The year was 1994. Bill Clinton was two years into his first term, Nelson Mandela had just been elected as South Africa’s first black president, and the World Wide Web wasn’t a big thing yet. Rocking in the aftershocks of Southern California’s 6.7 Northridge earthquake, Doctor Robert Gregg founded Millennium Dental Technologies (MDT) to explore the benefits of laser technology and treatments for dental patients in private practice general dentistry.
“This is a company founded by clinicians for clinicians, and it’s all about the patient. That is the foundation of what we are doing,” says Dr. Gregg. “We were able to merge that philosophy with laser technology to develop a treatment protocol our periodontal patients would accept.”
Foundations in LANAP Research
Our doctors were building on the early pioneers of laser dentistry, specifically Dr. Terry Myers back in the late 1980s. A thin fiber-optic delivery handpiece and pulsed Nd:YAG laser was the “first soft tissue study utilizing a pulsed Nd:YAG dental laser.” Following this initial research, multiple studies followed, including Midda, 1990; Tseng, 1991; Lin & Horton, 1992; Cobb, 1992; and Gold & Vilardi in 1992. Dr. Gregg continued research to test tissue interactions with different lasers and operating parameters—from surgical argons (515 nm), free-running Nd:YAG “Neodymium YAG” (1064 nm), Ho:YAG “Holmium YAG” (2100 nm), Er:YAG “Erbium YAG” (2940 nm) to Continuous Wave (CW) carbon dioxide.
In their research, the doctors discovered something they didn’t expect. Individual laser wavelengths with modified operating parameters (not seen in dental lasers at the time) worked with tissues in new ways. This effect produced different results than what wavelength-specific tissue interactions would predict.
Working with basic science, relevant medical literature, and laboratory investigations, Dr. Gregg uncovered the safe and effective combination of operating parameters of wavelength, pulse duration (the “on” time of the pulse in millionths of a second) and Hertz (the rate of repeating a pulse at any given pulse duration). These observations evolved into the critical operating parameters of the LANAP protocol— a U.S. FDA-cleared surgical treatment using a laser and piezo ultrasonics for moderate-to-severe periodontitis.
This led to “Laser ENAP for Periodontal Bone Regeneration,” published in Dentistry Today in 1998. The article reviewed two case studies showing dramatic bone re-growth in support of “hopeless” teeth. Three additional case studies were published over the next five years. However, case studies printed in a trade journal (read: a non-peer-reviewed publication and the only periodical printing the initial findings of two general practitioners) did not impress many in the periodontal specialty world.
Research Collaboration Helped Propel MDT’s Work Forward
Despite this initial disappointment, using “ENAP” in the title triggered the attention of Professor Raymond Yukna, DMD, MS, at Louisiana State University (LSU), who had been involved in the development of the first scalpel ENAP technique. Dr. Yukna started a dialogue regarding the authors’ claims. This exchange led to a collaboration on a human histological research project.
And just like that, more research was under way.
Early publications for LANAP research were the culmination of the conversations started in 1998, the tissue research with different lasers and operating parameters in 1994, and the early periodontal pioneers referenced above. They include the following (with links to read or download):
- In 2003, Drs. Gregg published an 8-year retrospective review.
- In 2003, Professor Yukna published in The International and American Association for Dental Research(IADR) his first human histological abstract on three of the study patients.
- In 2004, Dr. David Harris published a research article in SPIE—The International Society for Optical Engineering Lasers in Dentistry X confirming Nd:YAG killed pathogenic bacteria associated with periodontal disease.
- In 2004, Dr. Yukna published a second IADR human histology abstract on the final six patients and twelve teeth. The manuscript of this university-based, prospective, blinded, calibrated research was later published in the International Journal of Periodontics and Restorative Dentistry in December 2007.
But even human histology was met with opposition. A second human histology study was planned and designed with multi-rooted teeth.
- Dr. Marc Nevins framed a new human histological study, developed in 2010. The results of this study were presented for the first time at the 2011 AAP Corporate Forum and later published in the International Journal of Periodontics & Restorative Dentistry in 2012.
Additional information not published in Dr. Nevins study was submitted to the FDA in 2015. Based on the additional information, PerioLase MVP-7 became the first and ONLY device cleared for True Periodontal Regeneration.
LANAP Research Continues to Sway the Skeptics
Cynicism is the constant companion to the LANAP research. Since the market introduction of the LANAP protocol in 1999, it has been met with skepticism. Even doctors training in the LANAP protocol find the results difficult to believe. The typical initial reaction is “This just can’t be possible. I’ll keep track of my own results and we’ll see.”
And they do. Here are a few examples:
- Dr. Lloyd Tilt, the first periodontist to adopt the LANAP protocol, collected over 9 years of clinical data, including split-mouth assessments. In 2012, he published “Effectiveness of LANAP over time as measured by tooth loss” in General Dentistry.
- Dr. David Mangot wrote about “Advancing the Standard of Care with the LANAP Protocol” in April 2013 for Dentistry Today. He emphasized how they could achieve the goals of regeneration for a wide variety of patients—and in a minimally invasive way.
- Drs. Thomas and Mark McCawley and Dr. Thomas Rams shared their results with “LANAP Immediate Effect In Vivo on Human Chronic Periodontitis Microbiota” at the American Association for Dental Research 43rd Annual Meeting in 2014. They concluded that the LANAP Protocol “immediately suppressed putative bacterial pathogens below culture detection limits in 17 out of 20 teeth (34 out of 40 sites) with deep periodontal pockets…”
- Dr. I. Stephen Brown compiled a case series, “Current Advances in the Use of Lasers in Periodontal Therapy: A Laser-Assisted New Attachment Procedure Case Series,” published in Clinical Advances in Periodontics in May 2013.
- Dr. Braden Seamons wrote about “An Alternative to Conventional Periodontal Surgery: A look at a minimally invasive approach using the LANAP® protocol” in April 2015 for Inside Dentistry. He discussed how the LANAP protocol tends to be more patient-accepted compared to conventional periodontal surgery and provides excellent results.
- Dr. Craig Long published a case study in 2016 where he treated a diabetic patient suffering from periodontal disease using the LANAP protocol. The 62-year-old male patient with Type 2 diabetes and Type IV chronic adult periodontitis, agreed to the LANAP protocol. At nine months, his tissues appeared pink with no inflammation and his radiographs revealed new bone growth.
“We have no competitors when it comes to our protocol. We have no competitors when it comes to our technology and how we are interfacing and changing the experience with the patient and the doctor in how they use this technology,” Dr. Robert Gregg said.
Few entities in laser dentistry today have worked in the field for over ten years. Millennium Dental Technologies’ LANAP research began over 20 years ago. And now, we have more and more clinicians from multiple specialties that are doing the same with outstanding results not only for the field of laser dentistry but also for their patients.
Isn’t it time you discovered what LANAP research has to offer your patients, too?
Midda M. Nd:YAG subgingival curettage. Innovation et technologie en biologie et medicine. Actes du deuxieme congres mondial. L’impact des lasers en sciences odontologiques. Paris, 1990:105ISSN 0243-7228.
Tseng P, Gilkeson CF, Pearlman B, Liew V. The effect of Nd:YAG laser treatment on subgingival calculus in vitro. J Dent Res 1991;70(4):657, Abstract 62.
Lin PP, Horton JE, et al. – J Dent Res 1992;71:299 Abstract 1548 – The effect of a pulsed Nd:YAG laser on periodontal pockets following subgingival application; Abstract 1546 – The effect of a pulsed Nd:YAG laser on periodontally diseased root surfaces: a SEM study; Abstract 1547 – A comparative effect of the Nd:YAG laser with root planing on subgingival anaerobes in periodontal pockets.
Cobb CM, McCawley TK, Killoy WJ. A preliminary study on the effects of the Nd:YAG laser on root surfaces and subgingival microflora in vivo. J Periodontol 1992;63(8):701-707.
Gold SI, Vilardi MA. Effect of Nd:YAG laser curettage on gingival crevicular tissues. J Den Res 1992;71:299, Abstract 1549.
Gregg RH, McCarthy DK. Laser ENAP for periodontal bone regeneration. Dent Today, May 1998; 17(5):88, 90-91.
Yukna RA, Carr RL, Evans GH. Histologic evaluation of an Nd:YAG laser-assisted new attachment procedure in humans. Int J Periodontics Restorative Dent 2007;27(6):577-587.