1) scaling and root planning
2) flaps and osseous remodeling
It was evident that the upper two modalities were unpredictable regrading the regenration of bone,fibers and the attachment around the teeth. Although scaling and root planning eliminate the bacteria from around the teeth, the long epithelium tissue would grow in around the tooth before the bone can make its regeneration,thus preventing the bone and surrounding tissue from rebuilding back around the teeth.
Nowadys, a third modality has been introduced to the bouquet;the LANAP
The LANAP (Laser Assisted New Attachment Procedure) allows removal of the inflamed epithelium,cleaves bond between calculus and root surface and kills biofilm.Thus scaling and root planning becomes effective. The final pass with the LANAP laser stimulates osseous regenration and leads to the formation of a fibronectin clot.
According to John chrispens DDS,the Laser for use in the LANAP procedure is the Nd:YAG and namely the periolase MVP-7.2.
The patient is asked not to brush in the area for one week post LANAP therapy.
Each laser works within a specific wavelength. Nd:YAG absorbes within the range of heme(darker colors),therefore penetrates into the tissue.
The Diode laser uses heat,therefore burns the tissue and penetrates only a short distance into the gingival sulcus before causing damage to the tissues. The CO2 and Er:YAG are absorbed by H2O, which is at the surface of oral tissues and do not penetrate into the gingival sulcus. Therfore, they have little effect on the biofilm in areas greater than 2mm subgingivally. The goal of the LANAP is not biofilm control but regenration.
Some periodontists contradict this formula. They suggest a membrane to stop epithelial cells from growing down into the socket and give bone and fibroblasts a chance to grow up.They say the laser will de-epithelialize the pocket but the epithelium will still grow back.
The LANAP protocol:
A) Perio probe indicates excesssive pocket depth
B) Laser radiation vaporizes bacteria, diseased tissue, pathologic proteins, and alerts the practioner to the presence of tartar.
C) Ultrasonic scaler and special hand instruments are used to remove root surface accretions.
D) Laser is used to form a gel-clot containing stem cells from bone and Periodontal ligaments.
E) Reattachment of rete ridges to clean root surface, with a stable fibrin clot at the gingival crest to create a closed system.
F) occlusal trauma adjusted
G) New attachment is regenerated
