ࡱ> ?A>%` BbjbjNN .,,,B,JJjL!!!!!!$hR^E^^^EZ^^^{^ 𩣰$:4p0,$i|EE(^^^^   April 29, 2009 John S. Findley, D.D.S., president American Dental Association 211 East Chicago Ave. Chicago, IL 60611-2678 312-440-2500 Dear Dr. Findley, We are writing about the recent ADA Laser Position Statement now published on the ADA website.  HYPERLINK "http://www.ada.org/prof/resources/positions/statements/lasers_final.asp" http://www.ada.org/prof/resources/positions/statements/lasers_final.asp We find the ADAs position to be inaccurate and misleading, especially with regards to LANAP. We are disappointed in this final statement that was released without review by either one of us as the developers of the LANAP protocol. Specifically is in not accurate to say, the therapy included intrasulcular applications to remove sulcular epithelium. This study reviewed moderate to advanced periodontal disease, and as such periodontal pocket applications of the Nd:YAG were investigated. The second paragraph on the LANAP protocol appears to be conjecture, opinion, and speculation, and is hardly worthy of an official position statement from the ADA. This paragraph and therefore the ADAs position statement are seriously flawed. Specifically, The Yukna/LANAP study is the 4th largest human histology with a control group ever published in the prestigious, peer-reviewed periodontal scientific literature. To call it a pilot validation or a small sample size is an attempt to minimize the significance of the findings.  HYPERLINK "http://www.millenniumdental.com/pdf/YuknaArticle.pdf" \t "_new"  HYPERLINK "http://www.millenniumdental.com/pdf/YuknaArticle.pdf" \t "_new" http://www.millenniumdental.com/pdf/YuknaArticle.pdf It is a completely false representation to state that the study was not blinded. The study was blinded to the patient (proximate teeth were treated in all but one case), blinded to the calibrated clinical examiner, and blinded to the histologist. We have heard the two main critics of LANAP, Dr. Charles Cobb and Dr. Doug Dederich both AAP periodontists and members of the ADA Laser Working Group on different audio recordings. John S. Findley, D.D.S. April 29, 2009 Page Two Their rationale for making this assertion is that the IJPRD does not clearly state the clinical examiner was blinded. However, Dr. Gerald Evans was the blinded clinical examiner, and Ron Carr was the blinded histologist. If that was important, the editor of IJPRD, Dr. Ron Nevins, or the peer-reviewers should have pointed that out. It was an easy clarification to make. However, the IJPRD manuscript clearly states on page 579 in the M&M Section, The 3 most central 200 micron serial step sections were blindly and randomly evaluated for the nature of the healed tissue Underlined and italic emphasis added. It is disingenuous to state the sample size was small. This was a human histological study that involved block-sectioning with bone. Human Investigation Review Boards (IRBs) regard human experimentation very seriously. IRBs regard block section removal of teeth especially rigorously. Consequently, bone block sections of human tooth/bone histology is not performed on the same numbers of patients and teeth as in a clinical study comparing established treatment methods which do not involve intentionally created bony defects. The placement of the pre-treatment notches were fully explained in the peer-reviewed manuscript in the December 2007 issue of the International Journal of Periodontics and Restorative Dentistry (IJPRD). Yukna, RA; Carr RL; Evans, GH: Histologic Evaluation of an Nd: YAG Laser-Assisted New Attachment Procedure in Humans. Int J Perio Rest Dent 27(6):577-587, 2007.  HYPERLINK "http://www.millenniumdental.com/pdf/YuknaArticle.pdf" \t "_new" http://www.millenniumdental.com/pdf/YuknaArticle.pdf It is absolutely baffling what the Council can possibly mean in the statement regarding extrapolation to early and moderate chronic periodontitis, when considering the beneficial outcomes from a study of moderate to severe periodontitis. This statement is more argumentative than enlightening. Similarly argumentative is the Councils comments on the creation of a stable fibrin clot (referred to as a seal by the Council). If the authors do not understand the benefits of creating a stable fibrin (1st connective tissue) clot, then one must question the expertise of the Council and its members in wound healing 101. There are numerous flaws, inaccuracies, and unscientific biased opinions thorough the entire position statement. We would hope that the ADA would thoroughly investigate the mechanism by which AAP members, with known agendas regarding laser use in periodontics, could be in charge of an ADA Working Group on laser use by dentists, and without the input of the inventors of a protocol that was discussed and editorialized. Sincerely, Robert H. Gregg, DDS Delwin K. 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