LANAP™ (Laser Assisted New Attachment Procedure)
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Invented over 25 years ago, the Laser Assisted New Attachment Procedure (LANAP™) is among the newest procedures used to treat periodontal disease using the PerioLase MVP-7™ Nd:YAG laser.
It is important to note that LANAP™ is an FDA-patented protocol, which can only be achieved using the PerioLase™ Nd:YAG laser. Unlike other lasers, the PerioLase™ was invented to specifically accomplish the LANAP™ protocol. Using digitally controlled pulse durations down to microseconds, or 10-6 seconds, the PerioLase™ delivers a precise amount of energy for treatment which Dr. Noraian records much the same way dosages of medication are recorded. All lasers are not created equal and their uses are limited by the medium used to create the laser energy inside of them.
What About LANAP™?
When you have periodontal disease, LANAP™ offers you a regenerative treatment option that is more comfortable, more cosmetic, less invasive, and less expensive with results that are comparable to guided bone regeneration or bone grafting.
Cosmetically, this procedure is the most preserving of tissues about the teeth compared to any procedures requiring traditional flap access. Any treatment of periodontal disease has some effect on the inflammation caused by the disease process. As the inflammation resolves, there will be some shrinkage of the soft tissues, and LANAP™ keeps this change to a minimum because only the unhealthy tissue is removed.
Full mouth treatment with LANAP™ may reduce the time for a surgical procedure by about 50%. The procedure is offered as either a full mouth treatment in one sitting or two half mouth procedures split over two visits not more than one month apart. Typically, the one sitting option is accomplished most comfortably with conscious sedation, similar to what is used for procedures such as a colonoscopy.
Occlusal adjustment, or adjusting the high contacts of the teeth, is an integral part of the LANAP™ protocol. The reason for this component of care is to allow the new attachment to adhere to teeth that are not moving from traumatic contacts as it is difficult for the body to heal to a moving target. Over time, teeth may have shifted significantly due to the disease process and likewise the adjustment may also be significant requiring fillings, crowns or bridgework to be remade. We caution you about this possibility as dentalwork may be replaced whereas teeth cannot.
Post-operative instructions will be reviewed at your consultation and at subsequent visits and provided in writing. Narcotic post-operative medications are not needed after this procedure as you may feel similar to what you might expect from a good thorough deep cleaning of your teeth and gums. The effectiveness of the procedure generally depends on the patient’s willingness to follow a strict post-operative diet and careful oral care.
Periodontal maintenance every three months at our office is a required part of your follow up process for the first 12 months following surgery. Dr. Noraian requests completing this important procedure at our office as our staff are aware of how to avoid disrupting the healing tissues at your maintenance visits. We do ask you to continue to see your general dentist for check-ups above the gumline during this initial 12 months after surgery at an interval they deem appropriate for you. At your 12-month maintenance visit, Dr. Noraian will perform a complete periodontal examination, adjust your bite as needed, your teeth will be cleaned and a full mouth set of radiographs will be taken.
Why Cleanings Every 3 Months?
The bacteria responsible for periodontal disease repopulate after about three months time as shown in the periodontal research. In order to disrupt the flora, keep the teeth and root surfaces free of deposits, and control your body’s reaction to bacteria, Dr. Noraian advocates cleaning your teeth every three months and this regimen is just as important following LANAP™.
Steps of LANAP™
There are 22 distinct steps associated with LANAP™ and for discussion purposes we have consolidated them to seven noted below to correspond with the pictures above:
- Once adequate anesthesia has been achieved, the bone is sounded to accurately record the bony defect caused by the disease.
- Digitally pulsed laser energy removes the diseased tissue from the inner pocket lining and sterilizes the pocket bacteria associated with gum disease while leaving the healthy tissue undisturbed.
- As the pocket opens, the laser energy loosens the hard deposits allowing for special scalers to more easily clean the root surface.
- On a different setting, the pocket is re-entered with the laser light to create a sticky fibrin blood clot which helps seal the pocket to keep out debris and to allow the gum to heal from the inside out.
- The tissue is light compressed to keep the size of the blood clot to a minimum and further seal the pocket.
- To keep the teeth from banging against each other and dislodging the clot, the occlusion is adjusted. The occlusion will be checked and adjusted during the healing period as needed. Some cases require splinting and/or a nightguard for additional stabilization of the teeth.
- Over the next 6 to 18 months, the body will continue to heal and a new connective tissue attachment will form.
Dr. Noraian’s Experience with LANAP™
In 2008, Dr. Noraian was certified to use the PerioLase™ and he was the first periodontist in Illinois to acquire it for the benefit of his patients. He was taught by the inventors, Dr. Robert Gregg and Dr. Delwin McCarthy; Dr. Raymond Yukna, the periodontist who conducted the FDA research which confirmed that cementum-mediated new attachment (regeneration) occurs with LANAP™; Dr. Lloyd Tilt, who published the first work showing reduction of tooth loss long-term with LANAP™ consistent with other methods of periodontal surgery. Since acquiring the PerioLase™, Dr. Noraian has completed many cases of LANAP with similar success rates to Guided Bone Regeneration.
It is important for Dr. Noraian to provide you with the risks, benefits and alternatives to your treatment options which he will review with you at your treatment consultation.