Office Visit: Enjoying Dentistry Again

Welcome to the second installment of Office Visit, where we visit a Townie’s office and profile their equipment, design or unique practice philosophy. If you would like to participate, or nominate a colleague please send me an e-mail at tom@dentaltown.com.

This month we are pleased to take you inside Dr. Glenn van As’ office in Vancouver, British Columbia, Canada. Dr. van As lectures internationally on laser and microscope dentistry, so it is no surprise that his office has many different high-tech items.

Name: Glenn van As
Practice Location: Vancouver, British Columbia, Canada
Graduate from: The University of British Columbia
Year graduated from dental school: 1987
Year when practice opened: Associated with practice until 1996 when it was purchased from the senior doctor.

Equipment List

Magnification
• 3, Global Surgical Corporation dental operating microscopes – www.globalsurgical.com

Lasers – Operatory
• HOYA ConBio DELight, VersaWave and Diodent I – www.conbio.com
• 2, Ivoclar Vivadent Odyssey – www.getodysseylaser.com

Lasers – Diagnostic
• DIAGNOdent caries detection device – www.kavo.com

Cameras – Extraoral
• Nikon 995, 5000, D70, and D2X – www.nikon.com

Miscellaneous
• LED Dental Inc. VELscope – www.velscope.com
• Ondine Biopharma Corp. Periowave – www.periowave.com

Q: When did you decide that having an office filled with high-tech equipment was an important goal?

A: I graduated in 1987 from dental school and practiced with my father in our family general practice until 1996, when I purchased the practice. At that time, I heard Drs. Buchanan and Ruddle lecture on endodontics in Seattle. While there, I was exposed to the power of the dental operating microscope for endodontics. I realized I enjoyed doing endodontics and I couldn’t visualize the root canal system like Dr. Ruddle was doing as he located canals (MB2), instrumented and obturated canals and disassembled teeth with obstructions such as post, pins and separated files. I decided I either had to start referring more of my cases to an endodontist using a scope, or buy one myself.

Q: How would a dentist in your community describe your office?

A: Thomas, I sort of chuckled at your question. When I started to use the microscope for all of my dentistry in late 1997, I got a lot of weird looks, questions and derogatory statements from colleagues and acquaintances. They referred to me – negatively – as the “scope guy” or the “laser doc.” Initially, the somewhat derogatory terms made me a little upset; however, slowly but surely the skepticism changed to interest. Colleagues began asking if they could come by to the office and observe, or they phoned and asked me questions about either lasers or microscopes. Locally, the provincial dental association asked me to do some lectures at the annual meeting. Soon, the local dental faculty at the university will be incorporating microscopes into their undergraduate program.

Q: Which pieces of equipment have provided the fastest return on investment? What factors made this possible?

A: That is a really tough question. All of the technologies have given me something different and new, plus allowed for a positive return on investment. Some have provided for faster ROI than others. Things like the DIAGNOdent have yielded an almost instant ROI. Whereas, things like the microscope have helped improve the quality of my own work, my ergonomics (how do you put a ROI figure on your neck and back) and the ability, through the use of its video equipment, to market and sell the treatment the patient requires. Lasers will provide a positive ROI as well, depending on the type of practice that one has. A soft-tissue laser can help with the time requirements in tissue management for fixed prosthodontics, and provide for new procedures such as frenectomies and biopsies. A hard-tissue laser, in addition, can provide for anesthetic-reduced restorative procedures, and osseous recontouring that will add marketing ability (new patients), and new procedures for many practices.

Q: Please explain why you have three different digital cameras? Do they serve separate purposes, or is this a case of updating equipment?

A: In our office, we have a variety of camera setups. I have a separate digital SLR setup (Nikon D2X), which I use for facial photographs, orthodontic photos and cosmetic profile photos. In addition, we have a Nikon 995 (Coolpix) camera, a Nikon 5000 (five megapixel point-and-shoot camera), and presently a Nikon D70 (digital SLR) on the dental operating microscopes. In the case of the Nikon D2X, we purchased it because the cameras on the microscope were not able to take facial photos, but are able to take photos from commissure to commissure. We also can take magnified photos of individual teeth that are superior to what we can obtain with the Nikon D2X (without cropping). The three point-and-shoot cameras are all cases where over the last five years we have upgraded our equipment on the microscope as new, superior equipment became available. I use the digital SLR on my main scope for documentation and the Nikon 5000 on my second microscope (we have three in the office). The Nikon 995 is used to digitize radiographs, as we at present don’t have digital radiology throughout the office.

Q: You own six lasers. Please explain your rationale. Are the duplicate types for the sake of efficiency? What was the sequence of purchase?

A: We have two hard-tissue lasers, three soft-tissue diode lasers and one non-functioning argon laser. I purchased the Argon laser around 1999 to cure composites and cut soft tissue (eliminating cord) at over $50,000 Canadian. I realized lasers were a powerful tool for several reasons in my practice, but the hard-tissue laser (Er:YAG wavelength) was the glamour boy of lasers. In 2000, I helped with some documentation and early trials with the HOYA ConBio DELight and in January 2000, we purchased one which has since been upgraded (2005) with new software and a new fiber. I purchased the laser for its purported ability to be used with little to no chemical anesthesia. Nowadays, the majority of the time I am using the Er:YAG for soft-tissue refinements in cosmetic cases, and for the removal of osseous tooth structure in both an open- and in some instances closed-flap environment. Soft-tissue diode lasers are seen by many clinicians as an electrosurge replacement. They are sturdy, lightweight, portable and excellent for hemostasis and soft-tissue ablation. I have purchased two of the three diode lasers, and we use them for crown troughing and soft-tissue ablation as needed. I have a full-time associate and he uses primarily one of the diodes in his daily routine.

Q: Do you have the VELscope. Tell us about it and how you use it in your practice?

A: Yes, we have recently incorporated the VELscope into our practice as a primarily dental-hygiene-driven mucosal examination system for oral cancer diagnosis. This device is used to help detect early stages of oral cancer through using multi-spectral fluorescent visualization. In the last six weeks, we have begun to incorporate this device in our hygiene recall exams to help detect early signs of pre-malignant lesions. It appears to be a very accurate and helpful diagnostic tool in the battle against oral cancer.

Q: Which pieces of equipment are most appreciated by your patients? Why?

A: Patients seem to realize microscopes are not the standard piece of equipment in most offices. The hard-tissue laser is appreciated by the mothers of young children as I am able to provide a lot of the restorations without the dreaded shots.

Q: Select five pieces of equipment from your list and describe the following:

• Date of purchase
• Reasons for purchase
• Equipment that it replaced
• Procedures added to the practice as a result of this new technology
• How you market it to your patients
• Is there something currently on the market you would consider for an upgrade
• If you could change anything about this item, it would be…
• Who enjoys this more – you or the patients?
• 
  

Click on the Glenn's Top Five icon for the answers

Q: What is your philosophy regarding office technology? Do you enjoy the latest and greatest, does it attract new patients, make life easier, etc.? What misconceptions do your colleagues have about technology?

A: Wow, what a great question and there are a lot of answers to this. Since 1997, I think I have become very open minded to new technology, especially as it relates to lasers and microscopes. I do enjoy using and having the latest upgrades for most of my equipment. There is a limit, though, to time and resources for these purchases and you must always try to balance the need to be ahead of the game, and the financial as well as emotional costs of these purchases. I know I am producing three times what I produced in 1997, and am far busier than I was then. The biggest misconception is that the technologies will become outdated. In all honesty, I still use most of the technology I have.

Q: Is it difficult to incorporate new technology into your daily routine? What is your approach to integrating new technology into your office?

A: Well, in our office the team realizes and promotes the fact we are fairly advanced when it comes to the technologies of lasers and scopes in the office. Our team is fantastic, supportive and interested in the new technologies; most recently with the integration of the Periowave and VELscope devices. We all are learning, not only how to use the products, but how to integrate them into the office routinely. It’s always a work in progress!

Q: How do you address staff training each time you add a new piece of technology? Do you take them to training, do a lunch and learn or use local sales reps from the area?

A: The most important thing in integrating new technology in a dental office is to have the support and understanding from your dental team. You need to address the vision of where your practice is going, and help them achieve proficiency in how the unit works and how it is to be integrated into the office. I also believe that when staff is included in the decision-making process of how best to integrate the technology into your office, technology stands to be better accepted as a friend of the office instead of a foe! For instance, in the case of the Periowave and VELscope, we have had a couple of lunch and learn sessions where the sales reps have come in to explain how the unit works, and how other offices are incorporating the unit into their office. We have set deadlines of when we are to start using the technologies, and had discussions on how to charge for each item. There will be more staff meetings regarding both technologies, and I will offer the staff an opportunity to attend continuing education lectures on these technologies. After that – it’s time to stop talking and start doing. That, in the end, is the only way to get technology used routinely in your office. It cannot be used as a plant stand once it’s been purchased!

Q: Which items from your list were purchased as a result of a recommendation on Dentaltown.com?

A: Of all the products I have, probably the one I learned about most online on DT was the Isolite. This great rubber dam alternative is an awesome adjunct to laser dentistry, where unanesthetized patients have difficulty with rubber dam clamps. The Isolite provides suction, illumination, a bite block, tongue and cheek retraction plus isolation all in one marvelous product. I will say this though, I have met more people in my travels and lectures who know me from my posts on DT, than from any single other thing I have ever done. DT really makes it so no practitioner will ever have to practice alone again.

Q: How do you pay for this equipment – loan, lease? Do you have a technology budget each year or do you evaluate each purchase based on ROI. What do you consider a no-brainer purchase? Give an example.

A: We try to budget 5% of the gross annual income ($50,000) towards improving the technology in the office. Up to $20,000, I will pay cash, but more expensive than this, I tend to take out a short-term loan. Other pieces I purchased by doing lectures for the company involved. So, instead of receiving honorariums, I put the income towards the purchase of the product. In some cases, rather than purchase new, I have upgraded products (DELight laser and microscopes) to keep them operational until newer versions could be purchased.

Having said this, if you do endo all day long, or have neck and back problems, the microscope can be a savior to your practice. Initially, there may be a drop in ROI as you go through the learning curve, but eventually your speed will rebound to where it was before – or even faster – as you eliminate the poke and feel with the improved visual acuity possible with the scope. In addition, there are many instances where I think that a hard-tissue laser is the prime choice for someone trying to upgrade their practice to a new technology.