other products that we've used in the past so Im a believer.
Howard: Well I'm a believer that when you tell someone to take these trays home and soak your teeth in it but people want to be one and done they would I mean they could go to Walmart and buy a permanent in a box I mean I grew up five sisters back then only rich people could have it applied you would go to the store you buy a kit and they would come home and do it in the kitchen sink but girls today don't really want to do it in their kitchen sink they'd rather go to a salon and have someone else do it. I think the market for having someone else bleach your teeth is bigger than a do-it-yourselfer at home because time is money and that they just don't want to spend the time. Do you agree or disagree?
Harvey: I agree with that because I mean we we do home trays also in the office you know in our practice and a lot of times the patients will take them home and they'll sit on the bathroom counter and they'll use them once or twice and never follow through. When come into the office and had whitening procedure done, it's done right there and you know there's no compliance issues once they walk out the door so where our office is probably right now about a 25 75 split you know 25 percent in office 75 percent home as far as whitening is concerned.
Howard: and this late you lectured in Slovenia and on the Fotona website they even have an address in Slovenia is that where the laser is made?
Harvey: The factory is in Slovenia correct yeah and it's a the Fotona has been in existence since the 1960s they started out as a military like citing lasers fiber optics and that kind of thing and they developed from there but the the factory is there in Slovenia and the civilian people are very committed to you know their quality product.
Howard: Wow so it started out as military laser that is amazing so Slovenia used to be in Yugoslavia so it was it was that part of the USSR.
Harvey: Yeah I guess so yeah.
Howard: Wow so that was their high-tech military laser because um it was the competition of the Cold War that drove so much of space going to the moon lasers people you really have to go back and realize how important competition is to get a society moving. So that was an old military technology that is unbelievable. So have you been to so when you lecture there you obviously saw the plant and all that stuff?
Harvey: Yeah I've been in the factory very very secure facility I guess there's a lot of industrial espionage that goes on you know, so the majority of the factory is several stores below ground level stories down it's kind of like a concrete bunker from the Cold War days and very interesting but they manufacture probably in the high 90% of the machine right there CNC milling machines running 24 hours a day making components so they're they're pretty cool people when we go over there and and meet up with them and listen to the research and development people.
Howard: That is so cool my gosh that is so cool. So when you lecture and you, I mean you've had some prestigious gigs I mean Rocky Mountain dental conference, Seattle Study Club, Yankee, when your lecture you like at the Seattle Study Club what are what are you lecturing on whatever they both want to hear about?
Harvey: Well I mean it's it's usually one of two things either it's an introductory level program that I do for people who have no knowledge of lasers whatsoever or we talk about the you know the sleep apnea and facial aesthetics for docs that have had some exposure to lasers and they just want to see you know with the new cutting-edge technologies and so that I spend more time probably on the cutting edge technology end of it than the introductory level but I've lectured on various different levels depending on where the location was for the program.
Howard: Now are you placing implants too?
Harvey: Yes I am, so yes
Howard: You place the implant and we'll talk about that but by the way I love your website Boynton Laser Dental because you're tying in I mean when you start a business you got to have a unique selling proposition gotta be something well what's different than you how many dentists are in in Florida what would you guess?
Harvey: Four thousand maybe more...
Howard: Yeah I mean I think it's double that I think last I heard I think there were 8,000 dentists. So you gotta have a unique selling proposition and you work it right into your name Boynton laser dental I mean it's just it's just your marketing it's your image it's just it really defines you versus the dentist across the street, because one of the biggest problems in dentistry I don't think dentists have realized that is dentistry became so good it almost commoditized is self. I've had three experts on this show that said that when they're starting to Millennials versus senior citizens like with a millennial and someone says oh my god Suzy her appendix burst and she had to rush the hospital they just assume that all hospitals are the same no one ever talks amongst Millennials that Oh which hospital did you go to which doctor did you get because the doctors got so good they just assumed that if you're removing appendix in an emergency room in a hospital in America you got to be damn good. Whereas when you study senior citizens they have seen that they had so much more dentistry done on them they know that some dentists do root canals better than others and that this dentist did a lot of root canals but a lot of the people had to have them retreated by endodontist etc etc but the Millennials they haven't had a ton of Dentistry they had a bunch of root canals and crowns and so we're we're still market differentiation in the and around the world with baby boomer population but with Millennials we're really starting to commoditize ourselves and the one thing that's very neat about what you're doing is I mean you work your unique selling proposition right into your name your Boynton Laser Dental and that is so it's good marketing. I have to applaud you that, and the worst marketing the hardest marketing is when you have your name I mean if my dental office is called Howard Eugene Farran the second DDS MAGD I mean no one would remember it no one would know what it meant but they live in Boynton and they want to look for Dentist and you're a laser guy so it's Boynton Laser Dental and when you go to your website you just see laser all over it as opposed to the fact that you're placing implants which is huge but that's not even in your name but let's switch to implants how did you get into dental implants and how do you use a laser with dental implants?
Harvey: Well I started my dentist when I was a kid before I went to dental school was placing blade implants and...
Howard: Now you're giving away your age, they don't know what blades are.
Harvey: Right well he had you know done some work with Lenny Linkow and you know and those people back in the day so I was exposed to that watching him hammering those things in and you know and then my first job out of my residency program in South Florida was with a gentleman who ran there's a an educational program in Miami called Lindsey Hopkins and and he ran the dental division down there the implant division. So he was teaching implants down there and as his associate I was doing implants in his office in 1985 and just ever since okay so we've been doing implants an awful long time obviously things have changed quite a bit but the basics haven't.
Howard: and how are using a laser in that?
Harvey: Well we we used a laser for our initial osteotomy before we place the drill into the bone we use it with our soft tissue flap on occasion not always sometimes we use a scalpel. Once we've done our osteotomy with our burs we take the erbium laser and we clean out all the smear layer inside the osteotomy we open up the marrow spaces in the bone clean and detoxify that surface so we've got nice you know bleeding bone and right before the implant gets put in and then we use the nd YAG laser to stimulate healing, reduce inflammation and post-op pain after the implant is in place and the and the flap is sutured back in place. So it's quite a bit of laser involved with that too.
Howard: That is really amazing that you just mentioned Leonard Linkow whoo a lot of people around the world consider him the father of implant dentistry. I mean that's a lot of people would say that that was branmarc. What are your thoughts about calling Leonard linka the father of implant dentistry?
Harvey: You know from my experience personally and you know I would say absolutely you know he was the first person I ever heard of doing implants and I mean obviously they were blades there than not the type that we're using now but still he was in there placing those implants and I've seen patients in the last 10 years that have those blades still in place and they're functioning. So obviously they they had it right at that time.
Howard: I think he was just an amazing man I mean he was so amazing and we I have a RAP pthread to him on dental town under implantology but him in Carl Micsh and I just wanted one lesson of Leonard Linkow I want to remind all young Millennials when you see something you don't like or understand is that you know thirty years ago these guys placing blades and subperiosteal and ramus frames and that when they started doing that a lot of eyebrows are raised a lot of them got into a lot of trouble. I know dentists that did a hundred full mouth cases with subperiosteal and when the first one failed they took his license away and he lost his source of income and wouldn't got a trailer out of Apache Junction and just drank himself to death out of depression. So you know dentistry, most professions have a habit of eating their young and Leonard Linkow yeah it's really easy to say in 2019 that he is could be considered the father of implant dentistry and truly a legend but when Leonard started doing this stuff back in the day did he have any controversy I mean a lot of people raised a lot of eyebrows in the...
Harvey: Oh for sure absolutely
Howard: Yeah and so many times that you know you see something new going on so you just hey that's not the way we always did it so you're ready to throw the guy away these pioneers there's so many amazing pioneers in dentistry and you know so just be careful with them so um you're also you're also on the website of Academy of clinical technology ACT which is at t4med.com what's t4med.com. What's all that about?
Harvey: Well the the ACT is the educational arm of Fotona in the United States. So T4med was Fotona was originally owned by a Slovenian company and it was now its American owned. So before fotona became an American owned company T4med was handling the distribution of the fotona lasers in the United States, so that's the connection there. So I don't even know really still exists but II but ACT does exist as the education arm.
Howard: and so what implant are you placing?
Harvey: Right now I'm using biohorizons implants
Howard: Okay. The largest dental meeting in the world is the IDS meeting in Cologne Germany every other year and it's coming up here in March and rumor has it there's going to be between two and three hundred implant companies on display and the kids listen to you on this show she's 30 years old she really doesn't want to evaluate 300 dental implants companies. Walk her through why you went with bio horizon as opposed of the other 400 dental implant companies.
Harvey: Okay well I mean from me the majority restorative this restorative side is really important as a restorative dentist. If I was a surgeon placing implants and walk out the door afterwards and I didn't worry about restoring them then obviously you know how they handled during the surgical portion would be the most important thing but as a restorative dentist who places my own implants and then restores them I want them to be you know a simple technique for the surgical portion and then easily restored you know easy to take scans or impressions. I mean we're all digital in the office now so we're scanning but so it's got to be something that's that simple the components fit well together and that the that our local rep is available at a moment's notice if we ever need a component or something like that and that's a big difference because I looked at several other companies who I won't mention where the local reps were not available at all, all right we've loaned implants to other offices we've borrowed implants from other offices locally because of you know how our rep worked with us and that's really important to me, you know is that interaction and to know that we can you know have that flow in the practice so that that's that's important when you're selecting a product.
Howard: I think it's funny how we were talking earlier that on that Fotona was named after a photon was from Slavonia which used to be in the USSR is a military people don't realize that by own reasons is in Birmingham Alabama and that's another military spaceship I mean they they were making the solid rocket booster fuels for the space shuttle but the reason there's so many high tech scientists and Alabama links back to NASA and over half of all the NASA missions are military. So it's kind of like you have a military laser and use the military implant you know and...
Howard: and in economics we call that a cluster effect like if you had an idea for a carburetor the first thing in a many a PhD Kaunas to say is that if you want to hire someone with 10 20 30 years experience in a carburetor you have to move too the car cluster effect which would be Detroit. If you're gonna launch a movie you need to go to Hollywood if you're gonna really go far in insurance banking and finance you need to go to Manhattan and so you have these clusters because you know when you're running a business only people time and money and people tend to cluster in an area and Alabama is a very high-tech area. You talked about scannings and I can't let go off that so she's 25 years old she's like okay I can take an Impregum impression from 3m espe for 17 bucks why should I buy a $17,000 true definition scanner? So first what oral scanning did system did you use did you go with?
Harvey: We're using the Trio's and we're using the wireless and we've got a you know a laptop on a cart and it's convenient easy to use. The quality of the images is really good fast, so our patients love it you know. It's partially marketing just like everything else and and partially you know ease of use and and the ability to email the the scans to our laboratory and you know have the work get started in a much faster time period we can make modifications online with the laboratory. You know they can send us a design you know through email and that type of thing so the technology works really well make it makes my life you know much easier and our patients experience much better too so it's a combination of all those things together.
Howard: Okay but walk her through the decision why I'm you and with three shapes trios at a Copenhagen, Denmark why did you not go with Align Technology which owns Invisalign and the oral scanner iTero or 3M's true definition scanner, what what made you pick 3shape and 3M?
Harvey: Well we didn't want any powder and after using them I've used the other ones down at the Nova at the dental school so had some experience you know when I was the days that I was there working in the clinic with the students and I was just really happy with the with the scanning and the the ergonomics of it and all that and it just you know it works for us we've got beautiful you know scan images and we can do our shade matching with the system also when necessary we have complicated shades. So communication with the lab is really important and it just works it makes my life less complicated you know and whether you're starting your career or more advanced in your career if it makes things easier or more predictable for you makes it less stressful on a day to day basis too so that's that's a beautiful thing.
Howard: So it sounds like a big part of that was you wanted to use an intraoral scanner without optical powder as opposed to powder well and talked about that a little more. Why why was the optical scanning powder negative for you?
Harvey: Well I mean the patients were not big fans of the powder obviously you know there's pros and cons to the thickness of the powder you know moisture control things like that. When we have the laser we can control you know any bleeding we can recontour a tissue which makes scanning or even impressions you know much less technique sensitive and because we're dealing with the moisture issues but the powder with the moisture and then the patients really didn't like it so that was a big part of it too for us.
Howard: Now in your am I saying it right Boynton beach boynton beach?
Harvey: Correct right unless
Howard: If you're 70 percent geriatric are you doing any clear aligners or is that really not a big part of your practice?
Harvey: No we did a consultation today for clear aligners on a 60 year old patient so you know either they've had shifting they may have had ortho done when they were young and they've got shifting because of you know clenching, grinding, you know whatever and and they want to look better so here regardless of their age we've done you know we've had patients in ortho up to 80 years old probably over the years.
Howard: yeah I am I can vouch this case with you if you don't believe me on this case it sounds too good to be true you can talk to a Harry green who's an orthodontist in Phoenix to help me on the case but again when you're young when you're a millennial and you come out of school you think the people who want bleaching bonding veneers are a bunch of hot 20 year olds well 20 year olds are already hot and they don't have any money and the number one orthodontic case I probably did a thousand worth of cases in 30 years the number one happiest patient I can't see her name because I HIPAA but her name's sue and she lives in Casa Grande and Harry green help me do the case and she retired from Michigan where Kalamazoo, Michigan moved out to Casa Grande this is back in like eight in the 80s and I just I just said to her you know she had really crowded teeth and I said um have you ever considered braces and she goes flash none of my age she goes I just retired here I'm 65 I said well I'm pretty sure if you're alive you can still do braces you know you just it doesn't really work once you're dead but as long as you're alive I think it works I did that case and then and that was back when I'd only done four or five so I got stuck so I had endured a local orthodontist come by and see her and help me with the case Harry Greene she was the most she still talks about it to this day I mean this is 31 years later and the they she claims the cured her TMJ but I'm not talking about anything I'm talking about the fact that the looks of it she hated her smile for sixty five years, I did braces on her and she's still giddy about it and now she's got to be in her 80s. I mean so just so we all bring to the table our biases and so young people like the young millennial dentist they think the only way you can advertise on Facebook and Google AdWords when you you know when you live in a country 325 million on people I can assure you factually statistically that the number one mailing success in dentistry is still direct mail and I when I say that I can quote ten different people who have been on this podcast that have reams of data some of them that are doing the advertising for dsos with hundreds of locations but direct mail is more beneficial than Facebook ads and from visiting the some of the greatest cosmetic dentists on earth sixty five-year-old plus women have more money, more appetite for cosmetics and are more grateful and the Millennials they don't need it or they hardly need it they don't have hardly any money. So again when you see an 85 year old woman with a liver spot the size of a golf ball in her head you just don't sit there and start writing off that she doesn't want younger prettier bleaching Botox whitening teeth. I mean and I'll never forget a my four boys their great grandmother on both sides, one missed 100 by four months and the other one I think she missed it by like nine or ten months and I'll never forget and I was little taking my boys over there when I think I last visitor when she was like 98 and you walked in her bathroom and she had the same makeup laid out as my five sisters that were there in high school and she was in there and we were gonna go out to eat and she was in there getting primped for 10 minutes I mean and then the lady was 90 some years old I mean she couldn't even see and I was it's just amazing how what's that?
Harvey:She still wanted to look good.
Howard: Yeah she still wanted to look good and I'll tell you how old you're this you might not ever have a patient this old says she was that 90 I think she was 96 when my boy asked us yes she said great number well what was the name of your husband again and he had you know he passed away like in his 60s and she couldn't remember for a second and she had to ask oh my god what was his name and you might think that's could you imagine being married to someone for 30 years and you live so long they get our time.I remember I mean I have a hard time right now remembering teachers names that I had in high school when I was in college I could name every teacher I had all the way back to kindergarten but at 56 now and now I'm having trouble remembering the names of teachers I had in dental school but a man the money and the beauty and the people willing to pay for all this cosmetic stuff is the senior citizens. By the way the fastest growing demographics in the United States fastest growing demographic United States women over 100 second fastest women over 90 third fastest women over 80. Women live five years longer than men and I think geriatric dentistry could easily become one of the biggest most rewarding specialties and it's not even especially yet. On that oral scanner when you bought the three shape trios intraoral scanner does your lab give you a discount if you send in an oral scan versus an emperor impressing because they don't have to pay a human to pour it up and model and trim it and all that or not really?
Harvey: Not really no, you know and that was a question that I had when we started to sew but there their answer to me was well we've had to invest in all this software technology and milling technology and that's all you know very expensive for them to. So no you know we scan the patient for a for a TMJ orthotic appliance and I sent it to the lab in the lab said well we have to charge you for a model because we need we have to digitally print the model first before we make the appliance so I was like well you know why do you need that so there's a whole discussion about that but no we don't save any money you know but on but we're not dealing with alloys anymore so I guess our lab fees are lower because of that too because most of what we're doing is ceramics.
Howard: That is interesting. A lot of the laboratories have said on this podcast and that they have far less remakes with the oral scans, in fact some labs say that their dentists that use them on average will have a 5% remake that's one out of 20 and the oral scan is so much more accurate that it drops it to from 5% to 1% did you notice a less remakes switching the oral scanners or not really?
Harvey: I would say a little bit less but definitely less occlusal adjustments and contact adjustments you know much less chair side time involved with adjusting once we went digital.
Howard: What would I like most about when I got digital scanning is the fact that my gosh when I first time I used and you saw your prep up on the computer screen you were embarrassed you wanted to delete the file and run out of the room and run across the four-lane road and hope you get hit by a car. I mean I think the fastest way to increase your quality is dentist wears loops you all know that but then I go in the office and all the wet hands have to wear loops I mean what your assistants making the temporary and she doesn't have loops your hygienist is doing the cleaning shell is all wet hands on deck have to have loops next would be so any form of magnification I don't know a single endodontists she doesn't have a microscope and they're usually checking before they operate and they pull in the scope and they drop it down they have a mount on the ceiling and they're only looking at 8 X and they all swear by it and I think the reason oral scanning is so important is because it really helps sapien when he can see his work at you know 40 X on the computer screen is that how do you agree with those remarks?
Harvey: Oh absolutely I mean you know I use four and a half loops and I use a global microscope also for my restorative and pareo and endo. So the magnification makes a huge difference in the quality of the dentistry that we do.
Howard: Okay well do that decision why did you buy a microscope Global out of St. Louis instead of a Zeiss out of Germany?
Harvey: Well I'll preface this I'm a camera guy and lenses are very very important to me, so for my my cameras I use Sony mirrorless full-frame cameras I use Zeiss lenses or Sony professional line but when I tested the microscope so I had the Zeiss and the global in the office for about three four weeks each and I personally couldn't see a significant difference in the optics but the global microscope had a dedicated filter drawer for my laser protective optics whereas the zeiss had to be attached on the outside of it. So is much more cumbersome so that was a reason but I couldn't personally see the difference plus the the global has a lifetime warranty on it so that was you know a couple of the things that guided me in that direction.
Howard: Wow so global was more laser friendly than Zeiss?
Howard: Wow that is actually the, my only claim to fame is I'm the only dentist who's listened to all of my podcasts and that is I never even thought I Carl Zeiss is out of and by the way Americans say Germany it's not Germany of the whole world cause of Deutschland including uh Deutschland. If you're going to IDs I got to tell you my embarrassing story when I was the young kid going there the first time I was I was on a layover in Heathrow in London I was looking for Cologne, Germany and I couldn't find it on the noise panicking is I only had an hour layover and finally I found a pilot and I said how come Cologne Germany's not on there he goes oh my god he goes American American its Kuhn its Kuhn Deutschland and I went back to the deal and there was but only in America do we call a Germany or do we call a Germany or do we call Deutschland, Germany but huh that is very interesting Carl zeiss out of henna is that henna Jena Deutschland or just Jenna do they pronounce a J like the Spanish with a silent is that Hannah or Jenna Deutschland but ha that is amazing so my last question I can't believe we went over an hour god we went 10 minutes over an hour thank you so much my last question is this, you lecture to the students at Nova I lecture to the students in my backyard and uh what advice would you give I want you to finish with this. Your daughter just walked out of Nova she's got four hundred thousand dollars in student loans she just got her diploma and she said dad give me some advice what would you tell her?
Harvey: Well she completed school already alright she's walking out the door and she's not coming to work with you right you know my son graduated from Nova about two and a half years ago and he's in the practice here with us now and he's also an adjunct in Nova at the same time. So basically just learn as much as you can expand the knowledge that you were given in dental school because you're not done, even 35 years out of dental school I'm still learning every single day and and that's the best advice that I could give is don't think you know everything because none of us ever does and just keep learning and keep absorbing and stay open-minded that would be the best advice I could give.
Howard: Ya because III think it the year 2019 you're where none of us are gonna live long enough to before the science is all in on dentistry it'll always be an art and a science in our lifetime because we all know what we know but we don't know what we don't know and dentistry is a very humbling experience because I think it's far I think you have to come out of school and practice five years before you're humbled enough to realize that the amount we don't know in dentistry probably is greater than the amount we know in dentistry. It was only we're only five thousand years after the pyramids, I've always kind of thought that dentistry is probably at the 50-yard line I mean that science at the 50-yard lines I mean I I bet it's gonna be another five thousand years before they just understand all math, physics, chemistry, biology and dentistry do you think you think it's that far away or do you think it's closer?
Harvey: You know what we we don't know things change I mean some things that twenty years ago we thought were an absolute we're finding out that they're not. You know we're fighting about the connection between periodontal disease and and dementia and Alzheimer's now where is you know 20, 30 years ago who ever would have thought about those things so it I think it's gonna be a constant learning experience I don't think there's ever gonna be an endpoint as far as education and knowledge is concerned it's just going to keep going because like I said some of the things that we take for granted now 20 years from now they may not be you know the end-all explanation to things.
Howard: Oh and I'll just get one final example they were we were in school they they taught by PhD people had PhDs in physics and chemistry would say that an atom was 99.99% empty space and now they say oh except for a dark matter and now you know and now I that atom is a cancer and in fact I could believe I read an article the other day I was reading one this weekend and in one article I was talking about how Einstein said you couldn't go faster than the speed of light and this is by a guy with a PhD right. That you can't go faster than speed light and in the same article he's talking about how the universe is expanding faster than the speed of light so these galaxies are falling off the horizon because they're the galaxy is expanding faster than the speed of light so every amount of time we're gonna see less and less galaxies because they're moving away from us faster than the speed light and I'm like, did you just said you can't go faster than the speed light and now you're saying the galaxies the universe is expanding faster the speed light. I mean to just to read in that one paragraph you can't go faster than the speed of light and the universe is expanding faster than speed lights like hello I mean so all these absolutes aren't always gonna be absolutely the first four elements for what earth wind fire and water and now they've found 93 different ones on earth. Hey Harvey seriously I know you're a busy dentist I know you see 10 to 15 patients a day I know this is your what you did at the end of the day I'm so honored and privileged that the end of a long hard working day you decided you come on my show and talk to my homies for an hour and I cannot tell you how grateful I am thank you so much for coming on the show.
Harvey: and I appreciate your time and then speaking with you this evening to it was a pleasure.
Howard: and you know who I want to follow up on you're still let's get on my buddy Keith Bateman KGB and the president photon and Jeff Jones send them an email tell them that I want to give them on the show and also a Mark Colonna on using lasers in endodontics
Harvey: Yeah I'll send me an email this evening.
Howard: Alright buddy and tell your son ah he's got a big shoes to follow I hope he does well doing that.
Harvey: He's doing a great job thank you
Howard: All right have a great day