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BreakthroughTechnique for Treating Periodontal Disease     Pinnacle Dental Seminars         Dr. Edward Brant              ...
Right Tool For The    Right Job
A Revolutionary Way toTreat Periodontal Disease• How I became interested: • Colleagues • Peer-reviewed research • Failure ...
Pendulum has swung too faraway from saving natural teeth
A Revolutionary Wayto Regenerate Tissue     Before and Afters
Before   After
Before   After
Before   After
Before
After
Before
Before
After
Post - OpAfter
Before   After   After
After
Before
After
Before         After
Before
After 4 weeks
How Credible Is         This Thing?• FDA Approval• Human Histology of New Attachment• CRA rating of 9.7• My own eyes.
A Mysterious New FangledWay to Regenerate TissueWhich Patients Say Yes To• Less traumatic than traditional perio  surgery•...
Periolase MVP-7
Can any laser do this?• For Perio you need a Nd:YAG laser    •   Attracted to dark pigmented tissue and bacteria    •   Kn...
Why This Laser, From       This Company• Laser Physics (Wavelength and Operating  Parameters)   • High Peak Powers for Sho...
Periolase=High Peak Power for        Short Duration
Why This Laser, From          This Company• When the light energy  gets there:   • Bactericidal and seeks the color red   ...
Laser Energy Goes Through Water and     Interacts Only With Pigment
Interaction with Pigment Only
Why This Laser, From  This Company• Deeply Penetrating • 2-7 mm past tip • Into Tissue and up to 1.75 mm into    Dentinal ...
Wielding a Sword to Care for    Periodontal Disease              • High Peak Powers              • Affinity for Red and Bla...
LANAP Protocol• Periostat start one week before and keep  them on for at least 3 months• LANAP 1/2 mouth at a time • Rx an...
Laser Periodontal Therapy or LANAP (Laser     Assisted New Attachment Proceedure• (A) - Anesthetize and                  !...
Laser Periodontal Therapy or LANAP (Laser     Assisted New Attachment Proceedure• (C) - 3 rounds of  scaling and root plan...
Laser Periodontal   Therapy or     LANAP• (D) - Second pass with the laser • Finishes debriding the pocket • Kills gram ne...
Laser Periodontal   Therapy or     LANAP• (F) - Occlusal Adjustment • Depth of the osseous defect is    proportional to th...
Laser Periodontal Therapy or LANAP (Laser   Assisted New Attachment Proceedure                   • (G) -New               ...
Animation of Periolase
Restorative Needs• Extracoronal or  Intracoronal splinting for  excessively mobile teeth
Historical Review          Conclusions•   Remove diseased tissue•   Kill bacteria, remove infection•   Minimize trauma    ...
Preponderance of the   evidence so far•   LANAP obtains pocket reduction by regenerating    tissue not taking tissue away ...
RaffleTime!!!!!!!
Another Tool,                  Another Choice• Offer the patients a   choice  • Laser ANAP  • Scaling and Root Planing, Oc...
How Is Periodontal DiseaseManaged in the General Dental                   Office?• Non-surgically, OHI, Sc and RP, LDD, Rec...
Perio Specialty Has To      Do Better
Problems with Conventional Pocket                Reduction Surgery•   Difficulty in patients accepting    the referral from...
Problems with Conventional Pocket                  Reduction Surgery•   Gingival Recession Which    Can Lead to:    •   Ob...
What Would You WantFor A Family Member?• Imagine what it can do for mild and  moderate cases• Good tool for predictably ha...
Generalized Mild with Localized ModeratePeriodontal Disease
Generalized Moderate to Severe         Periodontitis
Advantages of LANAP•   Little to no post-operative discomfort for patient•   Addresses periodontal disease not only    mec...
Other Uses of the      Periolase• Biostimulation • Trismus • Temporary Relief of Muscle Spasm    Associated with TMD• Peri...
Peri-Implantitis
Outcome   Tissue   4 months   7 months Exam     Check      Later      later          11/09      3/10       10/10 Periolase...
Periolase Is Not Indicated• Comprehensive care or large  Perio-prosth case where  crown lengthening would be  helpful
Periolase Is Not Indicated• Invasion of biological width cases
Periolase Is Not Indicated• Gingival hyperplasia or  deep pseudo-pockets
Disadvantages• Best to do full  mouth                         Shout out to Peebles• Occlusal adjustment        Prosthetic ...
Disadvantages• Active treatment needs to be  bunched together within the first  month• Anti-infective and Anti-collagenase ...
Conclusion• It Works• There is Documentation• Majority of Patients Need It• High Acceptance Rate • No Cut, No Sew = Greatl...
Why Now?• No perfect implant system• Pendulum may have swung too far with extraction  and implant placement
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.

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

  1. 1. BreakthroughTechnique for Treating Periodontal Disease Pinnacle Dental Seminars Dr. Edward Brant St. James December 15, 2010
  2. 2. Right Tool For The Right Job
  3. 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. 4. Pendulum has swung too faraway from saving natural teeth
  5. 5. A Revolutionary Wayto Regenerate Tissue Before and Afters
  6. 6. Before After
  7. 7. Before After
  8. 8. Before After
  9. 9. Before
  10. 10. After
  11. 11. Before
  12. 12. Before
  13. 13. After
  14. 14. Post - OpAfter
  15. 15. Before After After
  16. 16. After
  17. 17. Before
  18. 18. After
  19. 19. Before After
  20. 20. Before
  21. 21. After 4 weeks
  22. 22. How Credible Is This Thing?• FDA Approval• Human Histology of New Attachment• CRA rating of 9.7• My own eyes.
  23. 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. 24. Periolase MVP-7
  25. 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. 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. 27. Periolase=High Peak Power for Short Duration
  28. 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. 29. Laser Energy Goes Through Water and Interacts Only With Pigment
  30. 30. Interaction with Pigment Only
  31. 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. 32. Wielding a Sword to Care for Periodontal Disease • High Peak Powers • Affinity for Red and Black • Deeply Penetrating
  33. 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. 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. 35. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure• (C) - 3 rounds of scaling and root planing ! with EMS Piezo Scaler
  36. 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. 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. 38. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure • (G) -New Attachment Without Junctional Epithelium
  39. 39. Animation of Periolase
  40. 40. Restorative Needs• Extracoronal or Intracoronal splinting for excessively mobile teeth
  41. 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. 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. 43. RaffleTime!!!!!!!
  44. 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. 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. 46. Perio Specialty Has To Do Better
  47. 47. Problems with Conventional Pocket Reduction Surgery• Difficulty in patients accepting the referral from the restorative dentist• Patient Acceptance• Varying degrees of discomfort
  48. 48. Problems with Conventional Pocket Reduction Surgery• Gingival Recession Which Can Lead to: • Objectionable Esthetics • Root Caries
  49. 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. 50. Generalized Mild with Localized ModeratePeriodontal Disease
  51. 51. Generalized Moderate to Severe Periodontitis
  52. 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. 53. Other Uses of the Periolase• Biostimulation • Trismus • Temporary Relief of Muscle Spasm Associated with TMD• Peri-Implantitis
  54. 54. Peri-Implantitis
  55. 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. 56. Periolase Is Not Indicated• Comprehensive care or large Perio-prosth case where crown lengthening would be helpful
  57. 57. Periolase Is Not Indicated• Invasion of biological width cases
  58. 58. Periolase Is Not Indicated• Gingival hyperplasia or deep pseudo-pockets
  59. 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. 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. 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. 62. Why Now?• No perfect implant system• Pendulum may have swung too far with extraction and implant placement

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