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SwpmnSpectatorNd:YAG users please help me understand the differences between two currently recommended protocols for treatment of periodontitis. Lares Laser SoftCare and Millennium Dental Technologies(MDT) Laser Periodontal Therapy(LPT):
A) Diagnosis phase similar.
B) Laser SoftCare appears to advocate that the hygienist initially debrides calculus/plaque from the patient with an ultrasonic scaler. Nd:YAG laser is not used during this phase. Root planing/scaling with hand instruments is performed conventionally.
C) Laser Periodontal Therapy protocol indicates that initially the dentist, using chemical anesthesia, applies the Nd:YAG at 100-150usec Pulse Duration(PD) to open a gingival trough around the affected teeth. This provides access to the root structure for removal of calculus and also some degree of coagulation. Then the dentist uses an ultrasonic or perhaps piezoelectric scaler plus hand instruments to remove calculus.
D) Laser SoftCare implies that during the second phase of treatment(after hygienist debridement), the dentist applies the Nd:YAG fiber at 120usec PD to vaporize epithelial lining, debriding the pocket(sulcular debridement). Coagulation is also achieved during this phase and if necessary PD is increased to 300usec to provide increased coagulation.
E) Laser Periodontal Therapy seems to indicate that during the closing phase, a PD greater than 300usec and perhaps up to 650usec may be necessary to achieve proper coagulation. This results in a stable fibrin clot which provides the scaffolding for true regeneration of the periodontium including cementum, osseous structures and periodontal ligament. Here I’m a bit unclear on PD necessary to finish the procedure – some references I have show final PD as 150-650usec.
F) Both protocols mention pressure to compress tissue against the root surface and stabilize the clot.
G) MDT LPT protocol includes adjustment of occlusion and splinting of mobile teeth.
Thanks for your help,
AnonymousGuestAllen, I can’t speak to the Lares protocol but you have the Millenium LPT down pretty well. As far as PD for the final pass coagulation, I find that I’m most often in the 550-650 usec range, although in some anterior areas I have decreased that significantly even going as low as 150. It does vary with the pocket and surrounding tissue.
I can’t imagine a hygienist 1st doing SRP. How are they going to get adequate access? Is Lares still providing their training via CD?
czeqm8SpectatorThere are a couple of things with the scaling procedure that are different with the protocol from Mellinium than what is mentioned here. I will let Bob chime in if he chooses. I am not able to teach the LANAP protocol. It is a patented procedure. The way I understand it, if I tell you they will hunt me down and …… Just kidding. I just don’t think that I can do a good job with the instruction, and I am sure Bob will see this soon.
Matt
Robert Gregg DDSSpectatorHey Allen,
We taught Lares everything they know about laser perio–but not everything we know.:cool:
Yet, we continue to learn about laser perio as we still practice what we innovated–and patented.
Laser SoftCare is a poor substitute/knock-off for LANAP. (Now you all know a key reason we patented the procedure!)
Laser SoftCare has no scientific or clinical data or studies to support their methodology in the same manner in which Millennium has for LANAP. Everything they reference is other people’s stuff and old methodologies repackaged as SoftCare.
I’m sure any pending or near-future 510(k) application for Laser ANAP would have nothing to reference other than the PerioLase MVP-7 as a “predicate” device.
Even if some company could get FDA clearance for Laser ANAP, and could successfully avoid patent/copyright litigation from Millennium Dental–it isn’t just knowing the parameters and the steps within the steps of the LANAP protocol, but knowing when to use what and how. That’s all part of training of the sort you cannot get on some CD-ROM for ALD recognized Standard Proficiency and some pig jaw and black ink on paper exercises.
So like Ron stated, sometimes 150 is a more appropriate hemostasis setting under certain circumstances.
The various circumstances are not likely to be known by a manufacturer w/o clinical expertise–or their incompletely trained substitute clinicians who may have slept through Bootcamp and/or not completed Day 4.
Maybe later I’ll tell you what I REALLY think @&^%$
Bob
SwpmnSpectatorQUOTEI can’t imagine a hygienist 1st doing SRP. How are they going to get adequate access? Is Lares still providing their training via CD?Thanks, Ron, and that appears to be one of the key differences in the protocols, that LPT is a dentist-only CONSERVATIVE form of periodontal surgery. The dentist uses the Nd:YAG laser to open the gingival sulcus for access to roots, calculus and pathogens. Isn’t another reason for the first pass with Nd:YAG is that the laser treatment may alter calculus composition/adherence and perhaps facilitate removal?
Lares provides the user with CD training. There is an option to have a Lares clinician come to the dentist’s office and instruct the doctor while procedures are performed on his/her patients. Appears that this is not included in the fee for the laser unit itself. Rather easy to see that this type of education would pale in comparison to the comprehensive training mandated by MDT.
SwpmnSpectatorMatt and Bob:
That’s cool guys – not asking anyone to reveal proprietory information and appreciate your comments. My objective is to have an accurate, general knowledge of the protocols and be able to differentiate the procedures as well as their respective Nd:YAG systems.
AnonymousGuestQUOTEQuote: from Swpmn on 4:25 pm on July 6, 2005
Isn’t another reason for the first pass with Nd:YAG is that the laser treatment may alter calculus composition/adherence and perhaps facilitate removal?Correct. Seems like the number I remember is 30% easier removal. I’ll see if I can find the study but I bet Bob G. probably has it
Robert Gregg DDSSpectatorFunny Ron,
Sounds like you are feeling better?
Liu showed 50% less working stokes after FRP Nd:YAG. Day 2 Notebook “Laser Literature”.
Now to go and torment David K.
Bob
AnonymousGuestSorry, I must have converted the % into metric for our non US visitors. 😉
Actually, I think its called 1 week vacation and the 30% is what I forget about laser studies!
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