Dental Tribune United Kingdom Edition

September 10-16, 201220 Perio Tribune United Kingdom Edition A historical perspective of the development of the Laser-Assisted New At- tachment Procedure is present- ed in this article. The simplicity of the protocol is discussed, as well as its nuances. The con- cept of the Laser-Assisted New Attachment Procedure (LANAP) was born back in 1989 with Drs Robert Gregg ll and Del Mc- Carthy. As with most general dentists battling with the day- to-day realities of periodontal disease, they were looking for an answer on how to better care for their patients. The re- ality at the time was that peri- odontal disease was difficult to treat and maintain. It was primarily based on older con- cepts of wound debridement and amputation. Once treated, relapse was common. We know periodontal disease is a mul- tifactorial disease process and patient behavioural routines can play a significant role. It is a wonder that the conventional treatments worked as well as they did. Even when they did work, there often were signifi- cant secondary repercussions clinically as well as psychologi- cally. Clinically, many of these traditionally treated cases were difficult to restore whenever dental prosthetic treatment was needed and patients were often left with the compromised aes- thetic result of a long tooth ap- pearance. Post-surgically, there was significant root surface exposure and with patients’ in- creased life span and the inci- dence of dry mouth, root caries can become a very difficult en- tity to control. More problematic, is that psychologically many of these patients felt that the discom- fort from the procedure and/ or the residual tooth sensitiv- ity after treatment was so great that they would not complete remaining areas that needed treatment or declined retreat- ment when they relapsed. Fur- ther complicating matters, the patients would recant their ex- periences to friends and fam- ily, making case acceptance for periodontal treatment often a challenge. During this same time, Drs Gregg and McCarthy were involved in the early use of Nd:YAG lasers in dentistry. Confronted with patients not wishing to lose teeth and declin- ing traditional surgery or extrac- tion, they developed the LANAP protocol, which eventually led to its US FDA clearance in 2004. In concept, the LANAP protocol is rather simplistic. The ulti- mate goal is to set up the perio- dontal environment to promote self-regeneration of the lost at- tachment and osseous structure that result from LANAP—Laser-Assisted New Attachment Procedure Reinforced when new attach- ment was found on all the LA- NAP-treated teeth in the initial histology studies done by Dr Ray Yukna. LANAP is also a very safe protocol. The use of the Nd:YAG laser has often been of concern by some owing to pos- sible damage to root surfaces and the tissue attachment but, with a basic understanding of laser physics, laser–tissue in- teraction parameters were de- veloped that enabled the use of an Nd:YAG in a very safe and effective manner. LANAP is also standardised. That is, before a doctor can obtain his laser he goes through three days of training: one day of laser phys- ics and laser–tissue interaction and then two days of hands-on training with patients. This is then followed up by two more separate days of treating pa- tients to refine techniques and add other treatment modalities utilising the Nd:YAG. Because of the simplicity, predictability and standardisation of LANAP, it has become a very safe and effective way to treat periodon- tal disease. The simplicity of the LANAP protocol can be seen in Table I. The LANAP protocol Step A Patients undergo a full den- tal examination and treatment plan—as with all dentistry. If they have an appropriate diag- nosis of Type III or greater peri- odontal disease, all treatment options are presented to the patient. The initial step of the LANAP protocol, after anaes- thesia has been administered, ism bone sounding around each tooth. The objective is to deter- mine areas of osseous defects that cannot be seen radiograph- ically. Step B This is the first time the laser is used. The objective of this step is to remove only diseased epithe- lium, to affect selectively bacte- LANAP - Laser-assisted new attachment procedure Dr David Kimmel discusses the LANAP protocol Fig. 1_Selective thermal ablation of epithelium. Fig. 2_Formation of the stable fibrin clot. Fig. 3_Periodontal charting. ‘We know periodontal disease is a multi- factorial disease process and patient behavioural routines can play a significant role’