Lasers
continue to make waves in periodontology
By Rochelle
Sharpe, DrBicuspid.com contributing writer
October
12, 2009 -- As the first periodontist in the
"Lasers
are a wonderful option for doctors and patients to consider in treating periodontal
disease," Dr. Tilt said at the
But just
five days before Dr. Tilt delivered his lecture, complete with new statistics
showing the advantages of laser treatments over traditional techniques, the AAP
endorsed the
The policy
was another blow to Millennium
Dental Technologies, which invented the LANAP procedure and began selling
its PerioLase laser in 1999 for removing dental
caries as well as diseased tissue in periodontal pockets. In its policy
statement, the
But the
criticism didn't deter Dr. Tilt, a
Speaking
at the AAP meeting, he told a crowded room of periodontists
that the
By
contrast, in the three studies examining patients treated with more traditional
methods, 9.8% of teeth were lost in one study and approximately 5% of teeth
were lost in the other two. The authors of these studies, however, followed
patients much longer than Dr. Tilt did. The studies showing 5% tooth loss
followed patients for 12.5 years and 13.6 years, while the one showing 9.8%
tooth loss followed patients for 19 years.
Dr. Tilt
also said that only 4.7% of his patients were going downhill after six years,
compared to the longer studies where 14.3%, 15.8%, and 23% of patients were.
Even though the other studies were longer, he said, their duration could not
account for the poorer performance results.
Not only
do patients get better results with LANAP, he said, but they are more likely to
accept the laser treatment. With lasers, he said, there is no postoperative
swelling or bleeding, no additional gingival recession, and no extra tooth
sensitivity.
Dr. Tilt
stressed the necessity of treating all his patients' teeth. "It's
important to disinfect the entire mouth," he said, pointing out the
laser's capacity to reduce infections. In the studies of more conventional
methods, dentists did not treat each tooth.
Effectiveness
questioned
In spite
of such testimonials, though, few periodontists use
lasers in their practices. Dr. Tilt estimates that fewer than 8% of his
colleagues use them.
|
With LANAP, the laser fiber is
inserted between the periodontal tissue and tooth to selectively remove
diseased or infected pocket epithelium from the underlying connective tissue.
Image courtesy of Millennium Dental. |
The low
numbers are partially due to the controversy over the lasers' effectiveness.
"There
isn't a huge amount of research," said Meg Dempsey, an AAP spokeswoman.
"There isn't anything conclusive."
Indeed,
there are few studies on laser use for periodontal work, and they have
generated vigorous debate. Even online forums are filled with heated
discussions. A recent post about LANAP on a dentistry online forum generated 63
responses, with dentists analyzing the latest research studies and spinning
conspiracy theories.
"The
AAP is terrified of GP's with lasers," John G. McAllister, a
For its
part, Millennium continues to cite the work of Raymond Yukna,
D.M.D., M.S., director of advanced periodontal therapeutics at the
The
Millennium
vigorously opposed the
"It
is terribly unfortunate that ... the use of lasers for the purposes of treating
periodontal disease, and the research that supports it, continues to be
marginalized," wrote Delwin McCarthy, D.D.S.,
chief technology officer of Millennium, in a formal rebuttal to the
Millennium
argues that Dr. Yukna's study was not small, given
what it was examining. It is the fourth largest human histology study in the
periodontal scientific literature, it said, pointing out that institutional
review boards strictly limit the size of such studies.
History
of skepticism
Using
lasers for periodontal treatment has met with skepticism for years. Douglas Dederich, D.D.S., Ph.D., former vice-chair of the
In 2000,
he wrote the U.S. FDA that there was "significant concern" in the
dental community that applying the laser in the gingival sulcus
"represents a serious risk to the dental pulp." The damage may not be
detectable by standard pulpal tests, he wrote, but
research with animal tissue examined under a microscope had shown severe pulpal damage. If such damage were to occur in humans, it
would require root canal therapy.
Later, in
a 2004 article in the Journal of
the American Dental Association titled "Lasers in dentistry:
Separating science from hype" (Vol. 135:2, pp. 204-212), he and co-author
Ronald Bushick, D.M.D., Ph.D., wrote that laser
curettage "appears to be neither scientifically nor ethically
justified." They did say, however, that early evidence shows
"exciting potential" for lasers to produce superior attachment levels
after root debridement compared to mechanical planing.
Dr. Dederich could not be reached for comment as to whether he
thinks that potential is now any closer to reality. And the AAP declined to
comment beyond its formal endorsement of the
So, for
now, the controversy continues, with dentists relying on their own judgment,
experience, and existing research to figure out what is best for their
patients.
Copyright
© 2009 DrBicuspid.com