June 15, 2020
Donato Napoletano, DMD
Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry and today we’re talking with Dr. Donato, or Dino, Napoletano, a general dentist practicing in Middletown, New York, just outside New York City. Dr. Napoletano earned his dental degree from Boston University. Today we’ll be talking about his 15-year journey with LANAP and the PerioLase and how it’s impacted his practice over the years, And of course, his patients. Dr. Napoletano, thanks so much for joining us today.
Dr. Donato Napoletano: Thank you Marty. Thank you for having me.
MK: I want to start just kind of at the beginning. How you first heard about LANAP and the PerioLase and what your journey was from that first moment to deciding to incorporate it into your practice.
DN: Well, my journey first started in 2004, where I first purchased a new erbium laser. Of course, back then they were saying the erbium could treat both teeth and gum disease. I figured that was the most versatile wavelength to start with. So I started with the erbium; however, after treating a few cases, perio cases, I wasn’t really liking the results I was getting. Also with the erbium on teeth, you really need to see the interaction between the laser and the tooth structure. So from there, I ended up incorporating microscopes to practice. The microscopes helped greatly, but I still wanted to be able to treat perio disease with laser. So I then went to using a diode laser, incorporating that with my scaling and root planing protocol. After doing that for a little while, I noticed that that wasn’t really working to my satisfaction, either. I wasn’t really seeing much improvement over scaling and root planing alone. Then, I kind of sidetracked and went into CEREC. The PerioLase actually came towards the end, so I actually evolved into using the PerioLase. I think I got there after incorporating two other laser wavelengths and learning more about laser physics along the way, I started to realize that maybe the wavelengths that I was using weren’t really appropriate. Then somehow I learned about the PerioLase and LANAP, and that brings me to where we are today.
MK: So you clearly had experience with other lasers. I remember you just mentioning just now that originally your erbium laser had some sort of claim to treat gum disease? From everything I know about lasers, erbiums cannot treat gum disease, at least effectively. Is that what you found? And what is different between it and the PerioLase or the Nd:YAG?
DN: Yes, that’s exactly what I found. So with the erbium, you know, it would indiscriminately just remove tissue, similar to a diode, and that really wasn’t the goal. After learning more about PerioLase and how it functions, that it more selectively removes disease tissue. In fact, as I started using it with the aid of the microscope, I could actually visually see the laser tissue interaction and the differences between the interaction between the PerioLase, diode, and erbium.
MK: So you incorporated LANAP in 2005, which relatively was early. We started selling it in 1999, so that’s still relatively early in terms of how much science and FDA clearance was released at that point. Do you normally consider yourself an early adopter of technology?
DN: Well, considering that I was, I think the third dentist in New York State to be certified to use the PerioLase, I think, yeah, I think I do consider myself an early adopter.
MK: Were you skeptical at all at that point that this new-to-you laser and protocol could effectively treat gum disease?
DN: Well, again, because of my previous experiences with the other wavelengths, I was very skeptical. But after learning more about it, and because at the time they were offering a six-month money back guarantee, I figured I really I had nothing to lose at that point. So I decided to go ahead and try the Nd:YAG. Now, interestingly, after using it for about a year, I had one patient in particular come in, who had very, very severe periodontal disease. I actually was trying to convince the patient for me not to treat him. He was a professor and he only had it a couple of years until he was going to retire. He didn’t want to have his teeth extracted because of a fear of his denture flying out while he was speaking, while he was lecturing. So he kind of twisted my arm a little bit and said, “You know, I just need a couple of years. If you could just give it a shot, you know, just till I retire,” he goes, “I would be really grateful.” He seemed like a nice guy, and I figured that this was the perfect case to try the PerioLase to see what kind of results I could get. Again, it was a very, very severe case, the periodontist wouldn’t touch him, very loose teeth, suppuration everywhere. I mean, honestly, I told him, “I don’t even think we’ll get six months.” But again, he was like, “Just give it your best shot. If it works, it works.” So I said, “Okay, let’s give it a try.” And, to my surprise, actually, we got 10 years out of this teeth until they needed to finally be extracted! But it was certainly exceeded my expectations and even the patient’s expectations.
MK: Wow. If that was one of your first patients, you tried this on it sounds like your skepticism didn’t last very long?
DN: No, exactly. So you know, I started out doing easier cases, I started in 2005. He came along in 2006. So it was after a year that I had experience using the laser, so he was one of my worst cases. And I figured, if it if it works with him, then I’m probably gonna feel a lot more confident that it’ll probably work with earlier, moderate stage cases as well.
MK: Did you find that LANAP was more readily accepted by patients than anything you were doing previous to that point?
DN: Absolutely. At the time, I even had patients that had a quadrant of conventional surgery done and they weren’t going back to have the other three quadrants treated because of the discomfort they were in following the procedure. I just had all these perio patients in my practice also, that just were refusing going to the specialists. I was doing a lot of scaling and root planing, but again, I wasn’t really getting very definitive results. I was finding that they would regress back and after about a year or 18 months later, and I’d have to scale and root plane them again. So of course, the patients, when they heard that I had a different way of treating it, possibly a little more definitively than scaling and root planing alone, they were all on board to give it a try.
MK: So as you were getting started there with LANAP and getting it into your practice, you, of course, had to come and get trained. And I’d like to hear a little bit of your thoughts on that training experience and how it set you up for success…Assuming you feel that it did set you up for success and just how the how the training program landed with you.
DN: Well, I mean the training, again, I can only compare to the training that I got with a diode and the erbium, which consisted basically of just learning about laser physics…I think with the diode we used pig jaws. But with the PerioLase, it was a completely different experience, because we not only got the education of the physics, but also practicing directly on patients. You know, when you’re able to learn while working directly on patients, it’s just the whole different experience.
MK: I did want to mention, you said earlier about, “at the time there was a six-month clinical guarantee,” and I should probably put in here that that is still the case from Millennium Dental [Technologies]. They guarantee the clinical results of the LANAP protocol for six months. I’d like to ask now, kind of looking back, you’ve now been using the PerioLase and LANAP for the better part of 15 years. Couple angles of that. Do you still find that you…Well, let me ask you this. How often are you doing LANAP these days?
DN: I do it as often as I was when I first started. Maybe, because of more experience over the years, and this doesn’t go for LANAP, it goes for any procedure, but I’m a little more selective on the cases that I treat. So let me clarify that. For instance, you know, if I have a patient that’s coming in and they have crowns that are impinging on the biologic width, going in and treating it with the laser may not be addressing all of the causes. I found that out the hard way, where I had a few cases where I treated that maybe didn’t work out as well as I liked. But that was really my own fault because they were cases that really needed to be deconstructed and reconstructed again, restoratively, and maybe even treated surgically in those cases. But for classic, conventional, inflammatory, chronic, periodontitis- I mean, really – there’s no reason to really have to go into surgical mode anymore. I find that it’s just so much more effective and the patients like it better. Post-op for the patients is almost nothing, honestly, to the point where even the patients are surprised. So it’s really been a very good thing that I did by adding this technology to my practice.
MK: Well, you took the words out of my mouth, but I was going to ask you for a little retrospective of the last 15 years of doing LANAP. It sounds like it’s been really, almost all positive.
DN: Very positive. Actually from the first year that I started out of dental school, I had an experience with my own Dad, a man who I never saw shed a tear my whole life. Coming out of dental school, he only had his two front teeth maxillary front teeth remaining, and it came within months that I started practice, they had they had to come out. After pulling those two teeth out, I saw tears coming down his cheek. It was at that time that I realized, you know, us as dentists, we sometimes don’t realize that the teeth, are attached to people, even though my dad only had [the two.] In my mind, it was like, “I don’t understand what the big deal is. All the other teeth, they’re gone. You only have those two fronts.” Well, to him, those two fronts were the most important teeth that he had. Through the years, I encountered a number of patients, like him. And so from that point early on, the focus of my practice has always been to save teeth over extracting them, and certainly the PerioLase helped me fulfill that really well.
MK: Fantastic. Thank you so much for sharing your story with us. I do want to plug your practice website if anybody would like to learn more about you or live in the Middletown, New York, area. That’s https://www.donatodental.com/ And of course, learn more about the LANAP protocol at www.LANAP.com And if you’d like to hear more stories week-to-week on this podcast, please subscribe wherever you download your podcasts. Dr. Napoletano, thank you again for joining us today.
DN: Thank you. Marty was a real pleasure. Thank you again.