Lawrence A. Nurin, D.D.S.

A Periodontist Who Cares

 

The Annapolis Method of Laser-Assisted Periodontal Surgery
 
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Larry's Laser Tips



Dear Colleague,
I live in a small town of 35,000 people and I'm the only "laser doc" around. However I believe in laser technology and with luck over the years I have networked and been associated with some of the best periodontal and research minds today. With their help and guidance I have put together a method of applying this technology to periodontal treatment that seems to help patients without the traditional pain, etc.

A few years ago I developed a routine that seems to incorporate all the principles to treating pockets with depths of 4 to 6 mm. I kiddingly called it the Annapolis Method of Laser Assisted Periodontal Surgery (c). I would have named it the Maryland Method but my friend Gus Levidites named a bridge after Maryland. I couldn't name something else the Maryland----.

Attached is the routine that I use on a daily basis. You might want to give it a try.
 
ND:YAG laser and the Waterlase laser.

Step 1:  Curettage (subgingival curettage and root treatment):
Power: 30 to 40 mj at 20 to 30 Hz.   (WL  .75 watts with 10% water & 11% air)
The tip is placed right in the pocket and run around the entire area that you are treating: single tooth, sextant, quadrant, half mouth, or whole mouth.
 
Step 2:  Gingivectomy/gingivoplasty:
Power: (without anesthesia) 30 to 40 mj at 30 to 50 Hz., (with anesthesia) 40 mj at 80 to 100 Hz.   (WL  1.5 watts and 10% water and 11% air)
Cut away or ablate the diseased tissue just as if you were using a scalpel or a gingivectomy knife.
 
Step 3:  Scaling/root planing:
With ultrasonic, hand-scaling, Waterlase laser, or air/powder.  Use the tip to remove necrotic tissue and deposits on the root surface. This also remove unwanted products on the root surface produced by the laser (ammonia) as well as toxins. You will find that there is minimal if any root sensitivity as well. The Waterlase laser will also remove the smear layer and enhance the root surface for fibroblast migration---without leaving any amonia products. Must be used below 1 watt with the Waterlase laser in this step.
 
Step 4:  Cauterization (slight or no contact):
Power: 40 mj at 40 Hz.   (WL   0.50 to 0.75 watts 11% air and no water)
Removes tissue tags and cauterizes cut tissue edges.
When you do this you diminish bleeding and seal the lymphatic and nerve endings. For post operative discomfort I give my patients a sample or two of orabase with Benzocaine and a few samples of Advil or Motrin. They take the ibuprofen before they leave the office and before the anesthetic wears off (if I used anesthetic). I usually do use anesthetic.

 

Annapolis Method of Laser Assisted Periodontal Surgery for the Waterlase MD

For the treatment of 4 to 6 mm pockets

I developed a routine for treating 4 to 6 mm pockets using the laser.

Basically there are 4 steps plus an occlusal adjustment and/or night guards or retainers- if necessary.

     a. Sucular Debridement: with injected anesthesia or oraquix topical anesthesia, or the turtle technique set the laser to 0.5 watts at 20 hz and S mode run the laser in the sulcus, quadrant by quadrant-slowly-connect all the dots. I place the tip at the bottom of the pocket, withdraw about a mm and activate the laser and withdraw in a sweeping motion-section by section.

     b. Gingivectomy or plasty: at 1.25-1.75 watts 45 hz and H mode- trim away any diseased or excess tissue.

     c. Root Preparation: traditional ultrasonic and hand scaling to remove any and all calculus, etc.

     d. Cauterization: at 0.5 watts S mode and 20hz I run the laser around the marginal gingiva and up onto the roots to remove any tissue tags, cauterize any bleeders, and deepithelize a margin of 2 to 4 mm around the tooth. This stops bleeding, desensitizes the roots, remove the smear layer, and micro etches the roots.

All of this is done with the C 6-9mm tip, or if the patient has a small mouth, you can use the T4-6mm or G6-6mm tips-at reduced power.

Then, as I mentioned, you can do an occlusal adjustment and evaluate for a night guard or a retainer.

Give this all about 4 to 6 weeks to heal and then reevaluate everything.

Of course you improve the patients home care (I like the Sonicare toothbrush) and then give them a prophy-to remove the toxins on the root surfaces.

Recalls may have to be every 3 to 4 mos. instead of 6 mos.

Antibiotics as may be necessary---Doxycycline 50 mg twice a day for 10 days or Periostat 60 tabs, 1 pill twice a day with 2 renewals.

If the pockets remain---time to send the patient off to the periodontist. But that should do it for most cases without too much discomfort.

Give this a try. I think you will like the results. 

Good luck,

Larry
   

EXCELLENCE WITH COMPASSION