Trisha Shetty (Editor)

Laser assisted new attachment procedure

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Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of periodontitis, intended to work through regeneration rather than resection. This therapy and the laser used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy. LANAP is presented as an alternative to traditional treatment methods for patients with severe gum disease, and, when paired with regular control and maintenance of overall oral health, can result in reduced gum loss, pain and inducement of periodontal regeneration.

In LANAP surgery, a variable free-running pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG at 1064 nm wavelength) dental laser is used by a dentist or periodontist to treat the periodontal pocket. The laser is intended to selectively remove diseased or infected pocket epithelium from the underlying connective tissue.

The PerioLase MVP-7, the Nd:YAG laser used during the LANAP protocol, received FDA clearance for Periodontal regeneration – true regeneration of the attachment apparatus (new cementum, new periodontal ligament, and new alveolar bone) on a previously diseased root surface when used specifically in the LANAP Protocol on March 2016.

CO2 laser systems (at the 10,600 nm wavelength) including LightScalpel, Lutronic, and Cynosure are also cleared by the FDA for the "Laser Assisted New Attachment Procedure."

Efficacy

The use of lasers in treating periodontal disease has been seen by some dental professionals as controversial. The American Academy of Periodontology stated in 1999 that it was "not aware of any randomized blinded controlled longitudinal clinical trials, cohort or longitudinal studies, or case-controlled studies indicating that 'laser excisional new attachment procedure (or Laser ENAP)' or 'laser curettage' offers any advantageous clinical result not achieved by traditional periodontal therapy. Moreover, published studies suggest that use of lasers for ENAP procedures and/or gingival curettage could render root surfaces and adjacent alveolar bone incompatible with normal cell attachment and healing." The current AAP website indicates that lasers can be used to treat periodontal disease, but patients should be aware that different laser wavelengths have different appropriate applications in periodontal treatment.

Newer articles suggest the LANAP protocol offers advantages over conventional surgery when treating certain medically compromised patients. Due to the minimally invasive nature of the protocol and the hemostatic capacity of the Nd:YAG laser, discontinuing anticoagulation therapy is ordinarily not needed. Since 2001, 375 cases have been published documenting positive results for LANAP patients, including demonstrated bone regrowth in most.

References

Laser-assisted new attachment procedure Wikipedia


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