Science of LANAP

Science for those that need the Science

Dr John McAllister is the author of this, which was published in the Prestigious Peer Reviewed Journal “Compendium”. Link to Article The article portrays the before and after x-rays for three patients treated with the LANAP procedure, along with showing the histological evidence of regeneration linked to the LANAP (Laser Assisted New Attachment Procedure) treatment.

This article shows Human Histology that shows regeneration in the periodontal pocket of hopeless teeth. Article

This is another Human Histlogy regeneration result. Individuals who were identified as needing teeth removal as part of their treatment course of action were asked if they were interested in donating their teeth to science so that everyone would be able to see the results that were occurring with Laser Gum Therapy.

These individuals had one side of their mouth treated using the LANAP and the other side of their mouth treated using the gold standard in gum disease treatment, which is to have the mouth scaled and the root planed. After a three-month period, the teeth were cut out ‘in block,’ which simply means the tooth, gum, and bone were sectioned out as a whole and then put under a microscope for evaluation.

The results were impressive. In 100% of the laser side there was “New Cementum, New Connective Tissue Attachment to the Root Surface in the absence of Long Junctional Epithelium” What this means in lay terms is that individuals saw a reversal in the disease. On the other side where the ‘gold standard’ of SRP was used there was 0% reversal in the disease. If you would like to read the fourth largest Human Histological Periodontal Study, it can be found at IJPRD Peer Reviewed study

This article is the first peer reviewed article completed on the Laser Assisted New Attachment Procedure (LANAP). It involved the random audit of x-rays from four private dental offices, using Iamago Digital technology. In 90 percent of cases reviewed, a reduction of 50 percent was seen in pocket depth. Read the Peer reviewed article

This peer-reviewed article was written by Dr Lloyd, and published in the Academy of General Dentistry, titled “LANAP in Private Practice – Effectiveness as Measured by Tooth Loss” Read the LANAP Research

In this article the therapeutic index of the two laser types, the Diode and the Nd: YAG, were examined. The therapeutic index is defined by the ratio of the laser energy dose that destroys pathogens (therapeutic dose) to the energy dose that damages normal tissue (toxic dose).

Therapeutic dose: A) Level that destroys pathogens

Toxic dose: B) Level that destroys normal tissue

Therapeutic index: B/A

For these experiments the therapeutic indices using our Pg biofilm/soft tissue model are:

Diode 146 / 96 (J/cm2) = 1.5

Nd:YAG >1400 / 58 => 24

The difference in therapeutic index between Nd:YAG and diode shows that the pulsed Nd:YAG has a 16 times greater selectivity for destruction of pigmented oral pathogens than the diode laser. Lasers and Bacteria

This is a video of the author of the above paper, speaking about lasers and gum disease.

This article shows the University of Texas along with three dental offices and their results after using lasers to treat gum disease for several years. They showed that 90 percent of the time there was a 50 percent reduction in pocket depths. The x-rays also confirmed an increase in bone density. Read the LANAP Results Study

The body of literature indicating there is a relationship between oral conditions, specifically periodontal diseases and inflammatory-driven systemic disease states, is mounting; both in quantity and the overall strength of evidence. This begs the question: When, how, and why did the mouth become separated from the rest of the body?

Gum Disease and Systemic Health

It’s common for people to visit a periodontist who can help them keep their teeth. One concern is that patients often do not understand the hidden agenda some gum specialists may have. After all, it uses far less time and it is significantly more lucrative to place a dental Implant than it is to save 32 teeth using LANAP, even though the cost to benefit ration of 32 to 1 is relatively close. Read the article Where is periodontology heading? To understand the way some periodontists have chosen to take their profession.

U.S. News and world report on LANAP Laser Gingivitis Cure.
A couple of years ago, Kevin Ireland, 50-year-old manager of a Utah Dinosaur Park, had his gums fixed twice. With his first treatment his lower gums were peeled back using a scalpel to excise the infected tissue and then stitch him up. This was a very painful and uncomfortable experience for the patient. During the time Kevin’s gums were healing, his periodontist received training in a new laser technology that targets diseased tissues without harming healthy ones. So a few weeks later when Kevin had his the treatment of his upper gums it was virtually pain free.

These types of high-tech advances are transforming how patients experience oral care, and in some cases, it significantly shortens treatment time and recovery time.

Ireland’s periodontist was one of a number of periodontist who chose to lay aside their scalpels in favor of the laser-assisted new attachment procedure, or LANAP, a treatment for infected gums that the Food and Drug Administration approved in 2004. The pulsing laser can distinguish by color between healthy and diseased gums and zaps away only bacteria and infected tissue, which has a darker pigment than the surrounding healthy gums.

According to a study in the December issue of the International Journal of Periodontics and Restorative Dentistry, LANAP helps connective tissue and bone form between the gums and teeth. “There were also signs of regeneration of diseased root surface in all LANAP treated teeth,” says Ray Yukna, the study’s lead author and director of advanced periodontal therapies at the University of Colorado School of Dental Medicine. In theory, that means there is less chance of the infection returning.

The laser’s heat seals the gums with “thermal clot, creating a physical barrier to any bacteria or tissue that could re-create gum pockets,” says Sam Low, an associate dean of the University of Florida College of Dentistry and President of the American Academy of Periodontology. Read the U.S News Article

If you have been told by a dentist or periodontist to pull your teeth and have an implant(s) placed, you’ll find this article scary. What it says, is that if you have gum pockets (periodontal readings) of 7 mm and bleeding the dentist or periodontist should remove your teeth. In light of LANAP, this is a shocking statement that could lead patients to make wrong choices. In my practice, I have taken and reversed gum pockets of 12 mm to healthy sulci of 3 mm. Could you imagine having your teeth removed and expensive treatment like bone grafting and implants placed because your dentist or periodontist read this article
DE 4/1/09 Vol 99, Issue 4

Here is the video.

Fourteen % of the AAP Lanap.

Periimplantitis and Lanap.

Three Hundred Sixty Five published cases in peer reviewed journals with LANAP.

Five AAP Trusties Lanap.

Pre published Human Histology shown.

Lanap 3 visits Vs. blade Tx 9 visits.


LANAP, pulsed Nd:YAG procedure

YUKNA, Carr, Evans. Histologic Evaluation of an Nd:YAG Laser‐Assisted New Attachment Procedure in Humans. Int J Periodontics Restorative Dent 2007;27(6):577‐587 LSU, Louisiana

TRUNIN, Lobanov, Kirilova, Fedorina. Morphological evaluation of Nd:YAG laser exposure to parodontal tissues. Stomatologiia 2008;87(5):27‐30. Compares traditional open curettage with and without adjunctive Nd:YAG laser treatment. One month after traditional curettage signs of chronic inflammation were still present, while after the laser exposure complete regeneration of the tissues was achieved. .

HARRIS, Gregg, McCarthy, Colby, Tilt. Laser‐assisted new attachment procedure in private practice. General Dentistry Sept‐Oct 2004;52(5). Clinical data on pocket reduction 6+ months post‐treatment from multiple clinicians. Compares results with previous periodontal literature from osseous surgery, Widman flap, SRP alone. BioMedical Consults, Calif.

HARRIS, Gregg, McCarthy, Colby, Tilt. Sulcular Debridement with Pulsed Nd:YAG. SPIE 2002, vol.5610. BioMedical Consults, Calif

NEIL, Mellonig. Clinical efficacy of the Nd:YAG laser for combination periodontitis therapy. Pract Periodontics Aesthet Dent 1997;9(6Suppl):1‐5.

GOLD, Vilardi. Pulsed Nd:YAG Laser Selective De‐Epithelialization. J Clin Periodontol. 1994;21:391‐396. Human histology. Studied the efficacy of pulsed laser in removing lining epithelium in patients with moderate periodontitis. 83% of sections exhibited complete removal of epithelium within the pocket, no evidence of damage to underlying connective tissue. Columbia Univ., New York

GREGG R, McCarthy D. Laser periodontal therapy: case reports. Dent Today Oct 2001, 20:10. Four case reports, data on procedure, pocket depth reduction, changes in radiographic bone density.

LONG CA, New attachment procedure: using the pulsed Nd:YAG laser. Dent Today 2008 Feb;27(2):166‐71. Case report, information on procedure, pocket depth reduction, changes in radiographic bone levels. 2 patients, 50 teeth, 300 probing sites. FDA Clearance #KO30290 US PATENT: #5,642,997

Nd:YAG laser as within the periodontal pocket

QADRI, et al. A short‐term evaluation of Nd:YAG laser as an adjunct to scaling and root planing in the treatment of periodontal inflammation. J Periodontol 2010 Aug;81(8)1161‐8. In the short‐term, SRP in combination with a single application of a water‐cooled Nd:YAG laser significantly improves clinical signs associated with periodontal inflammation compared to treatment with SRP alone. Univ. Dent. Med., Huddinge, Sweden

QADRI, et al. Long‐term effects of a single application of a water‐cooled pulsed Nd:YAG laser in supplement to scaling and root planing in patients with periodontal inflammation. Lasers in Med Sci. 2010, June 27. Split‐mouth single blind randomized controlled clinical trial. Plaque index, gingival index, periodontal pocket depth significantly lower on test side as compared to SRP alone. GCF volume lower on test side. Nd:YAG application in conjunction with SRP had a positive long‐term effect on periodontal health compared to SRP alone. Univ. Dent. Med., Huddinge, Sweden

MUMMOLO, et al. Aggressive Periodontitis: laser Nd:YAG treatment versus conventional surgical therapy. Eur J Paediatr Dent. 2008, June;9(2)88‐92. Univ L’Aquila, Italy

WANG, Ding, Wu. The effect of pulsed Nd;YAG laser used as an adjunct to subgingival scaling and root planing.

Hua Xi Kou Quiang Yi Xue Za Zhi, 2003, Aug;21(4)292‐4. Laser therapy followed by SRP appeared to have a stronger effect on converting the subgingival micro‐ ecosystems to healthy status than SRP alone. Laser appeared to have a stronger bactericidal action in vivo, especially on the dark‐pigmented G‐ rods. Sichuan Univ, China

MIYAZAKI, et al. Effects of Nd:YAG and CO2 laser treatment and ultrasonic scaling on periodontal pockets of chronic periodontitis patients. J Periodontol. 2003, Feb;74(2):175‐80. Comparison of ScRP, Nd:YAG irradiation, CO2 irradiation of pockets as monotherapies. Laser application as a monotherapy not significantly different from ScRP as monotherapy in reduction of bacteria, inflammation levels. Niigata Univ, Japan

NANDAKUMAR, et al. In vitro laser ablation of laboratory developed biofilms using an Nd:YAG laser of 532nm wavelength. Biotechnol Bioengin. 2004, June 30;88(7):729‐36. In vitro study on hard surfaces. Laser irradiation effectively removed live bacteria from the biofilm. Japan

ARCONIA CJ, et al. The effects of low‐level energy density Nd:YAG irradiation on calculus removal. J Clin Laser Med Surg 1992 Oct;10(5):343‐7. Calculus removal on extracted teeth, hand instrumentation, control, Nd:YAG at various energy densities. Energy densities of 49‐98 J/cm2 appeared to mimic the type of calculus removal with hand instrument with negligible effect on root surface under scanning EM. Baylor Univ, Texas

RADVAR M, et al. An evaluation of the effects of an Nd:YAG laser on subgingival calculus, dentine and cementum. An in vitro study. J Clin Perio 1995 Jan;22(1):71‐7. Extracted teeth, evaluate Nd:YAG effect at various energy settings, with repeated applications. Laser caused greater damage on calculus than either cementum or dentine. Glasgow Univ, UK

Nd:YAG laser and antibacterial activity

RADVAR, et al. An evaluation of the Nd:YAG laser in periodontal pocket therapy. Br Dent J. 1996 Jan 20;180(2)57‐62. In vivo, bacterial culturing comparison of ScRP alone and ScRP in combination with laser irradiation. Glasgow Univ, UK

WARD, et al. Inactivation of bacteria and yeasts on agar surfaces with high power Nd:YAG laser light. Lett Appl Microbiol. 1996 Sept;23(3):136‐40. In vitro, agar substrate. Nd:YAG killed a variety of G+ and G‐ bacteria and two yeasts. At the lowest energy densities where bacterial inactivation was achieved for the majority of organisms (around 2000J/cm2), no effect was observed on the substrate surface. Univ of Glasgow, UK

KLINKE, et al. Antibacterial effects of Nd:YAG laser irradiation within root canal dentin. J Clin Laser Med Surg. 1997 Feb;15(1):29‐31. Studying bacterial kill in dentin slices up to 1000 microns. Strep mutans. Highly significant elimination of bacteria for all thicknesses following laser irradiation . Dresden Tech Univ, Germany

MORITZ, et al. Nd:YAG laser irradiation of infected root canals in combination with microbiological examinations. JADA, Vol. 128, Nov. 1997:1525‐1530. Univ of Vienna, Austria

HARRIS, D. Laser antisepsis of Phorphyromonas gingivalis in vitro with dental lasers. BiOSO4, 5513‐22. AARD, 2003. Biomedical Consults, Univ Calif Dental Sci, San Francisco

HARRIS D. Therapeutic ratio quantifies laser antisepsis: ablation of Porphyromonis gingivalis with dental lasers. Lasers Surg Med 2004;35(3): 206‐13. Pg cultures grown on blood agar under standard anaerobic conditions. Hemoglobin is a primary absorber of Nd:YAG wavelength. Large difference in ablation thresholds between P gingivalis and the host matrix represents a significant therapeutic ratio. Pg was ablated without visible effect on blood agar substrate. Bio‐Medical Consultants, California.

LIOUBAVINA‐Hack N. Lasers in dentistry 5. The use of lasers in periodontology. Dutch. Ned Tijdschr Tandheelkd. 2002 Aug;109(8):286‐92. Netherlands

NANDAKUMAR, et al. Laser impact on bacterial ATP: insights into the mechanism of laser‐ bacteria interactions. Biofouling(Japan) 2003, Apr;19(2):109‐14. In vitro, marine biofilm. Abrupt bacterial ATP reducation, increasing with increased exposure time. Decreased ATP production was associated with bacterial mortality. Japan

NANDAKUMAR K, et al. Recolonization of laser‐ablated bacterial biofilm. Biotechnol Bioeng 2004 Jan 20;85(2):185‐9. Study of bacterial regrowth after laser ablation with Nd:YAG in marine biofilm. Found reduced rate of bacterial regrowth, thought to be due to lethal and sublethal impacts of laser irradiation on bacteria. Pulsed laser irradiation may be important as an ablating technique for biofilm, removal in natural systems. Japan

GRASSI, et al. Antibacterial effect of Nd:YAG laser in periodontal pocket decontamination: in vivo study. Minerva Stomatol 2004, June;53(6):355‐9. In vivo, bacterial cultures. Author concluded the the use of the Nd:YAG laser represented, in mild to moderate periodontitis, an aid to scaling and root planing and, in the same way, in more advanced disease for traditional surgery therapy. Univ Bari, Italy

BERGMANS, et al. Bactericidal effect of Nd:YAG laser irradiation on some endodontic pathogens ex vivo. Int Endod J. 2006, Jul;39(7):547‐57. A possible supplement to existing protocols for canal disinfection as the properties of laser light may allow a bactericidal effect beyond 1mm of dentine. Leuven, Belgium

GIANNINI, et al. Nd:YAG laser irradiation with low pulse energy: a potential tool for the treatment of peri‐implant disease. Clin Oral Implants Res. 2006, Dec;17(6):638‐43. It was found, by light and atomic force microscopy , that Nd:YAG laser, when used with proper working parameters, was able to bring about a consistent microbial ablation of both aerobic and anaerobic species, without damaging the titanium surface. Univ. of Florence, Italy

WANG, et al. Evaluation of the bactericidal effect of Er,Cr:YSGG, and Nd:YAG lasers in experimentally infected root canals. J Endod. 2007, Jul;33(7):830‐2. E faecalis was reduced by 98% at 1.5 watts power with Nd:YAG, ErCr:YSGG reduced bacteria by 77%. Peking Univ, China

KRESPI, et al. Laser disruption of biofilm. Laryngoscope. 2008 Jul;118(7):1168‐73. In vitro study, biofilms grown on 4 different substrates. As a result of laser‐generated shockwaves, the biofilm was seen to oscillate and break off with individual pulses. Large and small pieces of biofilm were totally and instantly removed from the surface to which they were attached. This laser technology has the ability to generate a powerful stress wave sufficient to disrupt biofilm without any ill effect to the underlying host structure. Columbia Univ, New York

TAYLOR ZD, etal. Bacterial biofilm disruption using laser generated shockwaves. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:1028‐32. In vitro evaluating bacterial reduction in biofilm on hard surface substrates, evaluating cell death within biofilm. 55% reduction of viable bacteria from laser shockwaves alone. Method may prove useful in the treatment of infected wounds where standard methods such as debridement or topical antibiotics have proven ineffectual. UCLA, Calif. VURAL, et al. The effects of laser irradiation on Trichophyton rubrum growth. Lasers Med Sci. 2008 Oct;23(4):349‐53.

KRANENDONK, et al. The bactericidal effect of a Genius Nd:YAG laser. Int J Dent Hyg 2010, Feb;8(1)63‐7. In vitro study with 6 bacterial species (Aa, Pi, Pg, Tf, Fn, Pm). 15 seconds laser exposure in non‐contact mode was found to be effective for total killing of the six tested pathogens. Centre for Dentistry, Amsterdam, Netherlands

FRANZEN, et al. Bactericidal effect of a Nd:YAG laser on Enterococcus faecalis at pulse durations of 15 and 25 ms in dentine depths of 500 and 1,000 microns. Laser Med Sci. 2011 Jan;26(1):95‐101.

Lasers provide more effective disinfection than conventional treatment using Surgical Access

rinsing solutions. Bactericidal effects at 15 and 25ms at both dentin depths ranged from 29% to 70% depending on depth and exposure. (100ms is average expsore with LANAP) . Aachen Univ, Germany.

ROMANOS, GE, Brink B. Photodynamic therapy in periodontal therapy: microbiological observations from a private practice. Gen Dent 2010 Mar‐ Apr;58(2)368‐73

WANG, et al. The effect of pulsed Nd:YAG laser used as an adjunct to subgingival scaling and root planing. Hua Xi Kou Qiang Yi Xue Za Zhi 203 Aug;21(4):292‐4. In vivo. Laser therapy followed by SRP appeared to have a stronger effect on converting the subgingival micro‐ ecosystem to healthy status than SRP alone. Laser had stronger bactericidal action in vivo, especially on the dark‐pigmented G‐ rods. Sichuan Univ, China

BERKITEN, et al. Comparative evaluation of antibacterial effects of Nd:YAG laser irradiation in root canals and dentinal tubules. J Endod 2000 May;26(5):268‐70. In vitro, S sanguis, P intermedia. At 2.4 watts 98.5% of all sections were sterilized for S sanguis, 100% for P intermedia. Scanning EM supported light microscope findings. Marmara Univ, Turkey WHITTIERS CJ, et al. The bactericidal activity of pulsed‐Nd:YAG laser radiation in vitro. Lasers Med Sci 1994;9:297‐303.

MORITZ, et al. The bactericidal effect of Nd:YAG, Ho:YAG and Er:YAG laser irradiation in the root canal: an in vitro comparison. J Clin Laser Med Surg. 1999;17:161‐164. In vitro, Nd:YAG eliminated 99.16% of bacteria studied without unfavorable temperature rises within substrate. Univ of Vienna, Austria

MERAL, et al. Factors affecting the antibacterial effects of Nd:YAG laser in vivo. Lasers Surg Med 2003;32(3):197‐202. Study to determine the minimum bactericidal energy level for strains of streptococcus, bacteroides, staphylococcus and candida. Hacettepe Univ, Turkey

SCHOOP, et al. Bactericidal effect of different laser systems in the deep layers of dentin. Lasers Surg Med 2004;35(2): 111‐6. In vitro, all wavelengths studies disinfected even the deepest layers of dentin without significant temperature change. Univ of Vienna, Austria

BEN HATIT Y, etal al. The effects of a pulsed Nd:YAG laser on subgingival bacterial flora and on cementum: an in vivo study. J Clin Laser Med Surg 1996 Jun;14(3):137‐43. 14 patients, 150 sites ( 100 treatment, 50 control). Sc/RP alone compared to Sc/RP with Nd:YAG laser application. Bacterial cultures and SEM microscopy. Testing levels of Aa, Bf, Pg, Td. Microbial analysis showed posttreatment reduction in all 4 bacterial types compared to pretreatment and control. European Laser Academy, Belgium

PIMAT S, et al. Study of the direct bactericidal effect of Nd:YAG and diode laser parameters used in endodontics on pigmented and nonpigmented bacteria. Lasers Med Sci 2010 June 27.

Epub. In vitro study. E faecalis, E coli, P gingivalis. P gingivalis levels reduced by 57% as a result of Nd:YAG irradiation. Univ of Ljubjana, Slovenia

SCHULTZ, et al. Bactericidal effects of the neodymium:YAG laser: in vitro study. Lasers Surg Med 1986;6(5):445‐8. Cell suspensions of S aureus, E coli, P aeruginosa studied for sensitivity to wavelength and thermal effects of Nd:YAG laser. Low dosages (>1,667 J/cm2) resulted in 2 to 8 log decline in bacterial numbers.

RAMSKOLD, et al. Thermal effects and antibacterial properties of energy levels required to sterilize stained root canals with an Nd:YAG laser. J Endod 1997 Feb;23(2): 96‐100. Study to establish clinically safe, effective levels to remove pigmented bacteria from root canals, create sterility in 85% of canals. Karolinski Institute, Sweden

Nd:YAG laser effects on inflammatory proteins

LEE, et al. The subgingival microflora and gingival crevicular fluid cytokines in refractory periodontitis. J Clin Periodontol. 1995 Nov;22(11):885‐90. Coll of Dentistry, Seoul National Univ, Korea

SHIBA, et al. Nd:YAG laser irradiation abolished the increase in interleukin‐6 levels caused by peptidoglycan through the p38 mitogen‐activated protein kinase pathway in human pulp cells. J Endod. 2009 Mar;35(3):373‐6. Laser irradiation inhibits the increased in IL‐6 by peptidoglycan. Laser irradiation regulates intracellular signaling molecule activities to exert its anti‐ inflammatory effect.Hiroshima Grad School Biomed Sciences, Japan

DOMINGUEZ, et al. IL‐1beta, TNF‐alph, total antioxidative status and microbiological findings in chronic periodontitis treated with fluorescence‐controlled Er:YAG laser radiation. Lasers Surg Med. 2010 Jan;42(1):24‐31. Madrid, Spain

GOMEZ, et al. Adjunctive Nd:YAG laser application in chronic periodontitis: clinical, immunological, and microbiological aspects. Lasers Med Sci. 2010 June 10. SRP with and without Nd:YAG laser compared. SRP with laser application produced superior results to SRP alone in reducing IL‐l beta and TNF‐alpha in GCF. Showed to be a potential adjunct to SRP. Madrid, Spain

LUI, et al. Combined photodynamic and low‐level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodonal Res. 2010, Sept 22. Test sites showed greater reduction of IL‐1beta levels in GCF over controls. Univ of Hong Kong, China

ELTAS A, Orbak R. Effect of 1,064nm Nd;YAG laser therapy on GCF IL‐1B and MMP‐8 levels in patients with chronic periodontitis. Lasers Med Sci 2011 May 26. SRP with and without Nd:YAG laser therapy. Found that laser addition was more effective than SRP alone in reducing PPD, CAL, GI, and GCF values. Inonu Univ, Turkey

GIANNELLI, et al. In vitro evaluation of the effects of low‐intensity Nd:YAG laser irradiation on the inflammatory reaction elicited by lipopolysaccharide adherent to titanium dental implants. J Periodontol. 2009, June;80(6):977‐84. Univ of Florence, Italy

Nd:YAG lasers, effect on fibroblasts, osteoblasts, connective tissue, bone

GUTKNECHT, et al. Effects of Nd:YAG‐laser irradiation on monolayer cell cultures. Lasers Surg Med. 1998;22(1):30‐6. In vitro, histological effects of Nd:YAG laser irradiation on a fibroblast cell culture with regard to thermal damage and cell necrosis. The laser creates an exactly bordered damage between cells, stable results proving that the laser effect can be limited to within a micrometer, removing exactly one cell monolayer without effect deeper cell layers. Tech Univ of Aachen, Germany

YUKNA, et al. Histologic Evaluation of an Nd:YAG Laser‐Assisted New Attachment Procedure in Humans. Int J Periodontics Restorative Dent 2007;27(6):577‐587. LSU Univ, Louisiana

NINOMIYA, et al. Increase of bone volume by a nanosecond pulsed laser irradiation is caused by a decreased osteoclast number and activated osteoblasts. Bone. 2007, Jan;40(1):140‐8. The mineral apposition rate, and bone mineral density of the laser group on day 7 after laser irradiation were significantly greater than those of the control. These data reveal that the increased bone volume by nanosecond pulsed laser irradiation causes an increase in osteoblast activity and a decrease in osteoclast number. Matsumoto Dent Univ, Japan

HAMAOKA, et al. Nd:YAG laser improves biocompatibility of human dental root surfaces. Photomed Laser Surg. 2009, Oct;27(5):715‐20. Rat model, tooth removal/reimplantation. Nd:YAG laser irradiation improved the biocompatibility of the dental root compared to four other external root treatment. Less inflammation after reimplantation than other methods. Univ Paulista‐UNIP, Brazil

KIM, et al. High power‐pulsed Nd:YAG laser as a new stimulus to induce BMP‐2 expression in MC3T3‐E1 osteoblasts. Lasers Surg Med. 2010, Aug;42(6):510‐18. Seoul Natl Univ, Korea

CHELLINI, et al. Low pulse energy Nd:YAG laser irradiation exerts a biostimulative effect on different cells of the oral microenvironment: “an in vitro study”. Lasers Surg Med. 2010, Aug;42(6):527‐39. Testing Nd:YAG effects on osteoblasts, endothelial cells and fibroblasts. Nd:YAG laser irradiation di not affect cell viability in all the tested cell types, but stimulated cell growth in the non‐sensitized osteoblasts, significant induction in the expression of osteopontin, ALP and Runx2 in osteoblasts, type I collagen in fibroblasts and vinculin in endothelial cells. Irradiation caused in increase in the intracellular Ca(2+) in osteoblasts, suggesting a role in regulating osteoblast differentiation. Univ of Florence, Italy

DANG, et al. Effects of the 532nm and 1,064nm Q‐switched Nd:YAG lasers on collagen turnover of cultured human skin fibroblasts: a comparative study. Lasers Med Sci. 2010, Sep;25(5):719‐ 26. Laser irradiation significantly increased expression of type I and III procollagen, accelerated collagen synthesis and inhibited collagen degradation. School of Life Sciences, Shanghai, China

YAMADA K. Biological effects of low power laser irradiation on clonal osteoblastic cells (MC3T3‐E1). Nippon Seideigeka Gakkai Zasshi 1991 Sept;65(9):787‐99. Cultured osteoblastic

Handout for CE16: Surgical Access Presented November 14 or Laser Therapy to Treat Periodontitis 8 at the 2011 AAP Annual Meeting

cells studies. Nd:YAG laser irradiation photoactivates osteoblastic cells, accelerates osteoblastic cell growth and calcification in vitro. Nagoya, Japan

STEIN A, et al. Low‐level laser irradiation promotes proliferation and differentiation of human osteoblasts in vitro. Photomed Laser Surg 2005 Apr;23(2):161‐8. 31‐58% improvement in cell survival over non irradiated osteoblasts, significantly higher (2X) osteogenic markers (alkaline phosphatase, osteopontin, bone sialoprotein) over non irradiated osteoblasts. Tel‐Aviv Univ, Israel

FUJIMOTO K, et al, Low‐intensity laser irradiation stimulates mineralization via increased BMP’s in MC3T3‐E1 cells. Lasers Surg Med 2010 Aug:42(6):519‐26. In vitro, cultured osteoblasts. Low‐intensity laser irradiation stimulates in vitro mineralization via increased expression of BMP’s and transcription factors associated with osteoblast differentiation. Nihon Univ School of Dentistry, Japan 62.

SARACINO, S et al. Superpulsed laser irradiation increases osteoblast activity via modulation of bone morphogenic factors. Lasers Surg Med 2009 Apr; 42(4):298‐304. In vitro; irradiation induces expression of TGF‐beta2, BMP‐4, and BMP‐7, type I collagen, ALP, osteocalcin, and increased the size and number of calcium deposits in human MG‐63 osteoblasts. Univ of Turin, Italy

NINOMIYA, T et al. Increase of bone volume by a nanosecond pulsed laser irradiation is caused by a decreased osteoclast number and activated osteoblasts. Bone 2007 Jan;40(1):140‐8 Epub 2006, Sep 15. The biostimulatory effects of laser irradiation pass on to soft tissue and hard tissue as well. The mineral apposition rate, bone mineral density, activated osteoblasts all increase soon after laser irradiation, along with a decrease in osteoclast numbers. Matsumoto Dental Univ, Japan

KIM IS, et al. High power‐pulsed Nd:YAG laser as a new stimulus to induce BMP‐2 expression in MC3T3‐E1 osteoblasts. Lasers Surg Med 2010 Aug:42(6):510‐18. In vitro, findings demonstrate that high‐power, low‐level Nd:YAG laser increased osteoblast activity, very efficiently accelerating mineral deposition. Osteoinductive effect likely mediated by activation of BMP‐2 related signaling pathway. Seoul Natl Univ, Korea

GREGG R, McCarthy D, Laser ENAP for periodontal bone regeneration. Dent. Today 1998 May 17:5. Two case reports of radiographic bone fill. GREGG R, McCarthy Dr, Laser periodontal therapy for bone regeneration. Dent Today 2002 May 21:5. Two case reports, procedure description, changes in radiographic bone density by Emago geometric reconstruction software (BioMedical Consultants Inc.).

GREGG R, McCarthy D, Eight year retrospective review of laser periodontal therapy in private practice. Dent Today 2003 Feb, 22:2. Retrospective evaluation of 22 patients evaluating changes in bone density by Emago geometric reconstruction software (BioMedical Consultants Inc.). Average 38% increase in bone density. Digital subtraction radiography.

Nd:YAG Hemostasis, other surgical uses:

Chopra SS, et al.Transformation of hemoglobulin into methemoglobulin during heating of blood: its role in the treatment of vascular lesions using an Nd:YAG laser treatment of vascular lesions. Ann Dermatol Venereol 2003 Jun‐Jul;130(6‐7):648‐51. Laser effect on blood vessel is to warm blood, photothermal modification of oxy‐ and des‐oxyhemoglobin to form met‐ hemoglobin which is 3‐4 times more absorptive of laser energy for enhanced hemostasis while preserving non‐targeted structures.

France Bellido‐Martin L. et al. Imaging fibrin formation and platelet and endothelial cell activation in vivo. Thromb Haemost 2011 May;105(5):776‐82. Describes in vivo animal models for visualization of platelet, endothelial cell activation, and clotting from laser‐induction.

ATKINSON BT, et al. Laser‐induced endothelial cell activation supports fibrin formation. Blood 2010 Nov 25;116(22): 4675‐83. Laser activation of endothelial cells produced rapid increase in calcium mobilization, fibrin formation, supports.

SILESHI B, ET AL. Application of energy‐based technologies and topical hemostatic agents in the management of surgical hemostasis. Vascular 2010 Jul‐Aug;18(4): 197‐204. Review of methods for hemostasis, including lasers, mechanisms by which they stop bleeding.

DAHREDDINE M, et al. Retinal arterial macroaneurysm complicated by premacular hemorrhage: treatment by YAG laser disruption. J Fr Opthalmol (French) 2011 Feb;34(7):131‐5. Case report of Nd:YAG laser photodisruption to drain accumulation blood from an arterial macroaneurysm with premacular hemorrhage, loss of vision.

IIJIMA H, et al. Nd:YAG laser photodisruption for preretinal hemorrhage due to retinal macroaneurysm. Retina 1998:18(5):430‐4. Five case reports using the Nd:YAG laser to create a focal opening in the retina to provide drainage from a retinal macroaneurysm.

PUTHALATH S, et al. Frequency‐doubled Nd:YAG laser treatment for premacular hemorrhage. Opthal Surg Lasers Imaging 2003;34:284‐290. Twelve patients, laser membranotomy for clearance of premacular hemorrhage. Safe, simple, noninvasive treatment alternative.

AHMED M, Management of intermittent angle closure glaucoma with Nd:YAG laser iridotomy as a primary procedure. J Coll Physis=cians Surg Pak 2006 Dec;16(12):764‐7. Nd:YAG laser laser iridotomy offers effective, long lasting, first line treatment for the management of primary angle closure glaucoma.

OPREMCAK E, et al. Restoration of retinal blood flow via translumenal Nd:YAG embolysis/embolectomy for central and branch retinal artery occlusion. Prospective study, 19 patients with retinal artery occlusion. Nd:YAG photodisruption of the emboli, restoration of blood flow, improved visual function.

WERNER JA, ET AL. Ultrasound‐guided interstitial Nd:YAG laser treatment of voluminous hemangiomas and vascular malformations in 92 patients. Laryngoscope 2008 Apr;108(4‐ 1):463‐70. Retrospective study of 92 patients receiving Nd:YAG laser treatment for removal or

Handout for CE16: Surgical Access Presented November 14 or Laser Therapy to Treat Periodontitis 10 at the 2011 AAP Annual Meeting

reduction of large hemangiomas and vascular malformations in the head and neck region. High level of effectiveness.

VESNAVER A, VOSAK DA. Treatment of large vascular lesions in the orofacial region with the Nd:YAG laser. J Craniomaxillofacial Surg 2009 Jun;37(4):191‐5. Prospective study, 28 patients with large vascular lesions (>3X3cm) treated with Nd:YAG photocoagulation to reduce or remove lesions. Used properly, safe and effective.

CHOPRA SS, et al. Evaluaton of laparoscopic liver resection with two different Nd:YAG lasers for future use in a high‐field open MRI. Photomed Laser Surg 2009 April;27(2):281‐6. Animal model, liver resection and hemostasis, histomorphometric analysis for thermal tissue effects. Thermally induced hemostasis, blood vessel sealing seen in liver tissue up to 2mm diameter.

VAZ AP, et al. Primary endobronchial leiomyoma –endoscopic laser resection. Rev Port Pneumol (English, Portugese) 2011 April14 e‐pub. Case study removing leiomyoma from right main bronchus with Nd:YAG laser through rigid bronchoscopy.

VENTRUCCI M, et al. Efficacy and safety of Nd:YAG laser for the treatment of bleeding from radiation proctocolitis. Dig Liver Dis 2001 April;33(3):230‐5. 9 patients, Nd;YAG for hemostasis of bleeding due to radiation‐induced proctocolitis. Safe and effective.yt56