Laser-assisted new attachment procedure

The use of lasers in treating periodontal disease has been seen by some dental professionals as controversial.{{cite journal |vauthors=Cobb CM, Low SB, Coluzzi DJ |title=Lasers and the treatment of chronic periodontitis |journal=Dent. Clin. North Am. |volume=54 |issue=1 |pages=35–53 |year=2010 |pmid=20103471 |doi=10.1016/j.cden.2009.08.007}} The American Academy of Periodontology stated in 1999 that it was "not aware of any randomized blinded controlled longitudinal clinical trials, cohort or longitudinal studies, or case-controlled studies indicating that 'laser excisional new attachment procedure (or Laser ENAP)' or 'laser curettage' offers any advantageous clinical result not achieved by traditional periodontal therapy. Moreover, published studies suggest that use of lasers for ENAP procedures and/or gingival curettage could render root surfaces and adjacent alveolar bone incompatible with normal cell attachment and healing."{{cite web | author = The American Academy of Periodontology | date = August 1999 | title = Statement Regarding Use of Dental Lasers for Excisional New Attachment Procedure (ENAP) | url = https://www.perio.org/sites/default/files/files/PDFs/Clinical%20Resources/Statement%20Regarding%20Use%20of%20Dental%20Lasers%20for%20ENAP.pdf}} A 2015 systematic review from the AAP regeneration workshop acknowledged more recent peer-reviewed studies showing periodontal regeneration,{{cite journal|vauthors=Nevins ML, Camelo M, Schupbach P, Kim SW, Kim DM, Nevins M |title=Human clinical and histologic evaluation of laser-assisted new attachment procedure|journal=The International Journal of Periodontics and Restorative Dentistry|date=2012|volume=32|issue=5|pages=497–507|pmid=22754897}} and further suggested that the LANAP protocol's minimally invasive nature may offer advantages in the regeneration of defects where minimal soft tissue change is required.{{cite journal|vauthors=Kao RT, Nares S, Reynolds MA |title=Periodontal regeneration - Intrabony defects: A systematic review from the AAP Regeneration Workshop|journal=J Periodontol|date=Feb 2015|volume=86|issue=2Suppl|pages=S77–S104|doi=10.1902/jop.2015.130685|pmid=25216204}} The current{{when?|date=October 2024}} AAP website indicates that lasers can be used to treat periodontal disease, and current controlled studies have shown that similar results have been found with the laser compared to specific other treatment options, including scaling and root planing alone. The website also states patients should be aware that different laser wavelengths have different applications in periodontal treatment.{{cite web|url=https://www.perio.org/consumer/laser-therapy.htm|title=Laser Treatment for Gum Disease|last=|first=|date=|website=American Academy of Periodontology|access-date=6 March 2017}}

In 2016, the FDA granted a new clearance of True Regeneration - the ability of the laser to regenerate alveolar bone, cementum, and periodontal ligaments when used with the LANAP protocol.{{clarify|date=October 2024}}{{cite web |last1=FDA Clearance |title=510K Clearance |url=https://www.accessdata.fda.gov/cdrh_docs/pdf15/K151763.pdf |website=Food and Drug Administration |access-date=12 November 2018}}

As of October 2017 studies of lasers in the treatment of periodontitis have yet to provide sufficient evidence that the use of lasers provide benefit over traditional therapy.{{Cite journal|last=Cobb|first=Charles M.|date=October 2017|title=Lasers and the treatment of periodontitis: the essence and the noise|journal=Periodontology 2000|volume=75|issue=1|pages=205–295|doi=10.1111/prd.12137|issn=1600-0757|pmid=28758295|s2cid=206284632}} Compared to Scaling and root planing (S/RP), the LANAP protocol immediately suppresses red and orange complex periodontal pathogens.{{cite journal |last1=McCawley |first1=Tom |last2=McCawley |first2=Mark |last3=Rams |first3=Thomas |title=Effects of LANAP on Chronic Periodontitis Microbiota |journal=Journal of the International Academy of Periodontology |date=2018 |volume=20 |issue=4 |pages=163–171 |pmid=31522151 }}

According to the Academy of General Dentistry (AGD), there are benefits to dental lasers including: reduce symptoms and healing times associated with traditional therapies; reduce the amount of bacteria in both diseased gum tissue and in tooth cavities; and control bleeding during surgery.{{cite web |title=What is Laser Dentistry |url=https://knowyourteeth.com/infobites/abc/article/?abc=L&iid=780&aid=3803 |website=Know Your Teeth|publisher=Academy of General Dentistry |date=January 2012 |access-date=18 April 2017}}

The 1064 Nd:YAG laser kills at least three different periodontal pathogens without harming normal tissues: (Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi), and Candida albicans (Ca); a pathogenic fungus. This unique aspect of laser irradiation to affect some tissue and not others is termed Selective Photoantisepsis, and is due to differential absorption between host tissue and pathogens.{{cite journal|title=The Black Bug Myth: Selective photodestruction of pigmented pathogens|journal=Lasers in Surgery and Medicine|date=September 2016|volume=48|issue=7|pages=639–719|doi=10.1002/lsm.22573|doi-access=free}}

Nd:YAG laser light treatment has shown a long-lasting effect on the shift of bacterial subgingival flora, decreasing pathogenic bacteria and creating an environment where normal flora survives.{{cite web |first1=Erica|last1=Migliorati |title=Lasers and bacterial reduction: A comprehensive technique to treat chronic periodontitis |url=http://www.dentistryiq.com/articles/wdj/print/volume-2/issue-2/focus-on-perio/lasers-and-bacterial-reduction-a-comprehensive-technique-to-treat-chronic-periodontitis.html |website=Dentistry IQ |access-date=28 April 2017 |date=2004-02-01}}

{{Portal|Medicine}}

• List of laser articles

{{reflist}}

• [http://www.millenniumdental.com/pdf/MDT-GD-Sept-Oct-2004.pdf Laser Assisted New Attachment Procedure in private practice] (General Dentistry, September - October 2004, Vol 52, No. 5.)

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Category:Periodontology

Category:Dental lasers