Thanks Ron, Dave, Allen and Danny for the kind comments.

I have been holding on to this case for a few months due to having a few things with MDT and my practice to deal with (like training 4 new clinical staff members!!). But I wanted to at least get the bone picture proof up for Danny.

I have a whole series on this case for the mesial and the distal.  How I flapped it, inpsected it, what I found, what I feel confirmed my initial impression when I first saw the failure on the mesial.  I will post the entire case after I get some time to label and resize–maybe in the hard tissue thread.

I think it important to point out that the mesial failure is a rarity in the LANAP protocol, but if there is to be a failure, this will be one place that is a good example as to why.  It is a mistake of inexperience, not root concavity per se–completely preventable which is why we use it in our training of what NOT to do.

Since the published success rate of Laser ANAP in private practice in the AGD article is 95%, what I feel is important to show is that we have a strategy to prevent typical early mistakes, understand why they happen, and when they do, how to treat them.

Anyone who does perio therapy knows about “asymetric” healing.  Laser ANAP has that too.  If I were to suggest otherwise, I would simply be putting out BS.

But the reasons for our asymetry is much easier to isolate since we are very simple in what we do to manipulate the tissue in the protocol.

Iwould also like to point out on the Hi Res photo, that there is clearly residual calculus present.  Not for one minute do I think the distal is any cleaner than the easier accessable facial.  Something appears to render the calculus less toxic (the 1064nm wavelength?) that perhaps is creating a more hospitable environment?

But this is not unique to lasers or Laser ANAP.  Charles Cobb in the Annals of Perio in Mechanical Instrumentation cites Johnson and the paradox of perio pocket healing even in the presence of 50% residual calculus.  What may be unique is the nature of the heal–cementum-mediated NA vs long JE.

Allen,

Always appreciate your questions.  The distal of #6 was treated shortly after to remove decay and in fact perform RCT.  It now has a temporary composite restoration and endo fill.

Thanks for the positive comments everyone.

More later……

Bob

(Edited by Robert Gregg DDS at 9:58 am on Oct. 28, 2004)

This really has been a great thread. What to you all think about Eric’s use of ME Blue as a chromophore? Do you think it will make a hugh cahnge in the use of the diode for perio? IS this still a repairative procedure?

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