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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.
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.