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Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
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Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery

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Dr. Brant gives explanation of technique and benefits and explains why laser gum surgery does not hurt compared to traditional flap surgery.

Dr. Brant gives explanation of technique and benefits and explains why laser gum surgery does not hurt compared to traditional flap surgery.

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  • 1. BreakthroughTechnique for Treating Periodontal Disease Pinnacle Dental Seminars Dr. Edward Brant St. James December 15, 2010
  • 2. Right Tool For The Right Job
  • 3. A Revolutionary Way toTreat Periodontal Disease• How I became interested: • Colleagues • Peer-reviewed research • Failure of conventional therapy/refractory cases. • Desire to do more perio and save teeth
  • 4. Pendulum has swung too faraway from saving natural teeth
  • 5. A Revolutionary Wayto Regenerate Tissue Before and Afters
  • 6. Before After
  • 7. Before After
  • 8. Before After
  • 9. Before
  • 10. After
  • 11. Before
  • 12. Before
  • 13. After
  • 14. Post - OpAfter
  • 15. Before After After
  • 16. After
  • 17. Before
  • 18. After
  • 19. Before After
  • 20. Before
  • 21. After 4 weeks
  • 22. How Credible Is This Thing?• FDA Approval• Human Histology of New Attachment• CRA rating of 9.7• My own eyes.
  • 23. A Mysterious New FangledWay to Regenerate TissueWhich Patients Say Yes To• Less traumatic than traditional perio surgery• No scalpels, No Flap, No sutures• Easier recovery - minimal pain, bleeding and swelling
  • 24. Periolase MVP-7
  • 25. Can any laser do this?• For Perio you need a Nd:YAG laser • Attracted to dark pigmented tissue and bacteria • Known to split fibrinogen to fibrin• Not an Erbium • Hard tissue laser• Not a CO2 • OH apatite and water• Not a Diode • Burns non-selectively• Other Nd:YAG lasers are trying but there is NO scientific or anecdotal evidence out there
  • 26. Why This Laser, From This Company• Laser Physics (Wavelength and Operating Parameters) • High Peak Powers for Short Duration • Allows dissipation of heat • Provides effective bactericidal effect
  • 27. Periolase=High Peak Power for Short Duration
  • 28. Why This Laser, From This Company• When the light energy gets there: • Bactericidal and seeks the color red and black • Dark pigmented tissue • Facilitates formation of Fibrin Clot
  • 29. Laser Energy Goes Through Water and Interacts Only With Pigment
  • 30. Interaction with Pigment Only
  • 31. Why This Laser, From This Company• Deeply Penetrating • 2-7 mm past tip • Into Tissue and up to 1.75 mm into Dentinal Tubules
  • 32. Wielding a Sword to Care for Periodontal Disease • High Peak Powers • Affinity for Red and Black • Deeply Penetrating
  • 33. LANAP Protocol• Periostat start one week before and keep them on for at least 3 months• LANAP 1/2 mouth at a time • Rx antibiotics for 7 days • 1/2 mouth of Occ adj• Continuing Occ Adj at post-ops• Nightguard• Perio prophies one mouth after and throughout the year
  • 34. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure• (A) - Anesthetize and ! probe to base of defect• (B) - First pass of laser • Bactericidal • Affect calculus • Denatures pathologic proteins • Removes sulcular lining • Leaves CT intact • Relax and Release tissue tension
  • 35. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure• (C) - 3 rounds of scaling and root planing ! with EMS Piezo Scaler
  • 36. Laser Periodontal Therapy or LANAP• (D) - Second pass with the laser • Finishes debriding the pocket • Kills gram negative bacteria • Initiates stable fibrin clot • Biostimulate reparative process• (E) Compress tissue as needed • Creates closed system
  • 37. Laser Periodontal Therapy or LANAP• (F) - Occlusal Adjustment • Depth of the osseous defect is proportional to the amount of occlusal discrepancy• Occlusal Night Guard
  • 38. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure • (G) -New Attachment Without Junctional Epithelium
  • 39. Animation of Periolase
  • 40. Restorative Needs• Extracoronal or Intracoronal splinting for excessively mobile teeth
  • 41. Historical Review Conclusions• Remove diseased tissue• Kill bacteria, remove infection• Minimize trauma • With occlusal adjustment• Sufficient and stable clot and keep it there• Prevent epithelial downgrowth
  • 42. Preponderance of the evidence so far• LANAP obtains pocket reduction by regenerating tissue not taking tissue away • New bone, cementum, connective tissue fibers• 91% of the teeth had 50 % pocket reduction• Results are reported to be long lasting, low incidence of refractory cases.
  • 43. RaffleTime!!!!!!!
  • 44. Another Tool, Another Choice• Offer the patients a choice • Laser ANAP • Scaling and Root Planing, Occ Adj, LDD • Flap and Osseous Surgery with Regeneration as needed • Extractions and replacement • No Treatment
  • 45. How Is Periodontal DiseaseManaged in the General Dental Office?• Non-surgically, OHI, Sc and RP, LDD, Recalls, etc.• Treatment is often insufficient to control the disease and it becomes a progressively degenerative condition. • Patient acceptance of referral is statistically low • Financial • Anxiety
  • 46. Perio Specialty Has To Do Better
  • 47. Problems with Conventional Pocket Reduction Surgery• Difficulty in patients accepting the referral from the restorative dentist• Patient Acceptance• Varying degrees of discomfort
  • 48. Problems with Conventional Pocket Reduction Surgery• Gingival Recession Which Can Lead to: • Objectionable Esthetics • Root Caries
  • 49. What Would You WantFor A Family Member?• Imagine what it can do for mild and moderate cases• Good tool for predictably handling periodontal disease
  • 50. Generalized Mild with Localized ModeratePeriodontal Disease
  • 51. Generalized Moderate to Severe Periodontitis
  • 52. Advantages of LANAP• Little to no post-operative discomfort for patient• Addresses periodontal disease not only mechanically, but at the bacterial level• Little to no recession• Bone regeneration possible without additional grafting materials• Presurgical root planing not required• More conservative than traditional osseous surgery, leaving options for retreatment open• Removal from blood thinners not required
  • 53. Other Uses of the Periolase• Biostimulation • Trismus • Temporary Relief of Muscle Spasm Associated with TMD• Peri-Implantitis
  • 54. Peri-Implantitis
  • 55. Outcome Tissue 4 months 7 months Exam Check Later later 11/09 3/10 10/10 Periolase used to get control of peri-implantitis
  • 56. Periolase Is Not Indicated• Comprehensive care or large Perio-prosth case where crown lengthening would be helpful
  • 57. Periolase Is Not Indicated• Invasion of biological width cases
  • 58. Periolase Is Not Indicated• Gingival hyperplasia or deep pseudo-pockets
  • 59. Disadvantages• Best to do full mouth Shout out to Peebles• Occlusal adjustment Prosthetic required• NightGuard• Final Restorative ideally needs to be delayed for one year
  • 60. Disadvantages• Active treatment needs to be bunched together within the first month• Anti-infective and Anti-collagenase Medications• Diet Modifications• Extra-Coronal Splinting
  • 61. Conclusion• It Works• There is Documentation• Majority of Patients Need It• High Acceptance Rate • No Cut, No Sew = Greatly Reduced Fear• Less Invasive, Less Painful, More conservative
  • 62. Why Now?• No perfect implant system• Pendulum may have swung too far with extraction and implant placement

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