Periodontal Surgery after Implant Placement?

Please elaborate on what your Periodontist is recommending and the reasons why? How many teeth are involved? Does the patient have active peridontal disease? There is a lot of detail needed in order to give you feedback. Please provide as much information as possible and will try to help.........Best of luck

If this patient needs perio surgery 2 months after implant placement the ball was dropped by someone big time. Implants should NOT be placed unless the perio is cleared up.You don't want the perio bugs around when you're tryong to get implants to integrate.That said it shouldn't pose aproblem ifthe surgeon doesn't poke around the fixtures.

This is a classic case of poor diagnosis and treatment planning.You should have known patient's perio condition and required treatment beforehand.A simple perio charting would have been enough to recognize problem and if you were not sure, patient should have been refered to periodontist before placing implants.Periodontal treatment shouldhave been finished.Teeth with questionable prognosis should have been extracted (AS YOU ARE NOT SURE ABOUT NEED FOR PERIO SURGERY,YOU MAY NOT KNOW THE NEED FOR EXTRACTION OFQUESTIONABLE TEETH.)and restorative design should have been decided in advance,NOT AFTER PLACING TWO IMPLANTS. This kind of situation arise due to fear of general dentist of loosing patient to specialists.

As long as flap design dose not enchroach upon implant site,perio surgery can be done,specially if two stage implants are burried under mucosa..

satish joshi Says: April 24th, 2007 at 8:15 pm "This is a classic case of poor diagnosis and treatment planning.You should have known patient’s perio condition and required treatment beforehand.A simple perio charting would have been enough to recognize problem and if you were not sure, patient should have been refered to periodontist before placing implants.Periodontal treatment shouldhave been finished.Teeth with questionable prognosis should have been extracted (AS YOU ARE NOT SURE ABOUT NEED FOR PERIO SURGERY,YOU MAY NOT KNOW THE NEED FOR EXTRACTION OFQUESTIONABLE TEETH.)and restorative design should have been decided in advance,NOT AFTER PLACING TWO IMPLANTS. This kind of situation arise due to fear of general dentist of loosing patient to specialists. " This is almost comical as I now am on the other side of the fence when it comes to periodontal disease. Of course, as stated, you always begin with the end in mind. A thorough risk assesment is essential at determining longevity of the treament you are endorsing. The problem is.... I don't know many periodontists that do a thorough risk assesment. Many are still of the dental school mantality... "Can I" save it and not "Should I" save it. If you have horizontal loss of 50 % or more on a 40 year old, you've done a great service by beginning the transition over to a treatment modality that is quite resistant to the traditional periodontal destruction many encounter. This nonsense about implants not integerating if there is active periodontitis in the mouth stems from a lack of understanding of the disease. Many of us, some unknowingly, place implants into a mouth riddled with periodontal pathogens and get integration just fine while loading either immediately or in six to eight weeks. Let me know if you need to see case after case of that listed. As far as perio "surgery".... What specifically? With the Periolase now available, there is little need for traditional flap surgery when the result are far supersceeded by LANAP without the horrific experiences reported. I had a local Periodontist endorsing a 6 X 11 FPD on mobile canines so he could extract the upper four incisors! They did have class III mobility and "iffy" bone levels. Let's just say that after LANAP, she hasn't lost one tooth and comes to tears each time she's in the office wondering why we don't charge more for LANAP than periodontists do for "TRADITIONAL GUM SURGERY". I freqently use the laser and watch the response before jumping certain teeth into implants. There is absolutely nothing wrong with what you've done as long as the patient and treating Docs understand the different endpoints and what is required to get there. To think that I'm scared of losing a patient to a specialist is somewhat silly. Why would that occur when my service mix, value, location, and guarantee of successfull restoration are something no specialist can come close to? Climb down and sit with the rest of us. We are all human but those with the capability to LANAP laugh at your comment on fearing someone without. Jackson

thank you Dr. Jackson, that was a great response and support from your side both morally and professionally. NOw some more help and information i needed --- will it be safe to d o a full mouth flap surgery ( for generalised periodontitis ) at this stage i.e. after 2 months of implant placement or should i wait for some more time for the implants to osseointegrate.( i agree to my mistake of placing implant prior to perio surgery and i am sure not to do the same in future but what now -- am i totally wrong or we still have a solutio nto it ). please give you suggestion from the valuable experience you have.

In my experience, as long as the implants are not included in the flaps, there will be no harm to the implants. I agree with Dr. Jackson that implants are frequently placed when active periodontal disease and that they successfully integrate. However, that scenario does not represent the standard of care, since the same pathogens that cause loss of attachment around teeth also cause loss of attachment around implants. Ideally, active periodontal breakdown should be addressed before implants are placed, if the best interests of the patient are foremost...unless, with informed consent, the patient wants the implants placed . As for his comments about flap surgery and the superiority of LANAP to flap surgery, let me point out that the LANAP procedure is based on a case study comprising (I believe) 2 patients and 6 single rooted teeth which had no adjacent teeth, severe horizontal bone loss and which were scheduled for extraction. Using local anesthesia, the teeth were root planed exceedingly thoroughly, since the surrounding gingiva were able to be retracted. Thus, the operators had what amounted to surgical access to the root surfaces and were able to visualize the surfaces in their entireity. The laser was then applied. Histologically, all teeth were found to have a mm or less of what could be argued to be new cementum. So the findings from treatment of six single rooted teeth with very unique characteristics, from two patients, are the basis for LANAP. To use results of this type to promote a treatment protocol is to promote a treatment protocol that is not driven by science, but one that is driven by marketing. The results have exactly no statistical signiicance. When I take medicine or submit to a medical or dental procedure, I want to make sure that the medicine or procedure has been rigorously studied on hundreds, if not thousands, of patients. Wouldn't you want the same for yourself or your family? In order to clean off a root surface and produce an environment that supports new attachment, or epithelial attachment, energy has to be applied and transferred to the root surface. This energy can be in the form of friction from a curette tip, from an oscillating ultrasonic or piezo tip or from a rotating bur, etc. Or, it can be in the form of various laser wavelengths. In order to obtain a clean root surface, visualization of and access to the root surface are required. Many times, because of adjacent soft tissue or tooth alignment or pocket depth or complex root surfaces(you only need to look at the root surfaces in a pocket with a microscope one time to gain an apreciation of how rough the root is and how little you can hope to clean it without proper access), the best method which will reliably provide both visualization and access for meticulous instrumentation of the root surface is to reflect a flap. That's just a fact of life. Now, there are many different types of flaps and many ways to develop them. In most cases in this practice where flap surgery is called for, minimally invasive regenerative surgery is implemented, using, at the least, binocular loupes, and frequently a microscope and an endoscope. Emdogain is used liberally. Over 90% of our patients only require non-narcotic post-operative meds. So much for the "horrific experiences" referred to. You may not be aware that there has been a paradigm shift in periodontics in that we now use microscopic magnification and instrumentation, biological modifiers and minimally invasive surgical techniques. What has not changed is that we continue depend on good studies based on sound science.

Dr.Jackson Why is it a comical to do proper treatment planning? P himself confesses he did make mistake in treatment planning. He is asking for your help for flap surgery and you are advising LANAP without knowing any details about patient's condition. Do you really believe laser is a majic wand that can cure all perio ills. Then there will not be any need for periodontists.Any dentist will take demo. offered by laser co.and start treating all perio cases. Good luck

I agree with periodoc and Dr.Joshi, placing implants in active perio condition should not be norm.Chances of infection in implants sites and (particularly if site is grafted for any reason) are very high. Patient's oral condition should be acceptable for any surgical procedures unless in emergency. Why would you rush to place implants in active periodontal disease just because you have past success. And lanap instead of open flap in every situation? You got be kidding Dr. jackson. As periodoc suggests flap are not HORRIFIC (as you suggested), if clinician knows what he/she is doing.

Dr. Jackson, Thank you for letting me entertain you.But I firmly believe that periodontal problems should be corrected before implant placement not only for infection point of view but also from aesthetic point of view as final architecture of gingival complex may not remain same and may cause aesthetic issues in aesthetic zone.

Satish, that is a very insightful viewpoint. One of the benefits of this forum is being exposed to treatment philosophies that expand one's horizons.

Dear Dr. Jackson Start treating patients as human beings and don't look at them as just $$$. I'm sure you are an AGD member, LVI guy, Linda Miles student, Rodger Levin guru, Sally McKenzie pupil, etc. Please practice Evidence-Based-Dentistry!! There will be enough money there for you!!!!

Dental Implant Patient with aesthetic failure - congratulations on the comments from satish joshi . I believe if I had a treatment planning , now I would be able to smile with confidence.

It's so wonderful to know that a recognized specialty is now on the way to be ignored thanks to commercial programs at the patient's expenses! you will see more and more studies from the old honest Branemark group, the one that Nobel biocare kicks out..including Prof Branemark! ( Lekholm, Jemt, Wennstrom, Lang, Berglundh..)about implant's long term failure (around 28% after 10 years) in susceptible subjects treated by world class surgeons and prosthodontists in swedish universities, due to over confidence in implant resistence to oral bacteria colonization and lack of follow-up. When bone loss happens, it progresses much faster then with tooth! please check litterature: Fransson C. :Prevalence of Subjects with progressive bone loss at implants in Clinical oral Implant Research 2005, Hardt CRE : Outcome of implant therapy in relation to experienced loss of periodontal bone support, Clin. Oral Imrpl. Res 2002, Karoussis IK: Association between periodontal and peri-implant conditions a 10 year prospective study, clin oral implt res 2004.and many more... We need to spend our time to learn from evidenced-based dentistry, not to get rapid credits from weekends courses on technical skill and how to make rapid money skill...We may make less $$$ than you but we have our patients'trust and long term relationship with both referrals and patients! We are not creating horrific memory but a memory of care and honesty!

Wasnt there a recent article in JOP or JOMI or ID just this year that determined that there wasnt any significant differences in the failure rates of implants placed in patients with or without active perio? Ill have to go back and look. I thought I read something and was sort of taken back when I read it. Certainly not the standard of care but it was a peer reviewed article and not anecdotal. My thought process on this is that at this juncture, if the implants were 2 stage and they are completely covered with KT, it would now actually be a good time now to tackle the perio, considering you are going to have to uncover thee implants and reexpose them to perio disease if you dont. In fact if it were me, thats what I would want to have done. get rid of the bugs and make sure OHI is impeccable before uncovery. Now that the patient is here, just trying to think things through. JMHO. Bill

Periodoc wrote As for his comments about flap surgery and the superiority of LANAP to flap surgery, let me point out that the LANAP procedure is based on a case study comprising (I believe) 2 patients and 6 single rooted teeth which had no adjacent teeth, severe horizontal bone loss and which were scheduled for extraction. NO IT STARTED WITH 7 PATIENTS THE END STUDY INCLUDED 6 PATIENTS BECAUSE THE 7TH PATIENT LIKED THE RESULT SO MUCH THAT HE WANTED TO KEEP IT. A TOTAL OF 12 TEETH. THIS HAPPENS TO BE THE THIRD LARGEST HUMAN HISTOLOGY REPORT IN THE PERIODONTAL LITERATURE. THIS THIRD LARGEST HITOLOGICAL REPORT IN THE PERIODONTAL LITERATURE SHOWED PROOF OF PRINCIPAL. WHAT IT SHOWED WAS THAT THE 6 LANAP TREATED TEETH HAD CEMENTUM MEDIATED NEW ATTACHEMENT TO THE ROOT SURFACE IN ABSCENCE OF LONG JUNCTIONAL EPITHELIUM THATS 100% ON THE CONTROL SIDE SRP 0% Using local anesthesia, the teeth were root planed exceedingly thoroughly, since the surrounding gingiva were able to be retracted. Thus, the operators had what amounted to surgical access to the root surfaces and were able to visualize the surfaces in their entireity. The laser was then applied. Histologically, all teeth were found to have a mm or less of what could be argued to be new cementum. So the findings from treatment of six single rooted teeth with very unique characteristics, from two patients, (6 PATIENTS) are the basis for LANAP. To use results of this type to promote a treatment protocol is to promote a treatment protocol that is not driven by science, WHAT DO YOU CALL HUMAN HISTOLOGY OTHER THAN ONE OF THE HIGHEST FORMS OF EVIDENCE OR DO YOU NEED DOG STUDIES? but one that is driven by marketing. The results have exactly no statistical signiicance. OTHER THAN REVERSING PERIODONTAL DISEASE When I take medicine or submit to a medical or dental procedure, I want to make sure that the medicine or procedure has been rigorously studied on hundreds, if not thousands, of patients. HOW MANY OF THE PROCEDURES YOU DO HAVE HUMAN HISTOLOGY TO BACK THEM UP? AS FAR AS THOUSANDS OF CASES THERE ARE ABOUT 450 LANAPERS IN THE US ALL OF THEM HAD A 6 MONTH MONEY BACK GUARENTEE IF FOR WHAT EVER REASON THEY DID NOT LIKE THE LASER THEY COULD HAVE RETURNED IT FOR A MONEY BACK GUARENTEE ONLY ONE HAS EVER EXERCISED THE RIGHT. CRA HAD IT EVALUATED IT RECEIVED A 9.7 OUT OF 10 NO OTHER DENTAL DEVICE HAS EVER GOTTEN A HIGHER RESULT. Wouldn’t you want the same for yourself or your family? YES THAT IS WHY I HIGHLY RECOMEND LANAP.

P as Dr J suggested Lanap is an excellent treatment for "generalized periodontitis" without using the blade, sutures, or emdogain ("Swedish baby pig teeth juice" direct quote from Strauman rep). LANAP = NO CUT, NO SEW, NO FEAR thank you Dr. Jackson, that was a great response and support from your side both morally and professionally. NOw some more help and information i needed — will it be safe to d o a full mouth flap surgery ( for generalised periodontitis ) at this stage i.e. after 2 months of implant placement or should i wait for some more time for the implants to osseointegrate.( i agree to my mistake of placing implant prior to perio surgery and i am sure not to do the same in future but what now — am i totally wrong or we still have a solutio nto it ). please give you suggestion from the valuable experience you have.

Gum Guy wrote Dear Dr. Jackson Start treating patients as human beings and don’t look at them as just $$$. I’m sure you are an AGD member, LVI guy, Linda Miles student, Rodger Levin guru, Sally McKenzie pupil, etc. Please practice Evidence-Based-Dentistry!! There will be enough money there for you!!!! I DON'T UNDERSTAND YOUR COMMENTS TO DR JACKSON IS IT THAT HE USES LANAP AS A TREATMENT ALTERNATIVE TO OSSEOS SURGERY? IF IT IS THE USE OF LANAP AS A TREATMENT FOR PERIODONTAL DISEASE MAY I SUGEST YOU READ A BOOK CALLED "WHO MOVED MY CHEESE" IT DICUSES CHANGE AND THE PROPER WAY OF HANDELING IT. IF IT IS ABOUT PLACING IMPLANTS IN A ACTIVE PERIODONTAL DISEASE STATE THEN I AGREE FOR THE BEST OUTCOME THE PATIENT SHOULD BE IN A STATE OF PERIODONTAL HEALTH BEFORE IMPLANTS. I STILL DON'T UNDERSTAND THE COMENTS ABOUT THE AGD,ETC...? IF YOU THINK THAT LANAP IS NOT WITHIN EVEDENCE BASED DENTISTRY YOU MIGHT WANT TO THINK AGAIN.

Gumguy Could you please explain what is meant by this remark? I’m sure you are an AGD member, LVI guy, Linda Miles student, Rodger Levin guru, Sally McKenzie pupil, etc. Please practice Evidence-Based-Dentistry!! There will be enough money there for you!!!!

Gumguy Do you have a problem with the AGD?

Back to my question. Isnt NOW the time to complete perio sx (whatever the method)since and if the implants are (hopefully)covered in stage 1? Wouldnt it be a ggod time to get rid of the bugs? As far as LANAP, I am certain it has merit in perio therapy, but we cannot discard traditional, time proven methods just because there is a new horizon in perio sx. More studies will prove the benefits an limitations of LANAP and possibly it will become a more traditional method in time and welcomed by the masses. But, on to treatment for this patient. Whats the BEST option NOW? I vote sx prior to stage 2. Bill

I'll vote LANAP prior to stage two.

Gumguy Do you have a problem with Linda Miles?

Gumguy, Do you have a problem with Sally McKenzie?

Seamentum Being that you are a periodontist are you going to the AAP you may be interested in seeing this. Here is a lecture that will be given in October at the AAP. Also in case anyone does not know Samuel Low..he is scheduled to be AAP president soon and has recently audited a boot camp (hmmmmm..could the pendulum be swinging the other way now?) GS02: LASERS: CLINICAL AND RESEARCH MODALTIES 8:00 - 10:00 am Program Track: Therapies to Obtain/Maintain a Healthy Periodontium Moderator: Robert M. Pick Speakers: Charles M. Cobb, Samuel B. Low, Raymond A. Yukna Lasers have entered the field of periodontics and when used properly offer the clinician a wonderful alternative to the scalpel. Clinically lasers offer the following advantages: A relatively bloodless operative and postoperative course, coagulation, vaporization or cutting, minimal swelling and scarring, usually no suturing, reduced to absent postoperative pain and high patient acceptance. Lasers have always caused controversy among periodontist’s, although this appears to be changing. Recent evidenced based research shows that certain lasers may be efficacious in guided tissue regeneration. This presentation will discuss ethical and efficacious uses, current controversies and the lasers future. Educational Objectives: Learn the process of guided tissue regeneration with the laser for the practice of periodontics. Discuss the current clinical uses that the laser can be used for. Evaluate the advantages in using the laser in practice. The reason I posted it here is that I can no longer post here cut and paste to your browser. http://www.osseonews.com/cadaver-bone-for-grafting/

The original post was not centerd around LANAP or AGD or Linda Miles or Sally McKenzie but around what to do now from a clinical standpoiint. And when. Could we get back to that? Bill

Dr Bill Woods wrote The original post was not centerd around LANAP or AGD or Linda Miles or Sally McKenzie but around what to do now from a clinical standpoiint. And when. Could we get back to that? Bill True but Gumguy came on and made the comment Start treating patients as human beings and don’t look at them as just $$$. I’m sure you are an AGD member, LVI guy, Linda Miles student, Rodger Levin guru, Sally McKenzie pupil, etc. Please practice Evidence-Based-Dentistry!! There will be enough money there for you!!!! I think Dr Jackson deseves a response. What did Gumguy mean by this comment? Was Gumguy infering that Jackson was not treating his patients like human Beings? SEE http://www.osseonews.com/cadaver-bone-for-grafting/ I wonder why I can no longer post on this thread? I vote for LANAP before stage 2

Lanap before stage two. If you are going to the AAP please go see GS02: LASERS: CLINICAL AND RESEARCH MODALTIES 8:00 - 10:00 am Program Track: Therapies to Obtain/Maintain a Healthy Periodontium Moderator: Robert M. Pick Speakers: Charles M. Cobb, Samuel B. Low, Raymond A. Yukna Lasers have entered the field of periodontics and when used properly offer the clinician a wonderful alternative to the scalpel. Clinically lasers offer the following advantages: A relatively bloodless operative and postoperative course, coagulation, vaporization or cutting, minimal swelling and scarring, usually no suturing, reduced to absent postoperative pain and high patient acceptance. Lasers have always caused controversy among periodontist’s, although this appears to be changing. Recent evidenced based research shows that certain lasers may be efficacious in guided tissue regeneration. This presentation will discuss ethical and efficacious uses, current controversies and the lasers future. Educational Objectives: Learn the process of guided tissue regeneration with the laser for the practice of periodontics. Discuss the current clinical uses that the laser can be used for. Evaluate the advantages in using the laser in practice. The reason I posted it here is that I can no longer post here cut and paste to your browser. http://www.osseonews.com/cadaver-bone-for-grafting/

I am just a dumb GP could some of you smart periodontists explain this? Thanks in advance :-) Learn the process of guided tissue regeneration with the laser for the practice of periodontics.

Hi there, You can now post comments again on the Cadaver for Bone Grafting thread. Comments were temporarily disabled there for site maintenance. Please post all new comments related to that topic there. http://www.osseonews.com/cadaver-bone-for-grafting/ Thank you. OsseoNews.com Editors

Thank You :-) :-) :-) ;-)

Dear PerioDoc: You mentioned your use of Emdogain in perio treatment. I have been unable to order any from Straumann. Do you have any otehr sources, alternatives??? Thank you.

Dr. Geller, Emdogain may be again available in November. Seems the FDA had some issues with the production facilities. I've been using either PRP or Gem 21 S when I've felt a biologic modifier is needed. I think that Emdogain brings more to the party than the Gem does, but I find that patients have little post-operative sequalae when I use it, as with Emdogain. I feel confident using any of the above, since they were tested on significantly more than 6 patients.

In this http://www.osseonews.com/cadaver-bone-for-grafting/ thread the remark was made "Just naming researchers or future publication is a waste of time." Well it is no longer a waste because Dr Ray Yukna's research and full manuscript on his IADR published LANAP histology has been published :-) in one of THE most prestigious peer reviewed/refereed perio journals in the world (published in 7 languages) this December in the International Journal of Periodontics and Restorative Dentistry (IJPRD).

This is an update from the AAP It was quite a presentation. Dr Cobb went first comparing apples to oranges (diodes to LANAP). Sam Low was very impressive and stated 4 things that he was pleased with saying: 1. The idea of a stble fibrin clot intrigues him 2. Biostimulation is an exciting area to explore 3. “You can’t change physics” 4. If you’re gonna use a laser, follow a specific and scientifically based protocol (as he was showing the LANAP steps). Then Dr. Yukna came up and gave the most resolved and emphatic presentation in support of LANAP. He then said in clonclusion, “I have not rasied a surgical flap to treat periodontistis in 1 1/2 years.” And many of us heard gasps in the room. By the way…..the estimated attendance was 1500-1600 periodontists in the room MDT signed a record number of orders at any trade show in the history of the company….and specifically periodontists

Johndds the 4600.00 dollar full mouth laser guy is back again to push the lasers sales. You have no shame. I thought the moderator closed one thread on you. Man the company must be paying you alot. You are basing all your treatment on one study. LANAP study: six teeth, two patients. You need to review long term data. Then again with the amount of money your charge patients for the laser s/rping and what the company must be paying you IMO, its no wonder you have disregarded evidence based dentistry. Doctors on this forum are to educated for that. Evidence based dentistry. Im a general dentist and I base my treatment on the evidence out there and I try to offer my patients the best out there. Thats why I treat some patients and refer out patients to specialists to offer the best treatments possible given there disease situation/presentation. There isnt a magic bullet for periodontal disease, your patients are owed better.

Dear Jhondds I think you should stop this. The whole thread discussion started with my comment about poor D&T and lack of proper refferal of patient from Dr. P. Dr.Jackson started 'laser magic talk' and rediculed me thinking I am a periodontist, and you climbed on band wagon for whatever interest you may be having. I am a proud GP and not ashamed to state that whenever need arises I do refer my patients to proper specialists,It is most ethical and in the best interest of patient.Even if laser is answer for every perio problem,still clinician has to learn how to do proper D&T.

Do lasers have a place in dentistry? This discussion is going the way of the earlier discussion " can gp's place implants". Since the inception of the American Academy of laser Dentistry [AALD] in 1992 in Chicago city and later becoming part of ISLD {I may be wrong here, please correct me.], laser use in dentistry somehow did not move to the forefront as did implants and did not attract as many researchers thus it fell to the few diehards and general practitioners to continue in trying to move the frontiers in dentistry. You guys should be commended however do be careful. The name Robert M Pick sounds familiar. I was at the Chicago AALD meeting in 1992 and I am not sure that I met him there. I was one of the two Malaysian dentist and has been using lasers in my practice since then.Lasers are expensive to purchase and also to maintain and not many dentist uses it. Well it has many uses in dentistry and it has proven itself for me these 15yrs.Try it out sometime and for those who like it all the best . I have not found a better modality then the Co2 laser in the management of teeth sensitivity due to buccal abrasion cavities. Removing a mucocele or doing a frenectomy the Co2 laser are a class on its own. Treating capillary hemangiomas with the NdYag lasers has to be experienced to be really appreciated.These are are some of the reasons why those using lasers are so passionate of what they are doing. Thecnology sometimes makes a procedure which is beyond the average practitioner's capabalities now possible. When we see results and excellent ones repeated again and again though not published or yet to be I think that is Evidence based Dentistry only it has yet to been proven. It is not easy to be published , so help us that that together all will benefit.

PRATT SAYS Johndds the 4600.00 dollar full mouth laser guy JOHNDDS RESPONSE You seem to bring up $ all the time do you have a problem charging patients for a service that can regenerate the #1 cause of tooth loss? Do you have a problem with saving peoples teeth? Do you have an ulterior motive in not saving peoples teeth? Are you being paid by implant companies to screw them down? At over $4000 a tooth let’s see, for 32 teeth at $4000 a tooth that is $128,000 that’s $123,400 difference do you fail to see that? PRATT SAYS is back again to push the lasers sales. You have no shame. JOHNDDS RESPONSE You have no shame if you do not at least inform your patients of the FDA cleared procedure that says “New cementum mediated NEW atachement in the abscence of Long Junctional Epithelium." PRATT SAYS I thought the moderator closed one thread on you. JOHNDDS RESPONSE I would like to know why it was closed so that the same mistake is not made again if the moderator would be so kind and tell me what in my or other posters they find so objectionable? I would immediately cease that activity please email me thank you. One reason might be that the topic kept being bumped up so much that nothing else would be discussed so I will reply to any comments when the thread has dropped off the page. Or was it due to the rude comments by Seamentom or Pratt? PRATT SAYS You are basing all your treatment on one study. LANAP study: six teeth, two patients. JOHNDDS RESPONSE As I have said before 12 teeth 7 patients. Besides the IJPRD, there are numerous peer reviewed articles that I hope, for your patient’s sake, you read. PRATT SAYS Doctors on this forum are to educated for that. JOHNDDS RESPONSE That is why they and you all have an opportunity to try the LANAP procedure in their practice for 6 months and if the claims made by the manufacturer are not true you can get a full refund. Now don’t your patients at least deserve the benefit of the doubt? It apears you are too cheap to even consider a kindler gentler alternative since you keep bringing up the $. PRATT SAYS Evidence based dentistry. I’m a general dentist and I base my treatment on the evidence JOHNDDS RESPONSE So how many of your patients have had LANAP? PRATT SAYS Out there and I try to offer my patients the best out there. JOHNDDS RESPONSE Why don’t you Offer LANAP? PRATT SAYS Thats why I treat some patients and refer out patients to specialists to offer the best treatments possible given there disease situation/presentation. There isnt a magic bullet for periodontal disease, your patients are owed better. JOHNDDS RESPONSE Yes, that is EXACTLY why I offer LANAP! Pratt why are you so afraid of LANAP?

John this is the last reply I will give you as you are a lost cause and people are starting to see through your antics. Any chance you get on these boards you use it to start spouting about this magic bullit for periodontal disease and that Millienium Dental is having records sales. Then you repost similiar things you already have said. Someone who talks about record sales of a dental company isnt concerned about there patients. Im not afraid of LANAP, I open to any treatment as long as it is based in sound evidence. To me the evidence isnt there yet on LANAP. One or two studys isnt enough for me to drop thousands on a laser unit and then charge my patients 4600.00 for treatment. JohnDDS has commented on that why should I refer and get inferior results. Im sure many specialist would take that as an insult. John what bugs me about you is that these boards are designed to help other doctors in different clinic situations. Yet any chance you get you use it to plug your laser and thrash specialist for placing implants (implants by the way has way more research behind it.) You use these boards to push the laser company and tell everyone. JohnDDS Quote "MDT signed a record number of orders at any trade show in the history of the company….and specifically periodontists" You have already admitted in a previous thread that you have spoken for the company and they paid for your time. Look into the word DISCLAIMER. Im done with this debate, good luck to you.

CLKoay Thank you for your comments as your comments are what these boards are truly designed for. I am open to the laser, Im sure there are plenty of applications for the laser in dentistry, but there definitely needs to be more research in the field.

IMHO some Periodontists have sold their soul to the titanium god and forgotten what their specialty is all about, they need to get back to saving teeth and gum gardening. Why has the perio community not spent $1 to disprove the LANAP procedure? A procedure that has been in the literature for over 10 years. You would think that they would be the first in doing the research to discredit it? Instead of investing in a study to disprove Lanap, last year the AAP sent out a hit piece against Millennium. Again the question needs to be asked have some Periodontists forgotten about saving teeth? Should they not be called implantologists? Have they chosen to become implantologists? If this is true then they have lost their specialty. You are a GP so you probably don’t know the Perio lit so ask your perio colleges who Ray Yukna is; he is not like me small time Gp, but a highly respected author in the perio literature. As a matter of fact the FDA perio would not work with just any researcher they would only work with 3 perios in the USA Ray was one of those 3. The Ray Yukna article has been published this month in the IJPRD. FDA clearance has been out for over 3 years the AAP has chosen to never publish “New Cementum Mediated Attachment to the root surface in the absence of long junctional epithelium” even though it relates directly to their specialty. Don’t you think they should know the FDA clearance that directly involves their specialty? Why have they not fought to rescind the FDA clearance? Directly related to their specialty. Oh I forgot they are now implatologists silly me ;-)

Unfortunately, John its guys like you that have killed the periodontist. Maybe if you referred disease cases to them and not wait to the point that they needed implants maybe they wouldnt be just doing implants. Even though I am a GP I do read the research: First off LANAP is just a fancy name for ENAP which yukna study in the 80’s now hes doing it again with a LASER. EXCISIONAL NEW ATTACHMENT PROCEDURE ENAP Yukna, et al. 1980: The ENAP is essentially subgingival curettage performed with a knife. The scalloped, internally beveled incision extends from the free gingival margin to the base of the pocket. Debridement, root preparation and primary wound closure with sutures and dressing follow The modified ENAP essentially involves the following modifications: 1) The initial incision is directed at the alveolar crest. 2) The complete removal of all the healthy connective tissue, granulation tissue and epithelium coronal to the bone. The modified ENAP is easier to perform, affords better access and more effectively utilizes the healing potential of the periodontal ligament. A disadvantage is the removal of intact connective tissue fibers with potential for attachment loss. Indications The ENAP and modified ENAP are limited to treatment of suprabony pockets with firm, fibrous pocket walls within a zone of adequate keratinized gingiva and areas of convex root anatomy which facilitate good soft tissue adaptation Clinical Studies: Examined the clinical results of the ENAP after 5 years in 56 surgical sites in human subjects, reporting an overall mean PD decrease of 1.8mm for the ENAP at 5 years. This was the same as that reported for the MWF and 0.5mm better than that following curettage of lesions of similar severity at 5 years postoperativerly. The mean amount of new attachment retained at the 5 year period was 1.5mm, comparing favorably to the 0.4 mm and 0.5 mm gains accompanying curettage and the MWF respectively (Yukna, et al., 1980). These studys where refuted by Lindhe and Nyman published 5-year results of an evaluation of 1620 teeth in 75 patients who had advanced periodontal disease and were treated with surgical pocket elimination (OSSEOUS SURGERY). Prior to surgery 113 of 247 teeth with furcation invasion (45%) were extracted. The remaining 134 teeth with furcation invasion were treated aggressively; i.e., 41% had scaling/root planing or furcation odontoplasty, 51% had root resections and 7% had tunneling procedures. All patients had excellent oral hygiene and were recalled every 3 to 6 months for 5 years. At 5 years: 1. plaque and gingival index scores were decreased; 2. pocket depths decreased from a mean of 5.7 mm to less than 3 mm; 3. radiographic bone scores indicated no further bone loss; 4. mobile teeth decreased from 57% to 26%; and, 5. no teeth were lost. and Kaldahl et al. reported on the 7-year results of a longitudinal study comparing coronal scaling, root planing, ENAP, modified Widman flap and flap with osseous resective surgery in 82 patients. The results were as follows: 1. all therapies reduced probing depth; 2. osseous resection was the most effective in reducing probing depth; 3. probing depths were reduced in direct proportion to the depth of the pocket; 4. osseous resection produced loss of clinical attachment in the 1-4 mm pocket; 5. modified Widman flap and root planing produced the greatest gain of clinical attachment in 5-6 mm pockets; and, 6. osseous resection resulted in the most recession. BOTH SHOWED FLAP OSSEOUS IS MORE EFFECTIVE AT MAINTAINING TEETH LONG TERM AND THERE IS COUNTLESS OTHER STUDYS TO SUPPORT FLAP OSSEOUS OVER ENAP OR LANAP OR WHATEVER YUKNA WILL CALL IT THESE DAYS. I dont refute that Yukna is a good researcher. But he has researched many things that have later fell out of favor as with most researchers. He has studys on ENAP, HTR Synthetic bone and Pep Gen 15 just to name a few. How many surgeons out there are still using PepGen 15? Just because the FDA approved something doesnt make it a magic bullit. Look into VIOXX, that WAS FDA approved HMMMMMMMMMMMM. My point is that you should not base all your treatment or CONDEMN A SPECIALTY based on one or two papers that are on 2 patients and 6 teeth. More research needs to be done in this field, which Im sure will come.

Pratt You and anyone who is interested can call MDT at 1(888) 495-2737 and they will send you a reprint of the IJPRD with Yukna's Human Histology. Then you will see that it was 7 patients and 12 teeth. Oh, I know how frugal you are so they will send the reprint, a $10 value, for free :-) Here is the Haris peer reviewed article http://www.biomedicalconsultants.com/HarrisGreggJGD04.pdf

Once again, just goes to show you how your in bed with the company. Like I said look into the word DISCLAIMER ...JOHN you are suppose to be a doctor. Do you have no shame. I saw the article in IJPRD already from my perio buddy of mine. Here let me give you some education in how to read an article with a keen eye: #1) this is a case report.....which anybody in research knows is very low in the evidence chain. Show me a randomized control clinical trial like in Bowers study and then ill be singing your toon. 2) The study is supported by millennium dental....anybody in research knows that puts a shadow on the article. 3) This isnt a new project that yukna did. This is the same patients he presented in the poster at the IADR. Go to the millennium dental website and click on research. There you will see the poster presentation. This paper is the same project as the poster, so it isnt new evidence. The radiographs in the poster are the same radiographs that are in the paper..................HMMMMMMMM if the results are so great accross the board, why only show the same radiograph series that were presented in his poster presentation .......HMMMMMMMMMMM could it be that is his best and only set of radiographs with evidence. Which by the way he could have gotten those results with occlusal adjustments which he says is part of the laser protocol. If you notice the radiographs he shows in the poster and in the paper are of the same bidge with the vertical defect. John my problem isnt with millennium technology or new tech. My problem is with you as a professional. You use ever opportunity on these boards to spout off about the laser which you are clearly getting paid for. You are preaching about treatment that has very little evidence behind it and charging patients and arm and a leg. You have clearly showed you dont read research and dont know how to read the research. Then you are trashing a specialty of the ada for doing nothing but implants yet you dont refer disease to them. Please John the Doctors on these boards are highly educated professionals. Please dont treat us like your a company salesman.

Way to go Chase! Thanks for your insight I will never read an article/case study the same way again Dr SS

I had the "opportunity" to view first hand, dozens and dozens of patients who had their periodontal problems treated by Laser "therapy" I would agree with Dr Pratt. Also I have read much of the literature and have heard opposing viewpoints at symposia. To my mind Lasers have very limited use in periodontal therapy. When I say opportunity I was unsurprised and dismayed by the results. These patients were charged significant sums of money with NO RESULT

I had the "opportunity" to view first hand, dozens and dozens of patients who had their periodontal problems treated by Laser "therapy" I would agree with Dr Pratt. Also I have read much of the literature and have heard opposing viewpoints at symposia. To my mind Lasers have very limited use in periodontal therapy. When I say opportunity I was unsurprised and dismayed by the results. These patients were charged significant sums of money with NO RESULT. The study by Yukna cited by johnDDS-is incredibly small in sample size. I've been a periodontist for over 25 years and seen many new things touted only to find later there were problems. Surgical pocket reduction when done appropiately still has the best long term success.

Disclaimer this is cut and paste from this thread http://www.osseonews.com/cadaver-bone-for-grafting/ As far as conflict of interest, I have owned the Periolase for about a year and a half, though my first patient, had the procedure done 9 years ago; I have seen first hand the reversal many times. The results are exactly what the manufacturer has claimed. So yes my patients have compensated me well for the service. As far as compensation from MDT I have helped at their booth during the AGD I received less than a third of my daily production for my time. Though the compensation knowing that someone else who has no knowledge of the outcome and may just stumble on it here is priceless! Because they would then be able to see the results all LANAPERs have experienced which would trickle down to all the patients who would benefit in saving their teeth. I have never been compensated for any lasers sold. Kick backs % of sales etc… MDT is not public, and I am not an owner of the company. Again I have been compensated many times by the patients outcomes. #1) As far as your statement "this is a case report" Below you will find some of my cases. http://ddsgadget.com/implantcases/?cat=79 There is a big difference between a case report and HUMAN HISTOLOGY that is what Ray Yukna has shown in the IJPRD that happens to be one of the highest forms of proof in the Perio literature. Do you have any idea how hard it is to conduct a study like that? The NIH and FDA frown on and rarely give approval for such a study. This one happens to be the third largest in the Perio lit. 2) Yes it is supported by MDT. Where are the AAP and the Perio world on this? $0 3) Pratt why don't you address the Human histology? If you do have the IJPRD? I have not been paid for any time on this site as described above. Pratt you and I seem to be going round and round on the same argument you don’t think the FDA clearance means anything or the current research is enough. I on the other hand feel it is sufficient to reverse the #1 cause of tooth loss in Adult Americans. I don’t think we will ever agree. I don’t think anything I write here will ever convince you. So I would suggest when the 5 year results come out, you can wait for the 10 year results, then the 20 year, then the rat studies, then the dog studies, and for you it will never be enough. I don’t think you could ever see yourself investing anything into saving your patients teeth. Because your argument will always be that the patients do not value their teeth enough to invest the $4,600.

Once again wrong again. I havent said the Laser will not help. I have tried to point out to you the great value of evidence based dentistry which you fail to see. Secondly, I also said that there isnt enough evidence yet to justify not referring to specialists or charging patients 4600 a pop which you so smugly pointed to in your posts.. As I already pointed out the IJPRD Paper is the same evidence Yukna already presented. Even though it is human histology it is still a case report. Look into Bowers human histo randomized controlled clinical trial. That is the type of study you need. Once again John, my problem isnt with new tech or the promise of lasers. My problem is with you: 1) You use ever opportunity to advertise the laser when the topic isnt even related to the laser. 2) You are clearly paid by the company which is a conflict of interest 3) You trash a specialty for doing implants yet you dont refer any disease. 4) You preach treatment that has very little evidence behind it. Which I hope you are including in your informed consent to your patients. 5) You fail to see what evidence based dentistry is about and you feel company sales of the laser ("MDT signed a record number of orders at any trade show in the history of the company") and a few publications supported by the company is enough to claim that a specialty has failed and you have the magic bullit. Like I said Doctors on this site are well educated please dont treat us like a salesman.

Pratt said; Once again wrong again. I havent said the Laser will not help. Johndds response; WOW that is the most remarkable thing I have heard you say. Congratulations on your break through ;-) Pratt said; I have tried to point out to you the great value of evidence based dentistry which you fail to see. I am blinded by the light see this Pratt said; Secondly, I also said that there isnt enough evidence yet to justify not referring to specialists or charging patients 4600 a pop This is where I strongly disagree the results have been so great that I think it has been a little on the low side, I’ve been thinking about raising the fee. Pratt said; which you so smugly pointed to in your posts. Johndds response;This is your smug reply “Johndds the 4600.00 dollar full mouth laser guy” just following suit. Pratt said; As I already pointed out the IJPRD Paper is the same evidence Yukna already presented. Even though it is human histology it is still a case report. Look into Bowers human histo randomized controlled clinical trial. That is the type of study you need. Johndds response;I don’t need anything I believe. You on the other hand should go about funding it so you can disprove it. Just like Ray did his goal in doing the reasearch was to try and disprove it ;-) Pratt said; Once again John, my problem isnt with new tech or the promise of lasers. Johndds response;Great as long as it is personal fire away. I got thick skin. Pratt said; My problem is with you: 1) You use ever opportunity to advertise the laser when the topic isnt even related to the laser. Johndds response;I didn’t start the discussion nor have I started anything just following the comments on this thread. 2) You are clearly paid by the company which is a conflict of interest Johndds response;Granted, though the end is more important than anything that I could ever be compensated by MDT. That end being more patients will not have to go under the knife, and LANAP becoming the Standard of Care for Periodontal disease. 3) You trash a specialty for doing implants yet you dont refer any disease. Johndds response;No one around me had the Periolase that my patients needed. Though my Perio across the streat picked one up after I brought a speaker to our Study Club. Oh and he didn’t return it after the 6 month money back guarantee. Funny NO periodontist has ever exercised that right  4) You preach treatment that has very little evidence behind it. Which I hope you are including in your informed consent to your patients. Johndds response;I always give my patients full informed consent. I hope you inform your patients of the option of LANAP, since LANAP is within the Standard of Care. Ever since the FDA clearance that’s now 3+ years old. 5) You fail to see what evidence based dentistry is about and you feel company sales of the laser (”MDT signed a record number of orders at any trade show in the history of the company”) and a few publications supported by the company is enough to claim that a specialty has failed and you have the magic bullit. Johndds response;No magic bullet though it sure seems like it. And yes the perio specialty has failed in disproving LANAP. Pratt said; Like I said Doctors on this site are well educated Johndds response;I totally agree with that statement. See we do have something in common. Pratt said; please dont treat us like a salesman. Johndds response;I don’t get it? Are you selling something?

John DDS "LANAP becoming the Standard of Care for Periodontal disease." Please show me any statement by the American Academy of Perio the ADA that LANAP is the standard of Care? Not sure how you dont get the salesman response. You seem to be more of a salesman for the company then a Doctor. Johns comments: "6 month money back guarantee." "MDT signed a record number of orders at any trade show in the history of the company” Using any chance he can to plug the laser. Are the above statements by a doctor or a salesman for the company. John your a lost cause, you need to look into the following words: Disclaimer Evidence based dentistry - (Do you even understand what a Randomized controlled clinical trial is vs a case report.) Never mind I give up.

To John DDS Since you are so confident of your results I propose that you conduct a study of your patients by independent practioners to study before and after Laser therapy. This of course would include detailed films, probings and charting(including gingival recession etc) prior to and after your therapy. I would also like to see any treatment done prior to Laser therapy such as very thorough scaling and root planing. Shouldn't be hard to do to prove your success should it?

Great Post Bruce. Even Yukna says in his article that the laser is combo treatment with occlusal adjustment, Scaling and root planing, Antibiotics etc. John McAllister DDS said "Why should I refer for an inferior service? I have seen the results first hand the reversal of the #1 cause of tooth loss in adult Americans!! I have slashed periodontal pockets in half consistently. 12mm infected and inflamed pockets to 2mm sulci over & over & over & over again with little or NO pain, with out screwing down the patient!" Tell me Dr McKelvy, your a periodontist. The research I read shows that Scaling and root planing is only effective up to 5 mm's. Since scaling is needed for the laser to work as written in Dr Yukna article. Is it possible for johndds to treat pockets with the laser beyond 5 mms? John by the way, Slashing 12mm pockets in half is 6mm not 2mm. When you do your research project make sure you have a stats person review it to check the math ;).

McKelvy you wrote that you have seen dozens and dozens of cases treated by the laser. Were the cases done with the Periolase or a "me too-LASER" case? FYI I know of one Diode manufacturer whose certified ALD trainer claims he does LANAP with a Diode and claims further that anyone with a diode can do it. He showed one case of 2 teeth... no x-rays, not exactly a scientific study. Painting stripes on a donkey and calling it a zebra works till he opens his mouth and says "Hee Haw". You have suggested “I propose that you conduct a study of your patients by independent practioners to study before and after Laser therapy” That is precisely what Harris did he is not a DDS but a PhD in statistics. biomedicalconsultants.com/HarrisGreggJGD04.pdf I would be completely open in allowing anyone to review my work. Would you like to fund it? I welcome anyone who has any doubt to come into my practice and do a review.

John DDS Why don't you ask the company who you obviously work for to fund a study? This along with others would cement the reputation of the Periolase as a wonder tool to reduce 12mm pockets without surgical intervention. Or you certainly could conduct your own study then have it peer reviewed. To answer your question there were two lasers in that practice one being the one you espouse. Perhaps if there had been any pretherapy ie. scaling better results may have been observed; but as you are no doubt aware case selection is very important. Dr Pratt is correct re scaling being difficult in deeper pockets-the anteriors of course are easier because of simpler root forms. A posterior 12mm pocket with concavities and convexities would be difficult or impossible to scale and be certain it was free not only of calculus but also necrotic cementum with bacterial components (that is why root planing is important John DDS. Yes I Know the laser will kill bacteria) Incidentally, I am not closed to the idea of lasers or any other improvement. I have had experience with much restorative and particularly the CEREC 3-great in the right circumstances(have done a couple of hundred restorations). The idea of using a laser in 12mm pockets or even 8mm and getting great results without opening and thouroughly debriding doesn't speak of success long term

McKelvy; If I or MDT funds the study don't you think I'll get Pratt's response? "The study is supported by millennium dental….anybody in research knows that puts a shadow on the article." Now wouldn't it be nice if the Perio community would fund it to disprove the efficacy? Again, I don't need to prove anything. I'm a private practicing GP and I know it works. And so does every customer who has ever used it. That is why it received 9.7 out of 10 in the CRA newsletter, no other dental product has EVER gotten as high a mark. That is why no Periodontist has ever returned it, even though they all had a 6 month money back guarantee. Periodontists make up 16% of owners, in the general population the GP to Perio relation is 6%.

Holy Moly all these business stats, Highest CRA, 6 month money back guarantee, percentages of who owns the machine. Geez John does the company give you stock options as well as pay you. On another note you keep making statements like why doesnt the perio community pay for a study to disprove the tech. I doubt very much a periodontist goal would be to try to disprove something that could potentially help there patients. But thats your attitude, being that you dont refer, you have a you vs them attitude. Man I hope you dont get burned someday, I hope you dont need a specialist to bail you out of a mess, because with your attitude, if I was a specialist in your neck of the woods you would be the last guy I would help. Dont worry about me slamming you for a study supported by the company, if your results are as great as you say I would love to see a study out of your office. Make sure if you conduct the study you use a standidized radiographs, stents, and all the othert bells and whistles of a research study. If you dont understand what Im talking about with all the bells ans whistles because its obvious you dont read articles as I do. Give your buddy Yukna a call and have him explain it to you.

I think u can improove the periodontal health of the teeth adjecent to the implants by placing dressings of citric acid after wahing the pockets with 2% chlorohexidine on alternative days for one week.Then For other teeth u can go ahead for perio surgery.

Pratt says; Holy Moly all these business stats, Highest CRA, 6 month money back guarantee, percentages of who owns the machine. Geez John does the company give you stock options as well as pay you. Johndds reply; I agree incredible stats from an incredible procedure. No stock option. :-(  Pratt says; On another note you keep making statements like why doesnt the perio community pay for a study to disprove the tech. I doubt very much a periodontist goal would be to try to disprove something that could potentially help there patients. Johndds reply; Lanap has been in the literature for 10 years, the perio community has invested $0 toward disproving or proving it’s efficacy but when MDT does some research you get “The study is supported by millennium dental….anybody in research knows that puts a shadow on the article.”

John Mcallister DDS bottom line is your a paid salesman of the company and people see through you. I cant believe we have people like you in our profession. I cant speak for the perio community as I am a gen dentist. But from the research I presented they disproved ENAP years ago and found flap osseous to be more effective. Yet you bash the speciality of periodontics and fleece your patients for 4600 dollars for laser scaling and root planing. Do you even offer your patients a perio referral? Nevermind dont answer it Im sure the way you convey things to your patients they jump at the laser rather then go to the evil periodontist. You conveniently ignored the facts that I and Dr.McKelvy told you about scaling 5 mm pockets and the studys that are out there (refer to above posts). But its not suprising since you obviously dont read anything unless it benefits your bottom line. When challenged to put out you own study you hid behind costs when it will cost you next to nothing to look at the data in your office and send it to an independent auditor. Like I said people see through you.

Pratt as I have said before I do not receive a % of sales, commission on any sale, I do not get paid for posting here, I am not a stock holder nor am I an owner of MDT. My compensation comes when I hear of the successes my fellow colleagues are having. Because I know that each patient who doesn’t have to go through the knife will have a kinder gentler experience. That, as I have said before, is payment enough. The research you presented refuted Enap this is not Enap but Lanap. Different technique different procedure, different outcome. The Enap is done with a blade the Lanap is done with a laser. The blade is an indiscriminate cutting tool the laser is selective, in that it removes the epithelium selectively without disturbing the underlying connective tissue. Also the laser kills black pigmented anaerobic bacteria. The laser also leaves a stable fibrin clot. It is like natures own band aid. On other threads on this site, you will hear of DDS’s having trouble clotting a patient on Cumadin, Heparin, or Aspirin. Periolase owners don’t have this problem because they can create a thermolitic clot. As far as the ability to scale only up to 5mm. So what? In the literature there is evidence that the laser denatures calculus allowing practitioners the ability to remove it with half the effort. Also, the laser opens up the pocket allowing bloodless and clear view of the root. Furthermore the Laser can be used at 10, 20, 30 mm+ depth whatever the operator’s desire. Pratt you brought up the point that 12mm pockets are not cut in half when they go to 2mm. YES, THAT IS THE EXCITING THING ABOUT LANAP. The deeper the pocket the better the outcome. See below. http://www.biomedicalconsultants.com/HarrisGreggJGD04.pdf Bottom line Pratt it's about what is best for the patient.

Like I said John your words are elctrons in space. Its time to put up or shut up. If your results are as great as you say do a research project and report your results. Remember the project should use a standard stent for probing and standardized radiographs. You should also get a several board certified periodontist to review your results to confirm. Or if your scared of the evil periodontists get a independent researchers to review. Remember to us a wide patient sample as to not slant the results to your successes. The study should have a large patient number so there is enough power. And since you been doing this for a while, you should do a follow up paper on the long term results. Once again call Yukna if you dont understand. Make me a believer, publish your results in a peered reviewed journal and then I will shut up. I look foward to seeing all these 12mm to 2mm results you are getting. Until then people will see you as a paid salesman of the company as evidence from above postings. Happy New Year.

what about some soft tissue buildup on teeth next to implant site (after implant): no perio disease now, but thin gum tissue from prior disease..or be sensible? do gum graft, wait, proceed w implant(s)?

Well I am using lasers myself in periodontal deseases and find it a great adjuct to the conventional therapy and I do not charge my patients more then with conventional treatment and adjuctional antibiotics. On Cerec there weren't evidence based articles and the manufacturer says to me that now they have cerec 3 they have solved all the problems from the past. So what was wrong with the cerec 1 and 2 which was presented as the machines to make crowns some years ago?!!. Evidence based is just what we have researched and unfortunately these days most of the universities and other researchers are well funded by companies, which give a lot of pressure on the outcomes of studies and even researches sometimes like to see the answers they want to see by setting up the test in a special way. But this isn't helping to raise the question stated at the beginning which is something what can occur too all of us. Maybe we can discus how to handle this kinds of problems when they occur and how we can solve them best without discussing the use of scalpel or laser! This kind of problem you see sometimes also occur later. You did all the neceessary periodontic treatment prior to placing implants, you place the implants and then the suprastructure and after three months you see the patient back with a starting gumdesease agian. Why? He/ she was only motivated to get the implants. This is a problem we see as GP's and maybe the specialist who only place the implants is not aware of these kind of problems. I think it is a very interessting question? Should we put the implants back in case of two stage under the gum/ let we stay the implants under the gum till this problem is resolved again, etc, etc. Answers on these questions are much more provitable for us then teh way we do it and talking about $$.

Bottom line Pratt it’s about what is best for the patient. Happy New Year :-)

Its time to put up or shut up. If your results are as great as you say do a research project and report your results. Dont keeping dodging it. If its about doing what best for your patient, dont charge there lungs out for treatment with little evidence behind it. You shouldnt be scared to show your results of your patients in a paper. You say you have 12mm pocket depth going to 2mm. Prove it and publish it. Happy New Year ;)

gee, i guess i shouldn't have bothered to interrupt yr passing(sp?)contest with my little on topic pt-oriented question (see above) and yet, on the thread started by ANON, who was wandering in the dark re the narrow alveolar ridge how to thing, the only person horrified enuf to opine, er, watch the procedure, some videos maybe...was a (seemingly) rep. meanwhile (re above) the OS got snarky when i mentioned that the perio had wanted to do some soft tissue reinforcement prior to implant placement - don't really know what his problem is, since when i asked him abt soft tissue he snottily said that he's an OS, see a perio.. meanwhile, when he opened for the sinus lift, (sidebar for details: looking at implants 2 and 4 w/bridge maybe, implnts 14,15. ["eyeteeth" missing childhood, ortho mvd all forward]hist perio disease, nicely arrested; pocket improvement, good density but narrow ridge, bone loss) he discovered (think i should have shown him that ctscan sooner; he doesn't do ct)what he described when nagged by me to explain- as "2 cortical plates with marrow between which started bleeding enuf to obstruct vision" and (eeuw,horrors) swollen sinuses..so he aborted mumbling something about sudafed. (of course i had tried to enter into discussion re sinus probs prior to, but got brushed off) think i'm in trouble? i should probably mention that i've been to 4GPs 4 perio he's OS #2 1 prosthodontist (great rep, married to him) and never could get a treatment plan out of anybody. (guess i'll be leaving the area soon-it's a small area)so i had to sort of figger it out myself, and now this. as to the CT, the other guy does the guided surg thing, but there's a wee matter of the sexual harassment charges (including an emplyee and a pt; i know the pt) which he apparently wriggled out of, but he is Yucky. well moving right along; this site is helping me even if noone ever answers me. pj

Due to space, this blog topic is now being closed to comments. Thanks to all for the insightful commentary.