May 11, 2020
Charles Braga, DMD, MMSc
Marty Klein: Welcome to Dentistry for the New Millennium. I am Marty Klein, Training Manager at the Institute for Advanced Laser Dentistry, and today we’re speaking with Dr Charles Braga from Raymond, New Hampshire. Dr. Braga is a Harvard graduate, both for his dental degree and periodontal residency. He’s lectured extensively on the Nd:YAG laser and the LANAP Protocol over the last 18 years and serves as a certified instructor with the Institute for Advanced Laser Dentistry. Here, we’ll talk about how and why he became just the second periodontist ever to incorporate the PerioLase MVP-7 into his practice and how the following two decades worth of literature and science has only reinforced his decision and what he sees every day with his patients. Dr. Braga, thanks for being here with us.
Dr. Charles Braga: It’s a pleasure to join you.
MK: You’ve been LANAPing nearly 20 years. Is that correct?
CB: I’ve been LANAPing since September of 2002. That’s almost correct. Yes.
MK: …getting there. So that was pretty early on, specifically as a periodontist. Are you an early adopter in general? Is that why you came aboard?
CB: I am usually far more cautious, but I had personal recommendations for this technology from someone that I worked with, a few anecdotal stories from friends that this seemed to be working at the time and was going to be a great new addition to periodontics, and I signed on knowing that I was at least cutting edge. I truly didn’t appreciate that at the time I was bleeding edge, I like to say, and things could have gone very, very wrong in so many technologies lead us down the wrong path. Thankfully, I’m sitting here almost two decades later and things went very, very right.
MK: You mentioned you talked to some friends, and anecdotally, this is before human histology or other peer-reviewed literature. Tell me a little more about that. I believe you were the 3rd – 2nd or 3rd – periodontist to purchase the PerioLase. Why didn’t you wait for more research? We hear that a lot from periodontists just now coming on board. So tell me a little bit more about that decision, pre FDA clearance.
CB: Only years later did I find out I was actually the second periodontist to adopt the technology. The first was my good friend Dr. Lloyd Tilt from Utah, and I was compelled to do so for a number of reasons. Namely, I was one of the first children of the more modern regenerative era. The use of barrier membranes, bone grafting, etc. to try to put back with the disease has stolen instead of helping the disease by taking more away as part of a receptive procedure. I thought there was merit in that, and after speaking to some friends or colleagues that had used this technology, and we’re getting positive results over what now I look back is really short time. I was stimulated by their personality, their charisma, their power of their speech to adopt the technology myself and pretty much haven’t looked back since. It’s a truly it was bleeding edge. And it was before, the histological studies or the FDA approval in 2004 but sometimes a bunch of good anecdotes from many good people you respect and whose company you enjoy is almost research unto itself. It’s something that was powerful enough to me to allow me to sign on and give this a try.
MK: Did you have other lasers at the time? Were you already a laser dentist?
CB: Well, that did help. I had been using lasers and dentistry since 1997. Mind you, I’d finished residency at Harvard back in 1996 and I was pretty fresh out, but I worked with someone who was very laser friendly, introduced me to the carbon dioxide laser – which is vastly different from the PerioLase and what it tries to achieve – and I was pretty much hooked. The value proposition of photons was there for me and LANAP was just a natural extension of that. So I started to tinker, and LANAP was part of my growth process and tinkering, and here I am today.
MK: You were one of our early certified instructors as well. So after adopting this for yourself with your patients, what made you decide to start teaching this to other clinicians?
CB: Well, to be perfectly honest, I had some teaching experience at Harvard with the International Program in Dentistry, and I thought it was a lot of fun. So after a suitable period to prove to myself that this was working, being efficacious and not harming patients, I just called the company and said, “If you have a need to go on vacation or need for an additional lecturer/instructor, I’d be happy to help out, just in case. Feel free to give me a buzz.” I guess you could say that I auditioned and the rest was history, and I’ve been teaching with companies since June of 2004. So bottom line, I thought it would be good to help others understand what I came to understand about the power of the technology, and I really thought it would be fun, and it certainly has been for a very, very long time.
MK: So, looking back over the last couple of decades, the PerioLase has endured. Why do you think that is? Why does it work the way it does and why are you still teaching new doctors and new periodontists alike how to do this technology? Two decades later, nearly?
CH: Well, I like to think of what we do as almost being like good cuisine. If there’s a good recipe, even if it’s hundreds of years old, it endures, maybe with slight modification or a few small tweaks, but if its inception is excellent than that persists and the excellence persists with it. The LANAP protocol was designed to be a recipe for predictability and for safety. Thankfully, the laser that was built to adhere to the protocol all made for a recipe for success that’s worked for me and continues to do so. So that’s how I pretty much look at it.
MK: Have you seen other protocols or other lasers come and go over the years? What do you think is different about LANAP or for the PerioLase in terms of its longevity?
CB: I’ve seen multiple manufacturers in multiple wavelengths over time, try to achieve what is achieved by the LANAP protocol and really fail when it comes to the idea of true regeneration. Everyone wants a knock off. Everyone wants to engage in “me too-ism” and the wavelengths were both inappropriate, the protocols were inadequate, there’s been no proper safety testing, there’s been no university-sponsored research, and frankly, there’s not been with other manufacturers the excellence of curriculum and education/educational standards that we’ve had here at the Institute for Advanced Laser Dentistry. So that has largely been an irreproducible recipe, beyond the LANAP protocol, that’s allowed for success and engendered a lot of goodwill in the dental community. I’m glad that I’ve been a part of that, and I enjoyed it myself. Between the safety, the efficacy and that goodwill all together. That is why I am still here. Both teaching and an acting back home is a LANAP periodontist.
MK: So I understand that wavelength plays a big role in what a laser can or can’t do. Can you tell us a little more about how the Nd:YAG wavelength in particular matters and why it’s the best one to treat periodontal disease?
CB: Importantly, the PerioLase is an Nd:YAG laser, a 1064 nanometer laser, and the wavelength is specific for targeting dark pigmentation. That’s important to me as a periodontist because I know that I need to short circuit P. gingivalis. I need to short circuit the red complex not just where the tip of the laser maybe in the pocket, but at distance. Nd:YAG radiation is specific to give me bacterial kill through absorption at distance. So I am able to subdue the red complex, not just at the tip but in Socransky’s privileged sites – those areas where germs tend to hide – dental tubules, in the interstitium, even destroy bacteria in the human general epithelial cell and leave the epithelial cells standing. This isn’t Millennium research, necessarily. This is basic biological research, dental research over time, showing that Nd:YAG lasers are capable of this. But if I’m able to do all of that and link it to a protocol that is regenerative and epithelial exclusive, it really makes all the difference for me. But it’s a protocol that’s not just a simple recipe, it’s a proven recipe for success and safety. And that’s where I hang my hat.
MK: Can you tell us a little more about why LANAP works? You mentioned the recipe, and it’s in its longevity, but I’d like to hear a little more about the science behind it or why it has endured or what makes it different.
CB: The basics or fundamentals of regeneration are pretty straightforward. The body would like to heal, and we need to tip the scales in favor of regeneration over degeneration by disinfecting the wound, somehow sealing it, and preventing further trauma or insult, and the body then, we hope, will heal. Barrier membranes, to a degree, could do that. Bone grafting could do that to a degree. But most importantly, using the PerioLase allows for a disinfected under gum space, a disinfection of the attachment apparatus throughout Socransky’s privileged sites. It allows for a sealing blood clot, which prevents epithelial down growth and then allows for healing and repose. It satisfies all of the requirements of regenerative surgery, but in a way that’s kind and gentle to the patient and also tissue-sparing. It’s vastly different from what I engaged in before. If you consider the literature, importantly IJPRD of December of 2007 where Dr. Ray Yukna’s study was published, it was powerful and compelling evidence that really solidified my position intellectually with respect to LANAP, and really did so with respect to those who were possibly doubting or questioning. But, of course, it could have been a one-off. The recapitulation of Dr. Yukna’s work by Dr. Nevins – Marc Nevins was my junior one year in the period residency at Harvard with me – decided to redo the Yukna work on a different continent, different histologist, and with multi-rooted teeth and largely showed the same that was shown in the Yukna study from 2007: true regeneration, bone PDL, new cementum, properly oriented Sharpy’s fibers. The things that a histologist might look at and consider to be the Holy Grail of or the hallmark of true regeneration. So that really, really clinched so much in my mind and in the minds of others. I look at other research that was done, even spur of the moment by a clinical practitioner, Dr. Lloyd Tilt back in March of, I believe, 2012 in the Journal of the Academy of General Dentistry. He had published a retrospective 10 years study of his patience and his successes with respect to tooth loss with respect to patients being downhill, as we say, having recurrent disease even in the face of recurrent and aggressive therapy. And he was winning against the seminal tooth survival studies of Wood McFall and McLeod. That, too, as a statistical analysis, was powerful evidence that LANAP in his practice was winning and that it could win for me, continue to win for me and win for others.
MK: Thank you for sharing your perspective and your story with us.
CB: Thanks very much for having me. I appreciate the opportunity.
MK: If you’d like to download the Dr. Yukna or Dr. Nevins histology articles discussed in this podcast, you can visit LANAP.com and click on the Research tab at the top.