August 16, 2021
Hugh Fleming, BDS
Marty Klein: Welcome to Dentistry for the New Millennium. I’m Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry. My guest today is Dr. Hugh Fleming, a general dentist in Sydney, Australia. Dr. Fleming first studied diagnostic medical radiography at Charles Sturt University, attaining a diploma in medical radiography. He earned his Bachelor of Dental Surgery and a graduate diploma in clinical dentistry in the area of oral implants at the University of Sydney, where he’s also a frequent lecturer. Dr Fleming, thanks so much for taking this trip around the world to join me today.
Hugh Fleming, BDS: My pleasure, Marty. Always good to talk to someone on the other in the other hemisphere.
Marty Klein: Now you first got trained on LANAP in 2014 and at that time there were only three other LANAP trained doctors in Australia. So I’m real curious to hear how you first heard about the LANAP protocol and what caused you to then get trained.
Hugh Fleming, BDS: A very close friend of mine, and also a dear associate, and another dentist by the name of Dr. Peter Elfar, who practices a little bit further up the coast from Sydney. Peter went to the mid-winter conference in Chicago. I think it was in 2012-2013, or there abouts. He first saw LANAP at the conference, came back having signed a check, and got his first machine and became a really strong advocate of the LANAP procedure. So he contacted me and to quote his words, he said, “Look here, you’ve got to get on to this. This is a game changer when it comes to treating perio.” He kept on my case for you know, a few months. And I said, “Well OK Peter, if you think this is so good, what I’d like you to do is bring your machine down from Port Macquarie and I’ll get you the treat a few of my patients and let me have a look at the results.” Which is exactly what he did. Then we sat on things for about 3-6 months just to see how the results were, and we were just simply astounded. So that pretty much made me decide to take the leap to become a LANAP-trained dentist. I think dentist number four in Australia. But I think Peter was pretty much the pioneer for LANAP in Australia. He was, I think, one of the first clinicians in Australia to bring the actual protocol here.
Marty Klein: Yeah. He was the first doctor, Dr. Elfar. So you saw it then with your own eyes. So there’s not a whole lot better evidence than that, than to see it in front of your own eyes with your patients. But were you at all concerned about your patient base really not having heard of this procedure before?
Hugh Fleming, BDS: No not really at all. We’ve got pretty good communication with all our patients. They were all introduced to it in a certain way and also along the lines that they would be treated with Dr. Elfar to start with. You know, it was a new technique and they were all very happy to progress through it, especially if they didn’t have to go through the periodontal surgery bit.
Marty Klein: Had you used any other types of lasers to this point or was this a brand new paradigm for you?
Hugh Fleming, BDS: Brand new paradigm for me. I was pretty much a laser virgin.
Marty Klein: So since there were only a few other LANAPers in Australia when you started, have you seen over time the Australian population either change or warm up to laser dentistry or has that changed at all since you started?
Hugh Fleming, BDS: Not a great deal, unfortunately. I think the promotion of LANAP is pretty much practice-based still. There hasn’t been a great deal put out there in the media or anything along those lines. So it’s very much pushed by the clinician or promoted by the actual clinician itself. We built our LANAP patient-based principally from three key areas and that’s from in-house marketing on our own patient base, Hugh Fleming dentistry website and social media, and our dedicated laser gum dentist website, which is based solely around the promotion of LANAP.
Marty Klein: Yeah, I noticed that you have those two different websites and I will give a shout out to them as we close, one separately just for your LANAP laser dentistry. So I’d like to hear more about that. And how you decided to push LANAP on its own spinoff website.
Hugh Fleming, BDS: Yes. When I took the leap into LANAP and went through the training and then came back, you know, we made the conscious decision to introduce & educate, and then promote LANAP and LAPIP procedures to the Australian market. I didn’t want to see it diluted from the mainstream dentistry arena. So that’s exactly what we did. We establish the laser gum disease website which is promoted through Google and also social media. Probably I would say 50% of our LANAP & LAPIP clients and the clients come through that website. You know, I must say also, the likes of Dr. Chris Barker, the periodontist from Queensland, I think you’ve already done a podcast with. He is very active in the Queensland area with regards to the fight gum disease website and Fight Gum Disease Awareness Month 2020, and also Dr. Peter Elfar with his LANAP Australia website, which promotes LANAP and LAPIP protocols very strongly to the general populace.
Marty Klein: OK, so you’ve recruited lots of patients to do the treatment. And I’m next curious then if the procedure itself has produced similar results to those first patients that you saw from Dr. Elfar, have you been able to replicate those clinical results?
Hugh Fleming, BDS: Most definitely.
Marty Klein: And I understand too that you have three hygienists who are also trained not of course for LANAP but for the lower power level, nonsurgical procedures. And I’d like to hear a little bit about how that’s been going with your hygiene department also trained.
Hugh Fleming, BDS: Yeah. Our hygiene department is one of the keystones of the Fleming Dentistry Practice. The hygienists play a major role in the recognition of treatment and ongoing maintenance of all our LANAP and periodontal patients. The hygiene is pretty much came from the outset to be part of the LANAP training and treatment program. And they have to form a lot of treatments in regards to low level lasers such as aphthous ulcer treatments, most biostimulation of TMJ and facial pain, LPD procedures during routine hygiene treatments and hygiene use. So it’s used extensively within the actual hygiene departments.
Marty Klein: Very good. Your website also says that for your practice there’s, and I’m quoting “No challenge we can’t solve.” And that stood out to me, I was wondering if there were a particular challenging case or two that comes to mind that the PerioLase helped solve.
Hugh Fleming, BDS: Certainly, you know, we’ve treated many challenging LANAP and LAPIP cases since 2014. I could rattle off a whole heap of cases, but one of the cases that really comes to mine came to us in 2016. It’s actually a LAPIP case. LAPIP itself has proved to be an implant lifesaver, for many, many patients. This particular lady came into the practice in 2016. She had five implants in the upper jaw and six implants in the lower jaw. All of these implants were chronically infected with peri-implantitis to some degree. The upper implants, looking at the radiographs, suffered from between 40 and 50% bone loss and the lower implants between probably 70-80% bone loss, in recollection. The previous treating dentists and orthodontists that all recommend removal of the implants in conjunction with extensive bone grafting procedures and then re-implantation. She was in a pretty distressed state. She had a lot of treatment and spent a lot of money having all these implants placed over a period of years. We agreed to take her case on board and treated her with a combined LANAP & LAPIP procedures. LANAP around the teeth obviously, and LAPIP around the actual implants, and placed her on a rigorous long-term maintenance and follow up program. We still see this lady regularly every 4-6 months. The last visit was January this year, and this lady still maintains all the implants in a disease-free state. And follow up CDCT Scans taken over this period have shown considerable bone regeneration around all the implants. And that doesn’t mean bone regeneration to the first round off the top of the fixture but certainly vast improvement okay on the status of bone levels from when she first presented.
Marty Klein: You know we love those stories because it’s really a win for the patient who doesn’t lose his or her in this case implants or natural teeth and you feel good about it because you got to deliver essentially on what other dentists might have said was impossible. When thinking about natural dentition, when you resolve the periodontal disease, it also opens up the possibility for additional treatments that would have really not been possible had the perio gone unchecked. Has that been your experience?
Hugh Fleming, BDS: Oh most definitely, Marty. As you probably are yourself familiar, and clinicians are, new cases when they present for LANAP have often been down the periodontal route several times, as in the surgical route, all come to the stage of pretty desperate need of care. So there’s really in the mouth of a plethora of treatment that needs to be done ranging from obviously periodontal problems, restorative problems, missing teeth, occlusal problems, and, you know, the list goes on. So our main aim when we see these patients is obviously the elimination of active disease and infection. Which is our primary treatment, our initial treatment goal. Obviously, LANAP plays an integral part in obtaining this. When we stabilize the active disease, we then sit down and say, “Well OK, from a long term what do we need to do to rebuild your oral health?” And obviously many treatment modalities such as crown and bridge, endodontics, implant dentistry, and Invisalign orthodontics often come into play in these cases over a period of time. So really many of our in that case has often become a long term work in progress to obtain long term optimal.
Marty Klein: Do you end up using the PerioLase for additional procedures whether cosmetic or prosthodontic? We call them value added procedures, or VAPs. Have you used your PerioLase yourself? We talked about the hygienist earlier. But do you use it?
Hugh Fleming, BDS: Yeah, we use it for other things as well. Some examples of that would be we do a lot of implant surgery and we do a lot of bone grafting and socket- grafting procedures. So I often have the PerioLase on side for the decontamination of the actual socket itself and blood clot formation and also biostimulation, frenectomies, and gingival re-contouring. We use the laser sometimes so that I do. I must admit find the laser a little bit slow in these sorts of procedures, so it may be a traditional surgical approach followed up with a laser to for homeostasis and also to encourage healing. Yes, we’ve still got the TMJ and facial muscle biostimulation and treatment of cold sores and aphthous ulcers, which I don’t do so much myself to use mainly in the hygiene department.
Marty Klein: Very good. I do have to point out just for our American listeners that the biostimulation for TMJ is not an FDA-cleared use of the PerioLase, it’s off label, although it certainly is used that way by many, many clinicians. One last topic here and that is that you have quite a lot of technology in your office. CEREC, 3D cone beam, digital intraoral imaging, digital x-rays. So I’m just curious if you found any particular synergy between LANAP and other technology in your office.
Hugh Fleming, BDS: The PerioLase fits well with the technology level of our practice and patients pretty much see it as being part of the course of the treatments that we provide. Two particular synergies I probably think of, Marty, that stand out is obviously the employment of scan imaging in both the diagnostics pre-LANAP and also in post-LANAP follow up. The patients not only see the extent of the disease initially, but also happily see the results 12, 18 months down the track. The second synergy that really stands out for us is to use Tek Scan bite analysis, which comes in really handy when we’re doing a collaboration of the occlusion, both pre and post treatment.
Marty Klein: Well, very good. I want to thank you on our behalf for being one of the pioneers in Australia. Again, you were you were number four and there are still only about I believe a dozen or 13 maybe in in the country. So I do want to point out your websites, plural. The first is http://hughflemingdentistry.com.au. And then the LANAP focused one that we spoke about earlier is https://lasergumdentist.com.au. I would like any of our listeners here to subscribe to this podcast if you haven’t yet or all of the podcast episodes can be found at lanap.com/podcast. Dr. Fleming, I know it’s early in the day for you. Thanks for spending some time with me.
Hugh Fleming, BDS: It’s my pleasure, Marty. Thank you about for allowing me to talk on your show.