Dawn Nicholson, Kris Blodgett, Charles Braga, Larry Finkbeiner, Jeanne Fourrier, John George, Robert Gregg, Allen Honigman, Bruce Houser, William Lamas, Neal Lehrman, Eric Linden, Delwin McCarthy, Tom McCawley, Randy McCormick, Ed Marcus, Kirk Noraian, Peter Rubelman, Maurice Salama, Steven Saunders, Brandon Seamons, David Thein, Michael Toms, George Vassos, David Harris
A large percentage of dental implants experience complications, most commonly, infection leading to peri-implantitis
and peri-mucositis, inflammatory disease involving pathogen contamination. It presents with radiographic findings of
crestal bone loss. At this time there appears to be no compelling evidence for an effective intervention. The LANAP
protocol is a FDA cleared surgical protocol that produces new attachment and bone regeneration when applied to
periodontally infected natural teeth. The LANAP protocol and laser dosimetry have been modified to treat ailing and
failing implants. Twenty-one clinicians who have been trained to perform the LANAP protocol and the LAPIPTM
protocol have volunteered 26 LAPIP case reports. The time from implant to intervention ranges from 3 months to 16
years. Post-LAPIP radiographs range from 2-48 months. Ten cases were excluded for technical reasons. All 16
remaining cases provide radiographic evidence of increase in crestal bone mass around the implant and, when reported,
probe depth reductions. All treating clinicians report control of the infection, reversal of bone loss and rescue of the
incumbent implant. Although the success/failure rate cannot be judged from these data, any successes in this area
deserve reporting and further study.
David Harris, Dawn Nicholson, Delwin McCarthy, Raymond Yukna, Mark Reynolds, Henry Greenwell, James Finley, Thomas McCawley, Pinelopi Xenoudi, Robert Gregg
Data are presented from a multi-center, prospective, longitudinal, clinical trial comparing four different
treatments for periodontitis, (1) the LANAPTM protocol utilizing a FR pulsed-Nd:YAG laser; (2) flap surgery
using the Modified Widman technique (MWF); (3) traditional scaling and root planing (SRP); and (4) coronal
debridement (CD). Each treatment was randomized to a different quadrant. Fifty-one (54) subjects were
recruited at five centers that included both private practice and university-based investigators.
At 6-months and 12 months post-treatment the LANAPTM protocol and MWF yielded equivalent results based
on changes in probing depths. The major difference observed between the two procedures was that patients
reported significantly greater comfort following the LANAP™ procedure than following the MWF (P<0.001).
There was greater reduction in bleeding in the LANAPTM quadrant than in the other three at both 6 and 12
months. Improvements following SRP were better than expected at 6 months and continued to improve,
providing outcomes that were equivalent to both LANAPTM and MWF at 12 months. The improvement in the
SRP quadrants suggests the hypothesis that an aspect of the LANAPTM protocol generated a significant,
positive and unanticipated systemic (or trans-oral) effect on sub-gingival wound healing.
We present data supporting the efficacy of the procedure, laser sulcular debridement (laser curettage), as an important component in the treatment of inflammatory periodontal disease. Laser Assisted New Attachment Procedure (LANAP) is a detailed protocol for the private practice treatment of gum disease that incorporates use of the PerioLase pulsed Nd:YAG Dental Laser for laser curettage. Laser curettage is the removal of diseased or inflamed soft tissue from the periodontal pocket with a surgical dental laser. The clinical trial conducted at The University of Texas HSC at San Antonio, Texas, evaluated laser curettage as an adjunct to scaling and root planing. They measured traditional periodontal clinical indices and used a questionnaire to evaluate patient comfort and acceptance. The Texas data (N=10 patients) are compared with pocket depth changes following LANAP. LANAP data were obtained from a retrospective review of patient records at three private practices (N=65). No significant differences in post treatment probe depth changes were found among the four centers indicating that the procedure produced consistent, favorable outcomes, and that results from controlled scientific clinical trials can be replicated in private practices. Reduction in pocket depths following laser treatment compare well with results obtained with scalpel surgery. The use of the laser offers additional benefits. We also present quantitative evidence from digitized radiographs of increased bone density in affected areas following LANAP.
Historically, many techniques have been attempted in the search for a satisfactory and consistent treatment of inflamed, painful, hyperemic pulpal tissue. Present techniques attempting to achieve profound local anesthesia in such tissue, have not been satisfactory. Local anesthesia techniques acceptable to the patient with painful hyperemic pulpal tissue, has eluded previous technology. The subsequent treatment of hyperemic tissue without sufficient anesthesia primarily involves undesirable invasive mechanical/surgical procedures. Described in this clinical trial is a technique using free running (FR) pulsed, Nd:YAG laser energy to ablate soft tooth pulpal tissue--a technique employed after conventional endodontic methods failed. A free running pulsed, FR Nd:YAG dental laser was successfully used at 20 pulses per second and 1.25 watts to photovaporize endodontic pulpal tissue (pulpectomy) to allow a conventional endodontic file to extirpate the remaining soft tissue remnants and access the root apex. Also described in this paper is the 'hot-tip' effect of contact fiber laser surgery. This clinical trial achieved the immediate, short term objective of endodontic soft tissue removal via photovaporization, without pain reported by the patient. The pulsed FR Nd:YAG dental laser used as described in this clinical report appears to be a very safe and very effective technique; offers a treatment alternative to traditional therapy that suggests high patient acceptance; and is significantly less stressful for the doctor and staff than traditional treatment options. Long-term, controlled scientific and clinical studies are necessary to establish the safety and efficacy of both the helium-neon energy for visualization and the low-watt pulsed FR Nd:YAG energy for photovaporization of soft endodontic pulpal tissue within the root canal. Research is especially needed to understand the effects of a low-watt, pulsed FR, Nd:YAG laser on the activity of osteoclasts and odontoclasts and identify risks for developing external and/or internal resorption after intracanal application of pulsed FR Nd:YAG laser energy.
Formation of dystrophic calcification deposits within the root canal of a tooth, have historically been difficult clinical endodontic complications. Presently, removal of such tissue, mineralized through the deposition of calcareous materials in a root canal (a 'calcified canal'), remains resistant to conventional endodontic techniques. The subsequent treatment primarily involves undesirable surgical procedures and/or loss of the tooth. Described in this clinical trial is a technique using free running (RF) pulsed, Nd:YAG laser energy to ablate hard calcified tissue which obstructed mechanical access of the root canal and root apex--a technique employed after conventional endodontic methods failed. This paper discusses the 'plasma' effect, 'spallation', canal illumination and transillumination using the helium-neon (HeNe) aiming beam. A free running pulsed, FR Nd:YAG dental laser was successfully used at 20 pulses per second and 1.75 watts to photovaporize and photodisrupt enough calcified tissue obstruction, to allow a conventional endodontic file to pass the canal blockage, and access the root apex. This clinical trial achieved the immediate, short term objective of endodontic hard tissue removal via photovaporization and photodisruption. The pulsed FR Nd:YAG dental laser used as described in this clinical report appears to be a very safe and very effective technique; offers a treatment alternative to traditional therapy that suggests high patient acceptance; and is significantly less stressful for the doctor and staff than traditional treatment options. Long-term, controlled scientific and clinical studies are necessary to establish the safety and efficacy of both the helium-neon energy for visualization and the low- watt pulsed FR Nd:YAG energy for photovaporization and photodisruption of hard calcified tissue within the root canal. Research is especially needed to understand the effects of low- watt, pulsed FR, Nd:YAG laser on the activity of osteoclasts and odontoclasts and identify risks for developing external and/or internal resorption after intracanal application of pulsed FR Nd:YAG laser energy.
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