PerioLase
Re: “I went to the PerioLase website and reviewed steps A-F. Let’s see if
I was able to copy/paste them~ not sure. Mike, tell me if I am off
base here but it looks like a Widman flap procedure~ incision is made
with pulsed laser irradiation instead of a scalpel. The epithelium is
dissected so that the root can then be adequately debrided with good
visibility and the end result is long junctional epithelium. Lynne”
M.Rethman: You got it. BTW, in the late 1970’s and early ’80’s there was a procedure called ENAP (for single-rooted teeth)… the same thing as LANAP only the first used a scalpel, the second a laser. ENAP as a distinct surgical entity fell apart when research noted no special capabilities for it or for curettage. Ray Yukna was one of the main names associated with ENAP back then, LANAP now.
For LANAP do achieve more than ENAP (or anything else for that matter), the laser must induce some sort of tissue differentiation into the specialized tissues (eg., cementum, etc.) natural attachment of tooth to alveolus. I’ve learned to never say never, but I suspect there is no magic that-got-stumbled-upon with the laser, more likely it’s biological crock, that permits sexy “hi-tech” marketing. (Another term that come to mind as a synonym for ENAP/LANAP is “surgical curettage.”)
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Category: dentistry
Robert Gregg, DDS Said,
September 7, 2008 @ 9:57 am
Just fooling around this morning before the start of the AAP in Seattle and celebraing Googles anniversary, I “googled” “periolase” and found this blog. As the co-developer of LANAP I’d like to clarify some misconceptions. 1st - the pulsed Nd:YAG laser doesn’t “cut” or “incise” gum tissue in the LANAP protocol in the same way a scalpel does in ENAP. A scalpel indiscriminately cuts through the diseased epithelium AND the connective tissue “rete ridges”. The pulses of 1064nm Nd:YAGin the 100 millionths of a second reflect off of CT and the rete ridges and are threfore not effected, but the diseased epithelium is selectively cleaved (aka “ablated”) off of the CT basement membrane. That’s is a critical element in tissue regeneration in that native stem cells (fibroblasts) are not injured. 2nd - It true that there is no “magic” with any laser–including the PerioLase MVP-7 and the LANAP protocol. There is, however, photonics and quantum physics in play as postulated by Albert Einstein, invented by Dr TH Maiman, and applied in medicine and dentistry for 40 and 20 years, respectively, that often confound our conventional training and understanding of the biologic and physiologic processes we thought we fully understood when we learned Newtonian physics (being celebrated at the AAP this year) in dental school. But “energy” of light (measured in electron volts or eV’s)behaves differently as a treatment modality in bilogic tissues than cold stainless steel - like LASIK vs radial keratotomy for eye refration. 3rd - the ability to change laser operating parameters and warm the blood (protein denaturization vs vaporization) at the end of the LANAP protocol permits a thermogenic clot vs a chemolytic cleavage of the fibrinogen to fibrin. This allows the gingival collar of tissue to be closed to the entire width and depth of the perio defect by a “white connective tissue fibrin” clot that seal the tissues closed. Once there is a closed system, the wounds of the periodontal tissues heal like any wounds in the mouth that have been successfully closed, such as in an apicoectomy (see Goldman 1945). Regeneration is then permitted. Applied physics, not magic.