August 31, 2020
Howard Drew, DMD
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. Howard Drew, a periodontist and Vice Chairman of the Department of Periodontics at the Rutgers School of Dental Medicine, near Newark, New Jersey. Dr. Drew received his DMD and his post-doctoral certificate in Periodontics, both from Rutgers. Today, we’ll talk about how LANAP first entered his radar, the journey to have it integrated into the Rutgers post-graduate periodontal residency curriculum, and where he feels LANAP falls within a periodontist’s armamentarium. Dr. Drew, thanks so much for being our guest today.
Dr. Howard Drew: Thank you for having me!
MK: You came through LANAP training in 2015, so I’d first like to start where you first started hearing about LANAP and the PerioLase and if you had experience with dental lasers prior to that, and really your own origin story of getting involved with LANAP.
HD: Great. Unfortunately, I had no experience with lasers. Like so many misinformed dentists, I was under the incorrect assumption that lasers were high-priced electrosurgery units. In fact, Rutgers published an article by Andy Sullivan and Barry Simon years ago, documenting both tissue and bone necrosis with the use of eletrosurgery. I thought lasers would be harmful to both the teeth and periodontium. Boy was I wrong! Lucky for me, Neal Lehrman, one of the initial periodontists to use the laser (and a good friend of mine and graduate of our program) helped me understand the science and the knowledge about laser periodontics. Learning physics and protocol from Millennium has taught me that lasers should be a part of the periodontal armamentarium.
Several years ago, I had the opportunity and the honor to speak at the LANAP Study Club in San Diego. I started that presentation stating that there were two types of dentists who were misinformed. The first type of clinician feels lasers are nothing more than expensive cauterization units. Unfortunately, I was part of that group. And the second type of dentist feels that ALL periodontal cases can be treated with the laser. To me, both groups are wrong, in my humble opinion, and don’t fully understand the biology and the literature today. I do feel that dentists should be incorporating lasers into their periodontal therapeutic regimes.
MK: I should point out next to listeners that the LANAP protocol is currently taught to post-graduate periodontal residents at Rutgers. So I’m interested to hear from you how that relationship started; at what point in time in doing this yourself did LANAP become a part of the school curriculum and how that program works.
HD: Well, full credit for bringing laser technology to Rutgers should go our Chairman, Andy Sullivan, and our Dean, Cecile Feldman. They had the intelligence and foresight to see that lasers are – and will be – a part of dentistry now, and in the future. Ray Yukna, a brilliant periodontist and my initial Millennium instructor had success teaching residents laser technology in Colorado. Ray gave us a lot of advice in implementing the program at Rutgers. We knew that residents needed a sound background in conventional periodontics prior to treating cases with the laser. In our three-year program, residents learn the science and literature throughout the program, but during the first year, they can only assist on laser cases. They don’t treat cases until their last two years.
MK: So why, specifically, do you see LANAP as a valuable part of the curriculum for your residents at Rutgers?
HD: We base a lot of what we do on good scientific studies. For example, studies by Harris, McCawley, McCawley, and Rams, have clearly demonstrated that the Nd:YAG wavelength will destroy periodontal pathogens. Studies by Ray Yukna have shown Nd:YAG causes less post-op discomfort compared to flap surgery, and additionally, caused much less recession. This is very critical in the esthetic zone. The early Vilardi & Gold histologic study noted that the Nd:YAG removes ulcerated epithelium but leaves healthy connective tissue almost intact. This also limits recession. Studies by Ronay have shown that granulation tissue harbors growth factors and stem cells that will aid in regeneration. When we hear the phrase “don’t scoop the goop”, it was actually first noted by famous periodontists like Kramer, Schallhorn, and Langer. They spoke about a hot lesion, and how that inflammation brought cells, vasculature, and growth factors into the area to aid in regeneration. And most important, now the human histology by Nevins, Schupbach, as well as Yukna, have clearly shown regeneration with the Millennium Nd:YAG laser works.
Additionally, at Rutgers, we like to use the lasers for some value-added procedures. Things like frenotomies, hemangiomas, biostim for TMJ*, for paresthesias, for osteo-necrosis. We’re constantly using the laser in our post-doctoral program.
However, our residents know that when crown lengthening is necessary, conventional surgery needed to achieve proper bony architecture and create biological width is done. They also know that no prosthetic case for natural teeth and/or implants will be completed with adequate attached keratinized tissue. Cuspid exposures, crown lengthening, implant uncoveries, pontic site developments, socket grafting, etc., all need good, proper tissue when they are complete. Root amputations, hemi-sections, they’re rarely done now, but they still require conventional flap surgeries. Marty: the point I’m trying to make is that lasers have made us all better clinicians. We think more now about tissue phenotypes, biological width, crown lengthening, root recession…all these things.
MK: You mentioned quite a few articles and references just then, and I do want to point out that most of those are available at LANAP.com/research. For any that are not, you can be contacted directly at email@example.com. At the time of this recording, LANAP is being taught actively at 3 schools nationwide; not at all dental schools, or periodontal programs. So I’d like to find out from you if Rutgers is usually at the forefront of technology in terms of curriculum or if LANAP had to rise to a certain standard to get incorporated?
HD: Well, you know, we’re very lucky in our department, we have Andy Sullivan as Chairman, Gus Cappetta as our PG director, and Joel Pascuzzi as our undergraduate director. All three have been trained by Millennium, along with a host of other Rutgers faculty. But these three periodontists have been instrumental to bring technology into our curriculum. Modalities like lasers, Nd:YAG, diodes, venipuncture with platelet-rich fibrin concentrated growth factors, dentinal grinding, osteotomes, versa technology, piezo surgery technology, digital dentistry, just to name a few. But again, we want you to realize: we’ve not abandoned conventional therapy, but we embrace laser periodontal therapy and newer technology as a vital part of our program. And I will tell you that having lasers in our program has enabled us to have some of the finest post-doctoral candidates apply into our program.
MK: You’ve been in academia for quite awhile. I’d like to ask how open students are today in accepting lasers as a component of their treatment when compared to previously?
HD: They’re very open! In fact, I’d have to say the students are the impetus to push this technology. The problem is, students lack the experience. Between Drs. Sullivan, Pascuzzi, Cappetta, and myself, we have way over 100 years of clinical experience (It should be noted I am the youngest of the 4!). But, although we are involved in academia, we’ve spent a majority of our dental lives in private practice. So, our role is to make students read and critique the evidence-based research and work, cases with numerous modalities. Then, to assess the best modality for the particular patient, and often that varies due to the factors we just discussed. Often, the choice, though, is laser periodontal therapy.
MK: I didn’t mention in your intro that you are a fully-trained IALD certified instructor. That’s a requirement of any instructor who teaches LANAP at a University, that you teach it the same way that the IALD does privately. What was the process like for you to train as an instructor, coming as an academic background?
HD: To be honest, the training was excruciating. The IALD training program probably is one of the hardest programs I’ve ever completed. But, after completing, I have to say, I have immense respect for Bob and Dawn Gregg, because you really see their commitment to education, and you really see the education they provide for their students and faculty. They should be applauded for their efforts. Too often, you see a lot of laser or implant companies giving minimal to no education or support to their users. You don’t find that with Millennium, and I have a lot of respect for their whole education process.
MK: You said earlier that you value LANAP as a part of your armamentarium, but only a part of that armamentarium. Can you expand on what you mean by that?
HD: You know, truthfully, laser education has made me a much better periodontist. As I said previously, I assess therapy and potential side effects of therapy much more diligently than I used to be. I don’t embrace the “No Sew, No Fear” concept, because I know very well that to be a complete periodontist, lasers are a big part of one’s armamentarium, but I also know you shouldn’t be throwing out your scalpel, suture materials and bio materials. You have to be a complete dentist. You need perio sugery. You need crown lengthening, mucogingival surgery, ridge expansion, sinus surgery, amputation, exposures, etc. We want our residents to be confident in all aspects of periodontal therapy, and to assess the case and choose the appropriate therapy.
MK: Well one last question for you, add that’s asking you to look into the future a bit and assess: what is the next frontier of post-graduate periodontics?
HD: I think right now that what is very exciting and very rewarding to me is that the pendulum is really shifting. Due to the high incidents of peri implantitis and the positive results such as LANAP and other perio-regenerative therapy, there is now a huge swing to save teeth, and this is incredibly rewarding to me. Even with severe and terminal dentitions, now with laser procedures, now with staging cases and conventional periodontics and prosthodontics, we are talking about the real future of dentistry. Hopefully, procedures where dentists remove 6-10mm of beautiful, healthy bone to place implants to create the necessary room for a prosthesis will soon be abandoned. And dentists are gonna look to save and regenerate bone, teeth, and potentially pulps. Dentistry is in an exciting time. Perio prosthetics is back, lasers are here to stay, and the future is bright. I am personally excited to be a dentist in the year 2020 and excited about the future of dentistry.
MK: Well I admire your optimism, for sure. I do want to thank you for joining us today, Dr. Howard Drew, again Vice Chairman of the department of periodontics at Rutgers School of Dental Medicine. And if you’re listening and you’ve not subscribed to this podcast, please consider doing so, we have a new interview each Monday, wherever you download your podcasts, or at LANAP.com/podcast. Dr. Drew, thanks again for your time today and for sharing your expertise with our listeners.
HD: Thanks so much for having me.
*biostim, or biostimulation, is not an FDA-cleared use of the PerioLase MVP-7.