Dr Ed Lipskis

Integrative Orthodontics Center

I practice in the Integrative Orthodontics Center, which is part of the TMJ and sleep therapy center of Chicago. This is a practice, very different than most orthodontic practices. We focus on airways, especially. We treat a lot of children, especially with sleep apnea, even adults. Adults are more difficult to treat. It’s kind of a mixed thing. My wife is also a dentist, practicing in the TMJ and sleep therapy aspect of the practice, and so she feeds me all her hardest cases.

Which patients do you use MLS laser for?

So we use the MLS laser on actually every single patient that comes in. That laser is amazing. The way that we practice, we’re trying to make skeletal changes. So normal orthodontics actually counts on inflammation to create a situation in which teeth can move into a space where voids are created.

With that mechanism, there’s no way to take and grow new bone. You’re limited to moving teeth within the existing bone. So with the MLS laser, it’s amazing, the inflammation reduction that we get, plus the pain for patients, plus the accelerated tooth movement that we get, it makes cases go way better.

I’m trying to take and move teeth with super, super light forces. When you do that, it’s a completely different mechanism than the way teeth are normally moved. And it allows osteoblastic activity at the bone’s surface, which then, whichever direction you’re moving the teeth, you can grow new bone that way. The MLS laser makes that happen better than doing it without it.

How does MLS Laser achieve this?

So there’s the biophysics of it, but in a nutshell, what happens is, inflammation is my enemy for this because in an inflammatory response, you actually counteract the things that would stimulate the osteoblastic activity. So when you have lighter forces, you’re actually moving the teeth, nudging them in the direction you want to go, and there’s four different mechanisms that we really understand.

The mitochondrial activity, the more efficiency in movement that the MLS laser engendered, makes that happen so much better.

There’s actually studies looking at not just at the MLS laser but other lasers that are at similar frequencies showing the tooth movement even when there’s some inflammation ends up happening faster. Unfortunately, most of those studies are extraction cases and just looking at dragging teeth across the extraction sites, but for me it makes a difference.

Shorter treatment time

I would say, on average, using that MLS laser cuts about a third of my treatment time. And that’s huge, form a patient satisfaction standpoint. From our actually being efficient in getting patients out faster. The treatments that we do are very complicated. Whenever you’re trying to make skeletal changes, especially in adults, it can take a long time. So cases that I normally treat out now in two years, without the laser, would really take about three years.

We have 5 MLS Lasers

The laser absolutely makes a difference. Which is why, in our practice we have five MLS lasers. And we have five because every single patient gets lasered. We have anywhere, 70 to 90 patients every single day.

And they’re all getting lasered. We have a treatment bay and some private rooms. So the private rooms because of the legal things with wearing glasses and things like that, we can laser there. But everyone who gets treated in the bay, we have a special dedicated lasering room that just, everybody filters through there.

Every staff member is trained how to use the laser so that busy days, it doesn’t matter. It could be someone from the front desk, whoever, but every single patient gets lasered. We’ve had patients that have come in, these are usually adults, that, Oh, I’ve got a meeting, I’ve got to go.

And then two hours later they’ll call back and they’re like, Can I come back and get lasered? It doesn’t feel as good as it normally feels?

So even perceptually for the patients it makes a difference, but there are cases where I’ve had people come in for extra lasering if we’re trying to grow the maxilla forward.

That seems to be the thing that is the most sensitive to different forces, inflammation creeping up and stuff like that. And when I have patients come in for extra lasering in between, I don’t even see them. They come in, and you sign. You’ll get a protocol written down for what these patients need, and with that, the differences are more extreme. When we don’t do that, we still get advancement, but it’s a little bit less.

Pre-programmed protocols

So there are fortunately for us, you can pre-program these things in. Working with Bioresearch in the U.S. along with ASA the Italian manufacturer, we worked out the most effective wavelengths and timeframes.

TMJ patients

We treat a lot of TMJ patients, too, and the TMJ protocols are all well known. Basically, I write a prescription in effect for every single patient, it’s in our notes. And then there’s a computer in there. The staff just looks up and sees what I’ve assigned to be lasered that day.

It could be just one thing, or on some of these patients that are complex, in the U.S., we fortunately have the right to laser all the way, basically, your collarbone. So we can do necks, we can do anything up here.

So I would say, typically, patients are getting three or four places lasered.

And sometimes it can be only one minute. If we’re advancing an entire maxilla non surgically, then we’re doing zygomatic arches. Your maxilla is connected to eight other bones. And so where the stimulation happens is that all the sutures–all the seams between those bones– so as many of those bones’ seams that we have access to, that’s what we try to laser.

Consistent results

We get amazing results all the time. A lot of people don’t believe that you can get lateral development in a lower arch. And the true test of that is, are you 1, uprighting the lower teeth?

So instead of just having the teeth move laterally like this and grow new bone there, are you just rocking the teeth out? So that’s what most people think happens. So we’re very careful to control that and take CBCTs out of every patient, we take progress ones. You can do this 11 micro-receiver exposure, super-low radiation, and just monitoring whether there’s bone continuing to be formed.

And what we’re finding, which is what studies from what Damon and other people have found, is you can laterally expand to down the lower arch and not only have continuous bone being deposited. The bone dimension when we’re done with treatment, generally tends to be a little bit thicker than when we started.

Stimulates bone growth

So the bone is better. I have periodontists that send me cases where they had people who had very thin bone, and they have some vertical bone loss. So we really can’t engender vertical changes in bone, but dimensionally around the teeth. So this one guy just sends me a little note. He goes, just move this patient’s teeth around, grow me some new bones so they become more stable.

So the laser along with these light forces together make that happen.

That is very cool, yeah. Sometimes for an implant, so if you’re got patients who have a missing tooth that’s been missing for a long time, so there’s a collapse of the bone there, we can take and, using the laser, because typically if you try to use normal orthodontic forces and move teeth into a position where the bone is collapsed, you don’t get any deposit. In fact, you tend to break the roots out of the cork and plate, and you’re basically doing a slow extraction on these teeth.

With the laser and these light forces, you actually stimulate the bone to grow, and this area where the bone has thinned, you move one tooth partway into that space, and then you move it back. And then you move the tooth behind the space back into it, and when you’re done, you’ve got a full dimension of bone that is ready for implants, and that can be done during the time of treatment. It’s not that big a deal for me to do that while I’m doing other things. So that’s a great application for the MLS laser. If I tried to do that without the laser, it doesn’t work as well.

How to be effective

Other than those very facts, I certainly want to be as effective as I can with my patients. The lasers are, they’re not outrageously expensive, but they’re not cheap. I’m not going to go get them without having some demonstration of effect. When we started using these lasers, we actually started with a different laser that was, it’s a different company. Not as effective, but still effective.

And what we found was, we were still getting these bony changes. But for example, if I’m trying to grow new bone forward on the front, I’m lasering with this other laser, I’d laser one minute over every single tooth individually. So I get the same effect or better with the MLS laser just for 30 seconds of going back and forth.

What kind of laser do you have?

We’ve got two different kinds. We’ve got the one with, we call it the Charlie head. So you can have a fixed point. Somebody’s got some neck issues, cervical spine issues. So cervical spine positions, rotations, things are very related to mandible positions, so we need those things changing at the same time that we’re changing things skeletally in your face in order to engender stability. So we can be lasering here at the same time we’re lasering other things with that, and the time savings is amazing.

In any kind of medical dental practice, the most expensive thing you have is your time. So the MLS laser is so much more effective. The dual wavelength thing just seems to really make the biggest difference in time savings and comfort for your patient.

Patients

That’s the other thing. Patients, I told you that one sample where the guy called back saying, Can I get back in to get lasered? We try everything we can in our practice to reduce the inflammatory response to what we’re doing. Orthodontics inherently can be inflammatory. So this makes a huge difference for us. I would say anybody who’s not tried one, it’s well worth having it. Like I said, we wouldn’t have five if it wasn’t working. And the changes that we make, would happen, but not to the same degree, and not as quickly without the lasers.