Human Clinical and Histologic Evaluation of Laser-Assisted New Attachment Procedure. (Nevins et. al., The Int’l Journal of Periodontics and Restorative Dentistry, 20012).
Although laser therapy in the field of Periodontics remains controversial, recent studies have shown promise that laser-assisted new attachment procedure (LANAP) may be able to reestablish periodontal health with reduced pocket depth and attachment gain. Limitations in clinical studies and the biological mechanism of wound healing using laser therapy in periodontics persist; however, this study examines the histological evaluation and healing response to the minimally invasive laser therapy. Eight qualified subjects with advanced periodontitis presented with 12 periodontal defects for the study and six teeth requiring extraction from patients not in the LANAP group were selected as negative controls. After therapy, LANAP treated teeth were removed en bloc including surrounding hard and soft periodontal architecture for histological preparation. Prepared samples were examined under brightfield/polarized light microscopy and micro-CT images. The results show no signs of root damage post therapy. After 9 months, the 12 teeth treated with LANAP had a mean increase of 3.8mm ±2.38mm and probing depth reduction of 5.4mm ±2.64mm (Nevins et. al., 501). Histologic analysis reveals the healing mechanism for LANAP treated teeth to be via long junctional epithelium, new attachment, and periodontal regeneration. Histology of prepared teeth revealed that LANAP has the potential to induce regenerative healing in patients with advanced periodontitis (502). Pt. 6 also presented with deep intrabony defects with clinical attachment loss (CAL)of 11mm and a mesial probing depth of 9mm (504). Post-LANAP therapy, post-operative radiographs show bone fill with 5mm CAL gain (figure 3b-c). Histology also shows regeneration of periodontal architecture including new cementum (NC) integration. (Figure 3e-f).
The conclusion of this clinical study shows evidence of increase CAL gain, reduction of periodontal pocket depth using LANAP. Moreover, this study shows that a minimally invasive periodontal procedure can lead to periodontal regeneration of cementum with collagen fiber integration that can be histologically observed.