Enrich your life and practice using the Waterlase laser By: Amanda Testa-Canto, DDS

I’ve been a licensed, practicing dentist in Texas for almost 13 years and I do a lot of cosmetic procedures at my upscale Houston office. Fortunately, my patients marvel and appreciate my continuing quest for the latest and most innovative equipment dentistry has to offer. The introduction of the Waterlase™ (YSGG laser) by Biolase Technologies, certainly affected not only my patient’s perception but also gave me a great deal of pride in my work. With the addition of the Waterlase™, I have the satisfaction of providing my patients with truly painless dentistry.

I’ve shared experiences with numerous dentists at dental conferences about how the addition of the Waterlase™ has affected their practices. Many new dentists have told me they purchased the Waterlase™ for their new practice to ‘kick start’ the influx of new patients. I’ve never heard of anyone who wasn’t completely blown away with its capabilities, performance and impact on their practice. For me, this fantastic laser provides a way to stay true to my commitment of giving my patients the very best dentistry I can provide, and that makes me feel very good about myself.

I’m sure all of you are very familiar with the dental phobic patient. Using the Waterlase™, most restorations can be done without anesthesia. Believe me, if you can help them conquer their fear by providing painless dentistry, you will have a mass marketing supporter for life! We all are well aware that the greatest cause of dental neglect is the fear factor. It’s absolutely fantastic to have a dental phobic patient tell you that you have given them the best dental experience in their life. Think about the impact this will have on future generations of patients. Imagine children growing up that are routinely brought in for a checkup and aren’t traumatized with all that negativity most adults associate and relate to their children about their previous dental experiences. It brings me great pleasure to know that how I practice today will ultimately affect the entire face and growth of dentistry in the future.

As a Waterlase™ user of almost three years, I can tell you first hand that dentists today cannot really afford to do without this magnificent technology because with increased consumer awareness patients expect and demand the latest innovations. I have yet to understand how anyone can justify losing existing business by ignoring what their clients want! My practice has grown leaps and bounds by personal referrals from patients that previously hated going to the dentist! Also, by incorporating the marketing tools offered through Biolase, I have managed to increase my new patients by 25-30%!

Aside from all the “feel good” benefits, there are many true clinical benefits in using the Waterlase™. Since water is the actual cutting agent, and there is no friction or vibration (as you would find with a dental drill), the chance of producing micro fractures with Waterlase™ is almost non-existent1. There is no smear layer, and the topography produced by the Waterlase™ is ideal for adhesive dentistry, so much so, that acid etch is optional.2 Bond strengths are also improved,3 and studies have shown reduced microleakage4 as well as higher secondary caries resistance over conventional preparations.5 Some European doctors have performed extremely innovative procedures such as sinus lifts6 and treating post-operative implant infection.7 Using a laser also gives me the confidence I’m providing clean, “bug free” preparations. In a recent study, clinicians from the University of Barcelona, found that pathogens in the root canal could be reduced by 97% through use of the Waterlase™!8 Patients especially love to hear that when the media gives them so many negative stories to ponder on about germs! Additionally, in our soft tissue uses we have been able to offer patients the great benefit of eliminating sutures from surgical procedures such as frenectomies and fibroma removals with much less postoperative pain.

Since my sister and I practice together, and both have the same goals for our patients, we had to purchase two Waterlase™ units at one time. Talk about being a little nervous about the huge investment! What we found, however, was that these lasers very quickly paid for themselves. While researching dental lasers, we found the YSGG laser (Waterlase™) was unique, extremely versatile and had more capabilities than other systems. With the superb soft tissue abilities of this laser, we were able to add procedures to our armamentarium that in the past we would ignore, such as fibroma removals, frenectomies, perio sulcular debridements and biopsies. And for the soft tissue contouring that we performed in the past with electro-surge, we now do these at preparation appointments with the confidence that the tissue will stay right where we put it. Nowadays, people are always so busy so providing the benefit of consolidating multiple appointments into one is an absolute seller! The opportunity of doing restorations in multiple quadrants without taking the time and energy for anesthesia has greatly increased revenues in our office. Previously, lasers had not offered such a wide range of both hard and soft tissue procedures.

Drs. Amanda Canto and her sister, Palmira Testa, have maintained a beautiful practice in the Houston Galleria district for the past 13 years.

I simply can’t imagine practicing without my Waterlase™. Sometimes I reminisce as to what my practice would be like without using the laser. I’ve included a chart on clinical and financial benefits for comparison as to the effect the Waterlase™ has made on my everyday operations. I can assure you that these examples are real and clearly demonstrate a few of the many clinical and financial benefits of using the Waterlase™ in my practice. Unfortunately, my hygienist’s production remains the same because in Texas, hygienists are not allowed to use lasers. Those of you in states where this is permitted can reap even more benefits. Although my hygienist can’t directly use the Waterlase™, she did add $1,200 to my office production through providing more patient convenience and better clinical results.

BEFORE WATERLASE	Revenue	WITH WATERLASE	Revenue
Hygiene Procedures:
Two blocks of two quadrants of SRP. Reschedule the patients for re-evaluations in 2 wks. 2X$320	$640	The same two blocks of two quadrants of SRP	$640
Our hygienist would also have a couple of continuing care apts. 2x$98	$196	Two continued care appointments	$196
New patient visit	$287	New patient visit	$287
		Before rescheduling the SRP patients, I perform laser treatments in four pockets on one patient and two quads on the other. We are able to bill these as reverse bevel gingivectomies, which are covered by insurance, and add production of $400 on her 1st patient and $800 on the other.	$1,200
Dentist Procedures:
Gingivectomies on #4-13 in preparation for porcelain veneers. Patient scheduled for 30 minutes to allow for anesthesia time and electro-surge, then rescheduled in 2-3 wks for the final preparations and impressions after healing.	$800	This case would have changed dramatically by being able to immediately proceed with the final preparations and impressions rather than rescheduling by doing the gingivectomies with the laser and not having to wait for the healing.	$16,400
Crown prep #31 scheduled for 90 minutes for crown preparation, provisional, packing cord and impression. Would likely result in a phone call from the patient that night, in the middle of my dinner, complaining of the pain caused by the cord!	$795	We would shorten the appointment to 60 minutes for crown prep. #31 by troughing with the laser, eliminating retraction cord and dramatically decreasing postop sensitivity. I rarely receive calls from patients when using the laser.	$795
Another typical case would be MO resins #2 & #3, and then patient is rescheduled for a later date to do additional resins on the left side.	$512	Since we need no anesthesia, we would not only do #2 & 3 but also #12, 18, 19, & 30 since no anesthesia was needed!	$1,256
A high production apt. would be for bridge preps #6-11 w/ veneers on #5 & #12 requiring pontic site receptacle formation and soft tissue contouring on #5 & #12. This would take approx. 180 minutes & requiring another apt. after healing for impressions. Would result in several calls from the patient regarding pain from the gingival work, not to mention the increased time in provisionals!	$9920	I could prepare my bridge and veneer case #5-12, do my tissue contouring with the Waterlase, and include the frenectomy, which in the past I would have ignored or referred out, and finalized impressions. This would eliminate an extra appointment; produce better comfort for the patient and additional revenue for my practice. My new patient would leave totally impressed by all of our new technology with a handful of referral cards to pass out.	$10,246
Rest of my day is spent in a NP exam for approx $150 and a complimentary cosmetic consultation who decided to “shop around” before making a decision on her full mouth rehabilitation.	$150	Due to the lasers and the care and attention we give our patients, my cosmetic consult would book with us without looking at other practices; place a deposit for her full mouth rehab because she was sure we would give her the best care available.	$20-40,000
TOTAL REVENUE	$13,300		$49-69,764

Convenience is one of the many excellent attributes of this technology. It allows me to perform multiple preps in multiple quadrants in one appointment. Not only do my patients like and appreciate this, my staff is less stressed as a result of these new efficiencies, not to mention happier and more satisfied patients.

Patients, who have ‘shopped’ around or were undecided on committing to an extensive cosmetic procedure have told me they made their decision to have me do their work due to the high tech image and because there is so much less stress in our office. They love seeing the high technology they’ve heard about in the news. It makes them feel intelligent and important in addition to decreasing their fear factor. Don’t worry about the economics…this laser definitely pays for itself!

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Bibliography:
1) Schoop, U., “An In-vitro Evaluation of a Hydrokinetic Tissue Cutting System”, (September 2001, Palma de Mallorca, European Clinical Symposium)

2) Lin et al, “Topographical Characteristics and Shear Bond Strength of Tooth Surfaces cut with a Laser-powered Hydrokinetic System”, Journal of Prosthetic Dentistry Col. 82 No. 4 pp451-454, 1999

3) Caputo et al, “Effects of Two Different Dentin Bonding Agents on the Shear Bond Strength of Tooth Surfaces Cut with a Er, Cr: YSGG Laser-powered Hydrokinetic System”, (August 2001, UCLA, California)

4) Ghiza, H, “Micro leakage of Class V Restoration prepared by Er, Cr: YSGG laser with and without conventional Acid-Etching”, (September 2001, Palma de Mallorca, European Clinical Symposium)

5) Young et al, “Treating Occlusal Pit and Fissure Surfaces by IR Laser Radiation”, (SPIE, 2000)

6) Roos, HJ, “Use of the Waterlase in Performing the Sinus Lift Procedure”, (September 2001, Palma de Mallorca, European Clinical Symposium)

7) Briant, R, “Use of the Waterlase in Treating Infected Implants”, (September 2001, Palma de Mallorca, European Clinical Symposium)

8) Arnabat et al, “Thermal Studies in Endodontic Applications and Bacteriologic Studies in Periodontal Applications of the Waterlase” (September 2001, Palma de Mallorca, European Clinical Symposium)

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A Texan at heart, Dr. Amanda Testa-Canto has been happy to call Houston home since 1979. She received her undergraduate degree from Southwestern University in Georgetown in 1985 and in 1989 obtained her Doctorate in Dental Surgery from The University of Texas Dental Branch in Houston.

While maintaining a highly successful practice, she has also been active on the dental lecture circuit, throughout the U.S. and internationally, extolling the economic and personal benefits of incorporating laser and aesthetic dentistry. Dr. Canto is a member of the AACD, ADA, TDA, AGD, ALD and is truly passionate about her work. You can reach her at: (713) 622-1977 or visit her website at: www.houstondental.com.