11. A Revolutionary Way to
Treat Periodontal Disease
• How I became interested:
• Colleagues
• Peer-reviewed research
• Failure of conventional therapy/refractory
cases.
• Desire to do more perio and save teeth
30. How Credible Is
This Thing?
• FDA Approval
• Human Histology of New Attachment
• CRA rating of 9.7
• My own eyes.
31. A Mysterious New Fangled
Way to Regenerate Tissue
Which Patients Say Yes To
• Less traumatic than traditional perio
surgery
• No scalpels, No Flap, No sutures
• Easier recovery - minimal pain, bleeding
and swelling
33. Can any laser do this?
• For Perio you need a Nd:YAG laser
• Attracted to dark pigmented tissue and bacteria
• Known to split fibrinogen to fibrin
• Not an Erbium
• Hard tissue laser
• Not a CO2
• OH apatite and water
• Not a Diode
• Burns non-selectively
• Other Nd:YAG lasers are trying but there is NO
scientific or anecdotal evidence out there
34. Why This Laser, From
This Company
• Laser Physics (Wavelength and Operating
Parameters)
• High Peak Powers for Short Duration
• Allows dissipation of heat
• Provides effective bactericidal effect
38. Why This Laser, From
This Company
• When the light energy
gets there:
• Bactericidal and seeks the color red
and black
• Dark pigmented tissue
• Facilitates formation of Fibrin Clot
41. Why This Laser, From
This Company
• Deeply Penetrating
• 2-7 mm past tip
• Into Tissue and up to 1.75 mm into
Dentinal Tubules
42. Wielding a Sword to Care for
Periodontal Disease
• High Peak Powers
• Affinity for Red and Black
• Deeply Penetrating
43.
44. LANAP Protocol
• Periostat start one week before and keep
them on for at least 3 months
• LANAP 1/2 mouth at a time
• Rx antibiotics for 7 days
• 1/2 mouth of Occ adj
• Continuing Occ Adj at post-ops
• Nightguard
• Perio prophies one mouth after and
throughout the year
45. Laser Periodontal Therapy or LANAP (Laser
Assisted New Attachment Proceedure
• (A) - Anesthetize and !
probe to base of defect
• (B) - First pass of laser
• Bactericidal
• Affect calculus
• Denatures pathologic proteins
• Removes sulcular lining
• Leaves CT intact
• Relax and Release tissue tension
46. Laser Periodontal Therapy or LANAP (Laser
Assisted New Attachment Proceedure
• (C) - 3 rounds of
scaling and root planing !
with EMS Piezo Scaler
47. Laser Periodontal
Therapy or
LANAP
• (D) - Second pass with the laser
• Finishes debriding the pocket
• Kills gram negative bacteria
• Initiates stable fibrin clot
• Biostimulate reparative process
• (E) Compress tissue as needed
• Creates closed system
48. Laser Periodontal
Therapy or
LANAP
• (F) - Occlusal Adjustment
• Depth of the osseous defect is
proportional to the amount of
occlusal discrepancy
• Occlusal Night Guard
49. Laser Periodontal Therapy or LANAP (Laser
Assisted New Attachment Proceedure
• (G) -New
Attachment Without
Junctional
Epithelium
52. Historical Review
Conclusions
• Remove diseased tissue
• Kill bacteria, remove infection
• Minimize trauma
• With occlusal adjustment
• Sufficient and stable clot and
keep it there
• Prevent epithelial downgrowth
53.
54.
55. Preponderance of the
evidence so far
• LANAP obtains pocket reduction by regenerating
tissue not taking tissue away
• New bone, cementum, connective tissue
fibers
• 91% of the teeth had 50 % pocket reduction
• Results are reported to be long lasting, low
incidence of refractory cases.
61. Another Tool,
Another Choice
• Offer the patients a
choice
• Laser ANAP
• Scaling and Root Planing, Occ Adj, LDD
• Flap and Osseous Surgery with
Regeneration as needed
• Extractions and replacement
• No Treatment
62. How Is Periodontal Disease
Managed in the General Dental
Office?
• Non-surgically, OHI, Sc and RP, LDD, Recalls, etc.
• Treatment is often insufficient to control the
disease and it becomes a progressively
degenerative condition.
• Patient acceptance of referral is statistically low
• Financial
• Anxiety
64. Problems with Conventional Pocket
Reduction Surgery
• Difficulty in patients accepting
the referral from the
restorative dentist
• Patient Acceptance
• Varying degrees of discomfort
65. Problems with Conventional Pocket
Reduction Surgery
• Gingival Recession Which
Can Lead to:
• Objectionable Esthetics
• Root Caries
66. What Would You Want
For A Family Member?
• Imagine what it can do for mild and
moderate cases
• Good tool for predictably handling
periodontal disease
69. Advantages of LANAP
• Little to no post-operative discomfort for patient
• Addresses periodontal disease not only
mechanically, but at the bacterial level
• Little to no recession
• Bone regeneration possible without additional
grafting materials
• Presurgical root planing not required
• More conservative than traditional osseous
surgery, leaving options for retreatment open
• Removal from blood thinners not required
70. Other Uses of the
Periolase
• Biostimulation
• Trismus
• Temporary Relief of Muscle Spasm
Associated with TMD
• Peri-Implantitis
75. Periolase Is Not Indicated
• Gingival hyperplasia or
deep pseudo-pockets
76. Disadvantages
• Best to do full
mouth
Shout out to Peebles
• Occlusal adjustment Prosthetic
required
• NightGuard
• Final Restorative
ideally needs to be
delayed for one year
77. Disadvantages
• Active treatment needs to be
bunched together within the first
month
• Anti-infective and Anti-collagenase
Medications
• Diet Modifications
• Extra-Coronal Splinting
78. Conclusion
• It Works
• There is Documentation
• Majority of Patients Need It
• High Acceptance Rate
• No Cut, No Sew = Greatly Reduced Fear
• Less Invasive, Less Painful, More conservative
79. Why Now?
• No perfect implant system
• Pendulum may have swung too far with extraction
and implant placement