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new attachment procedure (LANAP), is a therapy designed for the
effective treatment of periodontitis through regeneration rather than
resection. This therapy, and the laser which performs it (The PerioLase
MVP-7, Millennium Dental Technologies, Inc.) have long been in use by
the dental community. LANAP is a U.S.
Food and Drug Administration-approved patented protocol for the
treatment of periodontitis, or gum
disease. LANAP was developed and perfected in Cerritos, California
over many years by Dr.
Robert H. Gregg II and Dr. Delwin McCarthy to be patient-friendly,
dentist-friendly, effective, and predictable.
In LANAP surgery, a variable pulsed Neodymium:Yttrium-Aluminum-Garnet
(Nd:YAG) dental laser is used by a trained and certified dentist or
periodontist to treat the periodontal pocket. The laser energy selectively
removes diseased pocket epithelium and pathogenic bacteria (p. gingivalis)
from the underlying connective tissue. The necrotic epithelium is stripped
from the connective tissue at the histologic level of the rete pegs
and rete ridges. Since the laser energy is quite selective for pocket
epithelium, the underlying pleuripotential connective tissue is spared,
thereby permitting healing and regeneration rather than formation of
a pocket seal by long junctional epithelium. In periodontics it is a
process through which cementum-mediated periodontal ligament new attachment
to the root surface in the absence of long junctional epithelium is
achieved for the treatment of moderate to severe gum
disease (including gingivitis and periodontal
disease). Stimulation of existing stem cells permits the formation
of new root surface coating (cementum) and new connective tissue (periodontal
ligament) formation (collagen) on tooth roots. The paradigm of periodontal
healing in the absence of guided tissue regeneration barriers (GTR)
or bone grafting materials (allografts) has finally been successfully
challenged in the twenty first century.
LANAP science is always advancing. Most notably, the work of Raymond
A. Yukna (University of Colorado, formerly Louisiana State University)
has provided histologic, statistical, and radiographic evidence which
demonstrate proof of principle validity that LANAP results in pocket
depth reduction via cementum-mediated new attachment. This split mouth
study, comparing scaling and root planing to LANAP, employed radiographic
and histologic evidence derived from teeth harvested en bloc. Cementum-mediated
new attachment was a universal finding for the teeth which received
LANAP. Generally, the teeth receiving scaling and root planing evidenced
only long junctional epithelium as expected.
LANAP, most patients experience new root surface coating (cementum)
and new connective tissues (periodontal ligament) formation (collagen)
on tooth roots, preventing tooth loss. Pocket depth reduction is excellent
and comparable to that achieved by conventional resective osseous or
pocket reduction surgery, but without the gingival recession normally
associated with osseous surgery. Significant post-operative reduction
in gingival indices, gingival inflammation, and bleeding on probing
are also desirable results of LANAP
The patient experience is also generally positive. As LANAP is tissue-sparing
and contrary to the old fashioned resective paradigm, patients enjoy
a smile with minimal post-operative recession and attendant disfigurement
or root sensitivity. Minimization of post-therapy gingival recession
also reduces the future risk of root caries/dental decay of the tooth
root. Through the natural analgesic biostimulatory effects of laser
irradiation, patients usually have minimal post-operative discomfort.
This discomfort is easily controlled through the use of Non-Steroidal
Anti-Inflammatory Drugs (over the counter NSAIDs) such as Ibuprofen.
With normal three month periodontal recall and maintenance, the LANAP-provided
new attachment is remarkably stable and resistant to future periodontal
breakdown. Patients are encouraged to improve and maintain standards
of oral hygiene to prevent further active periodontitis.
See Laser Periodontal Therapy