Laser Gum Surgery (LANAP) -Winter Park Dentistry
Dr. Ramzi Matar (Winter Park Dentistry): Hello everybody, welcome to this episode of our video podcast. Today we have our guest Dr. Dan Quevedo, and our topic is a very common or upcoming procedure called LANAP, it stands for Laser Assisted Periodontal Surgery. I’ll let you get into the exact definition of LANAP, but that’s the common terminology for it. I’m very excited to have Dr. Quevedo, reason being that I’ve known you for years, I’ve known you from message boards and we happen to practice nearby from one another, I’ve been a fan of yours for years and years and every time I walk into your dental office is like I’m walking into dental school, you have a lot of knowledge, you’re invited by dental companies to go see their products and they fly you here and there, it’s just unbelievable the wealth of information you have and how people are always referring to you for expertise, so I thought “who better?”. I also know you do this procedure, LANAP, so let me turn it over to you Dr. Quevedo, tell everybody watching this what is LANAP.
Dr. Dan Quevedo: LANAP is an acronym that stands for Laser Assisted New Attachment Procedure, and it basically came into existence over about 15+ years ago in California, and it was to dentists who invented the protocol, and we’ve been using it in our office for about 8 years with great success.
Dr. Ramzi Matar (Winter Park Dentistry): How is it different, you know, there’s going to be people watching this with some kind of periodontal disease, commonly known as gum disease, they might have seen a dentist and they would have said “you might need surgery”, so how is this different than traditional gum surgery, traditional periodontal surgery?
Dr. Dan Quevedo: The biggest difference is that with traditional surgery, quite often, there are incisions that have to be made to flap the gum tissue back off of the bone, or in lamest terms peel the gums back, and this gives the surgeon direct visual access to see the root surfaces and the bone so that they can scale the tartar, the mineral on the side of the root, or at least try to, and when they’re done getting it nice and clean and smooth then the gum tissue is sawed back up into place, and that’s a greatly simplified version of what they do. It certainly works, but the unfortunate part of it is that it’s also typically very uncomfortable post-operatively for the patients, and so it has a bad reputation in the community in terms of discomfort, and even though we refer patients and have for years to have this procedure done, very few have actually followed through on the referral and actually have gone get it done, because they knew somebody somewhere, their neighbor, their family member who’s had this done and they were scared to basically get it done.
So by contrast LANAP involves no cutting, and no sawing, and the treatment is achieved by using the MVP-7 laser, which is made by Millennium Dental Technologies, and this is a laser that is very unique and that is able to very specifically target just the bad bacteria that are involved in gum disease. There are other systems like an electrosurgery or even other wave lengths of lasers that will kill these bacteria, but the problem is they kill more than the bad bacteria, they kill the good ones, they kill the good tissue. It just wipes out everything. That’s the advantage of the perio lase, it doesn’t do that. The healthy tissue, it leaves alone. The harmless bacteria, it leaves alone. It’s specific in its interaction with just the bad bacteria. And that’s in a nutshell what the difference is. There’s obviously a lot more than that, but…
Dr. Ramzi Matar (Winter Park Dentistry): As far as feedback, certainly, I’ve heard the horror stories, everybody’s heard or had a family member say “oh I had gum surgery, I’m never doing that again, I don’t care what you tell me”, I think anything general dentist watching this has heard that, or even a patient watching this they might have had a horror story themselves, and not to say gum surgery isn’t sometimes needed, but do you find that post-op the patients that you do the LANAP on, have a better feedback?
Dr. Dan Quevedo: Absolutely. On a ten scale, with ten being the most awful pain you can imagine, and zero being no pain at all, after LANAP I would say it’s maybe one or two on that scale. Most patients after traditional gum surgery would say it’s in the six to seven range, something like that. But just to be fair to traditional periodontal surgery, note everybody has terrible pain with it. The problem with these sorts of stories being shared from person to person out on the street, and among neighbors over the backyard fence, is that they get exaggerated a little bit. Even though it is uncomfortable it’s probably not something you would be eager to do, it’s probably not as uncomfortable as you think it would be either.
But just the same, when you’re trying to remove the core cause of the problem, which are the pathogens, the bad bacteria that cause this infection, it’s just very nice to know that you can actually eliminate all of them, because keep in mind when you’re simply scraping with a scaler, with a large relative instrument compared to the size of the bacteria, these bacteria are microscopic, it’s almost impossible to scrape all of those bacteria out, because it’s trying to scoop sugar with a fork instead of with a spoon. Just in the same way the grains of sugar would fall in between the tines of the fork, and leave a lot of them behind, the same thing happens with the bacteria, with traditional surgery or scaling the root plain, which is ad deep cleaning, either way you’re going to leave seeds behind, if you will, that are going to spread out and come back and haunt you later, whereas with the perio lase, during LANAP, it kills every one of them and you’re not leaving virtually any one of them. That’s to me, one of the biggest advantages, that you’re really getting rid of the bacterial component of the infection.
Dr. Ramzi Matar (Winter Park Dentistry): That’s the laser specific for those bad bacteria.
Dr. Dan Quevedo: That’s right, it doesn’t damage. This is a technical term that only dentists would understand, but histologically speaking, the [gum pockets are] very important for regenerating new attachment, new connection of the gums to the bone. With other wave length lasers and with electrosurgery, those get destroyed, which makes it very hard to get a new attachment. They’re completely unaffected, there’s no interaction whatsoever, with the perio laser.
Dr. Ramzi Matar (Winter Park Dentistry): So in the attachment, if you’re watching this, is everybody’s heard of their pockets or gum pockets, they have these measurements, and that’s what Dr. Quevedo’s talking about. Now the big question in my mind, is it as good? It doesn’t hurt, it sounds like it’s sort of a big invention, so the question is, does it work as well?
Dr. Dan Quevedo: The feedback from all the dentists doing it, and the researches being done so far, is at the very least it’s equal to traditional surgery. And there are many that feel that it’s better, time will tell, but it’s at the very least as effective. Less expensive as well, that’s the other nice factor.
Dr. Ramzi Matar (Winter Park Dentistry): Sounds like the trifecta. I know it’s relatively new, but there are studies that are coming out or have come out that support that, other than just dentist to dentist, or dentist to patient, tell me a little bit about that.
Dr. Dan Quevedo: Well the initial study was done at LSU, back when hurricane Kathrina had slammed onto the US, you remember that. Years ago, was that 2001? They had just finished the study when the hurricane came in, makes it easier to remember when they did that, but that’s another story. In that initial study that they did, they recruited quite the number of people in the dental school that had seemingly hopeless teeth that were scheduled for extraction.
They convinced these patients to let them give it a try to treat them with this new laser this new protocol, this new technique that was going to be known as LANAP, and most of them doing this experiment, they were going to go ahead and extract the tooth and give them a free implant and crown, courtesy of the university. So most of these people said “that’s great, I’m going to lose the tooth anyway, I’m going to get a free replacement tooth, a nice free implant”, and so they signed on, but if anything happened in the middle of the study, these diseased teeth that used to be loose and wobbly, they tightened up, they stopped bleeding, they stopped hurting, they got firm again. And about ¾ of the patients dropped out of the study, they said “my tooth is fine”, I don’t need to take it out, I don’t want my free implant.
So what ended up happening is that at the end there were only 12 to 13 patients that continued with it through to the very end, had their teeth removed, when they did the study they found out a new attachment on all of these teeth, one hundred percent. That’s unheard of in most medical organic studies. The inventors of this protocol were quick to point out that in their research leading up to this study, for the FDA, their record showed a 91% success rate, not a 100%, but be that as it may, the study that was done at LSU was 100% success, so just this past year they finished a study that was done all over the United States, in different places, a combination of dentist schools, offices, but what was what promised was a 90% success rate and at least a 50% reduction in all of the pockets. So what that means in English, is that if you got 32 teeth, and were expecting at least a 50% reduction in the pocket problems, on 91% of those 32 teeth, that means you might have 1 or 2 in the mouth that didn’t heal just as well as the rest of them did, and they might need a little bit more treatment, but those are great odds. I’ve seen ten or twelve millimeter pockets come down to 5 and 6, which is fantastic. When you treat the pockets that are that deep, you know that if you can move 12 millimeters down to 5 it’s a big victory.
Dr. Ramzi Matar (Winter Park Dentistry): I can tell you also, just talking to people, I hear great results like that, more and more people are getting into it, I’ve seen specialists doing nothing but this surgery, and moving away from traditional periodontal surgery. I know sometimes it’s necessary to do traditional surgery, so I don’t want to paint with too wide a stroke, but just the way you described this study for anybody watching this, this just reinforces why I wanted you on this topic. I don’t even know how you have time to practice, you’re like a textbook, you know so much literature. You have a full time practice, a family, I don’t even know how you do it. I’m always so impressed, I come talk to you and it’s literally like I’m going back to dental school, so I could spend hours at your office because I learn so much. But I do have one final question. Everybody watching this video clearly can see that you’re a Cowboys fan, I know you’re a diehard Cowboys fan, everybody can see that. So here’s my question; a few weeks ago, the Cowboys went to Seattle, and I believe beat them. Now, Seattle has the infamous thirteenth men…
Dr. Dan Quevedo: They call it the twelfth men.
Dr. Ramzi Matar (Winter Park Dentistry): Twelfth men, I’m sorry. So my question to you, is how many men you think Seattle would have had to have on the field to beat the Cowboys that night?
Dr. Dan Quevedo: *laughs* They would have needed a couple more. That score could have been a lot worse than it was, the Cowboys had three big mistakes, three turnovers, but if not for that they would have really stomped them. The reality of it is – even the commentator was saying it – the defensive line was mauling, that’s the word they used. And that’s kind of a strong statement,when you’re mauling the opposition, you’re whipping them pretty good.
Dr. Ramzi Matar (Winter Park Dentistry): So 15 to 16 men on the field, and they still might have lost then.
Dr. Dan Quevedo: In the last three years, they’ve only lost one home game. It’s almost impossible to beat them at home. It really was quite huge.
Dr. Ramzi Matar (Winter Park Dentistry): Dr. Quevedo, I really appreciate having you on the show, if anybody has questions, comments, post them, I’ll do my best to reply or send feedback to Dr. Quevedo for a reply about this topic, I know a lot of people are reading about it, learning about it, it’s a great alternative to traditional surgery. Thanks so much.
Dr. Dan Quevedo: You’re quite welcome, and if your readers want I can give you the website. It’s www.periolasedentist.net.