July 6, 2020
Ann Astolfi, 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 speaking with Dr. Ann Astolfi, a periodontist practicing in Bethlehem, Pennsylvania. Dr. Ann Astolfi earned her dental degree from the University of Pennsylvania, and her periodontics in implant specialty from Temple Dental School. She serves as a certified instructor with the Institute for Advanced Laser Dentistry. Today we’ll talk about her journey with LANAP and the PerioLase, the different ways in which she uses it in her practice, and how it supports her overall goal of less invasive and more holistic treatments. Dr. Astolfi, Thanks so much for joining us.
Dr. Ann Astolfi: Thank you, Marty.
MK: So let’s just start kind of from the beginning with your LANAP story. What originally attracted you to the LANAP Protocol? And how did you get started?
AA: I was at the AAP meeting, and there was an inordinate amount of buzz regarding LANAP and LAPIP before it was actually named LAPIP, when it was just treatment of perimplantitis with the laser. At that point, I could no longer refute that this was a viable modality, although our academy was not embracing it at that point. So I evaluated things on my own and I went and I saw a Dr. Yukna and his histology on the regenerative potential utilizing the laser. I sat next to a gentleman. I don’t even know his name or who he is, but he had it, he verified that it did work, and it worked great on implants. So that’s what sparked it: That’s what began, my investigation and then purchase. And once I purchased it, I was still very skeptical because it just seemed like it was too good to be true.
MK: Sounds like you had a mystery testimonial. Somebody next to you,
AA: Right, right
MK: And you also mentioned that the academy at the time was not fully supportive. What about your colleagues? Once you got trained and you now have your PerioLase in your office, how did both your GP and periodontist colleagues in your area react to it?
AA: The general practitioners really embraced it and were positive about it and excited and very encouraging. The other periodontist in the area were reticent and skeptical, and basically just said, “You know, it’s not gonna work any better than Electrosurge.” I just figured that was fine. I appreciated getting the greater market share of my area, so…
MK: And this was back in 2011. Has the attitude of your fellow periodontist changed at all since that time?
AA: Not really. Those that had any interests pretty much jumped on at 2011 to 2012. But the periodontists have not necessarily against in that regard. The general practitioners are far quicker to embrace technological change, I think.
MK: And did you see an uptick in referrals? At least with perio referrals at that point in time or since then.
AA: So I always describe it this way. Prior to becoming certified in LANAP, I did probably about 20 to 25% traditional periodontal therapy. The other part of my practice was made up through extractions, bone grafts, implants, soft tissue grafting, sinus grafting, things like that. After I began using LANAP, I saw my patient base change over into about 50% periodontal treatment. And so to that, I say I doubt very highly people in Bethlehem just had a surge of periodontal disease. Right? Um, my general practitioners are good and they continued to refer. So I surmised it to be that people finally started to accept this treatment modality for gum disease versus cutting, sewing, grinding their bone. We have a much happier patient base, and the staff is happier because the patients are happier.
MK: Well, certainly with that story, patient acceptance changed, but that is only as good as the treatment itself working, at least in your mind. You mentioned earlier that you were yourself very skeptical. So what did you find – you’re getting more referrals – but were you satisfied with how LANAP was working for those patients?
AA: Yes, and I had to be the Doubting Thomas and test it all myself. So I would initially, it wasn’t according to protocol, but I would do half mouth with traditional therapy, cutting and sewing and the other half with laser therapy. I always did the laser second because the patient would never let me to a different procedure after they’d had the laser. So what I found was, I had to go back to those traditional areas and retreat them with the laser. So, my skepticism was… I challenged it both with other people and myself, and then found a greater result through LANAP treatment. Not only you know the acceptance and the patient experience, but a good quality of keratinized tissue that’s more durable and more resistant than just essentially doing submarginal incisions and cutting all that inflammatory tissue away along with a good amount of connective tissue that is healthy.
MK: So I do want to point out for anyone listening. You had mentioned that that was against protocol to do half mouth traditional/half mouth, LANAP: LANAP is a full-mouth protocol, so that was how you were going against it at that time. I understand why, but I just want to point out what you meant by that. You also talked about implants and how that was a big part of your practice certainly before, at what point did you start using the PerioLase also around implants for LAPIP, and can you tell me a little bit about your experience in that area?
AA: Yes. So after a six month mark, once I began to feel more comfortable, than I addressed areas of perimplantitis that I began to use it for, let’s say, a Venus Lake or hemangioma, different value-added benefits of the laser, but not necessarily the primary factor for the laser. The LAPIP was just really significant. When I began there was no name, LAPIP was the treatment of implants with the laser, and the protocol began to get more refined. Now it’s a standardized protocol, but I saw a great response immediately, clinically in perimplantitis cases. It has to be the right selection, so if the implant is outside significantly the alveolar housing and you don’t really have walls to regenerate the bone, pretty much nothing is gonna work there. But if it’s within the alveolar housing and you have the walls to regenerate, there’s a great response. Radiographically we don’t see any response for 12 to 18 months on the X-ray, but you will see it clinically. You’ll see much better tissue quality, lack of suppuration and consolidation of the tissue
MK: On that note, or it was on the note of treating perimplantitis and natural dentition with a laser. Your website talks a lot about your focus on less invasive treatment and holistic treatment. Would you categorize the PerioLase in that way? And how has it fit in with that mission in your practice?
AA: Well, it was one of, if not the first, really advanced technological pieces of equipment I incorporated into my practice and from the positive experience with LANAP. Then I felt more comfortable moving on to CBCT, digital X-rays, prp, prf. The response from the patient is phenomenal because they realize the more advanced technology you have, with the education – not just separate – but advanced technology with the right education. You’re on the cutting edge of your profession, and that’s where patients want to be. They want to know that their doctor is experienced, competent and doing everything they can to give them the best outcome with the least trauma and basically scarring.
MK: You mentioned education there. I know we pride ourselves in not just selling a laser, but making sure every clinician gets hands-on, live-patient treatment under their belt with certified instructors, of which you are now one. Can you tell me a little more about how the education component made you more comfortable with doing LANAP or set you up for better success, and then why you became an instructor to boot?
AA: So I think that the education is second to none. You know, very few pieces of equipment do you buy that you have this level commitment of education. And by that I mean not just these five days that you’re incorporated into the protocol. But each time you’re here, you’ll have a different instructor and each instructor will contact you, and you have the freedom to contact them at any point at any time and say, “Hey, listen, I did this case. I’m concerned because this occurred or that occurred or the patient is in hyper occlusion and, you know, it was very difficult to get the occlusion set. This is what I did, any recommendations or questions?” and they’re great about getting back to you. In terms of, you know, it’s not just education of hands on with the patient. Maybe it’s education of “How do I incorporate this into my office because I have a rather rigid, fixed staff who is not embracing change?” So you know, a new piece of equipment like this with a whole new protocol can really rustle a lot of feathers. Maybe it’s “How do I incorporate it with, if you’re a specialist, with my general practitioners” and there is a tremendous resource here between instructors, online help, and the tech staff here is great. You know what I have very, very infrequently ever needed them. But every single time I call within 10 minutes, I have my problem remedied.
MK: So it’s ongoing education as opposed to just the initial training. I know one thing that our customers contact instructors about are additional ways to use their PerioLase; we call them VAPs or Value-Added Procedures. Are there other procedures that you regularly use the PerioLase for or that you’ve helped other clinicians with?
AA: Yes. So one of the big ones is the hemangioma treatment. Just the other day, I had a lady in for a soft tissue graft and I said to her she had a hemangioma on the left vermilion border, probably about seven millimeters. I said to her, “While I have you numb, are you interested in me getting rid of this for you?” And she said, “I would love that. My dermatologist said they can’t get rid of it!” and I said, “Yeah, it’s not a problem. It’ll take about less than 10 seconds. It will crust over, look like a little ulceration, and then it’s gone.” She was loving that. Now that’s one of the nice things. Herpes labialis, it’s a fantastic ability to be able to treat that. If the patient lets you know when they’re in the prodrome and you give a little bit of energy to their lip extraorally, that virus tends not to come down and come out in an outbreak. And then they typically have less and less outbreaks as you’ve treated them. That’s another one. Pretty much all of my tennis team knows I have a laser and any tennis elbow, plantar fasciitis – all those things are treated.
AA: Yep, biostim! It’s almost the kind of thing the more you use it, the more you need to use it because you find all different opportunities. So I would say, like the first 6 months of practicing with it, I literally used it only for LANAP. And then, as I became much more comfortable with it, “Let me let me use it here… Let me use it.” You know, a patient that’s on Coumadin and can’t stop their anti-coagulant: take out a tooth, I’m gonna put a bone graft in, I’ll use it within the socket to get some nice hemostasis, put the graft in my membrane suture, and then I use it a little bit over the top to make sure I have a really good clot. So that’s nice for us because it’s good for the patient and it’s good for me because on a Friday night that I’m not getting called in.
MK: Wow! Well, thank you for telling us about that. And just to wrap up here, I do want to give a plug to your website, which is drastolfi.com. That’s d- r- a- s- t- o- l- f-i, if you would like to learn more about Dr Astolfi in her practice. Thanks for spending the time with us and sharing your story and perspectives.
AA: Thank you, Marty. Appreciate it.
**Note: Biostimulation, as discussed in this episode, is not an FDA-cleared use of the PerioLase MVP-7.