Periodontics is the branch of dentistry concerned with the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth. Periodontists are also expert in the placement and maintenance of dental implants. Today there are two dozen indications for use with various dental laser devices; and the clinical applications continue to increase, making the laser one of dentistry’s most exciting advances with unique patient benefits. Laser-assisted new attachment procedure (LANAP™ ) is therapy designed for the treatment of periodontitis through regeneration rather than resection. This therapy and the laser used to perform it have been in use for more than a decade. In surgery a variable dental laser is used by a trained and certified Elk Grove dentist or periodontist to treat the periodontal pocket. The laser energy selectively removes diseased or infected pocket tissue from the underlying connective tissue. Since the laser energy is quite selective for pocket epithelium, the underlying pleuropotential connective tissue is spared, thereby permitting healing and regeneration rather than formation of a pocket seal by long junctional epithelium.
Each wavelength has a somewhat unique effect on dental structures, due to the specific absorption of that laser energy in the tissue. Some lasers are only absorbed by blood and tissue pigments, while others are only absorbed by water as well as hard tissue, like enamel, dentin, and bone. More specifically, the wavelengths can be categorized into three groups. Diode and Nd:YAG wavelengths target the pigments in soft tissue and pathogens as well as inflammatory and vascularized tissue. Carbon Dioxide lasers also easily interact with free water molecules in soft tissue as well as vaporizing the intracellular water of pathogens. Erbium lasers are sometimes called all tissue instruments because of their very short temporal emission mode and absorption in the water of soft and hard tissue.
Lasers produce light energy that can be absorbed by a target tissue, and this absorption process produces a thermal reaction in that tissue. Depending on the instrument’s parameters and the optical properties of the tissue, the temperature will rise and various effects will occur. In general, most non-sporulating bacteria, including anaerobes, are readily deactivated at temperatures of 50 degrees C. The inflammatory soft tissue present in periodontal disease can be removed at 60 degrees C; moreover, hemostasis can also be reached within the same heat parameters. Soft tissue excisional or incisional surgery is accomplished at 100 degrees C, where vaporization of intra- and extra cellular water causes ablation, or removal of biological tissue. Likewise, the aqueous component of tooth structure and bone also boils at this temperature; thus cavity preparation, calculus removal, and osseous contouring can proceed.
After the procedure, most patients experience new root surface coating and new connective tissues formation on teeth roots, preventing tooth loss. Pocket depth reduction is comparable to that achieved by conventional pocket reduction surgery, but without the gingival recession normally associated with osseous surgery. Significant post-operative reduction in gingival indices, gingival inflammation, and bleeding on probing are also common desirable results of using lasers in periodontics. Lasers use spares more healthy tissue than scaling and root planing, patients experience minimal post-operative recession and disfigurement or root sensitivity. These results reduce the future risk of root caries and dental decay of the tooth root. Minimal pain is easily controlled through the use of ibuprofen. Patients are encouraged to improve and maintain standards of oral hygiene to prevent further active periodontitis.