Immediate Effects of Laser-Assisted New Attachment Procedure (LANAP) on Human Periodontitis Microbiota

The Laser-Assisted New Attachment Procedure (LANAP) surgical protocol was compared to ultrasonic root debridement alone for immediate post-treatment effects on putative bacterial pathogens in deep human periodontal pockets.

In a case series of 26 systemically healthy adults with severe periodontitis, 20 patients were treated with the LANAP surgical protocol and 6 patients received ultrasonic root debridement alone. LANAP surgery was performed using a free-running, pulsed Nd:YAG laser, with laser energy (4.0 W, 150-μs pulse duration, 20-Hz) first directed circumferentially around teeth parallel to root surfaces in a coronal-apical pass to probing depth for selective pocket epithelium ablation and to initiate reflection of a gingival fl ap. After ultrasonic root debridement and gingival flap advancement to the alveolar bone crest, a second laser pass (4.0 W, 650-μs pulse duration, 20-Hz) was similarly performed in an apical-coronal direction to thermally induce a fibrin clot at the tooth-gingival flap interface. Subgingival biofilm specimens were collected before and immediately after completion of the treatments from 2 inflamed periodontal sites with greater than or equal to 6 mm probing depths on a single tooth per patient, and selected periodontal pathogens identified using established anaerobic culture techniques.

Red and orange complex bacterial species were culture-negative immediately post-treatment in 17 (85%) of 20 LANAP-treated patients, but only 1 (16.7%) of 6 patients subjected to ultrasonic root debridement alone.

The LANAP surgical treatment protocol, but not conventional ultrasonic root debridement alone, immediately suppressed red and orange complex periodontal pathogens below culture detection limits in most deep human periodontal pockets.