LANAP®/LAPIP® Technical Blog

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What is LANAP®/LAPIP®?

The FDA-approved, Periolase® MVP-7™ laser-driven regeneration and disinfection technology for teeth and dental implants. LANAP® stands for “laser-assisted new attachment procedure.” LAPIP® is the “laser-assisted peri-Implantitis procedure.” Both may be used non-surgically or with flap reflection.

The LANAP® protocol is as follows1, 2:

1. Locally anesthetize the site of interest (enough to permit bone sounding).
2. Place the Periolase® tip into the sulcus, parallel to the root surface. Power the machine (at 4 W with a 100 ms pulse) and remove the infected epithelium lining of the pocket in coronal to apical and troughing motion. Using photothermolysis, the laser will target microbial pathogens and diseased epithelium, leaving healthy connective tissue. Eliminating infected epithelium will aid visualization of subgingival calculus.
3. Remove calculus and plaque from the root surface with ultrasonic scalers.
4. Perform a second pass with the Periolase® tip, parallel to the root surface, at 4 W power with a 650 ms pulse in a troughing motion to complete epithelial debridement and initiate formation of a fibrin clot.
5. Manually compress the gingival tissue against the root surface to establish a firm fibrin clot. A stable clot may act as a natural guided regenerative barrier, thwarting formation of a long junctional epithelium and promoting instead a new connective tissue and osseous attachment to the cementum.
6. If a flap was raised, then suture as needed.
7. Splint mobile teeth and adjust traumatic occlusal interferences to permit undisturbed healing.

The LAPIP® protocol is similar to that of LANAP® except that the light-dose used around implants must be significantly less than that used around teeth (about 1/3 of power) to curtail implant and soft tissue attachment damage.

What is the FDA approval level achieved?

The Periolase® MVP-7™ laser has attained regulatory clearance FDA 510(k), i.e., safe and effective and substantially equivalent to a legally marketed existing device.3 The approved indications for marketing are as follows:

  • – Abscess incision and drainage
  • – Aphthous ulcers treatment
  • – Biopsies excision and incision
  • – Crown lengthening
  • – Hemostatic assistance
  • – Fibroma removal
  • – Frenectomy
  • – Frenotomy
  • – Gingival incision and excision
  • – Gingivectomy
  • – Gingivoplasty
  • – Operculectomy
  • – Oral papillectomy
  • – Tissue retraction for impression
  • – Vestibuloplasty
  • – Selective ablation of enamel (first degree) caries
  • – Exposure of unerupted I partially erupted teeth
  • – Implant recovery
  • – Lesion (tumor) removal
  • – Leukoplakia
  • – Pulpotomy
  • – Pulpotomy as adjunct to root canal therapy
  • – Removal of filling material such as gutta percha or resin as adjunct treatment during root canal retreatment
  • – Sulcular debridement (removal of diseased or in named soft tissue in the periodontal pocket) to improve clinical indices including gingival index, gingival bleeding index, probe depth, attachment level and tooth mobility
  • – Laser-assisted new attachment procedure (cementum-mediated periodontal ligament new-attachment to the root surface in the absence of long junctional epithelium)
  • – Periodontal regeneration – true regeneration of the attachment apparatus (new cementum, new periodontal ligament, and new alveolar bone) on a previously diseased root surface when used specifically in the LANAP® Protocol

What laser is used?

The PerioLase® MVP-7™ is a Nd:YAG (Neodymium-doped Yttrium Aluminum Garnet) pulsed, adjustable-duration, soft tissue dental laser with a 1064 micron wavelength that passes through water and hydroxyapatite but is absorbed in melanin and hemoglobin. The pulsing bursts minimize damage. The pulse rate is customizable (7 levels), which allows for a power range of 0.2 to 6 Watts. Pre-programmed procedure settings exist for user convenience.

What effects does the laser achieve using LANAP®/LAPIP® protocol?

  • Regeneration of periodontal attachment (connective tissue and bone). This has been supported by histological human studies.5,6
  • Microbial disinfection. The Nd: YAG laser has a bactericidal effect on certain pigmented periodontal pathogens, including all red complex microbes (P. gingivalis, T. forsythia, T. denticola) as well as orange complex organisms.7, 8, 9
  • Hemostasis
  • Faster wound healing/less gingival recession10, 11
  • Less patient discomfort11

What are the results of LANAP® as measured by human clinical studies?

  • Generally, the adjunctive use of LANAP® with scaling and root planing will decrease pocket depths and improve clinical attachment loss, especially in deep pockets (initially > 5 to 7 mm).12, 13, 14.
  • LANAP® allows for retention of teeth at similar levels to more aggressive, conventional surgical therapies15
  • Better patient comfort and less bleeding in the long-term compared to traditional flap surgery16

What training did Dr. Sonick and Ma undergo in order to offer LANAP®/LAPIP® services?

Dr. Sonick and Dr. Ma are already seasoned, board-certified periodontists and implant surgeons with decades of advanced clinical practice. An intensive, patient-based training course taken over a year granted Dr. Sonick and Dr. Ma the ability to become LANAP®/LAPIP®-proficient practitioners.

References
1. Robert HG. Introduction to the LANAP protocol for the treatment of periodontitis. LANAP procedure.
2. Jha A, Gupta V, Adinarayan R. LANAP, periodontics and beyond: a review. J Lasers Med Sci. 2018;9(2):76–81.
3. LANAP® Protocol FDA Clearance K151763.
4. Nicholson D, et al. Pulsed Nd:YAG laser treatment for failing dental implants due to peri-implantitis. Lasers in Dentistry, Ed. Peter Rechmann, Daniel Fried, Proc. of SPIE Vol. 8929. 2014.
5. Nevins ML, Camelo M, Schupbach P, Kim SW, Kim DM, Nevins M. Human clinical and histologic evaluation of laser-assisted new attachment procedure. Int J Periodontics Restorative Dent. 2012 Oct;32(5):497-507.
6. Yukna RA, Carr RL, Evans GH. Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans. Int J Periodontics Restorative Dent. 2007 Dec;27(6):577-87.
7. McCawley TK, McCawley MN, and Rams TE. Immediate effects of Laser-Assisted New Attachment Procedure (LANAP) on human periodontitis microbiota. Journal of the International Academy of Periodontology 2018 20/4: 163–171.
8. Grzech-Leśniak K, Sculean A, Gašpirc B. Laser reduction of specific microorganisms in the periodontal pocket using Er:YAG and Nd:YAG lasers: a randomized controlled clinical study. Lasers Med Sci. 2018 Sep;33(7):1461-1470.
9. Harris DM, Reinisch L. Selective photoantisepsis. Lasers Surg Med. 2016 Oct;48(8):763-773.
10. Dilsiz A, Sevinc S. Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser. Acta Odontol Scand. 2015 Feb;73(2):144-9.
11. Aoki A, Mizutani K, Schwarz F, Sculean A, Yukna RA, Takasaki AA, Romanos GE, Taniguchi Y, Sasaki KM, Zeredo JL, Koshy G, Coluzzi DJ, White JM, Abiko Y, Ishikawa I, Izumi Y. Periodontal and peri-implant wound healing following laser therapy. Periodontol 2000. 2015 Jun;68(1):217-69.
12. Sgolastra F, Severino M, Petrucci A, Gatto R, Monaco A. Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy: a meta-analysis. Lasers Med Sci. 2014 May;29(3):887-95.
13. Sağlam M, Köseoğlu S, Taşdemir I, Erbak Yılmaz H, Savran L, Sütçü R. Combined application of Er:YAG and Nd:YAG lasers in treatment of chronic periodontitis. A split-mouth, single-blind, randomized controlled trial. J Periodontal Res. 2017 Oct;52(5):853-862.
14. Nevins M, Kim SW, Camelo M, Martin IS, Kim D, Nevins M. A prospective 9-month human clinical evaluation of Laser-Assisted New Attachment Procedure (LANAP) therapy. Int J Periodontics Restorative Dent. 2014 Jan-Feb;34(1):21-7.
15. Tilt LV. Effectiveness of LANAP over time as measured by tooth loss. Gen Dent. 2012 Mar-Apr;60(2):143-6.
16. Harris, DM, Nicholson DM, McCarthy D, Yukna RA, Reynolds, MA, Greenwell H, Finley J, McCawley TK, Xenoudi P, Gregg RH. Change in clinical indices following laser or scalpel treatment for periodontitis: a split-mouth, randomized, multi-center trial. Lasers in Dentistry, edited by Peter Rechmann, Daniel Fried, Proc. of SPIE Vol. 8929. 2014.