Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Lasers: The LANAP Protocol: Laser-assisted New Attachment Procedure by Robert H. Gregg II, DDS

More by this author (1)
The LANAP Protocol: Laser-assisted New Attachment Procedure
by Robert H. Gregg II, DDS

LANAP Protocol: What is It?
Although approximately 80 percent of Americans suffer from some form of gum disease, about 97 percent of those with moderate to severe periodontitis are not being treated.1 These disturbing statistics need to be addressed. The LANAP protocol is a patient-friendly, laser periodontitis surgery with consistent, reproducible and positive results. Acceptance of the LANAP technique introduces a treatment option that more patients are willing to accept.

During the 1990s, Dr. Delwin McCarthy and I began doing research on the use of a laser for the treatment of periodontal disease. In 1998, we published our findings on periodontal bone regeneration.2,3 In 2004, the U.S. Food and Drug Administration cleared the LANAP protocol4 for the treatment of periodontal disease.4 Later, in 2007, in conjunction with our work, histological proof of not only bone generation, but new cementum mediated connective tissue attachment was published by Dr. Raymond Yukna, DMD, MS (University of Colorado, formerly at Louisiana State University).5

A key component of the protocol is the PerioLase MVP-7 digital dental laser developed by Millennium Dental Technologies – a true pulsed Nd:YAG laser. The wavelength of this laser is 1064nm. It can be utilized to achieve peak powers in the thousands of watts and has the ability to vary the pulse duration (length of time of each laser pulse). This wavelength of laser light targets diseased or infected pocket tissue away from the underlying connective tissue. The necrotic epithelium is stripped from the connective tissue at the histologic level of the reté ridges. Since the laser energy is quite selective for diseased tissue, the underlying connective tissue is spared, thereby permitting healing and regeneration rather than formation of a pocket seal by long junctional epithelium.


Clinical Case
Nick DeTure, DMD, performed a full-mouth LANAP protocol on May 19, 2009. The 54-year-old male patient suffered from 6mm to 12mm of pocketing in his molar areas with bleeding on probing in April 2009. The patient had already lost 15 teeth and was reluctant to lose any more. At his initial visit, the patient was on Norvasc, Simvastatin and penicillin with a history of periodontal surgeries – one full-mouth surgery and another on the right side. A clenching habit was exacerbating an already uncomfortable condition. His last perio maintenance was performed in February 2009, and plaque control was good: PI 20 percent, BP 135/84 and pulse 71. Fremitus was noted at #4, along with minor staining and a phase contrast bacterial slide sample remarkable for a high number of white blood cells, spirochetes and motile rods.




An Overview of the Procedure
There is no initial periodontal therapy started prior to the LANAP protocol. The LANAP procedure is generally completed in two visits, although it can be done in one.6 On average, each of the two visits are two hours long. Patients are seen at a one-week post op for an evaluation and then at 30 days post op to have a supragingival prophylaxis.

Thereafter, supportive perio therapy is performed every three months. Patients are closely monitored during this time. At one year, a postoperative evaluation is done, which includes full periodontal probing and full-mouth radiography. At this time, phase two dentistry can be initiated once it has been confirmed that the periodontal condition is stable.6

Generally, during this first year, no restorative work that requires disturbing the periodontal tissue is done – only caries control and temporization. Subgingival cleaning and probing are discouraged. Since many of the patients that are indicated for LANAP treatment have avoided dentistry for years, they often require some restorative dentistry prior to the procedure, as they would not be able to wait a year before undertaking the needed restorative treatment. In this case, direct restorations are placed as needed and when indirect restorations are indicated, temporaries are placed with the understanding that the final restorations will be placed at a later date.6




LANAP Training
The LANAP Training Continuum is a year-long, comprehensive, live-patient, hands-on training program that dentists undergo to ensure that they are safe and effective in the LANAP technique. The first three days of training, Laser BootCamp, focuses on safety and efficacy in the LANAP protocol. Upon completion, dentists are granted a conditional license to use the LANAP protocol and have been awarded a Standard Proficiency Certificate. Evolution 4 of the Training Continuum is designed to take place after six months of clinical LANAP practice and experience. During Evolution 4, the new LANAP “initiate” will return to gain more insights for successful, safe and optimal LANAP protocol techniques, methodology, and laser operating parameters, and realize improved LANAP outcomes and greater clinician and operatory efficiencies. Upon completion of Evolution 4, dentists receive an Expanded Proficiency Certificate.

Evolution 5 of the LANAP Training Continuum is an integral part of the established Continuum of LANAP training that, upon successful completion, leads to a certificate in “LANAP Proficiency” and elects the LANAP-proficient clinician as a Fellow in the Institute for Advanced Laser Dentistry. Evolution 5 focuses on increasing energy density for even greater LANAP performance, versatility, adaptations, and increased capabilities, as well as improved clinical outcomes and management methods of clinically difficult LANAP case types. Only upon completion of Evolution 5 may the doctor use quartz fiber optics in different diameters, such as the 300 and 400micron fibers that have been custom manufactured with the ability to curve in the extreme bend-radius that LANAP often requires. Dentists who complete Evolution 5 have achieved one of the highest levels of clinical, live-patient, hands-on training in advanced laser dentistry available today.

Patient Acceptance of the LANAP Protocol
Even patients who have traditionally avoided dental treatment or have experienced traditional surgery in the past accept LANAP treatment. They are seeking an alternative to traditional surgery and are familiar and comfortable with the use of lasers for LASIK treatment for their eyes. Thus, they consider laser treatment for periodontal disease a viable alternative. Clinically, what immediately becomes apparent is that post operatively there is minimal discomfort, shrinkage of swollen, puffy gums and reduction of bleeding.

After the procedure, the patient can see that the tissues feel and look healthier. Since LANAP treatment is not a cut-and-sew procedure, no native tissues are injured; the recession associated with traditional surgery is not present. Consequently, the patients do not have the root sensitivity or longer-appearing teeth.6

References
  1. 7th Annual Conference on Periodontal Surgery on November 8-9, 1996. Michael Newman, DDS, PhD
  2. Gregg RH and McCarthy D. Laser ENAP for periodontal bone regeneration. Dentistry Today, 1998; 17(5):88–91.
  3. Gregg RH and McCarthy D. Laser ENAP for Periodontal Ligament (PDL) Regeneration. Dentistry Today, 1998;17(11)
  4. 510(k) Number K030290, FDA Cleared July 2004
  5. Yukna R, et al. Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans. Int J Periodontics Restorative Dent 2007;577–87.
  6. Harris DM, Gregg RH, McCarthy DK, Colby LE, and Tilt, LV. Laser-assisted new attachment procedure in private practice. General Dentistry, 2004;52(5):396-403


More Research for the LANAP Protocol
The preliminary report for the independent, nine-month en-bloc human-histological study by Marc Nevins, DMD, MMSc, positively supports the LANAP protocol for treating periodontitis.

Preliminary Research Details
  • Twelve teeth designated as “hopeless” were identified as study teeth prior to treating all teeth with the LANAP protocol: Eight single and four multi-rooted.
  • Pocket depths of 8 to 16mm pockets and up to 50 percent gingival recession.
  • All teeth were Class III vertically mobile/compressible.
  • All four molar teeth had Class III furcations.
  • Twelve study teeth were removed en bloc after nine months.
  • Two teeth were destroyed in the histological processing: one single root tooth and one multi-rooted tooth.
  • Six additional teeth were used for calibration and proof of notch placement. All six teeth showed the notches placed in diseased calculus with calculus and bacteria extending apical to the notch.
  • All 12 “hopeless” teeth returned to clinical, radiological and histological health.
  • Histologically, 10 teeth showed regeneration up to the bottom of the notch, with five teeth showing regeneration in and above the notch. A sixth tooth showed cementum-mediated new attachment.

Preliminary report was presented at the 2011 AAP Annual Meeting. Full analysis of clinical, radiologic and histologic findings are expected in 2012, with subsequent submission for peer-review and publication consideration.

 
Author's Bio
Dr. Robert Gregg is a former faculty member at UCLA School of Dentistry. He has been using lasers clinically since August 1990, including CO2, free-running pulsed (FRP) Nd:YAG, both single and variable pulsed; FRP Ho:YAG, surgical Argon, CW diodes and Er:YAG. He has given lectures nationally and internationally on the subject of clinical laser applications, and has conducted seminars for the UCLA Department of Continuing Education. Dr. Gregg along with Delwin K. McCarthy, DDS, formed the Institute for Advanced Laser Dentistry (IALD) in 2001.

About the Institute for Advanced Laser Dentistry (IALD): The Institute for Advanced Laser Dentistry is an internationally recognized non-profit educational and research center dedicated to providing evidence-based clinical training in advanced laser dentistry therapies. The IALD is both ADA CERP and AGD PACE accredited, and is committed to its continuing education (CE) programs. The IALD includes more than 20 certified instructors, who train dental professionals in laser dentistry techniques. In addition, the organization aims to reach more underserved patients with gum disease by offering free treatment to qualified patients in their training clinic – about $750,000 in free dental services each year. The IALD’s ultimate goal is for the percentage of patients seeking treatment for periodontitis to reach the percentage of patients seeking general dental care. For more information, please visit www.theiald.com.
Dentaltown Magazine
May 2024
Dentaltown Magazine May 2024 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2024 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450