Survey of Dentists Reveals Clear Trend Toward WaterLase Technology.

MISSION VIEJO, Calif. -- The WaterLase dental laser from Biolase Technology, Inc. (Nasdaq: BLTI) improves patient comfort and increases practice revenues, according to dentists that have adopted this innovative technology. For this reason, an estimated 4,000 Biolase dental systems have been installed worldwide over the past few years. Still, the bulk of conservative dentists are holding back due to fears of technology obsolescence and the cost of acquiring this equipment.

Based on World Health Organization data, there are approximately one million active dentists worldwide. Compared to other medical specialties, dentists represent the single largest potential market for medical lasers. The sheer size of this target market has comfortably driven sales of dental lasers manufactured by Biolase (San Clemente, Calif.) and a handful of smaller competitors. Currently, Biolase controls an estimated 70% of the U.S. dental laser market with its WaterLase technology.

In spite of several years of attempts to penetrate the dental market with WaterLase, it is estimated that less than three percent of dentists in the U.S. currently own this technology. "Our recent random survey of U.S. dentists was conducted to sample attitudes towards this new technology," explained Michael Moretti, president of the market research firm Medical Insight, Inc. (Mission Viejo, Calif.). Based on this research, and over 15 years of tracking development of the global dental laser market, Mr. Moretti believes the dental laser market "has finally turned the corner. Until recently, interest in purchasing and using dental lasers was largely limited to early adopters that enjoyed bringing new technologies to their patients. But now, I finally see a clear trend towards mainstream dentists moving from curiosity to a purchase decision based on the feeling that they need to offer WaterLase treatments due to competition and patient demand."

The ongoing use of WaterLase to treat participants on the FOX television reality series "The Swan" highlights the popularity of this innovative dental technology. "Millions of television viewers now know about WaterLase and the benefits of dental laser treatment," commented Mr. Moretti. "Combined with internet marketing and local media advertising by thousands of dentists that offer WaterLase, we are witnessing a pull-through effect as patients search for dental practices that have this high-tech, painless technology."

"WaterLase is positioned to revolutionize dental care, and will ultimately change the way the public views dentistry," said Jack D. Rosenberg, D.M.D., who practices general dentistry in Burlington, Mass. No-shot no-drill fillings are here, but that is just the tip of the WaterLase iceberg.

"The best illustration of how my practice has changed is called the osseous crown lengthening. The procedure is used to idealize the gum and bone tissue around a tooth needing a crown, for cosmetic or functional reasons. Previously, the patient would go to the specialist for an $800 scalpel surgery including incisions, sutures and considerable post-operative pain. Then the patient waited two to three months to have the crown completed in order to achieve good aesthetics results. Now I can accomplish the same $800 procedure and prepare the tooth for a crown in one visit without a scalpel, sutures, pain, months of waiting or any loss aesthetics. It's a win-win, except for the specialist!

"Truth be told, I may not have purchased my WaterLase for the purist reasons. I was not thinking that I wanted to do less invasive, more patient-friendly laser dentistry; I just wanted a good "hook" when marketing my practice. It seemed at the time that if the WaterLase could do half of what I heard it could, that would make a huge impact from a marketing perspective. But this laser is so much more than a marketing device. It has truly revolutionized my own practice and will soon do the same to dentistry as a whole. I am now delivering better, more productive, patient friendly dental care because my own clinical outcomes far exceeded the expectations of my patients and myself. So, it turns out that I am not marketing a gimmick, but real clinical results and a stack of success stories from happy patients."

"I feel the WaterLase has made me more productive," said Bruce Waterman, D.M.D., a general dentist in private practice in Brandon, Fla. "Patients are also provided a distinct service that they cannot find elsewhere. Patients save time and often they don't need anesthesia, which sometimes medically is a nice option. If someone has a lot of medical problems or takes quite a bit of medicine, you'd rather not give them a shot."

Fillings can be smaller, and thus more conservative, when using the WaterLase. "The laser also sterilizes your preparation and you can treat multiple areas of the mouth in one sitting," Dr. Waterman said. "Clinically, gum disease can be treated as well." Dr. Waterman, who uses the laser to perform gingivectomies, rates the effectiveness of the WaterLase to cut hard tissue as "fair. It is also slow."

Dr. Waterman estimates that 25% of his patients are suitable for the WaterLase without anesthetic. "Children respond favorably. They don't think dentistry's a big deal. Moms will tell them, 'You don't know how good you have it!' Because you can treat multiple areas, I can be more productive in a certain amount of time. Patients also schedule one visit vs. two or three."

According to James Kahal, D.D.S., a general and restorative dentist in private practice in Laguna Hills, Calif., the WaterLase has increased his efficiency for routine operative dentistry. "You want to do the fun restorative cases, but the patients with one or two fillings need to be cared for, too. The WaterLase has made me much more efficient with operative dentistry." In addition, before acquiring the WaterLase, Dr. Kahal had never performed any soft-tissue procedures. "I am now doing some limited soft-tissue, such as osseous crown lengthening, as my experience with the laser becomes more comfortable. Instead of referring the patient to the periodontist for crown lengthening, you may be able to eliminate flap surgery. This is better and less expensive for the patient."

Dr. Kahal said it is more efficient not having to wait for anesthesia, especially in the Class 1 - 4 fillings. "There is less chair time for the patient. I am also able to practice more conservative dentistry. There is less trauma for routine fillings. With the drill, you might remove more tooth." The WaterLase also offers less pulpal heat generation compared to the drill. "The WaterLase cuts hard tissue very well. I use it for Class 1 - 6 cavity preparation and for bone removal," he said.

Dr. Kahal estimates 90% of his patients are suitable candidates for the WaterLase without anesthetic. "These are mostly operative dentistry cases." Children also respond "very well. They love it. I call it my 'waterjet' and I spray the cavity away. Children think it's fun. They don't have to have a shot. I have also discovered that children respond better than adults to the sensation that the laser generates." Overall, "I believe the WaterLase more than pays for itself. The 'wow' factor of the patient has also exceeded my expectations."

"One advantage of the WaterLase is that you can work on all four quadrants at one sitting, without numbing," said Brett Egelske, D.D.S., a general dentist in private practice in Indianapolis, Ind., who also performs cosmetic procedures. "Less time is spent with an individual patient. You lose a lot of time with anesthesia. Multiple sessions can also be avoided."

Following removal of a tooth, the WaterLase "sterilizes the area where the tooth was," Dr. Egelske said. "Patients also heal extremely quick." Patient anxiety is reduced, too, because there is no shot. Compared to a drill, "there is less fracture of the enamel," Dr. Egelske said. "With the drill, you tend to weaken the tooth in certain situations. I have also heard that the WaterLase is effective in killing bacteria inside where the decay was."

However, the main reason Dr. Egelske purchased the WaterLase was not to replace his drill. "I still think that when cutting on teeth, the drill is faster. With a drill, I can cut a crown prep in 10 to 12 minutes. With the laser, it takes twice as long." On a scale of 1 to 10, the laser cuts hard tissue "around a 6.5." Dr. Egelske uses the laser to cut hard tissue for occlusal cavity prep, root canal sterilization and crown lengthening.

Dr. Egelske acquired the WaterLase so he can perform certain procedures he used to refer out. These include crown lengthening and gingivoplasty. "When you enhance someone's smile, typically the teeth are all different sizes. You want to contour the gingival tissue. The laser allows you do this without numbing," he said.

About 70% of Dr. Egelske's patients and procedures are suitable for WaterLase treatment. "Children respond really well. Because there is a lot of water associated with the laser, we tell kids we are just going to spray some water on their teeth, clean their teeth, and get rid of the cavity bugs. So they sit there, thinking you are simply squirting water on their teeth."

Todd Porter, D.D.S., a general dentist in St. Paul, Minn., noted that the WaterLase "has allowed me to do a lot more soft-tissue procedures and to expand my practice into areas that I previously did not use laser, such as endodontics, oral surgery and periodontics." Patients have also benefited aesthetically and comfort-wise. "The WaterLase has allowed me to perform some procedures faster than I can with traditional, older methods." A prime example is electrosurgery.

"The WaterLase is quieter than the drill," Dr. Porter said. "The noise is not as aggravating to the patient or medical staff. The laser has also allowed us to eliminate some of the traditional materials. We're exchanging metal burs for laser tips that don't touch the tooth at all." However, "the WaterLase cuts tooth structure typically slower than the traditional high-speed handpiece. But it does not create the heat or the microcracks, and does not cause jeopardy to the pulp tissue itself."

Dr. Porter estimates about 50% of his patients can be treated successfully with the WaterLase without anesthetic. "Mostly, these are soft-tissue procedures, and Class 1 and 5 procedures. Children respond much better, although I have limited experience with younger patients. If you purchase the WaterLase and maximize the opportunities, it is definitely a great return on investment."

"I don't know if the WaterLase has economically benefited our practice," said L. Cory Evans, D.M.D., a general dentist in private practice in Salt Lake City, Utah. "But it has benefited our patients very well, particularly our pediatric patients. I don't believe I have used anesthetic on a child for over one year now. This is a big plus for these little guys and gals. I think the response from the parents is equally as positive. In fact, one parent commented to me that there is no longer any disincentive to bringing their children to the dentist."

Compared to the drill, the WaterLase "has no anesthetic and it increases bond strength for the resin fillings I like to place," Dr. Evans said. "The procedure time is also reduced by about 25%." Dr. Evans conveyed that the laser cuts hard tissue "very well. I use it mainly for cavity preparation. I have also used it a few times for osseous recontouring. It works really well for that." About 90% of Dr. Evan's patients who are scheduled with the WaterLase do not require anesthetic. "These are mostly cavity preparations. I enjoy using the laser. I think it sets our practice apart from the average dentist. It is a high-tech piece of equipment that we bought with our patients' best interest in mind. By and large, patients appear to be pleased with our forward-thinking approach."

Ralph Wilson, D.D.S., a periodontist in private practice in Scottsdale, Ariz., has been investigating dental lasers for awhile, but does not use any. "There is a lot of marketing about what these lasers can do, but not a whole lot of effort in backing up these claims," Dr. Wilson said. "Some of the better applications for lasers right now appear to be for general dentistry with certain fillings. However, there are limitations, in that you cannot remove an old silver filling because it sparks."

For the procedures Dr. Wilson performs, the laser "tends to cause a delay in healing compared to cutting with the scalpel. A hard-tissue laser like the WaterLase or erbium tends to be a little bit more ragged. Besides not being as precise, these lasers would actually slow me down slightly because they do not cut as effectively as a scalpel or even a bur." Dr. Wilson is also concerned about laser claims of anesthetic not needed for certain procedures. "For the purposes of my field, you still have to use anesthetic. If I could use a laser and not have to use anesthetic, I'd buy one. In addition, if a laser made me more efficient or improved my outcomes, I would buy one."

Dr. Wilson is currently investigating a novel laser with a free-running pulse. For lasers in general, "bleeding would be reduced for some procedures. But typically I don't have problems with bleeding."

"My perception of a dental laser is that this is a tool that has gained a lot of popularity in recent years, and appears to be progressing in its usefulness in various different types of procedures," said David Halpern, D.M.D., a general dentist from Columbia, Md. "Some of the difficulties with lasers in the past -- heat dissipation, heat control, controlling the direction of the laser beam -- are slowly being resolved. Before, the ability to perform procedures with accuracy was limited. But today, lasers can be used to cut into tooth structure itself and perform some surgical procedures beyond just cauterizing wounds. These include the creation of actual surgical sites, harvesting of bone for bone surgeries, and even in root-canal therapy. The technology has reached a point where more and more individuals are looking to use it in their practices. However, I think it still has a way to go before there is universal acceptance."

Dr. Halpern does not use a laser because the technology has yet to achieve "what I think is the penultimate in design and effectiveness. I want to invest in a laser that is going to remain stable for at least five years and not change. Meanwhile, I have excellent specialists that I refer to for various procedures. These specialists use lasers."

Ray Fossick, D.D.S., a general practitioner with an emphasis in restorative from Nashville, Tenn., believes that for some dentists "a laser may be a worthwhile tool, but for others it is not. I can do things better without a laser. The only time I used a laser was several years ago for bleaching teeth. But I found it was not effective and it cost more for the patients. I ended up doing tray bleaching. I also don't perform soft-tissue procedures, for which lasers seem to be best suited for. And I feel I can do hard-tissue procedures better without a laser. The laser is not quite precise enough. It would not be a very good return-on-investment for me."

"I believe that dental lasers are still evolving," concurred Lawrence Bailey, D.D.S., director of Renaissance Health Care Network in New York City. "Lasers are also pricy. It is upwards of $50,000. This is prohibitive to my public-health practice. But I still believe lasers serve a purpose. From what I've seen, they are phenomenal. I think the laser is a viable alternative to traditional use of electrosurgery or the high-speed drill. It is also great for biopsy, taking out soft tissue atraumatically, and increasing wound healing. Laser is also effective for coagulation. Lasers are bringing dentistry into a new age. At some time in the future, dentists who do not use lasers will not be providing patients with the latest technology. But the overriding reason I do not use laser at this point is because of the cost. And I don't think the cost will eventually become lower. As manufacturers keep improving the technology, they will justify maintaining the high price, if not higher."

Cindy Flanagan, D.D.S., a Houston-based general dentist in private practice, predicts that lasers "are absolutely the way dentistry will be going in the future. There is no question. But at this moment in time, they are not quite as useful because there are so many types of lasers. In order to replace traditional modalities, you would need to purchase more than one type of laser." Dr. Flanagan has yet to adopt laser technology because "there is no type of laser which allows you to remove existing filling materials. For example, most of my patients are baby boomers with traditional silver fillings. You can't treat these with a laser because the mercury in the filling would be vaporized."

While opinions among dentists vary regarding the ultimate role of dental lasers, this technology is undeniably here to stay. And as the most sophisticated dental laser currently available, the WaterLase has proven to be a valuable asset in providing periodontal, restorative, cosmetic, surgical, pediatric, endodontic, and preventive care -- and many of these treatments painlessly without anesthesia. This one instrument is used for diverse types of dental services ranging from desensitization of teeth and treatment of aphthous ulcers to complex crown preparations and root canal therapy. Its versatility and wide acceptance by dental health care providers and patients alike ensure that the WaterLase will have a major impact on the future of oral health care.

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