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Laser Gum Treatment
Laser Gum Treatment
LANAP a laser procedure that reverses gum disease.

Laser Periodontist discuses Lanap Comments Off

Laser Periodontist discusses the FDA cleared laser procedure LANAP. Lanap is a laser procedure that reverses Advanced Gum Disease.

LANAP surgery, a variable free-running pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG at 1064 nm wavelength) dental laser is used by a trained and certified dentist or periodontist to treat the periodontal pocket. The laser energy selectively removes diseased or infected pocket epithelium from the underlying connective tissue. The necrotic epithelium is stripped from the connective tissue at the histologic level of the rete ridges. Since the laser energy is quite selective for diseased tissue, the underlying pleuropotential connective tissue is spared, thereby permitting healing and regeneration rather than formation of a pocket seal by long junctional epithelium.

In periodontics, the LANAP protocol is a process through which cementum-mediated periodontal ligament new attachment to the root surface in the absence of long junctional epithelium is achieved for the treatment of moderate to severe gum disease (including gingivitis and periodontal disease). Stimulation of existing stem cells permits the formation of new root surface coating (cementum) and new connective tissue (periodontal ligament) formation (collagen) on tooth roots. The procedure’s success has challenged the old paradigm of periodontal healing in the absence of guided tissue regeneration barriers (GTR) or bone grafting materials (allografts).

Early LANAP research showed consistent mean pocket depth reduction (50%) and improved bone density (48%) in an 8-year retrospective study of the protocol’s earliest clinical results. The Emago imaging system demonstrated that 100% of these cases showed some amount of bone density increases. The procedure has also proven effective at reducing pocket depth without gingival recession over a 6-month period.

Raymond A. Yukna (University of Colorado, formerly Louisiana State University) has provided histologic, statistical and radiographic evidence to demonstrate LANAP’s efficacy in pocket depth reduction via cementum-mediated new attachment. His in vivo split-mouth study comparing scaling and root planing to LANAP employed radiographic and histologic evidence derived from teeth harvested from treated patients en bloc. LANAP-treated teeth demonstrated universally cementum-mediated new attachment. Teeth treated with scaling and root planing evidenced only long junctional epithelium as the body of scientific evidence shows.

After the LANAP procedure, most patients experience new root surface coating (cementum) and new connective tissues (periodontal ligament) formation (collagen) on tooth roots, preventing tooth loss. Pocket depth reduction is comparable to that achieved by conventional resective osseous or pocket reduction surgery, but without the gingival recession normally associated with osseous surgery. Significant post-operative reduction in gingival indices, gingival inflammation, and bleeding on probing are also common desirable results of the LANAP protocol.

Because the LANAP protocol spares more healthy tissue than scaling and root planning or osseous surgery, patients experience minimal post-operative pain, bleeding, swelling, gum recession or root sensitivity. These results reduce the future risk of root caries/dental decay of the tooth root. Any discomfort is easily controlled through the use of non-steroidal anti-inflammatory drugs (over-the-counter NSAIDs) such as ibuprofen.

With regular three-month periodontal recall and maintenance, the LANAP-provided new attachment is stable and has proven resistant to future periodontal breakdown. Patients are encouraged to improve and maintain standards of oral hygiene to prevent further active periodontitis.

Drs. Gregg and McCarthy pioneered the use of the Nd:YAG laser to treat gum disease in the 1990s. Their success at regenerating bone growth and stimulating new attachment in their toughest patients encouraged them to perform further research and fine-tune the protocol that incorporates use of the PerioLase MPV-7 laser (Millennium Dental Technologies, Inc.)

Studies continue to uncover some startling consequences for poor gum health, which makes the creation of a palatable treatment an important tool in American health care. Widely reported studies have linked gum disease with heart disease and stroke. A recent case has now linked periodontitis with a full-term baby’s death. The mother’s untreated periodontitis is thought to have introduced deadly bacteria into her womb.

Although about 80% of Americans suffer from gum disease, about 97% of those with moderate to severe periodontitis are not being treated. Acceptance of the LANAP technique in gum disease treatment, introduces an option that more patients are willing to accept.

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