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399 LANAP with Periodontist Allen Honigman : Dentistry Uncensored with Howard Farran

399 LANAP with Periodontist Allen Honigman : Dentistry Uncensored with Howard Farran

5/20/2016 7:37:04 AM   |   Comments: 1   |   Views: 582

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AUDIO - DUwHF #399 - Allen Honigman


Dr. Allen Honigman, originally from Ottawa, Ontario in Canada, received his B.Sc in Biochemistry from the University of Ottawa. He then pursued an honors degree in Genetics at the University of Western Ontario. He then attended Idaho State University, and received his Masters degree in Microbiology and Immunology. After working towards a Ph.D. in Microbiology at the University of Texas Health Science Center at San Antonio, he decided on a dental career and went on to complete his Doctorate of Dental Surgery in 1991 at the University. From there, he went directly to UCLA, where he finished his periodontic specialty training residency in 1993. Dr. Honigman practiced in Southern California until he moved to Guam, in 1995, to accept a position as a periodontist and dental director for Pacificare. While there, he had the opportunity to lecture at local dental society meetings. In 1999 Dr. Honigman was offered a faculty position as the Director for Undergraduate Periodontic Clinical Education at Case Western Reserve University in Cleveland, Ohio where he was also awarded "Clinical Faculty of the Year" by the dental students. While there, he also gave a continuing education course on Periodontal Esthetic Surgery for the Cleveland dental community. In 2001, he moved to Arizona to practice and in 2003, opened his periodontics and implant practice in Chandler. He began utilizing CT guided implant treatment planning and placement in early 2004, and is one of the most prolific users of the technology in Arizona. In 2005, he became the first periodontist in Phoenix to incorporate LANAP into his practice, and in 2007, added a cone beam CT scanner to aid in accurate diagnosis and treatment planning of his periodontal and implant patients.

www.LANAP.com 


Howard:

It's a huge honor of me to be with my buddy, Allen Honigman.

 

Allen:

That's my honor, Howard.

 

Howard:

No, no, no it's all mine.

 

Allen:

No. It's all mine.

 

Howard:

We both live in P1hoenix, the valley and Allen's been, I've been referring him perio for damn near 30 years and he's a legend in so many ways. You really are. Every dentist I know that knows you thinks the world of you.

 

Allen:

Well that's nice to know.4

 

Howard:

You're known as a great periodontist. You're known as an expert in lasers.

 

Allen:

Yeah. I would say that. [crosstalk 00:00:39]

 

Howard:

When Millennium was associated with LANAP and when they started coming out, they were general dentists first, but not periodontist are getting involved.

 

Allen:

That's exactly it.

 

Howard:

Do you call yourself a periodontist?

 

Allen:

Absolutely.

 

Howard:

But because I heard that the last periodontal meeting they had a vote to change the name to periodontal and implantology, and periodontist won by 2%.

 

Allen:

Actually it didn't pass by one vote.

 

Howard:

What?

 

Allen:

It didn't pass by one vote to change the name of the American Academy of Periodontology, to the American Academy of Periodontology and Implantology. It didn't pass just by one vote.

 

Howard:

One more vote it would have passed?

 

Allen:

That's right, one more vote it would have passed.

 

Howard:

Do you call yourself a periodontist or a periodontist implantologist?

 

Allen:

No. There's technically everybody who does implants and calls themselves an implantologist. There really is no ...

 

Howard:

Say Again?

 

Allen:

Everybody who does implants could call themselves an implantologist because there really is no formalized training like a specialty that says you're an implantologist, there's no ADA specialty right now that says just for implants.

 

 

You can't go out of dental school and get your certificate in implantology, there is no technical specialty. There's a lot of guys who were out there who do a lot of implants and a lot of them do well. They take courses, the CE courses and things like that or they go through the American Academy of Implant Dentistry. There's the Misch course and things like that. That where you can get yourself really trained well to do implants well. Periodontist we're trained in our residency, mostly now, well before to do implants and now you see a lot more implants being done even at the dental school level now. Not just restorative but actually placing of the implants. I guess everybody could call themselves an implantologist, but I'm a recognized board certified periodontist.

 

Howard:

Are you placing implants?

 

Allen:

Absolutely.

 

Howard:

I tell you this.

 

Allen:

I got to tell you one story though.

 

Howard:

Okay.

 

Allen:

Okay. I remember you called me up one day at my office. You said to me, I don't remember what year but it's like 2000 and who knows what. You said to me, Allen, have you ever had a problem going into the nerve? You asked me that. You ever had a problem placing the implant in a nerve in periodontology paresthesia? I said, Howard, never have, never happened. And you said, now come on, just tell me. I said, never happened because at the time, I was one of the first users of guided implant surgery using CT scans. I avoided that problem from day one. When I started doing a lot more implants. Now, the majority of my patients get CT scans, I still do a lot of the guided surgery so I avoid that problem. And knock wood to this day, I've never had a patient have a paresthesia or hit a nerve or anything, so safety first.

 

Howard:

I have my fellowship in the mission suit, I have my diplomat in the International Congress Of Oral Implantologists, I've never had a paresthesia from placing an implant but I have had two or three from giving an injection. They all went away in about six months to a year.

 

Allen:

That's great.

 

Howard:

I want to say this, we're about the same age, how old are you? I'm 53, what are you?

 

Allen:

I'm a little older.

 

Howard:

Are you a little older?

 

Allen:

56.

 

Howard:

Well you look younger than me. It seems like of the nine specialties, endo, perido, pedo, all of them, yours changed more in the last 30 years than all the other ones combined.

 

Allen:

Oh, it's changed more I think personally, since I've been a periodontist. Since I graduated in '93 from UCLA, implants were just coming in to perio.

 

Howard:

In what year?

 

Allen:

I graduated in '93 from UCLA for perio. We didn't have all of the general instruments that we have now. There was no such thing as resorbable membranes, there was no such thing as Emdogain at the time, bone graphs ...

 

Howard:

Resorbable membranes, and what was the other one?

 

Allen:

Resorbable membranes, Emdogain for biomedics for getting bone to regrow into defects. Gor tex membranes were just coming out, they were just starting to get more accepted into ...

 

Howard:

And wasn't that out of Flagstaff in our state?

 

Allen:

That was, I think it was yes, Flagstaff, you're right. That's where Gor tex ...

 

Howard:

You know how Gor tex started? It was all the telegraph wires and then they decided they wanted to put a coating on them. So they built a 100 million dollar coating telephone wires, and then up in Flagstaff and north of us in Phoenix they started saying, well that stuff would make great floss, and then membranes and all.

 

Allen:

That's right, that's how it came out. Sinus slips, no one was doing any, no periodontist definitely weren't doing any sinus slips at the time. I've seen a transition so we were taught a lot of surgery. You know, cut the gums away and let the restorative dentist worry about everything else. Our job was just to make sure everybody had no pockets. You couldn't even do immediate implants. That was almost standard, like oh take the tooth out, place an implant. We didn't have that option because no one even thought about it, and Allonfours was a pipe dream. So no one even thought about what was going on.

 

 

Over the last 25 years, let's see it's 23 years since I've been practicing perio, I've seen a lot of changes that's happening in perio now, resorbable membranes, bone grafting, different bone grafting materials, biomedics, BMP, PRP, I mean all these things have really changed how we do perio.

 

 

I think one of the biggest changes that I've seen over the course of my time now, because I've been doing this for ten years now, I would say is LANAP. That's really been a cornerstone now of my practice of using the laser assisted new attachment protocol from Millinium. It really changed the way I practice, it changed the way I look at my patients and it's changed the way I look at, what we would have considered hopeless teeth before.

 

Howard:

And by the way, Al and I both had laser hair removal.

 

Allen:

That's right, it won't grow hair unfortunately.

 

Howard:

So if you're tired of shaving your legs and your underarms ...

 

Allen:

We can help you with that.

 

Howard:

So LANAP, explain LANAP. Why do you like LANAP?

 

Allen:

Why I like LANAP. When I went into practice in 2003, that's when I met you, 2003. I wish it was 30 years.

 

Howard:

Huh, because I was there in '87. I always thought you from there originally.

 

Allen:

No, I was in San Antonio getting my dental school done in '87.

 

Howard:

San Antonio.

 

Allen:

Yep. San Antonio, Texas. In 2000 I opened my practice, and by 2006, we have periodontists all over the valley. I was looking for a way to distinguish myself from the other ones, because we all do graphs, we all do implants, we all do whatever it is. I wanted to find a way to separate myself out from the pack. I looked into this procedure, I got a call from an old student of mine, because I was teaching at Case for a couple of years, and he said Allen you've got to get with this. It's amazing. I said to him, you're crazy. I've done a lot more surgery than you have. He'd only been in residency two or three years. I said, I've done a lot more surgery than you have, and it would be hard for me to understand how a laser can do what I can do. He just kept harping on me for almost a year.

 

 

A big shout out to Suresh Goel. Thanks a lot Suresh. So he harped at me and eventually I started looking into it and I got on DentalTown.

 

Howard:

What was his name?

 

Allen:

Suresh Goel, G-O-E-L

 

Howard:

G-O-E-L, Suresh and where is he out of?

 

Allen:

He's out of Rochester, New York. He does a lot of work now with Bruce Baer's group, the PDA.

 

Howard:

Productive Dental Academy.

 

Allen:

That's right. So he's doing a lot of work with them. It's hard to think about it, but a student was a big influence on me.

 

 

I looked around and I contacted Bob Greg through DentalTown. Gob Greg called me back and we talked about it, and I said, okay, let's do this thing.

 

Howard:

Is his wife a dentist too?

 

Allen:

Yeah, Dawn?

 

Howard:

Is she a dentist?

 

Allen:

Yeah, Dawn's a dentist also. She was a ...

 

Howard:

Greg and Dawn and what is their last name?

 

Allen:

Well now it's Dawn Greg.

 

Howard:

So it's Dawn Greg?

 

Allen:

Yeah.

 

Howard:

And what's Greg's first name?

 

Allen:

Bob Greg.

 

Howard:

Bob Greg. Okay so Bob Greg and Dawn Greg are the founders of LANAP or Millinium?

 

Allen:

It was Bob Greg and Dale McCarthy developed, this was interesting about the procedure itself. Bob Greg and Dale McCarthy, they got tired of their patients going to periodontists and either not getting work done, or half the work done. They said it's got to be a better way to do this. They were big into lasers at the time, so they started experimenting around, seeing what lasers did what, finding the right laser, finding the right wave length and the right protocol. What they was figured all that out first, then they developed the laser to fit their protocol. Whereas a lot of laser companies will build the laser and then say, hey, what can we do with this thing? Then try to fit the protocol to fit the laser.

 

 

They developed this back in the 80's and 90's and then they came out with LANAP. It was hard to sell a lot of periodontists on that a laser can do what you got all this training for, and all your surgical skills. They started doing that and then I know Dawn got on board in 2001, right after 9/11 actually. What's interesting is that Dawn was one of ...

 

Howard:

Is she a general manager ...

 

Allen:

She's a dentist.

 

Howard:

And Bob Greg?

 

Allen:

They're both general dentists. We're seeing a lot of perio innovations come out of general dentistry, which I think is fantastic. Dawn got on board, and what's interesting, when I was a resident, Dawn was one of my students in dental school. She was a dental student. I was one of her residents. We used to go around and check for perio. So then, when I came on board, she was one of my instructors, so things always come full circle sometimes.

 

 

I was looking for a way to just change my brand, I guess you could say, and increase my awareness of perio, because I got tired of cutting gums. I got tired of seeing patients come in for half their mouth, we cut their gums away, and then suture everything back, and now they have a lot of sensitivity and they don't want to go back and now your poor hygienists are stuck with these patients who have half mouth is okay, the other half still have a lot of deep pockets and you've got to find a way to fix these exposed roots.

 

 

I talk with Bob and I called some other periodontists in the country, and talk with them. They say get on board with it, and so I did, I made the leap. In fact, my future ex father-in-law at the time.

 

Howard:

Your future ex father-in-law?

 

Allen:

I didn't know he was going to be my ex father-in-law, but he became my future ex father-in-law, he was a big periodontist and he'd lectured a lot for Synplant on guided surgery. He's the one that got me into guided surgery. He told me I was crazy. He said, laser can't do what we've been trained to do. When I told him what I was going to pay for it, he say's, oh my God, I'm having a heart attack. I said, I'm still going to go with this, because they said we have a clinical money back guarantee. If it doesn't work, we'll take your money back. Bob says, I'll take the laser back, I'll give your money back and we'll part as friends. I said, great I can't lose. If it works, I've got a great thing, if it doesn't work I'm going to get my money back. I can keep doing what I'm already trained to do.

 

 

I ended up making the leap and I remember going back after at the six month mark, when you can make your decision whether to give the laser back or what. Bob asked me, hey Allen, are you going to give the laser back? I said Bob, you're going to have to pry it from my cold dead hands. I saw an increase of patient acceptance, because there's a fear factor involved when it comes to perio. If you send your patient to the periodontist, the first, there are only two things they think about. How much is this going to cost, and how much is this going to hurt. If you can take away the technically, surgical aspect, when they realize there's no real cutting or suturing, there's not scalpels or suturing, all of a sudden that fear is gone. Finding the way to pay for it all of a sudden becomes a lot easier for them.

 

 

It changed the way I practice and I know it's changed the way a lot of guys have practiced in the Valley. I was one of the first periodontist in all of Maricopa County to have it, and then all the guys who poo-pooed me, they jumped on board about four or five years after me. So there you go.

 

Howard:

So is it getting more accepted by periodontists nationwide?

 

Allen:

It is now, actually ...

 

Howard:

There's what, how many periodontists do you say there are? 4,000?

 

Allen:

Maybe just in the valley. Sometimes it feels that way. No I think there's 8,000 periodontists all around.

 

Howard:

In the whole world.

 

Allen:

In the whole world, yeah.

 

Howard:

And half of them are in America?

 

Allen:

Probably in America, yeah. About 35% of active AP members are now doing LANAP.

 

Howard:

35% of active American Academy of Periodontal?

 

Allen:

That's right. Are doing LANAP.

 

Howard:

So then why ...

 

Allen:

Why isn't everybody?

 

Howard:

Well no, I think that means it's valid.

 

Allen:

Oh absolutely, it is valid. If you look at a lot of things that we do in dentistry, a lot of it is peer to peer. If you come up to me and say, hey, you know Al, I'm using this new product and it's really good, it's been great results in my hands, I may not know anything about it, but I'm going to look into it. I'm going to try it because you're someone I trust. You have no reason to see me fail. So why wouldn't I trust you? Therefore, peer to peer is a big thing in all of dentistry, that is what we do.

 

 

I mean, CEREC is a big thing, look how that's just blown up.

 

Howard:

And they don't have 35% of dentists. They probably have [crosstalk 00:13:50]

 

Allen:

No but they have a lot of dentist to do it.

 

Howard:

They probably don't even have 15% of dentists.

 

Allen:

Well we don't have 35% of all dentists, we have 35% of active AP members. There's probably over 2,000 dental professionals in the US to do it, and now it's worldwide. Now we have doctors in Italy, England, the Philippines, we have four, five or six in Australia alone, Canada.

 

Howard:

So its 2,000 dentists are doing LANAP in America?

 

Allen:

Yeah. General dentists, periodontists, we have oral surgeons doing it, I think there's actually one ...

 

Howard:

I think one of the things that's a barrier to start this is, this ain't cheap.

 

Allen:

No.

 

Howard:

I mean how much does it cost to buy the Millinium dental laser and go though the training to start doing LANAP? Isn't it like a buck thirty?

 

Allen:

It's no, it's less than a buck thirty actually.

 

Howard:

How much is it?

 

Allen:

Right now, I know it's over probably like $108,000, but I don't know exactly what the cost is.

 

Howard:

So $108,000, you guys, Dude, I could buy a house, a rental property for $108,000.

 

Allen:

Right.

 

Howard:

So tell them why they should spend $108,000 buying a Millennial laser and learning LANAP?

 

Allen:

Well because if you look at it, if you went to buy a house and they said it's $300,000. You can't plunk down $300,000 tomorrow. No one's going to

 

Howard:

You could get a mortgage.

 

Allen:

You get a mortgage, right. So what do you do? You get it, you get yourself a lease and lease it out over five years, seven years, whatever you feel comfortable doing. Then all of a sudden it becomes much more manageable for you.

 

Howard:

So what's a five year lease on $110,000?

 

Allen:

I don't know, $1800 let's say.

 

Howard:

So $1800 a month.

 

Allen:

$1800 a month.

 

Howard:

So now we're talking about instead of $113,000 number on a balance sheet, where your assets equal your liabilities, you're talking about, let's look at this on a statement of cash flow, so you're paying $1800. If I'm paying $1800 a month towards this, how do I increase my cash flow $1800 a month to pay for that [crosstalk 00:15:55].

 

Allen:

Ah, that's a good question. This is what I tell a lot of general dentists. What you would do is if you have, a lot of dentists will see pockets 6, 7, 8 millimeter pockets, and they'll go through scale and root planing, and then they'll come back. And then they'll say he needs a periodontist, and then he sends the patient to the periodontist.

 

 

Instead of taking them through scaling and root planing, which is really not a definitive treatment, you would take them through LANAP instead. So you take them to a higher end procedure, but it's a more definitive procedure. So the patient ...

 

Howard:

Would you do the cleaning first?

 

Allen:

No, actually, the interesting thing with this particular wave length, the grungier and uglier and more inflamed the tissue is, the better the procedure works.

 

Howard:

Okay, let's watch this, a new patient comes in. They need four quadrants root planing care wash, take it from there.

 

Allen:

Take it from there? I would look at the pockets. If they're like fours and fives, and almost no bone loss, I would probably do scaling and root planing and let them heal and evaluate them later.

 

 

If I start seeing, if my hygienist takes the x-rays and I start seeing vertical defects, furcation involvements, 6, 7, 8, 9 millimeter pockets, I'm going to stop them there and I'm going to say, look, your disease is getting a little more severe than the average person. We have videos, we have a lot of good marketing actually, which I use a lot of. Show them a video that describes the procedure, describes the three procedures, scaling, root planing and transitional op surgery, LANAP, and then that's it. I show them this video, and then I talk to the patient. If I've shown them the video, I know they're going to be a good candidate for LANAP. Probably about nine times out of ten, they're going to take the LANAP treatment, because it tells them that they have a severe enough disease, they need more than just deep cleaning, and we have a way to fix them without cutting and without sewing, and that's the key. If you take out that scalpel, suture all of a sudden, it's like oh, that's not bad.

 

Howard:

Would the dentist be doing, would the hygienist be doing it?

 

Allen:

No, this is the dentist's thing.

 

Howard:

So now you're moving four quads and root planing, endo out from hygiene into the dental ...

 

Allen:

Right but you're getting, if you charge out ...

 

Howard:

What would four quads, root planing and endos be?

 

Allen:

It depends on if your PPO's or anything else, four quads and ...

 

Howard:

The average PPO price in the Phoenix valley.

 

Allen:

Probably about $800 a quad.

 

Howard:

So four quads of root planing ...

 

Allen:

No, four quads of osseo surgery. That's four quads of osseo surgery, if you look at ...

 

Howard:

It's $800 for four quads?

 

Allen:

No, $800 per quad.

 

Howard:

So that would be $800, $1600

 

Allen:

$3200.

 

Howard:

$3200.

 

Allen:

Right, so if you transition just one patient a month, okay?

 

Howard:

You'd double your money.

 

Allen:

And that's just one patient a month. So twelve patients a year, you'll make all your payments, plus you'll have money in your pocket. So if you do about 60, 70 patients you've already paid for it.

 

 

If you look at it from a general dental standpoint, general dentist standpoint, what you're getting is you're tapping into a revenue stream that you had no tap into before. Now, am I say you're going ...

 

Howard:

So when you do LANAP you can bill out, what code is it?

 

Allen:

There's different codes you can bill out at, depending on severity. Some doctors will bill at 4260, which is oseo surgery, 4261 which is oseo surgery for one to three teeth, you can do 4240 which is gingival flap for scaling and root planing, and 4241 which is gengival flap for scaling and root planing for one to three teeth.

 

Howard:

And these are generally $800 a quad on a PPO price?

 

Allen:

About, depending on, now the 4240 is going to be a little less, but they're more than doing scaling and root planing. That patient, let's say had 4 or 5 millimeter root pockets with a lot of bleeding, a lot inflammation, I may recommend LANAP but charge up to 4240 which is gingival flap for scaling and root planing, which is basically what I'm doing ...

 

Howard:

And what percent of these are getting paid by PPO's?

 

Allen:

They all get paid by the PPO's. I haven't had any problems in almost ten years.

 

Howard:

Do you think it's because only 2,000 dentists are doing it? But if 20,000 dentists are doing it, they'd crack down?

 

Allen:

No, I think it's just because if the probing depths on the x-rays match your code, the insurance companies really have not arguments against it.

 

Howard:

So the insurance don't know if the probing depths are real, you could make that up, but ...

 

Allen:

Well, we wouldn't do that.

 

Howard:

I know but you've got to think of worse case scenario. Do you think it's the radio graphic evidence of it that the insurance company ...

 

Allen:

I think it's the radio graphic evidence mostly, because you'll see bone loss.

 

Howard:

And what would they be looking for?

 

Allen:

They're looking for bone loss, more than just a hair, they want to see bone loss below the CEJ, and they want to see some vertical defect or something, but significant amount of bone loss. Not like, I'm not talking like 80%, if they see 10% bone loss, yeah, the pockets are probably 6's and 7's, things like that.

 

 

Back to the cost, what's interesting is Millennium's just rolled out, it actually just started this meeting is they're running, because you were saying that's a big nut, $108,000 right or whatever they're charging now, who knows? You get a discount, I don't know. What they're running out now because they want to see more general dentists, they want to see more people get involved with this, because it really is great for the patients. What they're running now is a leasing program. It's about 40% off, you lease it for three years. That includes all the training, five days of training. That's over the course of a year, then at the end of three years you have the option to give it back, just like you would a leased car, or say you know what, I want to pay the difference, that's been locked in before, and you can pay it off.

 

Howard:

So why don't you make an online CE course on this.

 

Allen:

We actually have them.

 

Howard:

On Dentaltown?

 

Allen:

Not on Dental, yes I did a CE course on one LANAP tip on Dentaltown last January.

 

Howard:

It was last January?

 

Allen:

Yeah.

 

Howard:

Is that right?

 

Allen:

Yeah. I came down to the studios ...

 

Howard:

With Howard Wilson?

 

Allen:

Not with Howard with, well Wendy Allen who used to be the marketing person for Millinium. We came down, I talked to you and then we did it in front of the big screen.

 

Howard:

I though we filmed it at Townie Live Lecture.

 

Allen:

I did a Townie Live Lecture two years ago. Maybe you did that too.

 

 

There is a way now for people who may not like that six figure number to get into it and see the benefit that they're going to get, not only to their patients, but to the bottom line. Once you start seeing the amount of work, like I said, if you just convert one scale root planing patient a month, just one you're going to make your payment for your lease and you're going to pocket money too. How do you get out of that?

 

Howard:

Okay, but are you talking about, when you talk about LANAP are you talking periodontal disease on natural teeth, or does this play into the booming peri implantitis?

 

Allen:

Absolutely, that's actually where this is really starting to pickup now, especially with the peridontist and the oral surgeon. Like I said, we've had oral surgeons buy this thing, not for perio but just to treat peri implantitis. I've been doing this for about four or five years now, for treating peri implantitis, been getting great results because again, if you look at the treatments out there now all involve surgery, flapping it back, putting in membranes, putting in bone graphs, and those all cost money and patients will balk at a certain price point. Then they say, you know what, take the thing out and just put a new one in or whatever.

 

 

This actually is a wonderful first option for peri implantitis because one, we're getting rid of the bacteria, we're removing diseased tissue, we're disinfecting the implant, even though we're not using the laser directly on the implant, it's just through scatter of the laser radiation that we're getting. Then we clean everything up and that's it. We use the laser again to seal it off, and we're finished. It takes me less than an hour to do one or two implants, very little to no trauma to the patients. They follow instructions, that's all followups and we just watch the bone heal. It's really amazing the results we're getting. The nice thing is because we haven't cut tissue, we haven't removed tissue, we haven't put a bunch of junk in there, if we have to and we still don't see the results we want or we get a little inflammation, you can still go back in and retreat it.

 

Howard:

Okay, but if you did that on peri implantitis, will you put that patient on a three month recall and keep doing it, LANAP again, again, again?

 

Allen:

Nope.

 

Howard:

What would you do?

 

Allen:

Well, first of all, you have to think people lost teeth for a reason. Usually, if people have lost a lot of teeth and they have a lot of implants, it's usually due to perio disease. These patients are at high risk of losing, of having problems with their implants. What you want to do, you want to keep that, especially you want to keep their periodontal status for their natural teeth as healthy as possible. I've always felt that patient who have implants, should be coming in every three to four months for perio maintenance, and at least once or twice a year having a peri-apical x-ray taken of that implant, so you can follow it to see if there's any bone loss all of a sudden. So you can catch it before it becomes a bigger problem for them.

 

Howard:

Once a year.

 

Allen:

At least once a year, they should have a peri-apical x-ray taken. Twice a year I would love to see, you know once every six months if they're coming in once every three months. Just to make sure, because I've had cases where the patient comes in, and we'll look and all we have is a bite wing, and the bone may look great on top, then you take the PA and there's big resolution area at the apex. That may have been caught a lot earlier.

 

Howard:

So Allen when you look at most marketing and advertising on implant companies, they're all saying their implant has about a 4% failure rate. There's a lot of people that are more cynical bastards like me who think that the American National average failure rate may be as high as 20%.

 

Allen:

Actually, if you look at peri implantitis studies, they can go as high as 40%. You have to understand, when someone says they have a 4% failure rate, and they say we have 96% success rate, what that actually means is, they're not looking at the levelness of bone, they're just looking, was the implant in or not in. The bone levels really aren't taken into account. You have to look at it from that standpoint. You have to understand, that's what when you see those success rates, I'm not looking at those. I'm looking at how much bone is lost over the course of the years.

 

 

Is one implant better than the other? I don't know. I've used five or six, seven different types of systems. I've found they all work well, but as long as you stick to biology. As long as you don't try to stick them into really think bone or try to push the envelope too far, or if you don't understand exactly what you're doing, that's where I think people go to the Mich course are far ahead of the curve, than those who go for the weekend warrior courses sometimes. Placing implants are easy. It's when it gets into complications, that's when it becomes hard. If you don't know how to handle the complications, you really shouldn't be placing the implants, at that point.

 

Howard:

My homies out there, they see implants that are up to 500 bucks for a Novo Vaio Care, down to $125 for an implant sur rack, and there's some coming out of Israel and Russia where they're under 100 bucks, has does an Osteocyte know if you're Novo Vaio Care or MegaGen or implant sur rack, where can you save money and where are you being foolish?

 

Allen:

I think that when you're starting out with implants, I think you have to go with one of the bigger companies, Nobel, Strauman, those ones and I'll tell you why. They have a much better customer support system. The reps are going to come out, they're going to help you out, they're going to help you order the implant, order the parts and everything else.

 

Howard:

But Strauman, but the mid frame MegaGen, didn't Strauman give MegaGen a $30,000,000 convertible bond?

 

Allen:

That I don't know.

 

Howard:

And they got assigned by June, so it could be by June 1 if MegaGen signs that, then the medium cost MegaGen would actually be a Strauman.

 

Allen:

That's right. I would suggest, start off with some of the bigger, more studied implants, because there's more data behind them.

 

Howard:

Name names, which ones?

 

Allen:

Like Nobel, 3i, Strauman, I've used Astra, I think makes a really nice implant.

 

Howard:

Astra with Dentsply?

 

Allen:

Astra is now Dentsply. There's another one, I can't remember the name of it, but there's a lot of great implants out there. As you get better and better at doing them, you start realizing that as long as you stay within the biological parameters of a millimeter bone around the implants, proper distance, proper occlusion.

 

Howard:

Just one millimeter all the way around?

 

Allen:

You need at least a millimeter and a half around an implant ...

 

Howard:

A millimeter or a millimeter and a half?

 

Allen:

I always go with a millimeter, but it could ...

 

Howard:

If you have a millimeter all the way around, do you think you're good?

 

Allen:

I think you're pretty good at that point. As long as you have at least a millimeter of solid bone around there. It can't be thin, you can't look through and go oh, there's the implant. I always like to place things subcrestal, I don't like right at the crest. The point is, as long as you stay within biological parameters, your implants are going to work.

 

 

As you get better and better, then you can start looking at some of the implants that cost a little less. Implant Direct I think makes a good implant.

 

Howard:

Who's the founder of that Implant ...

 

Allen:

Implant was a ...

 

Howard:

Jerry, was it Jerry Resnick?

 

Allen:

Not Resnick, it's Jerry, I can't think of his name now. I know him too. I've met him several times.

 

Howard:

What the hell is his name?

 

Allen:

I don't know.

 

Howard:

Was it Resnick? Jerry

 

Allen:

I don't think it's Resnick though. Isn't that crazy?

 

Howard:

One of the smartest guys in all of dentistry.

 

Allen:

Oh yeah, brilliant the way he did it.

 

Howard:

Oh my God, because he started Corvent.

 

Allen:

He started Corvent then he developed the internal hex, and he patented that so everyone had to pay him. When the patent expired, wait, I think he, was he bought out by Zimmer? Someone bought out Corvent, he developed the internal hex, then that was patented so any company that used internal hex had to pay him a royalty. He couldn't start making implants until, I guess some deal he made with Zimmer ran out. He was already tooling up for the implant ...

 

Howard:

And then he sold that to Kur, which is owned by Cyber, which is owned by Danaher.

 

Allen:

That's right, Danaher I think knows everybody.

 

Howard:

But the rumor is that his five year restrictive covenant has ended.

 

Allen:

Oh really?

 

Howard:

[crosstalk 00:29:55] And he's back. I called him, I said rumor has it you're back, I already applaud you. He goes, well I'm not back back yet, but as soon as I'm back, back, back I'll apologize to you.

 

Allen:

So there's Implant Direct makes a lot a good solid implant. They include a lot of things. They include a healing cap, cover screw, they include an abutment if you want to use it, or you want to use it for an impression coping. They include a lot.

 

 

MIS, I've been using for a long time.

 

Howard:

MIS?

 

Allen:

MIS, they're out of Israel, wonderful implant. Again, they include the cover screw, but they also include your final drill. So your final drill is always a sharp drill, which is nice too. You can almost use any system you want to do your initial osteotomies and then use their final drill to get the final shape, and then place your implant.

 

Howard:

You know how I got your, Ryan's my buddy, he's also my son. You know how your grandma, my mother calling, you know why I am her favorite son?

 

Ryan:

Why's that?

 

Howard:

Because I sent and her three girlfriends to Israel. On one of them bus tour things. She still thinks that was the highlight of her whole life. She spent 20 days seeing where baby Jesus was born, and she's just ...

 

Allen:

And that's it. That's amazing.

 

 

So yes, there's a lot of implants systems out there. I think Hyoscine has a good implant system, Dentium has a ...

 

Howard:

Hyoscine, that's Korean.

 

Allen:

That's Korean. Hyoscine has a good one, Dentium has a good one.

 

Howard:

So what are all the Koreans, Hyoscine, MegaGen, there's a third one in there.

 

Allen:

Dentium.

 

Howard:

Dentium, is that Korean too?

 

Allen:

That's Korean too I believe. Everybody has there, just like anything we do, there's no one implant to fit every single category. Sometimes you use a different implant system for a different case. Like Astra has a slanted implant on the top, it's angled so that for the ridges that have high on the lingual but low on the buckle. It fits right in there, so you don't have to worry about having one part [crosstalk 00:31:54]

 

Howard:

I'm going to start just bullet proofing you. The most talked about threads on dental [inaudible 00:31:58] implants. Screw or cement?

 

Allen:

I like the screw retain for the posterior, if you can do a screw retain in the anterior, that's great but I think the answer is easier to get the cement off of. I like screw retain more for posterior teeth because of all the peri implantitis that I'm seeing, a lot of it is because of what I call cementomas, cement underneath the bone, underneath the ...

 

Howard:

But what have you seen with cement, because some people saying that, well if you just didn't use a resin cement, but you use zinc phosphate cement.

 

Allen:

The whole idea behind the peri implantitis is that it's still caused by a bacteria that's from periodontal disease. What you have to realize is that if you have anything in there that's going to disrupt that tissue interface where joints, where it's tight against the implant, bacteria is going to get in and things are going to start blowing up. There is not periodontal ligament to slow the progress, there is no connective tissue attachment. It goes right from top, all the way down to the bone. It's like a osteomyelitis. It infects the bone right away, there's not a progression until it reaches the bone, so you have to be careful with that.

 

Howard:

How much of peri implantitis is trim planing. I'll see new patients, and they've got peri implantitis, where someone sunk two implants in a mouth or a bridge, and they had 6 millimeter pockets on five other teeth. Is a lot of peri implantitis from diagnosis and trim planing errors.

 

Allen:

I think it's more of that you have to look at your cases from the standpoint of, if you have a patient who comes in that's got periodontitis and inflammation, you have to take care of that first, before you place your implants. You have to remember that bacteria, the periodontal bacteria don't have zip codes, they don't just stay in their own little spot. They're jumping around, you're brushing your teeth and moving it all around too. You have to have a clean mouth really, to get an implant in. Actually, that's a nice thing about LANAP, is I've done implants as I've done LANAP because I'm cleaning everything off. I'm getting rid of the bacteria, it's the cleanest the mouth is going to be in a long time, and I can place that implant right away.

 

Howard:

Let me do this question. I don't think anybody really knows the answer, but I'm going to see what your opinion is. Let's say we had two patients, and one person has lost 80% of their teeth from root canals and the dentist tries to clean it up, and they try to save some canines or whatever. The other person just eradicates all of these, pulls all the teeth, puts them in a denture for three months, where there would be no anaerobic environment for the petri analysis to live, and then goes back and does like four on the floor. Do you think there would be less peri implantitis if there was not teeth that could have any bleeding gums, and you went to a full extraction, because I don't care if you have a full mouth gum disease, you pull all the teeth and make them a denture, their gums are all pink. There's no gum disease.

 

Allen:

Because there's no teeth.

 

Howard:

That's right. When you pull all those teeth, did you eradicate petri analysis because there's no gram negative anaerobic environment for them to live in?

 

Allen:

No, actually they're is still within the tissues.

 

Howard:

Of the tongue and the tonsils?

 

Allen:

No, under the gum. They're still in there.

 

Howard:

They're still in there?

 

Allen:

They're still in there just waiting, because they're intracellular so they can live within your gums. Now you're putting teeth back in, you're disrupting that sealed environment now with an implant that's popping up through the gingiva. Now it's oh, great, thanks a lot. Now I can [crosstalk 00:35:26]

 

Howard: