Case 2

“It’s About The Grid”

By Larry Gelb, DDS

A 63 year old healthy male presented as a new patient. Generalized moderate to advanced periodontitis with sulcular inflammation, suppuration, and heavy deposits of supra and sub-gingival calculus was noted.

At the consultation visit the patient was informed of the nature and extent of his disease and the treatment options available to him. They included conventional periodontal therapy and the LANAP-Laser Assisted New Attachment Procedure.

As is typical with my patients, he did not hesitate to choose the LANAP.

The mandibular left posterior sextant involving #17-#21 was the first area to be treated. The curious aspect of this case was the nature of the root surface on the distal aspect of tooth #19. Besides the heavy deposits of calculus, the root surface felt pitted suggesting that no amount of root planning could create a smooth surface. Furthermore, I suspect that I may have left some remnants of calculus at the base of the pocket. The pocket depth on the disto-buccal was 10mm, the disto-lingual was 7mm, and the direct buccal of the distal root had an 8mm pocket.

Ablation utilized 1000 joules at 3.6 watts at both 100 and 150 micro-seconds. Hemostasis utilized 347 joules at 3.6 watts and 550 micro-seconds followed by 200 joules of bio-stimulation and occlusal adjustment. Anti-inflammtory medications and antibiotics were prescribed and post-operative as well as dietary considerations were discussed and reviewed.

The patient was seen regularly and x rays were taken after 7 and 12 months. The area was re-charted at the one year anniversary of treatment. The 10mm pocket on the disto-buccal is now 4mm and the 7mm pocket on the disto-lingual is now 5mm with the treatment benefit being obvious on the x rays. 

Pre-treatment x-ray taken 6 mos. prior to procedure

7 mo. post-op xray.. n.b. distal of 19

Final film- 1 year post LANAP