Laser Light vs Surgery for Gum Disease
By Stuart Diamond – Editor-in-Chief, Empowered Doctor
Integrative medicine is a term that is often associated with simple and more natural treatments for health issues – in contrast to conventional medicine that tends to rely on more aggressive interventions, using synthetic drugs, surgery, or radiation when considered necessary. Usually, we think of integrative medicine as low-tech – herbs and natural supplements instead of drugs – acupuncture, massage, or chiropractic, for example, instead of surgery. Much of the underlying philosophy is about aiding the body to heal itself, instead of dramatic attempts to fix the problem. Less is more.
However, there is another way to think about integrative medicine – when actually more (hi-tech) is less. This occurs when technological advances allow for simpler, less invasive approaches that allow the body to heal itself – exposing the patient to fewer drugs, foreign substances, and less surgery.
Dentistry is one field where the impact of technology is making dental practices simpler, safer and less invasive. Dr. Richard Nejat is typical. His practice, Advanced Periodontics and Implant Dentistry, has several offices in the New York Metropolitan region.
“Many of my patients are seeking healthier alternatives. They are aware of what foods they eat. They exercise more. They are more and more savvy. After all, the dangers and benefits of all treatment options are available to them on the Internet. So my interest in better, alternative treatments, is not only personal but in response to my patients.”
Dr. Nejat is an experienced periodontist, treating advanced periodontal disease – an infection of the gum that can lead to inflammation, destruction of gum tissue, teeth, and bone. Traditional approaches for treatment require surgical debridement, removing of diseased gum tissue and bone – and may even require bone grafting. Forward thinking dentists are now using lasers. Instead of cutting away the gum, the dentist uses the laser inside the periodontal pocket – the space between the tooth and the gum. Only a micro amount of the diseased tissue on the inside of the pocket is removed. The area is cauterized and pressed against the tooth. This allows the tissue to form a tight seal around the base of the tooth and to heal naturally.
During traditional gum surgery, an incision is made into healthy gums, using a scalpel, to gain access and visibility to the site that requires treatment. While this incision will be stitched up after the close of the procedure, the action of cutting and sewing your healthy gum tissue can result in gum recession. Traditional gum surgery can cause your gum line to recede up to 15 millimeters which creates the need for additional treatments, such as gum grafts. With lasers, however, there is no need to cut or suture your healthy tissue, as it will remain intact. This also greatly reduces discomfort and healing times during gum surgery recovery.
The dental associations have yet to give a final stamp of approval as to which procedure is more effective in addressing periodontal disease. However, Dr. Nejat is clear in his assessment: “There is little doubt in my mind that that laser treatments work better than any other procedure I have used in the past. The procedure takes only a few minutes – with little or no pain. Usually, the problem is resolved in as little as one or two visits. Older methodologies would take 5 or 6 visits, risk infection, need more pain killers and antibiotics to be prescribed – everything that patients seeking more natural approaches to their health want to avoid. Patients are clearly happier to see good results with little or no pain. I can’t imagine anyone wanting to go back to an older methodology.”
One of the procedures is called Laser Assisted Regenerations or LAR. The diagram below provides an overview of how it works.
- Perio probe indicates excessive pocket depth
- Laser radiation vaporizes bacteria, diseased tissue, pathologic proteins, and alerts the practitioner to the presence of tartar
- Ultrasonic scaler and special hand instruments are used to remove root surface accretions
- Bone is modified at time of surgery
- Laser is used to form a gel-clot containing stem cells from bone and PDL
- Reattachment of reté ridges to clean root surface, with a stable fibrin clot at the gingival crest to create a ‘closed system’
- Occlusal trauma adjusted
- New attachment is regenerated