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October 12, 2005 at 5:18 pm #8483
I am very much impressed by the comments and desire of so many to concentrate on the positives of laser dentistry. I take the need to “move forward with the times” seriously. I shall be meeting with the conference chair ans scientific sessions chair this week-end and I shall press them on the hopes of visible improvements.
Any invitation to dinner is too good to miss – I guess I’ll have to try and earn it! Thank you all for helping me to see the situation more clearly. Kind regards, StevenOctober 14, 2005 at 6:24 pm #8503
Robert Gregg DDSSpectator
Sorry for not posting back sooner. Very busy week with patient care. I hope you can read and review sometime during this weekend for your board meeting considerations.
I appreciate you being open to the comments from everyone here on the LDF.
Some thoughts about ALD.
First–Del and 11 other dentists formed the first laser dental Study Club on November 9, 1988 in Detroit with Terry Myers.
The Laser Study Club was a clinical meeting with academicians playing a contributing role.
For the first several years at quarterly Study Club meetings, the meetings were clinically oriented, 1 hour presentations, with some research and scientific overview by an academician.
Now, it’s not even the other way around as clinical presentations of the sort dentists LEARN from have all but disappeared.
That needs to change drastically for the membership to be retained and ALD to grow.
There are enough scientific and research oriented laser organizations. There is:
1. The International Society for Laser Dentistry (ISLD) headed by Prof Lynn Powell.
2. The International Society for Optical Engineering (SPIE) headed up by Prof John Featherstone
3. The European Society for Laser Applications (ESOLA)
What is missing is a clinical academy run by clinicians, giving the clincial members what they want and need to perform in their clinical dentistry using various lasers and techniques–not 15 minute abstracts of the esoteric and scientific research.
That’s where ALD has lost its direction and way regarding the original founding purpose of the founders. ALD should be about the clinicains NOT the academicians!
That’s why the WCLI and MDT Annual Clinician’s meeting are growing in popularity and attendance–just like the good ‘ol days of the Laser Study Club.
Second–When the Institute for Advanced LAser Dentistry (ILAD) wants to attain the prestigious recognition of ADA-CERP and AGD-PACE, there are fair and unbiased requirements and criteria that are in place that IALD must meet. But the IALD is not required to be “members” of either ADA or AGD. There is no corporate membership required to participate, nor is there individual membership to be considered.
ALD should be no different in its standards and applications. Clear and unambiguous standards that apply equally to all organizations and individuals seeking recognition for their courses.
When Del and I received our Category E certification, I made the comment that the certification should be required to be renewed every 2 years. Not implemented if even considered.
Yet, even though Del and I have our “E” status–and paid quite a bit of money for the priviledge to learn how to teach, not know laser content–we were denied ALD SP recognition for 2 consecutive years while the SP Course Provider requirements from ALD were being changed. And I would argue that our combined knowledge and understanding that we review and refine regularly together and update constantly is at least as good as the present recognized ALD SP providers.
ALD must be fair and impartial if is to be respected as an independent autonomous certifying body.
Third–Hygiene is not perio surgery. Laser curettage is not equivalent to a surgical laser assisted new attachment procedure such as Laser ANAP. To compare the two is not appropriate. Putting periodontal surgery & regeneration in a “Hygiene/Perio Track” at any ALD annual meeting is inappropriate.
A world renowned periodontal reasearcher (the kind we would have been thrilled for 15 years ago–and should be today) was placed on the 4th floor balcony at the ALD’s second day of their annual meeting, in a small room with 25 seats and no AV equipment. Ultimately the room was at maximum capacity, standing room only to hear Prof Ray Yukna. That’s how the ALD treats a prestigious guest and academician who is a luminary in the periodontal community?
Fourth–That laser use by hygienists is illegal in 18 States in the US, yet, the dominate thinking in ALD is that the best application for dental lasers in the treatment of periodontal disease is laser sulcular debridement/laser curettage/Laser Soft Tissue Managment by hygienists is a mystery??
Nothing against hygienists. But the realities of the State regulatory and political environments in the AAP are being ignored with such an approach.
Thanks for listening and your consideration!
BobOctober 26, 2005 at 12:49 pm #8474
Just curious if Dr. Parker could share some of the thought at the ALD meeting about some of the comments madehere on LDF.
Thanks,November 2, 2005 at 7:24 pm #8486
Sorry to have taken time over the update. The meeting in Chicago was an opportunity to get some progress on the Tucson conference, amongst other things.
I am a little troubled about the lesser regard that Bob appears to give towards science as opposed to clinical experience with lasers. I sense that laser use mirrors in many ways the development of implants in dentistry. Without digressing, a deal of early enthusiasm was eventually polarised through research into the modality of “implant dentistry” that is now generally accepted. I feel that we are progressing in much the same way and, like implants, the universities are doing much of the “catch-up”.
Consequently, I have a fundamental wish to see laser use on all the main programmes, of all the major meetings, because of science and research.
I was invited to attend the recent ALD-Isreal meeting in Tel Aviv. This was a celebratory meeting to acknowledge the melding of the laser chapter with the Hebrew University of Jerusalem and associated academic bodies. This has raised the profile of lasers in Israel from mere existance to a mainstream modality.
For bodies like the ADA to accredit laser use in a more formal way, there needs to be concerted effort to establish scientific protocols and, perhaps more importantly, regulation of laser practitioners. I do not seek to unravel the complex framework of US professional recognition, but I sense the momentum towards Federal protection of patients. Many of the questions that will be asked, by these bodies, need to be addressed by laser organisations that speak with one accord. It appears patently obvious to me that, the impotence, allied to hype and anecdote, in gaining acceptance by academia, will also prevail in our dealings with Federal agencies.
The meeting in Tucson will seek to provide a bias towards clinical aspects of laser use. Amongst others, an unpecedented (for ALD) five invited speakers have been asked to present on various topics, with the sole provisor of “clinically relevant” subjects. Details are on the Academy website. I am aware that over 60 abstracts were submitted and emphasis is being given to a respectful recognition of speakers in presenting at the conference.
With regard to RCP status, I am tempted to suggest that a complete shift of emphasis has occurred from the early days of 1999 when this level of accreditation was launched. Anyone is free to view the application process, or to apply for acknowledgement. The core structure of RCP application is in recognition of the curriculum guidelines – a document which bears testimony to a time when many of today’s diverse opinions sought concord in an objective approach to laser education. I strongly believe that the approach of the Education committee (which oversees applications for RCP) and the Testing sub-committee (which sets SP written exams) is to recognise “obsolete” wavelengths such as Argon, but not to allow disproportionate representation. Nd:YAG, CO2 and the Erbium’s form the major reflection of laser use today and this is recognised in the course content. I would respectfully urge Bob and any other interested person, to look further into the RCP programme offered by the Academy.
Opinion is the privilege of the individual and I sense that, on the one hand, bodies such as ISLD and possibly ESOLA (perhaps to a lesser extent) are ostensibly linked to academia (perhaps suffocatingly so); at the risk of censure, WCLI seeks a more “up beat”, less stifling outlet, but one which may expose the objective observer to a combination of clinical claim and ego, although such is patently very popular.
As members of a wonderful Profession, one which has opened doors for me during 30 years, do we seek the “comfort zones” of a somewhat “lazy” acquiescence with laser use, based on a crescendo of claim and counter-claim as to “which is best”, or should we seek to channel the tremendous enthusiasm that exists, albeit from diverse poles of opinion, towards the education of those that matter – namely our patients and our revered regulatory bodies.
The Academy has done much to try and exorcise the ghosts of the past. With no dis-respect to those who have gone before, our PR is not good; however, there is a concerted move towards making the organisation less rigid, less elitist, more “open”. Perhaps we fall short of a possible “circus” approach by adhering to an evidence-based philosophy. Those who are members of the AAID may identify with such ideology, but the Academy is seeking, rightly or wrongly, to position itself between enthusiasm and pragmatism (or dogma), in its’ dual association with laser dentists (of all wavelengths) and the “Establishment”.
At a time when Prince Charles (and his ghastly wife!) are upholding the ability of the Brits to bore and stupify the USA, I am guilty of similar charges in writing the above. Only time will tell if my understanding of possible future develpments will prevail. What is plainly evident is that, worldwide, laser use is subject to scepticism or dis-regard, a play-thing of idle-rich dentists. That it deserves a better epithet is obvious, but it demands of us that we approach laser use in much the same way as those of us have approached dental implants during the past twenty years.
May I urge every reader of this to come to Tucson next March and speak with me; this serves the Academy well (obviously!) but it might build a platform from which a true representation of the enthusiasm, messianic slavery, or just plain evidence-based “junkery associated with lasers in dentistry, can find a common voice with which we can go forward.
Surely the “mad” group of laser dentists worldwide should suppress past differences and present misunderstandings, to try and work together; let’s plan the future of laser dentistry, not be victims of it. Kind regards, StevenNovember 3, 2005 at 2:16 am #8498
Robert Gregg DDSSpectator
Thank you for posting back.
I am confused by your opening statement about me. You wrote, “I am a little troubled about the lesser regard that Bob appears to give towards science as opposed to clinical experience with lasers.”
The “lesser regard” I hold toward science as opposed to clinical experience??? WOW!
Steve, you apparently haven’t been kept very well informed of my work with applied scientific research and its application towards relevant clinical procedures (experience).
So let me “untrouble” you……
First of all, it is clinicians who comprise the vast majority of laser owners and who have the need to understand how their lasers are and can be used by “real world” clinicians–supported by applicable science, not the acedemics of the world and the esoteric.
Secondly, Del and I are second to no one these days either as clinicians or manufacturers in designing, funding, and conducting academic, scientific research into the very aspect of laser clinical practical experience that you seem to think I show a “lessor regard”.
Del and I, through Millennium Dental Technologies as the financial vehicle (I draw no compensation), have funded the 3rd largest human histology study on perio regeneration ever conducted in the periodontal (not laser) literature, in the World.
The IADR research led to a completely new FDA clinical indication for use: “Laser assisted new attachment procedure”. Laser ANAP is the first new FDA periodontal disease treatment indication for use since 1997 and ADT’s clearance with “sulcular debridement”.
This landmark research was offered to ALD this year (as it has been next year) at the annual meeting in New Orleans where the ALD put Prof Yukna on the 4th floor balcony during “Hygiene/Perio” track, not on the main program. So it is understandable that many would not be familiar with the existance, nature, or significance of his research.
It is, however, a major milestone for laser dentistry both in terms of scientific achievement AND clinical relevance–not to mention regulatory accomplishment.
Del and I through LSU and Prof Ray Yukna have conducted the largest applied laser periodontal study since 1997 and the Mellonig and Neill study on lasers in periodontal intrasulcular debridement.
Peer reviewed and published in IADR (see link above).
I do not think our efforts have been completely and clearly represented in the ALD as a matter of scientific or regulatory interest by those in ALD. Otherwise, I don’t think you would have made such a statement about my regard for science.
We have designed with Ray Yukna, Charlie Cobb, Karen Williams a 5 site, multi-centered, prospective, longitudinal, controlled clinical study with 64 patients randomized for LANAP, flap surgery, S/RP and OHI and the control. The cost will run somewhere around ũmillion (that’s why I can’t draw a salary).
Steve, clinicians need relevant science, not the kind that has predominated at ALD in the past 5 to 7 years. They need clinical information, not academic dissertations.
I invite you to come to our clinician’s meeting and learn the latest scientific work that we are engaged in and see how we fashion that into a meanigful clinical meeting for the practitioners and entertain a few academicians in the process.
BobNovember 3, 2005 at 7:34 am #8487
Given the speed of your response, I guess that makes two dentists on the planet that have nothing better to do! Thank you.
Forgive me, my early remarks were in response to my interpretation of your comments:
“What is missing is a clinical academy run by clinicians, giving the clincial members what they want and need to perform in their clinical dentistry using various lasers and techniques–not 15 minute abstracts of the esoteric and scientific research.
That’s where ALD has lost its direction and way regarding the original founding purpose of the founders. ALD should be about the clinicains NOT the academicians!”
I accept and respect your diligence in fostering greater understanding of laser use in periodontics. My interpretation of relative worth applied to clinical and research emphasis was obviously incorrect and I am happy to acknowledge the fact. Kind regards, StevenSeptember 6, 2007 at 6:22 pm #8509
So what has changed since '05?
Why should I join the ALD? What benefits are there for me?
I am proficient with erbiums, diodes and Nd:YAG. I know how the lasers work and what they can and can't and shouldn't be used to do.
What is in it for me and my patients?
Sell me on membership.