This lecture reviews the role of laser therapy in dentistry in particular for Periodontal treatment. Dr. Smith reviews many of his own cases with the audience.
Please contact Dr. Smith with questions.
drsmith@cpident.com
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
INTRODUCTION
HISTORY
PRINCIPLES OF WORKING OF A LASER
FUNDAMENTALS OF LASER
CHARACTERISTICS OF LASER
CLASSIFICATION OF LASER
EFFECTS OF LASER ON SOFT AND HARD TISSUES
VARIOUS LASERS AVAILABLE FOR PERIDONTAL USE
APPLICATION OF LASER TREATMENT IN PERIODONTAL THERAPY
ADVANTAGES & DISADVANTAGES OF LASER IN PERIODONTAL THERAPY
LASER PRECAUTIONS
LASER HAZARDS
RECENT ADVANCES
CONCLUSION
Gingivectomy and gingivoplasty are the periodontal surgical procedures. It was first introduced by Pierre fauchard. It is used in pocket elimination by gingival resection whereas gingivoplasty refers to recontouring of gingiva in the absence of pockets.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
INTRODUCTION
HISTORY
PRINCIPLES OF WORKING OF A LASER
FUNDAMENTALS OF LASER
CHARACTERISTICS OF LASER
CLASSIFICATION OF LASER
EFFECTS OF LASER ON SOFT AND HARD TISSUES
VARIOUS LASERS AVAILABLE FOR PERIDONTAL USE
APPLICATION OF LASER TREATMENT IN PERIODONTAL THERAPY
ADVANTAGES & DISADVANTAGES OF LASER IN PERIODONTAL THERAPY
LASER PRECAUTIONS
LASER HAZARDS
RECENT ADVANCES
CONCLUSION
Gingivectomy and gingivoplasty are the periodontal surgical procedures. It was first introduced by Pierre fauchard. It is used in pocket elimination by gingival resection whereas gingivoplasty refers to recontouring of gingiva in the absence of pockets.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Lasers and its role in endodontics/certified fixed orthodontic courses by Ind...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Fluoroscopy ,Radiation safety and contrast agents including adverse effect an...Dr Ravi Shankar Sharma
IT includes everything related to fluoroscopy, radiation exposure, it,s effects, contrast agents , and it,s newer variants including gadolinium, anaphylaxis reactions and it,s management, images for epidural,intrathecal,subdural, intrarterial and intravenous contrast picture.
Light is an integral part of our life. Advances in technology are increasing and changing the ways that the patient experience dental treatment. One of the milestones in technological advancements in dentistry is the use of lasers The early 20th century saw one of the greatest inventions in science & technology, in that LASERS which later went on to became a gift to health sciences. Albert Einstein is usually credited for the development of the laser theory. He was the first one to coin the term “Stimulated Emission” in his publication “Zur Quantentheorie der Strahlung”, published in 1917 in the “Physikalische Zeitschrift”
Lasers are devices that produce beams of coherent and very high intensity light. The word LASER is an acronym for “Light Amplification by Stimulated\Emission of Radiation”. A crystal or gas is excited to emit light photons of a characteristic wavelength that are amplified and filtered to make a coherent light beam. The effect of the laser depends upon the power of the beam and the extent to which the beam absorbed. Several types of lasers are available based on the wavelengths. These range from long wavelengths (infrared), to visible wavelengths, to short wavelengths (ultraviolet), to special ultraviolet lasers called excimers. Lasers are used nowadays in many areas in the field of dentistry It is of the most captivating technologies in dental practice. Even though, introduced as an alternative to the traditional halogen curing light, laser now has become the instrument of choice, in many dental applications. Its advancements in the field of dentistry are playing a major role in patient care and well being.
LASER SURGERY
Class 4 > 500 mW Surgical lasers
Introduction
Surgery using a laser to cut tissue instead of a scalpel
Laser scalpel
Highly focused laser beam efficiently ablates (either vaporize or chip away) the living tissue.
At the same time, it seals (welds) capillaries, small blood vessels, lymphatics, and nerve endings, with significant benefits to both patients and surgeons.
MECHANISM OF ACTION
Photovaporolysis
Char – remnant of non-fluid cellular component.
Photoplasmolysis
Crater
Zone of carbonization- the limit of vaporization
Zone of coagulation and thermal necrosis- Slightly farther away from the center. This zone will eventually die.
Zone of hyperthermia- Farthest from the center. Beyond these zones there is no effect Depth of the crater and the diameter of these zones are directly related to power density.
20-watt Carbon Dioxide laser with plume evacuator
Highly absorbed by water, making it perfect for tissue cutting, vaporization and acoustical destruction.
Thermal injury to surrounding tissue is very superficial.
Lateral thermal injury of 0.05 mm to 0.1 mm
Because there is such minimal lateral thermal damage, injury to surrounding tissues is limited to what you see during application of the laser energy.
General parameters for CO2 laser use
Routine incision: Spot Diameter: 0.4 mm
Power Setting: 6 to 10 W
Routine ablation/vaporization Spot Diameter: 0.8 mm
Power Setting: 10 to 20 W
Delicate location incision: Spot Diameter: 0.3 to 0.4 mm
Power Setting: 3 to 6 W
Routine excision: Spot Diameter: 0.8 mm
Power Setting: 8 to 15 W
LASER USES
Less Pain - The laser seals nerve endings as it cuts. So the patient will have less pain.
Less Bleeding - The laser seals small blood vessels during surgery and speeds up surgery by minimizing bleeding.
Less Swelling - No physical contact except the invisible laser beam. The tissue will not be crushed.
Sterilization - The laser sterilizes the surgical site as it cuts. Bacteria and viruses are vaporized by the laser during laser surgery.
Faster Recovery - Less bleeding and swelling will result in faster healing.
Precision - The beam direction and power can be controlled precisely to remove thin layers of tissue and produce minimal side effects on the surrounding healthy tissue.
Reduced hospitalization time - All above factor will greatly reduce the procedure time.
Laser surgery benefits for surgeons
Unique surgical capabilities: Laser surgery improves many surgical procedures by making them simpler and reducing risk. This enables surgeries that are not practical with conventional methods.
Laser science is principally concerned with quantum electronics, laser construction, optical cavity design, the physics of producing a population inversion in laser media, and the temporal evolution of the light field in the laser. It is also concerned with the physics of laser beam propagation, particularly the physics of Gaussian beams, with laser applications, and with associated fields such as non-linear optics and quantum optics.
he ability of the laser to ablate prostatic tissue with minimal hemorrhage has concentrated most of the interest in urologically applied lasers to benign prostatic hyperplasia (BPH) [Anson et al. 1994]. Despite tremendous advances in the surgical and minimally invasive treatment of BPH, transurethral resection of the prostate (TURP) is still considered the ‘gold standard’. The risks of TURP are always mentioned when discussing the reasons for seeking alternative treatment modalities for BPH. Bleeding certainly remains a concern, especially in patients on some form of anticoagulation (heparin, coumarin related compounds, antiplatelet agents) or those with prostates in excess of 60–80 g. On the other hand, with the availability of transurethral resection in saline (TURiS), the TURP syndrome is nowadays considered by many to be a relatively rare complication
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Course Objectives
•
Brief History and Science of Lasers
•
Lasers and their use in Dentistry
•
Lasers in the Treatment of Periodontal Disease
•
LANAP and the opposing view
•
What you can do with this knowledge
3.
4. • 31% of adults surveyed by the ADA
said it was VERY important that my
dentist has a laser!
5.
6. Excuses for not using lasers
•
Too Expensive
•
Learning Curve Too Steep
•
Safety
•
Not Better Than Traditional Treatment
8. Benefits of lasers as described by
Dentists
• Increase patient comfort
• Increase effectiveness of treatment
• Improve patient acceptance of care
• Increase reparative and regenerative healing of patient
• Increase types of procedures by provider
• Improve office image
12. Lasers in Dentistry
• 1965 Gold used Ruby and CO2 Lasers
• 1970s CO2 and Nd:YAG (cw) on teeth
• 1980s Emphasis switched to incision of soft
tissue with CO2
• 1990s Introduction of Diode and Er:YAG and
pulsed Nd:YAG
14. Laser Basics
•
Electromagnetic Energy and the Photon and Wavelengths
•
Wavelength Spectrum - Relevance to Laser Dentistry
•
Pulsing Laser Energy vs. Continuous Wave Laser Energy
•
Absorption of Laser Energy by Water, Hemoglobin and
Pigmentation
•
Effects of Laser Energy on Tissue
15. Einstein’s THeory
Einstein and Niels Bohr
postulate the theory of
stimulation of
electromagnetic field to
emit amplified light
16. Einstein introduces the Photon
When an electron moves
from a higher energy level
to a lower energy level, a
photon (particle of light) is
emitted. Light emitted this
way (from movement of
charged particles) is called
radiation.
25. Pulsed Vs Continuous
Continuous emission of laser energy will non-selectively
ablate tissue
Pulsed Energy increases Wattage to area and reduces
Duty Cycle (time laser on)
Generally Nd:YAG runs 0.2% of time. This reduces
thermal effects on tissue
Varying the Pulse Duration can provide additional
benefits such as ablating tissue and hemostasis
26. Absorption of Laser Energy in
Tissue
Co2 and Erbium Lasers high
Absorption in water and
hydroxyapatite
Nd:YAG high absorption in dark
30. Laser Effects on Tissue
Photothermal – absorbed by tissue and converted to heat
Photodisruptive (Acoustic) – Pulsed laser energy converted to
mechanical energy in form of shock wave
Photochemical – laser energy converted into chemical energy.
Photodynamic – Requires light absorbing chemical to produce
biochemical reactive form of oxygen – singlet oxygen
Biostimulation – LLLT absorption of photon energy directly by
Mitochondria and improve healing, pain relief.
Cut tissue, ablate tissue, disinfect, coagulate, biostimulate
31. Common Lasers In Dentistry
• Diode
• Nd:YAG
• Er:YAG
• CO2
– 810, 940, 980nm
– 1064nm
– 2780nm
– 10,000nm
34. Lasers are Not Created Equal!
Laser Medium – Gas, crystal, solid state
Medium determines Wavelength (Frequency)
Wavelength Absorbed Differently by H2O and Tissue
Absorption Depth Determined by Wavelength
Pulse and Duration focus and concentrate Energy
36. Er:YAG = BioLase
•
2780 Wavelength
•
Absorbed by water and Hydroxyapatite
•
High Surface absorption
•
Excellent for hard tissue removal
•
Non-Selective for Soft tissue removal
•
Fiberoptic Delivery
37. CO2 Laser
•
10,000Nm mostly continuous wave
(millisecond pulsing offered in some)
•
Non contact
•
Absorbed by Water and Hydroxyapatite
•
Excellent for cutting soft tissue and surface
ablation
•
Hollow tube Delivery
38.
39. Diode
•
940nm (810nm and 980nm also)
•
Absorbed by Water
•
Continuous wave with programmable
pulsed setting
•
Disposable fiberoptic Delivery
52. What Laser is best for Periodontal Disease?
Periodontal Disease Manifests Clinically as Red Inflamed Tissue
The Disease is initiated by Bacteria generally black pigmented
anaerobes that invade tissue and cementum
53. Prevalence Of Periodontal
Disease
• 200 Million US Adults and nearly 95% have some form of
Periodontal disease with 30% having Moderate to Severe
Periodontitis
• Only 3% of the Moderate to Severe actually get treatment!
• When Detected and Treated Early this Disease Does not
have to be as Destructive regarding, Function, Phonetics,
Esthetics or Systemic Implications!
54. Complex Disease
• Commonly regarded as an interaction between bacteria and our
body’s host Response
• Contributory Factors include – Genetic Susceptibility, Systemic
Disease, Extrinsic Factors, Occlusal Forces and Local Irritants.
• Unfortunately there has been no Treatment Panacea!
59. Regeneration of Periodontium
• Berube – 1947 – Studied whether Regeneration was
possible of alveolar bone, ligament and cementum.
• Goldman – 1949 – Intrabony Pockets and defects could be
reversed via Regeneration
• Carranza – 1954 – Identified New PDL, cementum and
bone – or regeneration
• Essential Elements for Regeneration: Complete
Removal of Pocket Epithelium, Complete Sterility of the
Pocket, Well organized Fibrin Clot
61. Disadvantages of Regenerative
Surgery
•
Surgical manipulation of tissue with consequences
•
Increased sensitivity and risk of root decay
•
Cost of Procedure
•
Fear of Surgical Procedure
•
Must have Patients Cleared of Any Medical Issues i.e. clotting
concerns
65. LANAP Protocol
Full Mouth Treatment completed in one to two visits
No need for pretreatment Scaling
Nd:YAG laser used to disinfect and de-epithelize
Ultrasonic Instrumentation of roots
Nd:YAG laser used to develop sterile clot
Occlusal management:
splinting, occlusal guards, occlusal adjustment
67. Laser Requirements for Periodontal
Treatment
Want to Destroy Quantity and Quality of Bacteria
Want to De-Epithelialize
Want to Penetrate into cementum and gingival thickness
Want to Minimize damage to healthy tissue
Want to Stimulate Regeneration
68. Nd:YAG Gram Negative Effects
90% Perio Pathogens are black pigmented, gram negative,
anaerobic,
Porphyromonas Gingivalis is the key Red Complex pathogen
P. gingivalis resides, replicates in Epithelial, macrophages,
dentinal tubules
P. gingivalis found within Carotid Plaque
69. Nd:YAG Gram Negative Effects
Porphyromonas Gingivalis, Strongly correlated with
Periodontitis
Ablation of Pg with Nd:YAG complete and to a depth of
2mm from surface.
Kill rate 16x greater with Nd:YAG vs Diode
Blood samples prior to and after LANAP show complete
reduction of P.gingivalis 3 days after therapy
70. BioFilm Disruption
Laser irradiated surfaces removed bacteria from biofilm and
hard surfaces
Abrupt decrease in bacterial ATP = cell mortality
Effective bacterial ablation and slower rate of recolonization
71. BioFilm Disruption
4 different substrates biofilm seen to oscillate and break
off and instantly removed from substrate without effect
on substrate
55% bacterial reduction from laser shockwaves alone
independent of heat or wavelength
72. Elimination of Pocket Epithelium
Histologic study showed complete removal of diseased
epithelium without damaging the underlying tissue layers with
Nd:YAG.
Deeper penetration of Nd:YAG vs. Diode
73. Nd:YAG Host Modulation Effect
Decreased levels of pro-inflammatory proteins in tissue and
GCF.
Reduced IL-1b,IL-6, TNF, MMP-8, LPS
Increased levels of anti-inflammatory proteins
Increased IL-10, IL-18
74. LANAP is Evidence Based
Only Periodontitis Protocol with Scientific Proof
75. Nd:YAG vs Diode
Won’t Achieve Same Results – Peak Power energy over
2000 Watts with Fr Nd:YAG. Diode = 40 Watts
Need high peak pulse power to achieve penetration into
tissue
Diode has Hz or Repetition rate that is unable to
generate Penetration
No Hot Tip Effect with Nd:YAG – activated tips with
Diode
Thermal Damage to Connective Tissue with Diode
Too Hot or Not Hot Enough
77. LANAP Research - Early
10 Published Non-Peer Reviewed Articles Published
between 1998-2002 75 total Patients
Radiographic Bone Gain Stable over 10 years
Probing Depth Reduction over 10 years
All Patients had positive change in probing and or
radiographic sites.
78. Human Histology 1999
Single Pass of Nd:YAG 4 W, 100usec, 200mj to pocket
depth of 10mm
No Damage to Connective Tissue but Pocket Epithelium
totally eliminated
79. Journal of General Dentistry –
2004, Harris, David
Laser assisted new attachment procedure in private
practice
42 patients from 200 patient records in practice
91% of total sites reduced probing depths by 45% at 6
months.
Learned from these Early Studies that the healing time
requires up to one year for Results to be seen
84. Histologic Evaluation of Nd:YAG
Yukna - 2007
All LANAP Specimens:
New cementum and connective tissue
Control Specimens:
No new cementum or connective tissue
85. Histologic Evaluation of Nd:YAG
Yukna - 2007
Histologic evaluation 3 months post LANAP
LANAP vs. Control of SRP alone
86. Histologic Evaluation of Nd:YAG
Yukna 2007
Mean probing depth reduction
LANAP – 4.7mm
Control – 3.7mm
Attachment Gain
LANAP – 4.2mm
Control – 2.4mm
87. Dentistry Today 2008, Long, Craig
Non Peer Reviewed
New Attachment Procedure – Case Study
Comparison of xrays and probing at one year
Results 68.9% mean probe depth reduction
88. General Dentistry -2012, Tilt, Lloyd
Tooth Longevity: Measure to other Studies (laser)
LANAP – Significant reduction of lost teeth in clinical
practice.
LANAP – 0.4 teeth lost, other protocols average 2 teeth
% Downhill patients – 5% LANAP 15-20% other
Re-treatment – LANAP 15% total patients
89. Research Not Yet Published
2nd LANAP Human Histology Study – Marc Nevins
12 total teeth multi and single rooted teeth
Notched at apical extent of defect
All of these Hopeless teeth (15mm, mobility, recession 50%)
– All twelve returned to clinical Radiographic and histologic
health
10 teeth new attachment to bottom of notch
6 of ten teeth had cementum mediated new attachment
90.
91. Univ. Of Colorado
LANAP Data
LANAP Data
One year after treatment:
PD < 3mm
52%
93%
PD 4-6mm
36%
6.6%
PD 7-9mm
8.9%
0%
PD >10mm
0.7%
0%
92. Research Current
5 multi site locations (University Settings)
Randomized, blinded, longitudinal, calibrated
4 quad design LANAP vs. SRP vs. Flap vs. Coronal
Debridement
75 Total patients – 53 done to date
159. Post-Op Care - Patient
Three days of liquid diet
Soft food for one month
Two weeks Q-tip cleaning of area
Chlorhexidine on Q-tip or rinse two weeks.
Soft toothbrush for one month – then sonic brush
No flossing for two weeks
Flossing after two weeks to gum line only – one month
Maintenance visit one to two months after last session of
LANAP
160. Hygiene Post LANAP
No Probing for at least six months post LANAP
No subgingival scaling for six months post LANAP
Hand scalers and supra-coronal polish – ultrasonic on low
power just to gingival margin
Fluoride treatment OK
Low level laser treatment OK for disinfection
161. Patient Had Not been to Dentist in
20 years –
Referred to Physician – No
Systemic Problems
CT scan Obtained
182. LAPip Peri-Implantitis
Same protocol but reduced power 20-30J per pass
Ultrasonics used on lower level and with special tip
Second pass done to provide fibrin clot
Results showing great promise to reduce inflammatory
effects and gain clinical attachment.
184. Why LANAP over Traditional Approach?
Addresses all Treatment Objectives
Better Decontamination of Pocket
BioStimulatory and Regenerative
Shorter Active Treatment 2 weeks vs. 2 years
Less Invasive and Less Morbidity than Surgery
Not Necessary to Go Off Anti-Coagulants
Better Patient Treatment Acceptance
185. Laser Assisted Hygiene Therapy
Nd:YAG, Diode, Er:YAG – All can be used
Goals: Decontaminate, De-epithelialize
Decontaminate ALL patients prior to maintenance
De-Epithelialize pockets over 5mm or bleeding
SRP with hand instruments AND ultrasonics
Irrigating via Ultrasonices with medication ?
PerioScience Anti-Inflammatory rinses
Perioscope for Better Root Debridement
Voice: Let’s first talk about the quality of dentistry. The exclusive 940 nm wavelength used by the Ezlase delivers better dentistry because it was developed for dental procedures. Tissue does not have to be inflamed or pink to cut well, and it provides better hemostasis than other wavelengths. And take a look at these clinical photos – the 940 nm wavelength is a much cleaner cut and does not char.