Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
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Dr. Brant gives explanation of technique and benefits and explains why laser gum surgery does not hurt compared to traditional flap surgery.
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Similar a Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
Similar a Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery (20)
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Long Island Dental Specialist aka Periodontist uses Laser Periodontal Surgery and Dental Implant Surgery
- 1. Breakthrough Technique for Treating Periodontal Disease Pinnacle Dental Seminars Dr. Edward Brant St. James December 15, 2010
- 10. Right Tool For The Right Job
- 11. A Revolutionary Way to Treat Periodontal Disease • How I became interested: • Colleagues • Peer-reviewed research • Failure of conventional therapy/refractory cases. • Desire to do more perio and save teeth
- 12. Pendulum has swung too far away from saving natural teeth
- 13. A Revolutionary Way to Regenerate Tissue Before and Afters
- 14. Before After
- 15. Before After
- 16. Before After
- 17. Before
- 18. After
- 19. Before
- 20. Before
- 21. After
- 22. Post - Op After
- 23. Before After After
- 24. After
- 25. Before
- 26. After
- 27. Before After
- 28. Before
- 29. After 4 weeks
- 30. How Credible Is This Thing? • FDA Approval • Human Histology of New Attachment • CRA rating of 9.7 • My own eyes.
- 31. A Mysterious New Fangled Way to Regenerate Tissue Which Patients Say Yes To • Less traumatic than traditional perio surgery • No scalpels, No Flap, No sutures • Easier recovery - minimal pain, bleeding and swelling
- 32. Periolase MVP-7
- 33. Can any laser do this? • For Perio you need a Nd:YAG laser • Attracted to dark pigmented tissue and bacteria • Known to split fibrinogen to fibrin • Not an Erbium • Hard tissue laser • Not a CO2 • OH apatite and water • Not a Diode • Burns non-selectively • Other Nd:YAG lasers are trying but there is NO scientific or anecdotal evidence out there
- 34. Why This Laser, From This Company • Laser Physics (Wavelength and Operating Parameters) • High Peak Powers for Short Duration • Allows dissipation of heat • Provides effective bactericidal effect
- 35. Periolase=High Peak Power for Short Duration
- 38. Why This Laser, From This Company • When the light energy gets there: • Bactericidal and seeks the color red and black • Dark pigmented tissue • Facilitates formation of Fibrin Clot
- 39. Laser Energy Goes Through Water and Interacts Only With Pigment
- 40. Interaction with Pigment Only
- 41. Why This Laser, From This Company • Deeply Penetrating • 2-7 mm past tip • Into Tissue and up to 1.75 mm into Dentinal Tubules
- 42. Wielding a Sword to Care for Periodontal Disease • High Peak Powers • Affinity for Red and Black • Deeply Penetrating
- 44. LANAP Protocol • Periostat start one week before and keep them on for at least 3 months • LANAP 1/2 mouth at a time • Rx antibiotics for 7 days • 1/2 mouth of Occ adj • Continuing Occ Adj at post-ops • Nightguard • Perio prophies one mouth after and throughout the year
- 45. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure • (A) - Anesthetize and ! probe to base of defect • (B) - First pass of laser • Bactericidal • Affect calculus • Denatures pathologic proteins • Removes sulcular lining • Leaves CT intact • Relax and Release tissue tension
- 46. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure • (C) - 3 rounds of scaling and root planing ! with EMS Piezo Scaler
- 47. Laser Periodontal Therapy or LANAP • (D) - Second pass with the laser • Finishes debriding the pocket • Kills gram negative bacteria • Initiates stable fibrin clot • Biostimulate reparative process • (E) Compress tissue as needed • Creates closed system
- 48. Laser Periodontal Therapy or LANAP • (F) - Occlusal Adjustment • Depth of the osseous defect is proportional to the amount of occlusal discrepancy • Occlusal Night Guard
- 49. Laser Periodontal Therapy or LANAP (Laser Assisted New Attachment Proceedure • (G) -New Attachment Without Junctional Epithelium
- 51. Restorative Needs • Extracoronal or Intracoronal splinting for excessively mobile teeth
- 52. Historical Review Conclusions • Remove diseased tissue • Kill bacteria, remove infection • Minimize trauma • With occlusal adjustment • Sufficient and stable clot and keep it there • Prevent epithelial downgrowth
- 55. Preponderance of the evidence so far • LANAP obtains pocket reduction by regenerating tissue not taking tissue away • New bone, cementum, connective tissue fibers • 91% of the teeth had 50 % pocket reduction • Results are reported to be long lasting, low incidence of refractory cases.
- 61. Another Tool, Another Choice • Offer the patients a choice • Laser ANAP • Scaling and Root Planing, Occ Adj, LDD • Flap and Osseous Surgery with Regeneration as needed • Extractions and replacement • No Treatment
- 62. How Is Periodontal Disease Managed in the General Dental Office? • Non-surgically, OHI, Sc and RP, LDD, Recalls, etc. • Treatment is often insufficient to control the disease and it becomes a progressively degenerative condition. • Patient acceptance of referral is statistically low • Financial • Anxiety
- 63. Perio Specialty Has To Do Better
- 64. Problems with Conventional Pocket Reduction Surgery • Difficulty in patients accepting the referral from the restorative dentist • Patient Acceptance • Varying degrees of discomfort
- 65. Problems with Conventional Pocket Reduction Surgery • Gingival Recession Which Can Lead to: • Objectionable Esthetics • Root Caries
- 66. What Would You Want For A Family Member? • Imagine what it can do for mild and moderate cases • Good tool for predictably handling periodontal disease
- 67. Generalized Mild with Localized ModeratePeriodontal Disease
- 68. Generalized Moderate to Severe Periodontitis
- 69. Advantages of LANAP • Little to no post-operative discomfort for patient • Addresses periodontal disease not only mechanically, but at the bacterial level • Little to no recession • Bone regeneration possible without additional grafting materials • Presurgical root planing not required • More conservative than traditional osseous surgery, leaving options for retreatment open • Removal from blood thinners not required
- 70. Other Uses of the Periolase • Biostimulation • Trismus • Temporary Relief of Muscle Spasm Associated with TMD • Peri-Implantitis
- 71. Peri-Implantitis
- 72. Outcome Tissue 4 months 7 months Exam Check Later later 11/09 3/10 10/10 Periolase used to get control of peri-implantitis
- 73. Periolase Is Not Indicated • Comprehensive care or large Perio-prosth case where crown lengthening would be helpful
- 74. Periolase Is Not Indicated • Invasion of biological width cases
- 75. Periolase Is Not Indicated • Gingival hyperplasia or deep pseudo-pockets
- 76. Disadvantages • Best to do full mouth Shout out to Peebles • Occlusal adjustment Prosthetic required • NightGuard • Final Restorative ideally needs to be delayed for one year
- 77. Disadvantages • Active treatment needs to be bunched together within the first month • Anti-infective and Anti-collagenase Medications • Diet Modifications • Extra-Coronal Splinting
- 78. Conclusion • It Works • There is Documentation • Majority of Patients Need It • High Acceptance Rate • No Cut, No Sew = Greatly Reduced Fear • Less Invasive, Less Painful, More conservative
- 79. Why Now? • No perfect implant system • Pendulum may have swung too far with extraction and implant placement