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 From
Wikipedia, the free encyclopedia
Laser-assisted 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.
 After
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
Old school detractors (Periodontists) do exist and
tend to feel that LANAP does not succeed in its surgical
result. According to the American Academy of Periodontology:
"In conclusion, The Academy is not aware of any
randomized blinded controlled longitudinal clinical
trials, 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 incompatible
with normal cell attachment and healing." However,
when considering this information, this 10 year old
undated statement by the American Academy of Periodontology
was made in August 1999 and has since been rendered
irrelevant by additional peer reviewed publications,
namely the Yukna manuscript of human histology published
in the International Journal of Periodontics and Restorative
Dentistry in 2007, and the Harris article in General
Dentistry in November 2004.
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