Quote: from Rod on 1:10 pm on Mar. 23, 2003
…….
To me, root planing is numero uno!  Even before the diode laser, I’ve gotten incredible results with non-surgical.  Not uncommon to take 7-8 mm pockets to a 2 or 3.  Yes, I’m assuming I get a long junctional epithelial attachment, but I’ve found them to be, in general, very durable if the patient continues proper home care. [/quote]

Pt kept on 3 month recall then?

Quote: from Rod on 1:10 pm on Mar. 23, 2003
Next (I’d better hide on this one), I put all my patients on doxycycline for two weeks.  I insist we complete their mouth within the first week so that they still have a full week of doxycycline after we are totally finished.

Doxycycline is not only antibacterial, but it reduces natural collagenase.  It’s also been shown to enhance root attachment of fibroblasts.  Now, I’m not saying we’re gonna get a fibrous attachment, but in my book, any medication that can be shown to enhance fibroblast attachment has GOT to be making the tissues ‘happy’, and I’ll take ‘happy’ tissue any day.[/Qoute]

Any followup drug therapy? I know many advocate 3mths on Periostat, then 3 mths off,etc. 

Quote: from Rod on 1:10 pm on Mar. 23, 2003I use the laser on that visit, and that’s it!  I do NOT go back in to decomtaminate.  I just don’t see the reason.  [/Quote]
What about wanting to heal ‘bottom up’ and prevent epithelial down growth?

Quote: from Rod on 1:10 pm on Mar. 23, 2003 I scare the holy **** out of the patients by telling them the TRUTH about what will happen in the future if they don’t perform proper home care.  Are these ‘scare tactics’?  Well, if telling them the truth is scary, then so be it.  And I tell them exactly that.
[/Quote]

Is this where that ‘surgery’ word comes in?

Quote: from Rod on 1:10 pm on Mar. 23, 2003Someday, I hope to get around to checking out Bob’s laser more closely.  Now THAT sounds major cool!  Like some others, I do have some skepticism about actual bone regeneration, but only because I just haven’t had the time to really look into it deeply. [/Quote]

Make sure you see the histology slides he has of fibers reattaching/bone fill. I used to hate those slides in school thinking they were really all ink blot tests , but those I saw Bob show were impressive .

I know you advocate use of the Oral B 3d excel , do you have your patients using both the hydrofloss and  3D?

Thanks once again for sharing,

Hi Guys.

Great discussion!

Of course Rod has always got a TON of great stuff to share.

I really need to sit down with you Rod and–over a few beers of course–hash it all out with you.  My Power Point against yours!!  How about it?

Seriously though (and not excluding the beer), I don’t think we are that far off in our approach.  But we do have some great technology that makes a hugh difference over CW diodes.  And Ron’s right on,  we do have some killer human histology that shows bone, PDL, cementum regeneration–thanks Ron.

To answer Al:

There is a body of evidence as long as you are not “rfw” from the Dental Town posts (again, Ron, thanks for reminding me about that!:biggrin:).

In fact, the body of scientific evidence for pulsed Nd:YAG lasers goes back over 14 years starting with now deseased Marsh Midda, a once renowned international periodontist from Birmingham, England.

Now when I say that, I mean we have a body of scientific evidence that shows pulsed Nd:YAG lasers have additional effects that traditional S/RP alone does not have.  Like 99.9% reduction in bacteria over SR/P alone.  Like 100% removal of epithelium in 85% of the human histo sections at VERY low powers, better than SR/P alone.  And many other studies by Horton, Mellonig, even Cobb showing that lasers have an additive effect over SR/P alone.

Having said that, the Hecklers like “rfw” say, yeah but, there are no Head-to-Head peer reviewed, controlled, split-mouth longitudinal studies that show an addittional effect over SR/P alone.

Well, yes we do, but that really wasn’t where the investigations into the basic science questions were until recently.

So then Mellonig and Neill publish their paper.  And Placard Protesters like “rfw” say it is “underpowered”, and therefore irrelevant.

Controlled, Blinded, Prospective, Longitudinal University Clinical Trial

Neill ME; Mellonig JT. Clinical Efficacy of the Nd:YAG Laser for Combination Periodontitis Therapy. Practical Perio & Aesthetic Dentistry (Supp) Vol 9, No 6, August 1997, pp 1-5.

Results: Dr. Mary Elizabeth Neill, DDS, MS, and former AAP president James T. Mellonig, DDS, MS wrote: “…these findings suggest a longer lasting effect for the laser therapy in altering subgingival microflora. Clinical significance of these findings may suggest that mechanical scaling and root planing therapy alone may not be the most effective mode of treatment in patients infected with Porphyromonas gingivalis and Prevotella intermedia,…” “There are several additional areas where the adjunctive use of the Nd:YAG laser may be an advantage over scaling and root planing alone as a mechanical approach to nonsurgical therapy. These include the analgesic effect of the Nd:YAG laser, the hemostatic effect, and the antibacterial potential of laser energy.”

Perio critics criticized Mellonig’s and Neill’s study for being “underpowered” with only 10 patients, and for being published as a journal supplement, not peer reviewed. Still, the results of the controlled, prospective university trial, and the peer reviewed, retrospective “real world” clinical trial were nearly identical–except the private practice study treated patients with much more severe disease and pocket depths.

Yes.  Well, with a pulsed Nd:YAG:

Peer Reviewed, retrospective, blinded, multi-centered, private practice clinical study

Sulcular debridement with pulsed Nd:YAG

Harris, David M., Univ. of California/San Francisco School of Dentistry; Gregg, Robert H., McCarthy, Delwin K., Colby, Leigh E., Tilt, Lloyd V., Private Practice

Publication: Proc. SPIE Vol. 4610, p. 49-58, Lasers in Dentistry VIII, Peter Rechmann; Daniel Fried; Thomas Hennig; Eds.

Publication Date: 6/2002

We present data supporting the efficacy of the procedure, laser sulcular debridement (laser curettage), as an important component in the treatment of inflammatory periodontal disease. Laser Assisted New Attachment Procedure (LANAP) is a detailed protocol for the private practice treatment of gum disease that incorporates use of the PerioLase pulsed Nd:YAG Dental Laser for laser curettage. Laser curettage is the removal of diseased or inflamed soft tissue from the periodontal pocket with a surgical dental laser. The clinical trial conducted at The University of Texas HSC at San Antonio, Texas, evaluated laser curettage as an adjunct to scaling and root planing. They measured traditional periodontal clinical indices and used a questionnaire to evaluate patient comfort and acceptance. The Texas data (N=10 patients) are compared with pocket depth changes following LANAP. LANAP data were obtained from a retrospective review of patient records at three private practices (N=65). No significant differences in post treatment probe depth changes were found among the four centers indicating that the procedure produced consistent, favorable outcomes, and that results from controlled scientific clinical trials can be replicated in private practices. Reduction in pocket depths following laser treatment compare well with results obtained with scalpel surgery. The use of the laser offers additional benefits. We also present quantitative evidence from digitized radiographs of increased bone density in affected areas following LANAP.

http://spie.org/scripts….qs=spie

Study of 65 patients and over 1900 probing sites showed that laser periodontal therapy using a specific modality called “LANAP” for “Laser Ablation New Attachment Procedure” was reproducible in reducing 90% of pockets without any recession in ONE treatment by a minimum of 50% regardless of pocket depth as such:

> 4mm – 2.2mm reduction
> 6mm – 3.1mm reduction
> 8mm – 4.5mm reduction

By the way, “rfw” STILL hasn’t called me!  HA!

Oh, on another note–recent unpublished research completed and reported to me last Friday–shows pulsed Nd:YAGs have a 24 fold lethality factor in killing periodontal bacteria, with no thermal damage to subjacent tissues compared to diodes.

Bob

Hi Pat,

You’re back! How was your trip to South America?

What was your initial plan that you are referring to?

Come on up, don’t be nervous, I’ll be gentle…….I promise, you won’t feel a thing:biggrin:.

No laser physics course needed to visit. But you’ll come away with a different persepctive on all this stuff, I think.

Bob

Hi all,
As an absolute beginner with laser, I tried laser perio treatment on a friend of mine 2months ago. We carried out SRP 6 months before without much improvement.
Here’s what I did:
LA given,
Bolitec 980 , irrigating handpiece with saline irrigation into pockets at 4W 0.05sec on/0.05sec off, 15sec per tooth.
SRP,
Relase pockets with same parameters.
2 months after treatment, she returned last Saturday with pocket reductions from 9mm to 3mm. Lingual areas of lingually inclined lower molars showed the least improvement/no improvement ( 3 pocket sites ). All other areas improved to 3-4mm pocket depths.
Now I know I should have waited longer before checking up on the pockets.
She was very happy before she heard about the pocket depth improvements. She said she could feel a vast difference with this treatment.
Am I just lucky with this case?
It couldn’t be the SRP as it didn’t improve much after the first course of SRP.
Ken  

(Edited by Kenneth Luk at 12:03 pm on May 22, 2003)

David,
You’re not the only one.
i’ve been doing this and taking it to my other office once a week.
Ken