Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of

periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...

, intended to work through

regeneration Regeneration may refer to: Science and technology * Regeneration (biology), the ability to recreate lost or damaged cells, tissues, organs and limbs * Regeneration (ecology), the ability of ecosystems to regenerate biomass, using photosynthesis ...

rather than resection. This therapy and the

laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The fi ...

used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy. In LANAP surgery, a variable free-running pulsed

neodymium Neodymium is a chemical element with the symbol Nd and atomic number 60. It is the fourth member of the lanthanide series and is considered to be one of the rare-earth metals. It is a hard, slightly malleable, silvery metal that quickly tarnishe ...

yttrium Yttrium is a chemical element with the symbol Y and atomic number 39. It is a silvery-metallic transition metal chemically similar to the lanthanides and has often been classified as a " rare-earth element". Yttrium is almost always found in co ...

aluminum Aluminium (aluminum in American and Canadian English) is a chemical element with the symbol Al and atomic number 13. Aluminium has a density lower than those of other common metals, at approximately one third that of steel. It ha ...

garnet Garnets () are a group of silicate minerals that have been used since the Bronze Age as gemstones and abrasives. All species of garnets possess similar physical properties and crystal forms, but differ in chemical composition. The different s ...

( Nd:YAG at 1064 nm wavelength) is used by a dentist or

periodontist Periodontology or periodontics (from Ancient Greek , – 'around'; and , – 'tooth', genitive , ) is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting ...

to treat the

periodontal pocket Gingival and periodontal pockets (also informally referred to as gum pockets) are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth. Tooth gingival inte ...

. The laser is intended to selectively remove diseased or infected pocket epithelium from the underlying connective tissue. The Nd:YAG laser has been shown to reduce levels of microbial pathogens in periodontal pockets and vaporize the pocket-lining epithelium without causing damage to the underlying connective tissue.

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 trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...

s, 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 The alveolar process () or alveolar bone is the thickened ridge of bone that contains the tooth sockets on the jaw bones (in humans, the maxilla and the mandible). The structures are covered by gums as part of the oral cavity. The synonymous t ...

incompatible with normal cell attachment and healing." A 2015 systematic review from the AAP regeneration workshop acknowledged more recent peer-reviewed studies showing periodontal regeneration, and further suggested that the LANAP protocol's minimally invasive nature may offer advantages in the regeneration of defects where minimal soft tissue change is required. The current AAP website indicates that lasers can be used to treat periodontal disease, and current controlled studies have shown that similar results have been found with the laser compared to specific other treatment options, including scaling and root planing alone. The website also states patients should be aware that different laser wavelengths have different applications in periodontal treatment. As of October 2017 studies of lasers in the treatment of periodontitis have yet to provide sufficient evidence that the use of lasers provide benefit over traditional therapy. Compared to Scaling and root planing (S/RP), the LANAP protocol immediately suppresses red and orange complex periodontal pathogens. In 2016, the FDA granted a new clearance of True Regeneration - the ability of the laser to regenerate alveolar bone, cementum, and periodontal ligaments when used with the LANAP protocol.

Benefits of laser gum disease surgery

According to the Academy of General Dentistry (AGD), there are benefits to dental lasers including: reduce symptoms and healing times associated with traditional therapies; reduce the amount of bacteria in both diseased gum tissue and in tooth cavities; and control bleeding during surgery. The 1064 Nd:YAG laser kills at least three different periodontal pathogens without harming normal tissues: (Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi), and Candida albicans (Ca); a pathogenic fungus. This unique aspect of laser irradiation to affect some tissue and not others is termed Selective Photoantisepsis, and is due to differential absorption between host tissue and pathogens. Nd:YAG laser light treatment has shown a long-lasting effect on the shift of bacterial subgingival flora, decreasing pathogenic bacteria and creating an environment where normal flora survives.

References

External links

Laser Assisted New Attachment Procedure in private practice
(General Dentistry, September - October 2004, Vol 52, No. 5.) {{DEFAULTSORT:Laser-Assisted New Attachment Procedure Periodontology Dental lasers

Efficacy

Benefits of laser gum disease surgery

See also

References

External links