YAG
I concur entirely with Dr. Harrel’s post below.
Aloha,
MRethman
To: periotherapist@yahoogroups.com From: safetysuction@yahoo.com Date: Sun, 31 Aug 2008 09:50:14 -0700 Subject: RE: [periotherapist] Re: Periolase and Nd: YAG
Mike et al
I must have missed the initial post on this but I tried to piece it together from what remained in my mailbox.
First, let me repeat that I am very skeptical of LANAP. The ENAP was proven in a controlled study (by its originator – Ray Yukna) to NOT work. The only difference between and ENAP and LANAP is the use of the laser. The Magic Wand? Ray’s histology of LANAP published in JOP was interesting but unconvincing.
As you might guess, I have to comment on the occlusal aspect of the post. There is good evidence in a controlled trial (Burgett 1992) that an occlusal adjustment is very beneficial for non-surgical and surgical wound healing after periodontal treatment (roughly 0.50 mm improvement in mean attachment levels when compared to patients that had not had occlusal adjustment). In the material that I will be presenting at the AAP meeting next week, I will shows that certain occlusal contacts/discrepancies may be twice the risk factor for the progression of periodontal disease than are the traditional risk factors of male, smoking, and unsatisfactory OH. I plan on stating that anyone treating periodontal disease should treat the occlusion or you are ignoring one of the most treatable and most damaging risk factor in periodontal disease. That will probably get me in trouble! I have been there before.
I gleaned from some of the past conversations that someone recommended that the teeth to be treated with LANAP should be taken out of occlusion. Nothing in the literature supports this and I feel clinically that you would be doing a disservice to the patient. Occlusal stress should be minimized but the tooth should remain in function. That means a “definitive” occlusal adjustment should be performed not the shotgun approach of taking the tooth out of occlusion.
Steve
Category: dentistry
Robert Gregg, DDS Said,
September 7, 2008 @ 10:57 am
Dr Harrel - I can appreicate that you are skeptical of LANAP. But comparing scalpel ENAP to FRP Nd:YAG laser ANAP is comparing apples and oranges. LASIK to radial keratotomy. As far as the occlusion goes, I completely agree with you about the critical importance of removing occlusal interferences. That you might “get into trouble” with your presentation is a place I can relate to. But your understanding of what we ascribe to is not complete. We reduce the occlusion proprotionate to the extent of disease that the occlusal trauma contributes. Since I am a GP and perform root canal therapy, it is common practice to remove an endodontically involved/abcessed tooth completely out of occlusion. Is the periodontal considerations in a similarly abcessed periodontal attachment apparatus any different? We think in LANAP it is not. I look forward to listening to your lecture on Monday. Respectfully, Robert Gregg, DDS