Dental Tribune United Kingdom Edition

September 10-16, 201222 Perio Tribune United Kingdom Edition sulcus sealed against bacterial infiltration and to prevent the growth of epithelium down into the sulcus. Other laser wave- lengths not only lack the ability to form this stable fibrin clot, but also require repeated treat- ments to prevent epithelium growth down into the sulcus. The ability to select the laser tissue interaction specifically is unique to the PerioLase MVP-7 (Millennium Dental Technolo- gies). Through the use of spe- cific fibre sizes, energy, repeti- tion rates, pulse durations and standardisation of the energy at the fibre tip, this protocol can be followed in a predictable and reproducible manner. The high standard of training that each LANAP doctor receives also contributes to the predict- ability of this protocol and to its safety. Patients often present with different tissue types along with different degrees of dis- ease. One of the purposes of the handson training is learning to recognise these differences and how to change the laser param- eters accordingly so that the de- sired laser–tissue interactions are achieved. Step E The fifth step in LANAP is the compression of the fibrin clot to enhance the healing process. Because laser wounds heal by secondary intention, closer ap- proximation enhances the heal- ing time. Step F Following the compression and stabilisation of the clot, the last step of LANAP is refining the occlusion. Occlusion has been considered a greater cofactor in the progression of periodontal disease than smoking. In order to minimise this role, extensive adjustments are made to the dentition. The patients are then followed for nine to 12 months with routine supra-gingival cleanings and occlusal refine- ments. No sub-gingival restora- tive or periodontal probing is done during this time. Only during the final post-operative visit is a periodontal probing done. The results that are seen from LANAP treatment are very similar to the following cases, where new bone fill can be seen in vertical osseous defects. The bone fill ranges from simple proximal defects to the more complex furcation defects. The hallmark of LANAP is pocket re- duction, new tissue attachment and a lack of tissue recession. _LANAP case 1 The patient in this case was a 40-year-old female patient with a history of lupus, rheu- matoid arthritis and Sjögren’s syndrome. She was also a smoker. There was general- ised deep pocketing as seen in her periodontal charting. The extent of the osseous defect is shown on the lingual view of the right quadrant preoperative CBT scan. The initial post- LA- NAP evaluation was done at 15 months. Post-operative prob- ing is shown in Figure 5. The CBT from the lingual view of the right quadrant at 15 months postoperatively is shown in Fig- ure 6. The change in the osse- ous defects is apparent. Mini- mal to no recession is shown in the preoperative clinical photo- graph in Figure 7 and the post- operative in Figure 8. _LANAP case 2 The patient in this case was a 59-year-old male patient, with Type 1 diabetes and a smoker. His periodontal pocketing was 7 mm on the mesial second pre- molar. The preoperative X-ray is shown in Figure 9 and the 36-month post-LANAP X-ray in Figure 10. The 7 mm pocket had been stable and maintained at 3 mm for the last 36 months. The LANAP protocol will be 21 years old this year. It is com- ing of age. It has stood the test of time. There are over 1,000 trained clinicians applying LA- NAP. They have all been stand- ardised. The uniqueness of the protocol is that whether the doctor is new to LANAP or a vet- eran “LANAP’er”, his results are similar. During its early stages, early adopters accepted LANAP with anecdotal evidence alone, which was reinforced by the individual successes seen clini- cally. It was further validated by Dr Ray Yukna’s histological studies in 2003. As the LANAP multicentre clinical studies move to completion, it would be reasonable to expect to see LANAP become the conven- tional manner or the standard for the treatment of periodontal disease. It is a very simple but eloquent protocol, one in which the patient has no to minimal discomfort and treatment ac- ceptance is high. DT page 21DTß Table 1 Fig. 8_Post-op photograph. Fig. 9_Pre-op X-ray. Fig. 10_Post-LANAP X-ray at 36 months. About the author Dr David Kimmel 12124 Cobble Stone Dr Bayonet Point, Florida 34667 USA E-Mail: dskimmel@mac.com Tel.: +1 727 862 8513 Fig. 6_CBT scan 15 months post-op LANAP. Fig. 7_Pre-op photograph.