First, the patient is profoundly anesthetized with local anesthetic. Next, the patient’s pocket depths are probed down to the level of intra-osseous defects (bone sounding). The thin optic fiber is placed parallel to the root surface.. The first pass with the laser, called laser troughing, is accomplished with the short duration pulse. The free running pulsed Nd:YAG laser is combined with systemic antibiotics to achieve the optimal reduction of microbiotic pathogens (antisepsis) within the periodontal sulcus and surrounding tissues. Perio pathogens and pathologic proteins are selectively destroyed by the laser’s light energy, providing an aseptic surgical environment that allows healing following the laser hemostasis step.
The technique uses selective photothermolysis to remove the diseased, infected and inflamed pocket epithelium while preserving healthy connective tissue, literally separating the tissue layers at the level of the reté pegs and ridges. The practitioner is able to achieve both precise tissue ablation and aseptic hemostasis by varying the laser’s energy density, pulse duration and rate of repetition. The laser assists in the destruction of perio pathogens while preserving the healthy tissue.
The tenacity of the calcified plaque and calculus adherent to the root surface is modified by the laser energy so its removal with an ultrasonic scaler is more easily accomplished.
At this point, a second pass with the laser is taken to finish debriding the pocket and achieve hemostasis with a thermal fibrin clot. Gingival tissue is compressed against the root surface as necessary to close the pocket and aid with formation and stabilization of the fibrin clot. No sutures or surgical glue is needed. Mobile teeth above class II mobility are splinted. Occlusal adjustments are performed to remove interferences, minimize trauma, and provide balance to long axis forces and are considered an essential component of the LANAP protocol.
Finally, post-operative instructions specific to the LANAP protocol, diet guidelines and oral hygiene instructions are explained and their importance is stressed, and continued periodontal maintenance is scheduled. Patients are monitored at one week, 30 days and then every 3 months for periodontal maintenance. No subsequent probing is performed for at least nine months to a year to allow sufficient healing time for the cementum-fiber PDL interface.
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