Perio Insights | Scott Smith, DMD | Jeffrey Sibner, DMD | Amy Petrillo, RDH | Mark Weingarden, DMD | Mark Kress, MD
Perio Insights - with Scott Smith, DMD
Dr. Smith’s educational achievements include a B.S. in Honors Biochemistry from the Pennsylvania State University, a D.D.S. from the University of Maryland School of Dentistry, and a Certificate in Periodontology from the University of Maryland and Bethesda Naval Hospital. He has been awarded certificates in Laser Dentistry by the Institute for Advanced Laser Dentistry and is recognized by the same organization as a leader in Laser Periodontal Therapy.
Dr. Smith has been in private practice since 1993 located in King of Prussia, PA and focuses on Regenerative and Laser Periodontal Therapy, Dental Implant reconstruction, and Facial Esthetics. He has lectured nationally on subjects including dental implants, perio-pathogenesis, surgical & non-surgical Periodontal therapy, Laser Dentistry and Dental Implant maintenance. He is the director of the Valley Forge Dental Forum which was founded to help educate area dentists and hygienists in their pursuit of excellence. Dr. Smith has been featured on the Discover Health Channel for his professional expertise in the field of implant dentistry and smile esthetics. He was awarded Montgomery County’s Best Periodontist and Implant Dentist in 2009 and 2010 (Peoples choice award – Times Herald) and been chosen as one of the best Main Line Dentists since 2001 (Main Line Magazine Best of Awards).
Dr. Smith can be reached at his office 610-265-7023 or via email at: drsmith@cpident.com
| Perio Insights Article 411: |
July, 2011
To Lase or Not to Lase - That is the question
Scott Smith, DMD
Our current understanding of periodontal disease has undoubtedly improved our clinical outcomes. We have come to realize that this multifaceted disease requires a comprehensive approach clearly addressing each component of the causative factors. Regarding the bacterial component our knowledge of a complex biofilm protecting an array of symbiotic bacteria and quorum sensing interactions changes our concept of gross debridement. More specific treatment modalities enhancing qualitative end points can be employed.
Regarding the host response, we are more aware of the chronic inflammatory response and its deleterious effect on the periodontium. We are able to reduce the effects with various modifiers applied locally (medicated pastes, rinses, gums and the like) or systemically administered (low dose doxycycline). Risk factors such as smoking, diabetes and other chronic inflammatory diseases are identified and can be monitored and minimized with habit modification and medical care. Occlusal disorders are identified and eliminated or modified to lessen the micro and macroscopic changes to the periodontium.
Just as our minds have had to grapple with the ever changing perio-pathogenesis concepts, so too will our minds need to change regarding treatment modalities and therapeutic end-points. This therapeutic “tug of war” is being played out right now regarding the use of “lasers” in the treatment of periodontal disease.
Once considered off label dentistry, laser periodontal treatment is now providing enough sound histologic evidence and clinical efficacy that clinicians who were skeptical are giving it a second look. In 2004 the FDA approved a procedural concept called Laser Assisted New Attachment Procedure (LANAP) by Periolase MVP7 which uses a pulsed Nd: YAG laser. Studies supported by Yukna et al revealed not only significant clinical results compared to traditional modalities but also cementum meditated new attachment, essentially regeneration of the bone, ligament and cementum – gold standards in periodontal studies. Despite the mounting evidence, our professional organizations are still reluctant to accept lasers or even FDA approved laser protocols as viable therapeutic modalities.
When considering any modality of treatment our first concern must be safety for our patients. The most popular lasers on the market are diode types; Nd: YAG and Er: YAG. They have excellent safety records and are much gentler to the tissue than electrosurgical devices. Documentation and proof of efficacy is paramount. Histologic and clinical evidence compiled over 10 years clearly demonstrates that lasers are highly effective for treating most forms of periodontal disease.
Regarding the etiologic component of periodontal disease, laser therapy has been shown to be effective in eliminating the bacterial component of periodontal disease, including the biofilm. Bacteria are eliminated deep within the cementum, the inflamed gingival tissue and the alveolar bone. Endotoxins are dramatically reduced as well as the local inflammatory reaction. Periolase MVP 7 addresses occlusal interferences and minimizes the macro forces on the affected periodontium via the protocol.
I have no studies to indicate patient acceptance and compliance of laser therapy vs. traditional periodontal therapy, however, anecdotal evidence and personal clinical experience have revealed better compliance and patient satisfaction. After all, the best treatment modality is ineffective if patients are not willing to follow recommended care.
Following years of nay saying this periodontist is pleased to report that laser periodontal therapy is highly effective. Like any treatment modality, it is imperative to do thorough evaluation and get the appropriate training. I do not advocate one treatment modality as we know periodontal disease has many etiologic components. It is important; however, to be vigilant in our pursuit of understanding and improving our concepts and treatment options. As of this writing I am pleased to report that the American Academy of Periodontology is having three separate laser periodontal presentations at our annual meeting in November. Thankfully I am part of a growing number or periodontists and dentists reviewing the same data, seeing the same results and changing our dogmas…so perhaps it is time for you to ask the question to lase or not to lase?
Future articles will focus on the rationale for using laser periodontal therapy, patient selection, treatment protocols, duration of care, therapeutic end points, patient compliance, expense and insurance and how to get started.
Dr. Smith is a practicing Periodontist in King of Prussia, PA. He is not a sponsor for any laser company and is not compensated in any way for this article.