Tuesday, April 28, 2009
I would like to encourage all LANAP dentists to contact the ADA and express your disappointment in their statement.
John S. Findley, D.D.S., president
American Dental Association
211 East Chicago Ave.
Chicago, IL 60611-2678
1410 East 14th Street
Plano, Texas 75074-6359
I am writing about the recent ADA Laser Position Statement now published on the ADA website. I find the ADA’s position to be inaccurate and misleading, especially with regards to LANAP. [As an ADA member] I am disappointed in this final statement that was released without review by the clinicians who developed the LANAP protocol,
Specifically is in not accurate to say, “…the therapy included ‘intrasulcular applications’ to remove ‘sulcular epithelium’.” This study reviewed “moderate to advanced” periodontal disease, and as such periodontal pocket applications of the Nd:YAG were investigated.
The second paragraph on the LANAP protocol appears to be conjecture, opinion, and speculation, and is hardly worthy of an official position statement from the ADA. This paragraph and therefore the ADA’s position statement are seriously flawed. Specifically,
1. This study was, at the time, the 4th largest human histology – with a control group – in the prestigious, peer-reviewed periodontal scientific literature. To call it a “pilot validation” or a small sample size is an attempt to minimize the significance of the findings.
2. It is a completely false representation to state that the “study was not blinded”. The study was blinded to the patient (proximate teeth were treated in all but one case), blinded to the calibrated clinical examiner, and blinded to the histologist.
3. It is disingenuous to state the sample size was small. This was a human histological study that involved the block sectioning of the study along with bone. Human Investigation Review Boards (“IRBs) regard human experimentation very seriously. IRBs regard block section removal of teeth even more rigorously. Consequently, (IRBs) bone block sections of human tooth/bone histology is not performed on the same numbers of patients and teeth, as a clinical study comparing established treatment method and that does not involve intention creation of bony defects
4. The placement of the pre-treatment notches were fully explained in the peer-reviewed manuscript in the December 2007 issue of the International Journal of Periodontics and Restorative Dentistry (IJPRD). Yukna, RA; Carr RL; Evans, GH: Histologic Evaluation of an Nd: YAG Laser-Assisted New Attachment Procedure in Humans. Int J Perio Rest Dent 27(6):577-587, 2007
5. It is absolutely baffling what the Council can possibly mean in the statement regarding extrapolation to early and moderate chronic periodontitis, when considering the beneficial outcomes from advanced periodontitis. This statement is more argumentative than enlightening.
6. Similarly argumentative is the Council’s comments on the creation of a stable fibrin clot (referred to as a “seal” by the Council). If the authors do not understand the benefits of creating a stable fibrin (1st connective tissue) clot, then one must question the expertise of the Council and its members in wound healing 101.
ADA American Dental Association
The Periolase is a Free Running Pulsed Laser. What that means is that it is pulsed at microseconds.
A microsecond (abbreviated as μs) is one millionth of a second
The Perioslase pulses at 100 microseconds with a repetition rate (Hz) of 20.
When the laser is pulsing at 100us 20hz it stays off for 49,000+us, the equivalent of the pulse being on for 1 second and off for 8 minutes -- plenty of time for the tissues to cool and not cause collateral coagulation and necrosis. The flashlamp gives the ability to have a duty cycle of 0.2% (the time the laser is on, compared to the time it is off). Each pulse at 100ms and 20hz is around 2000 watts which kills any p. gingivalis (pigmented or not) and lots of other species. Most diodes have a functional duty cycle of about 25% due to the low wattage and don't kill the bacteria for the same reason.
This is why a pulsed laser is needed for soft tissue treatment of periodontal disease -- wattages need to be high, duty cycles need to be low.
LASER PERIODONTAL SURGERY
Wednesday, April 22, 2009
Nd represents the Periolase the only laser able to do LANAP you can see the depth of penetration can be up to 4 mm. This allows the laser to penetrate into privileged sites deep in the tissue.
Notice the Er being the Erbium (the Syneron, waterlase, Fotana, or Hoya) the CO2 (Deka) have a very shallow depth of penetration.
Monday, April 13, 2009
This image shows the different dental lasers on the bottom each in their respective wavelength. The Periolase is an ND:Yag with a wavelength of 1064 nm. The lines on the graph show the absorption in each of the different tissues. Notice that Melanin, Hb (Hemoglobin), and HbO2 (Oxigenated hemoglobin) completely disappear at about 1100 nm. This correlates to the increase in absorption in water once the wavelength is absorbed in water the rest of the tissues stop absorbing the energy. Therefore the ND:Yag is highly absorbed in Melanin. Dark pigmented anaerobic bacteria are full of Melanin. Dark pigmented bacteria have been postulated as being the primary bacteria responsible for Periodontitis.
Saturday, April 11, 2009
Laser phisics 101
A mplification by
E mission of
The Electromagnetic spectrum shows the different wavelengths on a graph.
Notice the visible spectrum between 400 and 700 nm the periolase is the ND;Yag that is 1064 nm.
If a laser dentist says that their laser can do LANAP it kind of like saying Blue is Red or Green is Yellow.
Each of these colors has a diferent wavelength and are absorbed diferently in diferent tissues.
LASER DENTAL SURGERY
Friday, April 10, 2009
I first looked at the Periolase. You might even have called me a doubting Thomas.
I referred a patient to my periodontist (one of the best in LA, teaches at USC) I knew this patient needed his teeth removed it was confirmed by the perio that he needed implants, and for all the training I had it was a good recommendation.
But the patient didn’t agree he searched for an alternative and found the creator of the LANAP procedure, & had the LANAP done. That was 10 years ago; those loose teeth that I knew needed to be removed are still there and firm. So every 3 months this guy would come into the office I couldn’t deny it had worked for him.
So I started to look into it, because as you know Periodontitis is the #1 cause of tooth loss in adult Americans. And I being a dentist, by definition a dentist doesn’t exist without a patient, and after asking my patients what they wanted from me, the usual response over and over again was “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, so for me it was a patient driven search.
So my journey took me to Dentaltown an online community where 40,000 dentists are signed up and discuss things like perio. Being a doubting Thomas I searched out “The Guy” you know the one “The guy” who always has something negative to say about every procedure or dental product you know “the guy” who always says “it didn’t work for me”. Well after many years of looking for “The Guy” I still haven’t found him. Still looking.
Fortunately the two knuckleheaded Gp’s that developed the LANAP protocol practice nearby so I would refer my hopeless cases to them every time it got harder and harder to refer, they would always try and sell me a laser, but I DIDN’T WANT A LASER!, I wanted to help my patients keep their teeth.
Then after seeing and understanding Ray Yuknas HUMAN histology, the FDA clearance that says “NEW CEMENTUM MEDIATED ATTACHMENT IN THE ABSENCE OF LONG JUNCTIONAL EPITHELIUM” the CRA 9.7 out of 10, never finding “THE Guy” on DT to say anything negative about the procedure or the laser, not being able to refer to anyone who had the laser, seeing my anecdotal case walk in the door every 3 months, I decided, I too wanted to help people keep their teeth. The rest is history you can go on this site to see my x-rays you would be shocked at what my perio readings are 12mm bleeding suppurating pockets going to 2mm healthy sulci, again INCREDIBLE RESULTS time after time. This is why I have NO problem recommending to my colleges this procedure.
LASER GUM SURGERY
He and I both agreed that my patient should have his teeth removed and Implants placed. For everything I knew that was a good recomendation.
His teeth were loose and he had lost most of the bone around his teeth.
But the patient did not want to get screwed with Titanium and searched out an alternative.
Fortunatly he found the creator of the LANAP procedure and had it done in 1997.
This patient has been coming into my practice faithfully every 3 months to have his teeth cleaned.
To this day over 12 years later he still has all his teeth.
In other words it reverses gum disease! The # 1 cause of tooth loss!
I have been a dentist for over 20 years and I have asked my patients
"What can I do for you?" "How can I help you?" "When you and I sit down here in 20 years what do you want?" "What are your dental goals?"
The constant response has been ...
I want to keep my teeth.
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