The ADA has come out with recommendations. Of interest is the following:

They do not recommend prophylactic antibiotics routinely.

In addition, immediately prior to and following surgical procedures involving bone, the patient should gently rinse with a chlorhexidine containing rinse. Typically, chlorhexidine is used two times per day for two months post surgery. This can be extended based on how the patient is healing.

Prophylactic antibiotics may be utilized during the healing/wound closure phase, for procedures that involve extensive manipulation of the bone (e.g. extractions, periodontal recontouring, sinus lifts etc.) but is not mandatory nor even recommended. Use of prophylactic antibiotics depends on the clinician’s level of concern relative to the individual patient and their specific situation including concomitant risk factors (i.e. prolonged use of oral bisphosphonates, older age, concomitant use of estrogen or glucocorticoids ∗). In some situations, prophylactic antibiotics may be instituted a day or two prior to the procedure.

I think that we should be just fine with our normal LANAP routine, but you might want to increase the chlorhexidine just to be safe.

Go to the ADA website for a complete list of recommendations.

(Edited by czeqm8 at 7:06 pm on June 15, 2006)

Here is an interesting case I saw Friday afternoon. !5 yr old boy with a history of petet mal seizures since birth. Taking Dilantin 100mg tid, Phenobarb. 10 mg tid (I believe). His DDS did an exam and prophy and sent him to oral surgeon for gingevectomy. Oral surgeon took one look and said he should be seen by a laser dentist so he was referred to me. He was premedicated as a precaution by his neurosurgeon.
YOu can see his preop anterior and max, occlusal view.
Obviously this child needs quite a bit of treatment. As he was going to a school dance that evening I decided to treat the max. anterior in the limited time available to us. I used Ron ‘s DRK topical for approx 5 min. I proceeded with the Waterlase using a g6 tip at 5W 11%A. to carve away the tissue immediately around the centrals careful not to affect the enamel( which did happen in spots). As this was going very slowly and there was so much to do I upped the wattage first to 1W and eventually 1.75 w 13%A 10%w using Mark’s C3 tip to essentially festoon the fibrotic gingiva much like you would a denture wax up. He felt nothing , essentially no bleeding, no post op pain. He had a good time at the dance. He and his parents were extremely grateful.
Comments and suggestions about this and future treatment for this patient would be appreciated.

Robert