36

Q: When did you decide that having an office filled with high-tech equipment was an important goal?A: I graduated in 1987 from dental school and practiced with my

father in our family general practice until 1996, when I purchased thepractice. At that time, I heard Drs. Buchanan and Ruddle lecture onendodontics in Seattle. While there, I was exposed to the power ofthe dental operating microscope for endodontics. I realized I enjoyeddoing endodontics and I couldn’t visualize the root canal system likeDr. Ruddle was doing as he located canals (MB2), instrumented andobturated canals and disassembled teeth with obstructions such aspost, pins and separated files. I decided I either had to start referringmore of my cases to an endodontist using a scope, or buy one myself.

Office Visit

Enjoying Dentistry AgainEnjoying Dentistry AgainTechnology rejuvenated the love Dr. Glenn van As had for dentistryBy Thomas Giacobbi, DDS, FAGDEditorial Director, Dentaltown Magazine

Welcome to the second installment of Office Visit, wherewe visit a Townie’s office and profile their equipment,design or unique practice philosophy. If you would like toparticipate, or nominate a colleague please send me an e-mail at tom@dentaltown.com.

This month we are pleased to take you inside Dr. Glennvan As’ office in Vancouver, British Columbia, Canada. Dr.van As lectures internationally on laser and microscopedentistry, so it is no surprise that his office has many dif-ferent high-tech items.

dentaltown.comAugust 2006

37

Equipment ListMagnification• 3, Global Surgical Corporation

dental operating microscopes –www.globalsurgical.com

Lasers – Operatory• HOYA ConBio DELight,

VersaWave and Diodent I –www.conbio.com

• 2, Ivoclar Vivadent Odyssey –www.getodysseylaser.com

Lasers – Diagnostic• DIAGNOdent caries detection device – www.kavo.com

Cameras – Extraoral• Nikon 995, 5000, D70, and D2X – www.nikon.com

Miscellaneous• LED Dental Inc. VELscope – www.velscope.com• Ondine Biopharma Corp. Periowave – www.periowave.com

Name: Glenn van As

Practice Location:

Vancouver, British Columbia, Canada

Graduate from:

The University of British Columbia

Year graduated from dental school:

1987

Year when practice opened:

Associated with practice until

1996 when it was purchased

from the senior doctor.

dentaltown.comAugust 2006

All of the technologies have given me something different and new, plus allowed for a positive return on investment.

Q: How would a dentist in your commu-nity describe your office?A: Thomas, I sort of chuckled at your ques-tion. When I started to use the microscope forall of my dentistry in late 1997, I got a lot ofweird looks, questions and derogatory state-ments from colleagues and acquaintances.They referred to me – negatively – as the“scope guy” or the “laser doc.” Initially, thesomewhat derogatory terms made me a littleupset; however, slowly but surely the skepti-cism changed to interest. Colleagues beganasking if they could come by to the office andobserve, or they phoned and asked me ques-tions about either lasers or microscopes.Locally, the provincial dental association askedme to do some lectures at the annual meeting.Soon, the local dental faculty at the universitywill be incorporating microscopes into theirundergraduate program.

Q: Which pieces of equipment have pro-vided the fastest return on investment?What factors made this possible?A: That is a really tough question. All of thetechnologies have given me something differ-ent and new, plus allowed for a positive return

on investment. Some have provided for fasterROI than others. Things like theDIAGNOdent have yielded an almost instantROI. Whereas, things like the microscopehave helped improve the quality of my ownwork, my ergonomics (how do you put a ROIfigure on your neck and back) and the ability,through the use of its video equipment, tomarket and sell the treatment the patientrequires.

Lasers will provide a positive ROI as well,depending on the type of practice that onehas. A soft-tissue laser can help with the timerequirements in tissue management for fixedprosthodontics, and provide for new proce-dures such as frenectomies and biopsies. Ahard-tissue laser, in addition, can provide foranesthetic-reduced restorative procedures, andosseous recontouring that will add marketingability (new patients), and new procedures formany practices.

Q: Please explain why you have three dif-ferent digital cameras? Do they serve sepa-rate purposes, or is this a case of updatingequipment?A: In our office, we have a variety of camera

Continued on page 38

The office of Glenn van As, Canyon Dental Centre(bottom floor), from the street.

Office VisitContinued from page 37

dentaltown.comAugust 200638

setups. I have a separate digital SLR setup (Nikon D2X), which Iuse for facial photographs, orthodontic photos and cosmetic profilephotos. In addition, we have a Nikon 995 (Coolpix) camera, aNikon 5000 (five megapixel point-and-shoot camera), and presentlya Nikon D70 (digital SLR) on the dental operating microscopes. In the case of the Nikon D2X, we purchased it because the camerason the microscope were not able to take facial photos, but are ableto take photos from commissure to commissure. We also can takemagnified photos of individual teeth that are superior to what wecan obtain with the Nikon D2X (without cropping). The threepoint-and-shoot cameras are all cases where over the last five yearswe have upgraded our equipment on the microscope as new, supe-rior equipment became available. I use the digital SLR on my mainscope for documentation and the Nikon 5000 on my second micro-scope (we have three in the office). The Nikon 995 is used to digi-tize radiographs, as we at present don’t have digital radiologythroughout the office.

Q: You own six lasers. Please explain your rationale. Are theduplicate types for the sake of efficiency? What was thesequence of purchase? A: We have two hard-tissue lasers, three soft-tissue diode lasers andone non-functioning argon laser. I purchased the Argon laseraround 1999 to cure composites and cut soft tissue (eliminatingcord) at over $50,000 Canadian. I realized lasers were a powerfultool for several reasons in my practice, but the hard-tissue laser(Er:YAG wavelength) was the glamour boy of lasers. In 2000, Ihelped with some documentation and early trials with the HOYAConBio DELight and in January 2000, we purchased one whichhas since been upgraded (2005) with new software and a new fiber.I purchased the laser for its purported ability to be used with littleto no chemical anesthesia. Nowadays, the majority of the time I amusing the Er:YAG for soft-tissue refinements in cosmetic cases, andfor the removal of osseous tooth structure in both an open- and insome instances closed-flap environment. Soft-tissue diode lasers areseen by many clinicians as an electrosurge replacement. They are

sturdy, lightweight, portable and excellent for hemostasis and soft-tissue ablation. I have purchased two of the three diode lasers, andwe use them for crown troughing and soft-tissue ablation as needed.I have a full-time associate and he uses primarily one of the diodesin his daily routine.

Q: Do you have the VELscope. Tell us about it and how youuse it in your practice?A: Yes, we have recently incorporated the VELscope into our prac-tice as a primarily dental-hygiene-driven mucosal examination sys-tem for oral cancer diagnosis. This device is used to help detect earlystages of oral cancer through using multi-spectral fluorescent visu-alization. In the last six weeks, we have begun to incorporate thisdevice in our hygiene recall exams to help detect early signs of pre-malignant lesions. It appears to be a very accurate and helpful diag-nostic tool in the battle against oral cancer.

Q: Which pieces of equipment are most appreciated by yourpatients? Why?A: Patients seem to realize microscopes are not the standard piece ofequipment in most offices. The hard-tissue laser is appreciated bythe mothers of young children as I am able to provide a lot of therestorations without the dreaded shots.

Q: Select five pieces of equipment from your list and describethe following:

• Date of purchase• Reasons for purchase• Equipment that it replaced• Procedures added to the practice as a result of this

new technology• How you market it to your patients• Is there something currently on the market you would

consider for an upgrade• If you could change anything about this item, it would be…• Who enjoys this more – you or the patients?

The hard-tissue laser is appreciated by the mothers ofyoung children as I am able to provide a lot of the

restorations without the dreaded shots.

Continued on page 40

Office VisitContinued from page 38

40 dentaltown.comAugust 2006

Earliest date of purchase

Reasons for purchase

Equipment that it replaced

Procedures added to the prac-tice as a result of this new tech-nology

How you market it to yourpatients

Is there something currently onthe market you would considerfor an upgrade.

If you could change anythingabout this item, it would be…

Who enjoys this more – you orthe patients?

Global Surgical dental operating microscope

1998

To improve the level of care of myendodontics cases.

2.5- 3.5x loupes.

Originally, retreats and started per-forming more molar endo. Now, I useit for everything.

Business cards, toothbrushes, inter-nal brochures and patient word ofmouth.

Currently, monitor-driven microscopes(such as the Digital Surgical Scope fromCamSight, www.camsight.com) andheads-up displays; but, in my opinion,they don’t offer the depth of field ordetail of the true operating microscopes.

The learning curve.

Me.

HOYA Con-Bio hard-tissue laser

1999

To provide anesthetic-free restorationsto my pediatric patients.

Traditional high-speed and anestheticin some cases.

Soft-tissue procedures including biop-sies, frenectomies, tongue tie releases,gingival soft-tissue recontouring, fibro-ma removal, cosmetic smile lifts,osseous closed- and open-flap recon-touring, in combination with manyrestorative procedures.

Patient word of mouth, businesscards, post cards, toothbrushes andin-office information.

No.

The cost and adding an educationrequirement.

Patients.

5Glenn’sTop Five

G6 VersaWave

41dentaltown.comAugust 2006

Continued on page 42

KaVo DIAGNOdent caries detecting laser

2002

To diagnose and therefore treatocclusal fissure caries at a much ear-lier stage (before cavitation).

Reduced the need for an explorerand radiographs for occlusal decay.

Treat occlusal fissure caries at amuch earlier stage.

None, with the exception of patienteducation on how the product works.

Yes, The DIAGNOdent pen.

The learning curve.

Me.

Ivoclar Vivadent Odyssey 2.4G diode laser

2005

As a replacement for my electro-surgery unit, older larger diodes that Ihad used in the office, as well as myvery large Argon dual-wavelength unit.

See above.

Soft-tissue procedures including biop-sies, frenectomies, tongue-tie releases,gingival soft-tissue recontouring,fibroma removal. Soft-tissue proce-dures where hemostasis is absolutelyinvaluable and necessary.

Don’t. Just part of my laser practice.

I would consider an upgrade to the2.4G with its cordless foot pedal,retractable fiber and simplified frontpanel.

The retractable fiber. It is not as easyto make sure the fiber is completelysterile as with other lasers where thefiber is autoclavable.

Me.

Nikon Digital Cameras: D2X, D70, 5000, 995

2000

As a replacement for 35mm slidecameras that were heavy and hookedup to the microscope.

See above.

Digital documentation of most procedures in my office for patienteducation, publishing articles andlegal purposes.

I show patients the photos after theirappointment before they leave theoperatory. Occasionally, I will sendthe patients a before and after (putinto a PowerPoint slide and saved asa JPEG) to their office e-mail to assistword of mouth marketability.

The Nikon D2X is the top-of-the-line12 megapixel camera, the NikonD200 is an upgrade over the D70.The other cameras were older ver-sions that I used previously.

The weight of the high-end digitalSLR (single lens reflex) cameras onthe microscope. There is a complexityto these cameras that make them dif-ficult for the neophyte to get the mostout of them.

Both.

D70

42 dentaltown.comAugust 2006

Office VisitQ: What is your philosophy regarding office technology? Doyou enjoy the latest and greatest, does it attract new patients,make life easier, etc.? What misconceptions do your colleagueshave about technology?A: Wow, what a great question and there are a lot of answers to this.Since 1997, I think I have become very open minded to new tech-nology, especially as it relates to lasers and microscopes. I do enjoyusing and having the latest upgrades for most of my equipment.There is a limit, though, to time and resources for these purchasesand you must always try to balance the need to be ahead of thegame, and the financial as well as emotional costs of these purchases.I know I am producing three times what I produced in 1997, andam far busier than I was then.

The biggest misconception is that the technologies will becomeoutdated. In all honesty, I still use most of the technology I have.

Q: Is it difficult to incorporate new technology into yourdaily routine? What is your approach to integrating new tech-nology into your office?A: Well, in our office the team realizes and promotes the fact we arefairly advanced when it comes to the technologies of lasers andscopes in the office. Our team is fantastic, supportive and interestedin the new technologies; most recently with the integration of thePeriowave and VELscope devices. We all are learning, not only howto use the products, but how to integrate them into the office rou-tinely. It’s always a work in progress!

Q: How do you address staff training each time you add anew piece of technology? Do you take them to training, do alunch and learn or use local sales reps from the area?A: The most important thing in integrating new technology in adental office is to have the support and understanding from yourdental team. You need to address the vision of where your practiceis going, and help them achieve proficiency in how the unit worksand how it is to be integrated into the office. I also believe thatwhen staff is included in the decision-making process of how bestto integrate the technology into your office, technology stands to bebetter accepted as a friend of the office instead of a foe!

For instance, in the case of the Periowave and VELscope, wehave had a couple of lunch and learn sessions where the sales repshave come in to explain how the unit works, and how other officesare incorporating the unit into their office. We have set deadlines ofwhen we are to start using the technologies, and had discussions on

how to charge for each item. There will be more staff meetingsregarding both technologies, and I will offer the staff an opportunityto attend continuing education lectures on these technologies. Afterthat – it’s time to stop talking and start doing. That, in the end, isthe only way to get technology used routinely in your office. It can-not be used as a plant stand once it’s been purchased!

Q: Which items from your list were purchased as a result of arecommendation on Dentaltown.com?A: Of all the products I have, probably the one I learned about mostonline on DT was the Isolite. This great rubber dam alternative isan awesome adjunct to laser dentistry, where unanesthetizedpatients have difficulty with rubber dam clamps. The Isolite pro-vides suction, illumination, a bite block, tongue and cheek retrac-tion plus isolation all in one marvelous product.

I will say this though, I have met more people in my travels andlectures who know me from my posts on DT, than from any singleother thing I have ever done. DT really makes it so no practitionerwill ever have to practice alone again.

Q: How do you pay for this equipment – loan, lease? Do youhave a technology budget each year or do you evaluate eachpurchase based on ROI. What do you consider a no-brainerpurchase? Give an example.A: We try to budget 5% of the gross annual income ($50,000)towards improving the technology in the office. Up to $20,000, Iwill pay cash, but more expensive than this, I tend to take out ashort-term loan. Other pieces I purchased by doing lectures for thecompany involved. So, instead of receiving honorariums, I put theincome towards the purchase of the product.

In some cases, rather than purchase new, I have upgraded prod-ucts (DELight laser and microscopes) to keep them operationaluntil newer versions could be purchased.

Having said this, if you do endo all day long, or have neck and back problems, the microscope can be a savior to your practice.Initially, there may be a drop in ROI as you go through the learning curve, but eventually your speed will rebound to where itwas before – or even faster – as you eliminate the poke and feel withthe improved visual acuity possible with the scope. In addition,there are many instances where I think that a hard-tissue laser is theprime choice for someone trying to upgrade their practice to a newtechnology.

Since 1997, I think I have become very open minded to new technology, especially as it relates to lasers and microscopes. I do enjoy

using and having the latest upgrades for most of my equipment.

Continued from page 41