1. Shareef Mahdavi ■ President ■ SM2 Consulting
Case Studies on Waterlase in TM
Today’s Dental Practice
Investing in Your Patients and Your Practice

2. A Tale of
Waterlase MD
Two Practices
TM
Case Study
A s a dentist, have you ever wondered what it
would be like if you could start all over again
and build your dream practice based upon all you
have learned over the years? Well, that’s exactly what
Robert “Bo” Turnage, DDS did… after 23 years in
clinical practice. His story offers significance for newly-
Robert “Bo” Turnage, DDS minted dentists, established practitioners and older
Friday Harbor, dentists verging on retirement.
Washington
After graduating from Loma Linda hovering at 80% of revenue. “My
in 1982, Dr. Turnage purchased philosophy was that pumping more
a small practice in Palm Springs, patients through the system would lead
where he and his family lived for the to greater financial success. I had to
next 10 years. With his wife and 3 work my tail off to keep the practice
small children, he decided to forego on track and profitable.” What kept
California’s fast-paced lifestyle and him up at night; however, were dual
relocated to Ellensburg, Washington, “nagging thoughts.” His kids were
a rural community between Seattle nearing the end of high school, and his
and Spokane. Dr. Turnage bought an wife and he thought about relocating
aging practice and spent the next 13 to their eventual retirement community,
years building it into the largest dental “somewhere we could truly enjoy
practice in the area. “We were ‘crazy natural beauty each and every day.”
busy’,” recalls Dr. Turnage who, with At the same time, the pace of work was
a 12-person staff, saw from 35 to 50 very stressful, even in a rural setting.
patients a day. “We had 6 operatories “There had to be a better way.”
and an in-house lab. But we also had Against the well-wishes of friends,
old-fashioned equipment, including they decided to up and move once
banana chairs, traditional radiography, again, to Friday Harbor, a community
and air-driven handpieces.” in the San Juan Islands north of
Over the years, his rural practice Seattle. During repeated visits to
grew to production of $120,000 per Friday Harbor, they would ask locals
month. “Not bad,” said Dr. Turnage, where they went for dental care. “What
but his high-volume practice generated we heard consistently was, “can you
tremendous overhead, which was get back to Seattle?” The Turnages
2

3. Old Practice New Practice
Description “High Volume, High Overhead” “Fewer Patients, Better Care”
6 operatories 3 operatories
Structure
13 staff 4 staff
No. of Patients per Day 35-50 8-10
No. of Work Days per Week 5 4
Monthly Production $120,000 $81,000
Time to Accomplish 10 years 5 months
Overhead 80% 65%
Typical Monthly Net Income $24,000 $28,000
Outlook Mature, Stable Infancy
Table 1 – Turnage
saw this as an opportunity to bring a digital x-ray units and Pano, microscopes
unique presentation of dentistry to and ceiling-mounted flat-panel TV/
the community of 7,000 year-round monitors. “We took a risk, not knowing “Utilizing the laser, I can offer
residents that grows to 22,000 in if and when patient acceptance would
summer. Starting from scratch, Dr. be there in a relatively small community. better care to fewer patients.
Turnage began to design a dental It was more expensive to start from
practice from the ground up. scratch, but I wasn’t handicapped by
It’s a controlled environment
They decided on an elegant harbor- outmoded equipment, systems or bad
that also gives me freedom to
view setting with Asian and European habits built in to an existing practice.”
antique furniture, dramatic lighting and Indeed, the risk is paying off.
enjoy a more relaxed lifestyle. I
lots of art. “We wanted patients to feel With only a small sign outside their
like they had walked into a high-end building and four “conservative” no longer feel like I’m going to
spa in Dallas or New York.” Next, they announcements, the practice is
decided to make high technology the attracting both high-end and working have a heart attack.”
focus of their practice as well as the class patients. “We have not only
differentiator in the community. “We attracted ‘dot-com millionaires’, but
also wanted patients to feel that they also long-time residents who are in
could get the highest level of care many of the service industries. We
without having to travel.” To accomplish also kept our fees reasonable to
this, they started by purchasing a laser. create even more value to our high-
“The Waterlase MD TM
has become the tech approach.” They opened their
cornerstone of our high-tech patient doors in May 2005 and business has
care approach,” noted Dr. Turnage, exceeded expectations. After 5 months,
who has also employed an additional they are averaging 53 new patients
BIOLASE LaserSmile TM
diode laser, per month. Production is at $632 per
Investing in Your Patients and Your Practice 3

4. A Tale of
Two Practices (continued)
Both staff and patients enjoy hour and growing steadily. In contrast The reduction in overhead creates
to the high-volume rural practice, Dr. net income that far exceeds the lower
the benefits of the laser. Turnage sees 8-10 patients per day volume of patients. “Utilizing the laser,
utilizing a smaller and simpler structure I can offer better care to fewer patients.
“My staff really appreciated that leverages technology. The lower It’s a controlled environment that also
overhead (now at 65% which includes gives me freedom to enjoy a more
that the ‘old dog’ was willing some equipment financing) has allowed relaxed lifestyle. I no longer feel like
more money to drop to his net income I’m going to have a heart attack.” The
to learn something new. line with only two-thirds the production Waterlase MD technology has greatly
required by his old practice (See Table 1, contributed to this being possible.
It motivates them to achieve
Figures 1 & 2). “The ability to practice dentistry with
a higher standard.”
Figure 1
Average Hourly Production and Revenue per Patient Visit
New Practice vs. Old Practice
$800
$700 $714
$600 $633
$500
$400
$405
$300
$200
$100
$24,000
$0
Old Practice New Practice
Hourly production Revenue per patient visit
4

5. For others like me who have been in practice
for 20 plus years, the laser gave me a new
sense of pride in my profession as well as the
ability to offer better patient care.”
a laser is hugely different, better and took some time to learn, but it’s a lot Figure 2
more fulfilling.” From bleeding control, more fun, it can do things I had never Average Monthly Production
to treatment options, to post-op pain thought possible and I now make them vs. Net Income
control, to periodontal, endodontic, part of my everyday practice.” with the Impact of Overhead
surgical, and restorative procedures, Dr. Turnage says his experience
$140,000
Dr. Turnage is doing things that starting over, “where no one knows your
previously often required referral to name,” has helped debunk his previous
a specialist or simply were much less belief that a successful practice depends $120,000
predictable. “Using the laser means heavily on longevity in one community. $120,000
fewer complications afterwards and “I now have time to do the simple
much less post-op pain.” but important things,” which include $100,000
Both staff and patients enjoy the developing a personal relationship
benefits of the laser. “My staff really with each patient, lunch with his wife, $80,000
appreciated that the ‘old dog’ was a phone call to his son at college, or $81,000
willing to learn something new. It extended staff meetings to review issues
motivates them to achieve a higher and opportunities. His advice to other $60,000
standard.” And patients, who are dentists can be applied to new and
hearing about this laser around established practitioners. “For the new
$40,000
town, quiz the staff before seeing dentist, you now have the opportunity to
the dentist to get the inside scoop. go ‘high-tech everything’ and you should
They ask questions like, “If the laser do so. The improvements in efficiency $20,000 $28,350
$24,000
gets bumped while the doctor is and effectiveness are incredible. For
working, will it cut off my tongue?” others like me who have been in practice
$0
The reaction from other local dentists for 20-plus years, the laser gave me a Old Practice New Practice
has been mixed: “Some embrace the new sense of pride in my profession
laser and recognize its potential while as well as the ability to offer better Gross Production
others seem skeptical that it could patient care.” And he wants to serve as
be applicable to their style practice.” a role model for dentists contemplating Net Income
One informal metric has been the retirement: “I am determined that when I
increasing frequency of the faxing of retire, my practice will be technologically
patient release forms to other dentists, current for the new dentist.”
which is occurring multiple times each With a view of the harbor from both
day. “Patients are actively seeking this his home and his office, Bo Turnage
technology!” exclaimed Dr. Turnage, has turned his dream into reality, with a
who likens his new practice to switching five-month old practice literally “in its
from driving a Cadillac to being in the infancy.” And he’s certainly proven to
seat of a Formula One race car. “Both himself that the third time around is
are automobiles, and the new one the charm! ■
Investing in Your Patients and Your Practice 5

6. Take this job
Waterlase MD
Case Study
TM
and Love It!
B y the end of 1999, Dr. Bruce Cassis had spent
19 years building a successful rural dental practice
in Fayetteville, West Virginia. “Being of service to
people in a positive way” is how Dr. Cassis describes his
philosophy. But he was also exhausted enough by the
daily routine to admit “this job stinks!” and instruct his
staff “don’t ever schedule another kid in my office!”
Dr. Bruce Cassis
Fast forward to 2005...Dr. Cassis has Immediately, however, he began
Fayetteville,
had his Waterlase TM
since late 2000 and generating more revenue and
West Virginia work life is described differently: “I’ve procedures with the laser. “We
never been happier or more satisfied introduced it to patients whether we
as a dentist. My TEAM — they’re not were going to use it on them or not.
staff — looks forward to work every And as a practice, we used the laser as
day and we have no more long faces. a business opportunity rather than just
“I believe that laser And I’m doing the best kids’ dentistry open the door and see what happens.”
imaginable.” In fact, his office has As shown in Figure 1, net collections
technology will become become a long sought after place of have more than tripled when comparing
employment in the community. calendar year 2004 to the same year in
‘the standard of care’
What happened? “The laser 1999. And 2005 is shaping up to be a
in the next 5-7 years. changed everything,” Dr. Cassis stated record year with production forecast at
emphatically. Early in 2000, Dr. Cassis $2 million, putting Cassis Dental Center
The laser is much more attended a lecture on dental lasers in in the top 1% of practices nationwide.
Charleston led by Dr. Bill Chen. “I got What might be surprising is that
accurate and can pinpoint it immediately as I was really interested Fayetteville, West Virginia has a
in soft tissue applications. My cousin population of 2,000 people. The
tissue much better than Steve (an ophthalmologist) had long practice draws from 3 counties and
been using lasers for eye surgery and has an active patient base exceeding
a burr.” asked ‘can’t you use a laser in the 5,000 people. “We are well known
mouth?’ Here I am using scalpels, which for pampering our patients, who
I didn’t like because it’s painful for the are everyday, hardworking people,”
patient and full of complications.” He commented Dr. Cassis. His patients
made his decision that night and was range from two years of age to 102.
the only one of twelve attendees to This is in keeping with his practice
invest in a laser. “Like my colleagues, I philosophy of a “lifetime of care” for
was initially thinking about ‘cost’ more people’s oral heath. The practice has
than ‘ROI’.” taken the time to understand local
6

7. Table 1 – Cassis – Change in Procedure Mix & Production 1999 vs. 2004
demographics and employment trends.
% Change $ Change
CDT Code # in 1999 # in 2004
Dr. Cassis noted that 75% of residents Volume Production
in his county own their homes; the 2330 Resin 1, Anterior 54 108 100% +$6,710
practice has also successfully connected 2331 Resin 2, Anterior 34 72 111% +$5,947
with employee groups in the area. 2332 Resin 3, Anterior 32 59 84% +$7,065
Creating affordability through patient 2335 Resin 4+ Surface, Anterior 25 30 20% $3,149
financing vendors such as CareCredit 2380 Resin 1, Posterior 11 1 –91% –$692
(Costa Mesa, CA) has also had a major 2381 Resin 2, Posterior 14 3 –82% –$790
impact. “We have figured out ways 2385 Resin 1, Posterior 187 413 120% +$44,709
to find money for people who desire 2386 Resin 2, Posterior 160 31 –81% –$17,651
our services. This is a huge part of our 2387 Resin 3, Posterior 50 240 380% +$36,035
revenue.” 3426 Apecoectomy 2 10 400% +1,231
Dr. Cassis has closely documented 4211 Gingivectomy 5 16 220% +$2,178
the types of procedures and frequency 7110 Extraction 120 194 62% +$12,224
with which they are performed. As 7210 Surgical Extraction 26 74 184% +$10,329
seen in Table 1, there has been a 7280 Surgical Access Unerupted 5 2 –60% –$654
dramatic shift in the procedure mix 7286 Biopsy Soft Tissue 1 10 900% +$1,673
since implementing the Waterlase. His 7340 Vestibuloplasty 2 3 50% +436
experience has led him to work both 7960 Frenectomy 6 23 283% +$5,554
as an instructor for BIOLASE as well 4240 Gingival Flap Procedure 0 3 NA +$1,494
locally as part of West Virginia’s Rural
Health Education Partnership. In that “If you understand a half a dozen This story is part of the message
program, dental students from West basic concepts, you can use the laser that Dr. Cassis wants to get out to
Virginia University’s Dental School come immediately with a live patient.” What dentists everywhere. “I believe that
through for a six-week rotation. Dr. impressed Dr. Cassis even more was laser technology will become ‘the
Cassis gives them a half-day training the response of his student: “It was standard of care’ in the next 5-7 years.
session specifically on the laser. His awesome. I did the same things I do at The laser is much more accurate and
most recent student was trained in school with the drill. The patient asked can pinpoint tissue much better than a
the morning of her first week and me, ‘have you started yet?’ after I had burr. I’d jump all over this if I were an
doing laser dentistry in the afternoon. completed the procedure.” older dentist, as it makes procedure
easier to do. Younger dentists have the
Figure 1 opportunity to really change the course
Business Performance 1999 (no laser) and 2004 (with laser) of their career.” In fact, colleagues who
$1400 were referring patients to him because
the laser could solve the problem are
$1200 $1,300
now investing in their own unit. “This is
good, because it raises the level of care
$1000
in our community.”
$800 Dr. Cassis is grateful for what the
Waterlase has done for his practice and
$600 $697 his patients. “On behalf of the eight
people who work here – our TEAM - I
$400 476 can say that the laser has changed each
$411
$302 of our lifestyles by helping us be more
$200 253 $233 successful at what we do.” Looking
$145
back at his decision to get into laser
$0
New Patients Net Collections Average Production Average Production dentistry, he offers this conclusion: “I’m
(thousands) per Patient per Hour
a much better dentist than I was six
1999 2004 years ago.” ■
Investing in Your Patients and Your Practice 7

8. Dentistry: The Perfect Combination of
Waterlase MD
Case Study
TM
Surgery and Art
L inda Kronick, DMD is one of those dentists that you
just want to get to know better. With a family practice
in Norwich, Connecticut that focuses on high tech dentistry,
her passion for the profession is a reflection of how she
lives:“I love people and want to make them happy.”
As a young adult, Dr. Kronick saw in the laser was showing up in daily
dentistry as a means of combining two in her expanded use of the Waterlase
Linda Kronick, DMD strong areas of interest: surgery and art. MD with her patients. With a focus
Norwich, Growing up, in the same town where on restorative dentistry, she is finding
she now practices, Dr. Kronick spent the laser much more efficient in doing
Connecticut time learning how to paint and also minimally invasive composite resins
worked in a surgical practice. and she routinely uses it for troughing,
She first learned about dental lasers in lieu of packing retraction cord, prior
while working in the surgical practice to final impressions for crown and
observing CO2 lasers being used in bridge procedures. “Doing additional
general and oral surgery. She eventually procedures, at the same visit, in the
had the opportunity to take courses and same or different quadrants are made
see exactly how the laser could work easy with the Waterlase MD. Patients
with both hard and soft tissue. “I was are grateful to have one visit rather
spellbound and knew I had to have this than several to complete their dental
in my practice.” treatment. That’s a plus for everyone,
In late 2004 she made the decision doctor and patient, in this busy world.”
to purchase the Waterlase MD TM
In addition, she is doing periodontal
(BIOLASE, San Clemente, CA) and had procedures that she used to routinely
it installed to start the New Year. “It’s refer out. “Four perio procedures, that
blown my expectations away,” noted she performs routinely, have generated
Dr. Kronick. “There is so much that I’m $38,000 in additional revenue so far,
doing and so much more to learn.” As and I’m just getting started (see Table
her experience and expertise grew over 1: Periodontal Procedures Performed
several months, Dr. Kronick’s confidence In-Office).” With the ability to do crown
Table 1 – Periodontal Procedures Performed In-Office via YSGG Laser
DPT Code
Crown Lengthening 4210
Gingivectomy 4211
Mucogingival Surgery 4299
Laser Assisted Scaling 4250
8

9. Figure 1 – Monthly Production, 9 Months YTD, 2005 vs. 2004 YTD Revenue such as the WCLI (World Clinical Laser
2004: $614,000 Institute) and meet other dentists who
$120,000 2005: $753,000
Growth 23%
will share their laser experiences with
2004 2005 you. You will learn a lot, because the
$100,000
lecturers are approachable and aren’t
$80,000 ‘prima donnas’”. Dr. Kronick speaks
with authority here, as she lectures to
$60,000 dental students at the University of
Connecticut School of Dental Medicine
$40,000 on restorative procedures.
Has the Waterlase MD been a
$20,000
good investment? Dr. Kronick offers
an unqualified “definitely yes” on
$0
Jan Feb Mar Apr May Jun Jul Aug Sep multiple levels. First, she paid off her
lengthening procedures at the same laser. “They love raving about it to laser via additional revenue within
time as crown preps, “one can impress our patients,” added Dr. Kronick. The 6 months of purchase. Second, this
immediately following the surgery with practice philosophy has always been device compares favorably to other
unparalleled accuracy. My lab could not to take time to educate patients and opportunities available to dentists.
believe the clinical results.” explain what the different technologies “This laser allows you to increase
Indeed, the data from her practice do for them. “Our patients see the revenue much more than with any
indicate that the laser has been the benefit and are just amazed at how whitening system being promoted
main reason for growth this year. As much better the trip to the dentist to you right now,” commented Dr.
shown in Figure 1, monthly production can be.” The influence of the laser on Kronick. Third is the professional
is up 23%, with several months over referrals has also been significant. Year development. “You will challenge
$100,000 in revenue. to date, the practice is seeing 33 new yourself and you will learn more.”
Her hourly production has increased patients per month, almost double from Her final advice: “Call one of us and
over $200, from $661 to $863. While the average of 18 new patients for the see what we are doing! The Waterlase
hourly production is up 31%, hours same period a year ago (Figure 3). Two- MD has helped me grow tremendously
spent on the job are down 6% (see thirds of the new patients are coming without having to get bigger. I have
Figure 2). “I’m working smarter per from referrals, with the balance from even more time to enjoy life and want
hour,” notes Dr. Kronick, who has a small amount of advertising (yellow my colleagues to have that same
worked fewer hours this year. She has pages, radio) that has been constant experience.” ■
used the extra time to learn more about over the years. “My phone now rings
the capabilities of the Er,Cr:YSGG laser. off the hook every day.” Part of this Figure 2
The response from her patients has can be attributed to the mothers of New Patients per Month
been similar in impact. “Patients are young patients: “Kids love it, and their 9 months YTD
2005 vs. 2004
thrilled because the laser makes their moms go running back to day care and
dentistry quicker, cleaner, and more schools and tell other moms,” Kronick
$120,000 33
precise. They go ‘wow’ when I tell them mentioned. 30
there’s a good chance they’ll have no Was it difficult getting started?
needle, no pain, and no post-operative “Like anything worth pursuing, there’s
numbing or swelling. And they are truly a learning curve. You need to give 20
grateful that I’m taking less of their yourself permission to take extra time 18
time and don’t have to refer them to a and to make mistakes. At first, you need
specialist.” to be the student before you can be the 10
Dr. Kronick has the full support of her teacher.” Dr. Kronick also has advice for
staff, many of whom have personally new users of the Waterlase MD: “Take
experienced dental work using the advantage of the fabulous meetings 0
2004 2005
Investing in Your Patients and Your Practice 9

10. Excelling in the
Waterlase MD
Case Study
TM
Mainstream
T ake a drive through Bensenville, Illinois and you will find
yourself in Middle America, both literally and figuratively.
A suburb of Chicago located not far from O’Hare Airport;
Bensenville is where Dr. Mark Stasiulis has been practicing
dentistry for the past 24 years. Far from the glamour and
glitz of the Magnificent Mile in downtown Chicago, Dr.
Stasiulis views his facility as representative of the typical
Dr. Mark Stasiulis
dental practice in the U.S., performing “bread and butter”
Bensenville,
dentistry. “We don’t look anything like those high-image
Illinois
places you see in the dental trade publications,” remarked
Stasiulis. His patients, however, appreciate the high-tech and
high-touch approach to dentistry taken by their dentist, a
solo practitioner who does much of the work himself.
Over the past decade, he re-engineered (BIOLASE, San Clemente, CA). That was
his practice to incorporate new in July 2001. Now, nearly 5 years later
technology. The journey began in with the addition of a LaserSmileTM diode
2000, when he took a course on micro laser (BIOLASE, San Clemente, CA)
dentistry. This led to an investment in Dr. Stasiulis has a wealth of experience
an electric hand piece, Diagnodent with the lasers and how they have
caries detection unit, and air impacted his practice. “They filled
abrasion system. His production grew a void in the type of care I wanted
immediately by 27%. “The Diagnodent to offer,” he said. “My days are so
unit really convinced me that early much better knowing that I use these
diagnosis of the decay process led to lasers to solve problems that present
more conservative early treatment.” themselves on a daily basis...from
The air abrasion system with its promise desensitizing sensitive roots and painful
of conservative preparations with no Aphthous ulcers in less than a minute,
need for anesthetic seemed perfect to the advanced surgical procedures
for these types of restorations. Dr. many of which require only topical
Stasiulis was frustrated by the dirt and anesthetic. I have performed so many
dust created by air abrasion and how restorations with the minimal use of
it irritated his breathing. The following additional anesthetic that they have
year he purchased a Waterlase TM
laser become routine.” Pain management
10

11. “Learn to use this laser, it will
Figure 1 – Gross Production, Average Charge per Procedure 1996 – 2005
improve your bottom line and it
$600,000 Acquires $180
Gross Production
Waterlase
(July, 2001)
also is a heck of a lot of fun.”
$500,000 $150
Average charge/procedure
Average Fee Per Procedure
Gross Production
$400,000 $120
$300,000 $90
$200,000 $60
$100,000 $30
$0 $0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
with the lasers has been a great the contrary, he has used the laser to laser dentists gain confidence and
marketing procedure in his practice. market “internally” and builds upon proficiency in use of the technology.
”The LaserSmileTM diode laser is the relationships with existing patients. “I am self taught, which was necessary
used daily to deliver ‘low level laser The Waterlase has allowed him to do five years ago because the collective
therapy’ that relieves many painful advanced procedures and eliminate experience was somewhat limited. It’s
dental conditions.” As one patient who the return trips for many of his patients. much easier today, with many more
received laser treatment for facial pain “They love the convenience as well courses, materials and laser-based
said, “It’s a miracle”. as the higher-tech approach.” Not colleagues that allow us to learn from
“Our patients’ perception seems to surprisingly, new patients travel from one another.”
be that we are using state of the art 1-2 hours away because they’ve been He added that it is essential for new
technology to give them less invasive referred by enthusiastic patients. users to “stick to the bread and butter”
treatment for their dental needs. The Beyond revenue and new patients, procedures that are easier to do and
hardest question I have to answer is the effect on his practice can be seen will help gain confidence. According
why more dentists don’t use lasers”. in both the types of procedures he now to Dr. Stasiulis, all classes of decay,
The lasers have dramatically impacted performs (see Table 1) and the average soft tissue work such as gingivectomy,
his patients’ perception of dentistry charge per procedure, which has grown frenectomy and cosmetic gingival
and of him as a dentist. “My practice from $89 in 1996 to the $150-$160 recontouring are all good procedures
and what we do cause our patients to range in the past year. to start with. “One mistake new users
believe that their friends need to know Dr. Stasiulis spends part of his time make is that they want the laser to do
about what we are doing and why we as a trainer and teacher to help new ‘everything’, which is unrealistic of any
are different.”
Using 10 years of data from the Figure 2 – Advanced Procedures Performed 1996 – 2005
practice, one can see the impact
200 Pre-Waterlase: Average = 143 With Waterlase: Average = 185
that the lasers has made on a host of
financial variables. Annual production
180
has nearly doubled from $279,000 in
the late 1990s to $529,000 with four 160
full years of laser usage (see Figure 1).
The average number of new patients 140
per year has grown 29% over the long
term (see Figure 2), “an appropriate 120
amount”, says Dr. Stasiulis, “for a stable
0
practice that does no advertising.” To 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Investing in Your Patients and Your Practice 11

12. Excelling in the Mainstream (continued)
technology, even one as remarkable as quantum leap forward from my original when broken down into a
the Waterlase.” However, on a recent Waterlase. It delivers better custom daily amount.”
training day a new user (Dr. Mark control over desensitization, restoration It is this type of analysis that,
Bancroft) performed a vestibuloplasty procedures and unbelievable soft tissue according to Dr. Stasiulis, is what will
as his first laser procedure under Dr. capabilities. This is the unit of choice create a “tipping point” in dentistry.
Stasiulis’s watchful eye. “I was so proud for dentists to incorporate into their “Awareness of lasers in medicine and
of this dentist that embraced the treatment regime.” in dentistry simply amazes me. Patients
new technology and performed this Aside from managing the learning are being exposed to laser-assisted
procedure like he had been using it for of the technology, Dr. Stasiulis comes dental treatment through the media.
years; by the way, with no anesthetic across colleagues every day who are They are looking to our profession
except some topical.” just unsure if the investment makes for this type of treatment. Currently
His results bear out this experience, financial sense. “On the first day I used only 5-6% of dentist utilize lasers in
as the number of advanced procedures the laser, my wife made me keep track their practices. I would recommend
performed has increased dramatically of the procedures I couldn’t have done all dentists considering adding laser
in the 3rd and 4th year since first that day without the use of the laser to treatment into their practices to read
acquiring the Waterlase. “It takes time see if it would pay for itself each day. the best seller Who Moved My Cheese.
to gain the confidence and get good On the third day, she told me to stop There is a paradigm shift occurring in
enough to do the procedures taught keeping track. She saw it was clearly dental treatment today. It’s great to be
in the advanced courses. All users paying for itself right from the start.” part of this movement toward minimally
will advance their utilization to their He added, “Doctors view this as a invasive dentistry.”
individual comfort zone. The list of $75,000 investment, which is wrong. Dr. Stasiulis’s’ enthusiasm for the
procedures I don’t do is much shorter This is a $90 a day decision: The right laser is buoyed by the fact that he
than the list of those I can.” Dr. Stasiulis question is, ‘can I perform $90 of treats blue-collar workers as well as
recently added the new Waterlase additional laser treatment each day?’ CEOs. “My practice isn’t fancy, but I
MD to his practice. “This new unit is a in order to offset the lease or loan cost wanted to give mainstream America
cutting-edge technology when it came
to the care of their teeth and mouth.”
Figure 3 – Advanced Procedures Performed 1996 – 2005 The impact on his patients and his
120 Apecoectomy practice has been nothing short of
Gingivectomy per Quadrant remarkable. My patients love it, and
Gingivectomy per Tooth my production and profitability (65% of
100
Crown Lengthening revenue) have increased. The laser has
been a technology investment that has
Free Soft Tissue Graft
80 made money and improved customer
Osseous Surgery
satisfaction. I rarely see this in dentistry
Frenectomy
60 Acquires Desensitization
with other devices being promoted to
Waterlase our profession.”
Pulpotomy
(July, 2001) His final words of advice to those
40 I&D
who are “on the fence” about laser
Vestibuloplasty
technology: “It doesn’t matter what
20 Fibroma
kind of practice you have. Learn to
Operculectomy use this laser, it will improve your
Aphthous Ulcer Treatment bottom line and it also is a heck of a
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Guided Tissue Regeneration lot of fun.” ■
12

13. In My
Own Words Waterlase MD
Case Study
TM
T
he final case study in this series is somewhat
different. Prior to my interview with him, Dr. Jonathan
Bregman wrote an essay precisely describing how laser
technology has changed his practice. Rather than re-write,
I chose to keep the text purely from his perspective as a
dentist. Following my introduction, I will turn over the pen
to him and allow you to hear his story…in his own words. Dr. Jonathan Bregman
Jonathan Bregman of Durham, North 2005 and says, “This laser has literally Durham,
Carolina will be celebrating his 30th changed the way I do dentistry with North Carolina
anniversary as a dentist this year. He almost every procedure I do. That’s
chose the profession at age 19, wanting amazing to me.” In fact, one of his
to help people improve their health patients is the dentist whom he bought
and noticing that dentistry had a clear his practice from 10 years ago. “He
beginning, middle, and end to the told me that if this laser had been
interaction with patients. As part of a around when he was in practice, he
career goal, he wanted to make sure would never have left dentistry.” That
that anyone who sat in his dental chair testimonial, from a dentist-as-patient,
would have a positive experience. After is part of what drives Dr. Bregman’s
following laser technology for about passion about laser dentistry. ”If I made
five years, he decided to purchase the no additional money using this, it would
Waterlase MD TM
last year after hearing still be worth it.” Here’s his story:
about BIOLASE’s next generation of
advanced dental laser technology. How has the Waterlase MD
“I’ve taken thousands of hours of CE changed my practice?
over the years and don’t ‘jump in’ but
It’s all about better and more
really evaluate what I learn,” remarked
comfortable patient care
Dr. Bregman. “I was excited about
what this could do for my patients. For almost thirty years of practice I
Once I did the hands-on clinic at a have focused on caring for patients in
dental meeting, I was convinced that an excellent way. That translates not
I needed to purchase and integrate only to the technical dentistry I perform
the technology into my practice.” but also to the care of the patient as
He acquired a Waterlase MD in early a human being. This new technology
13

14. In My Own Words (continued)
allows me to do so many procedures margin to the bony crest) done 1. The class V restoration at or below
in such a way that the patient sits up with the laser as a single visit the gingival crest: I can quickly and
and says, “I cannot believe what you followed by restoration after the easily remove the tissue to expose
have just done for me.” They say this laboratory completes the case decay, create a dry and clear field,
because: versus temporization, referral to then place and finish a much better
1. They did not have a needle ( one of specialist, surgical procedure, 6-8 restoration. All of this is done with
the main reasons that many people weeks healing, return to my office no chemical local. I need only
do not seek dental care) for re-preparation, impression, topical for the soft tissues. The laser
new temporization then finally the serves to numb the hard tissues. NO
2. The procedure was quick and easy restoration placed needles, retraction cord, hemostasis,
for them no ‘fighting the tissues’ required!
7. Gingivectomy procedure around
3. They experienced no discomfort orthodontic brackets done with 2. The removal of a crown, previously
4. They left without a numb lip topical anesthetic in just a few placed filling, deep decay: I can
minutes compared to local quickly and easily can remove tissue
Post treatment, there has not been
anesthetic with needle, blade tissue to gain a dry field for the placement
one patient who has mentioned any
removal, packing to cover tissues of the restoration or impression
discomfort from a soft tissue procedure
and perhaps a return visit.
that I have done over the last ten 3. The seemingly shallow Class I
months of using the Waterlase MD. 8. Any procedure that I would have restoration with a tooth that has
This has been accomplished due to a previously used a blade to open a a ‘little stick’ on the occlusal that
negligible zone of necrosis around the soft tissue flap versus the precise turns into a deep area of decay: I
lasered tissue and the sterilization of cutting and sealing off of the area can quickly and easily use the laser
the area with sealing of the blood and with the laser. to numb the tooth in advance so that
lymphatic vessels besides the nerve there is no worry about that deep
9. Frenectomy both labially and
endings. With minimal to no swelling area causing the patient a painful
lingually done with only topical
or discomfort, that is such a major plus! reaction. In the past, doing that
anesthetic and a laser bandage
Here’s a short list of what I’ve been able procedure without local anesthetic
to stop bleeding versus a local
to accomplish with the laser: because it appeared to be’ just a
anesthetic needle and sutures.
1. Crown and bridge using troughing very shallow cavity’ would cause a
versus a retraction cord 10. Aphthous ulcer treatment previously difficult and stressful situation to
not able to be done in my office is occur for the patient as well as the
2. Class V using laser removal of soft now done in less than a minute with dentist. No longer true with the laser.
tissues versus a retraction cord the laser. Pain is completely and
4. Children love the experience:
3. Biopsies using a laser bandage and immediately gone. The healing takes
Quick, easy, painless way to do
topical anesthetic versus local and place in 2 or 3 days instead of 7-10.
all soft tissue and hard tissue
sutures procedures without “the shot” ordeal
Predictability
4. Operculum removal in conjunction for the patient and dentist. One can
Pre Waterlase MD I would approach rely completely on laser numbing
with restoration of a tooth
procedures that would cause me to for everything from placing routine
5. Cosmetic re-contouring of the wonder just how things would turn out restorations to pulpotomies. Using
gingival tissue around anterior teeth or how I would get a great clinical topical only, the child experiences
with topical versus local and a blade result if I found ‘x’. Now, with the no discomfort at all during or
or electrosurgical tissue removal Waterlase MD the stress of dealing after any soft tissue procedure. A
with “the unknown” is dramatically common example is removal of an
6. Closed bony crown lengthening
decreased. Thus the enjoyment of operculum on a molar that needs to
in conjunction with routine crown
dentistry has been enhanced or be restored. In a matter of moments,
and bridge procedures to create
restored with the following procedures. the dentist can have a dry and clear
ideal biologic width (3mm from
14

15. field to visualize the distal groove of many of these same procedures in a asking about the new “needle-
the tooth to either remove additional much more time efficient manner less” technology. Over these past
decay or seal that area. Parents love because there is no need to place ten months, we have seen more
the fact that they do not need to and then wait for a chemical and more new patients coming
watch over their child to insure that anesthetic effect prior to starting. into our office for “laser dental
they do not accidentally bite a numb Also, I can work in multiple care” and many existing patients
lip…because there is no numb lip! quadrants very easily. Quickly and accepting either new or previously
easily gaining and maintaining a dry recommended care due to the
5. A perfect crown and bridge
and clear field for hard tissue advantages of dental lasers from the
impression can always be
procedures saves a huge amount of patients’ viewpoint as mentioned
accomplished: Troughing and
time and allows for better quality previously.
hemorrhage control if needed is
dentistry. Soft tissue procedures take
achieved using the Waterlase MD, Dentistry is just more
only a few minutes with no return
which makes this aspect of dentistry enjoyable to do!
visit needed (see Table 1).
so easy and stress free versus
Adding up all of the pluses mentioned
retraction cord and hemostasis. 2. Additional procedures: Some of
above, having my Waterlase MD
the procedures I am doing that I
6. The fearful patient: the dentist makes every day more predictable,
was not doing prior to getting the
knows that he/she can perform most enjoyable and less stressful. Also, each
Waterlase MD are:
routine procedures quickly, easily, day is more profitable. I use my laser
and painlessly without the dreaded a. Biopsy with almost every patient. They love
‘needle, drill, numb lip’. it, and I love it. After all, it is really all
b. Bony Crown Lengthening
about the patient and their comfort
Profitability c. Soft Tissue Crown Lengthening both physically and emotionally. The
Due to greater efficiency and d. Aphthous Ulcer Treatment Waterlase MD has provided me a
performing many procedures that I had tool to meet my patient’s needs in
e. Herpetic Lesion Treatment
referred out of my office in the past, I a better way each day. After almost
have paid for my Waterlase MD many f. Laser Root Desensitization thirty years of clinical dentistry, my life
times over each month. Here are the and the way I deliver dental care has
g. Labial Frenectomy
areas where I have achieved greater been dramatically changed through
profitability: h. Lingual Frenectomy this technology. Most importantly, the
Waterlase MD has changed, in such
1. Efficiency: For many years now, I 3. Practice builder: Even after just
a positive way, the way my patients
have performed most procedures in a few weeks of performing dental
experience dentistry.
my office quickly and with great care. laser procedures, we began to
Dr. Bregman’s story is typical of
Using the Waterlase MD, I can do have new patients calling our office
dentists who acquire and come to enjoy
what the laser does for their practice
Table 1 – Procedure Times: Before & After Waterlase MD of dentistry. “Many dentists still know
nothing about this technology,” added
Procedure Pre-laser Waterlase MD
Dr. Bregman. “I want to spread the
Occlusal Filling 30 minutes 15 minutes message that they should learn about
Crown and Build-Up 75 minutes 60 minutes and adopt this technology and not
Soft Tissue Biopsy focus so hard on the cost. I believe in
30 minutes 15 minutes
(stopped doing and now does via laser) that old adage, ‘do what you do well in
Facial Class V Filling with caring for your patients and the money
Sub-Gingival Involvement 30 minutes 15 minutes will follow’. That has never been truer
(time to perform two fillings)
than what I have experienced with
Gingivectomy the Waterlase MD technology in my
(around three teeth)
30 minutes 10 minutes
practice.” ■
Investing in Your Patients and Your Practice 15

16. Postscript from the Author:
As a researcher, what I found most interesting during the interview
process was the professional passion that was displayed by these
dentists. They were not saddled by the burnout mentality which
is so typical of dentists after being in practice for 15 to 20 years.
To the contrary, these users of Waterlase technology have an
enthusiasm for work that probably exceeds their first days out of
dental school. Their incorporation of laser technology has positively
impacted them emotionally as well as financially, and there is a joy
that’s been expressed in the impact they are having on patients,
including those who have been previously fearful of dentistry or
those who are naturally challenging to work with, such as children.
At their core, these dentists are amazed at how the laser has
transformed the way they deliver dental care to their patients and
want others in their profession to understand just how significant a
change the laser can make to one’s practice and one’s person.
About the Author:
Shareef Mahdavi has spent the past twenty years working in senior
sales and marketing positions with manufacturers of new medical
technology. During that time, he was responsible for launching the
laser technology used for LASIK, helping the procedure to become
the single-most performed elective surgery procedure in the U.S.
As President of SM2 Consulting, he advises medical device
companies and providers on ways to increase market adoption of
new technology. As a consultant to BIOLASE,TM he is researching and
writing a series of case studies to better understand the impact on
dentists who have integrated the Waterlase MDTM technology in
their practices. Shareef lives with his wife Renée, and their three
children in the San Francisco Bay area. You can reach him at SM2
consulting’s website, which is www.sm2consulting.com.
03/2006
Copyright © 2006 SM2 Consulting. All rights reserved.
BIOLASE, WATERLASE MD and LaserSmile are registered trademarks of BIOLASE, Inc.
All other trademarks are trademarks oftheir respective holders.