Q: Yesterday I had two quadrants (osseous surgery) done using the LANAP procedure. How long should I wait before having the other side done?

A: In our office, we generally do full mouth LANAP cases in one visit.  A small number of our patients have half mouth done no more than 7-10 days apart. Did you have a qualified laser periodontist perform your LANAP surgery?  I suggest you speak to the treating doctor to get the information you need to understand how the LANAP protocol should be performed.  A full description of LANAP is always discussed at our consultation visits and is part of the informed consent process for our patients.

Q: My dentist wanted me to be evaluated by a periodontist for possible bone loss. I went for an evaluation and he said I had bone loss and recommended osseous surgery 4+ per quad. I have no pain, no bleeding while brushing, but chronic bad breath.  I thought periodontal scaling and root planing would be done first before osseous surgery. Also, I was advised that I needed crown lengthening to prep a tooth for a crown. I am hesitant to have the surgery without trying the scaling and root planing. What are your thoughts?  Thank You.

A: This question seems to come up quite often from patients, doctors, students and residents, so I will try to explain how things have changed over the last 29 years in our approach to treating gum disease.

First, an accurate diagnosis is necessary.   Once we review the clinical information and full set of quality digital radiographs, we can determine how to treat the disease in the least invasive but most effective way possible with the best long term results.

We utilize laser therapy, which eliminates the need for separate scaling and root planing appointments and aggressive surgery (see our web site for more detailed information). We try to eliminate the need for conventional osseous surgery, when possible, and treat the entire mouth with the FDA-cleared laser approach (LANAP).

The advantages of this are to:

• Eliminate scaling and root planing as a separate procedure and eliminate the need for multiple appointments involving local anesthesia.
• Utilize the laser surgery instead of the conventional osseous surgery, where possible.
• If crown lengthening is needed, the area of conventional surgery is limited to the area in question.

We find that we can treat about 85% of our patients with the laser approach and in many cases, eliminate the need for cutting, suturing, scaling and root planing. In a worst case scenario, we can just do the conventional osseous surgery in very limited areas for crown lengthening. This comprehensive approach in treating periodontal disease makes for a pleasant post-operative experience for the patient with excellent results.

I would suggest a second opinion with a Periodontist trained in LANAP surgery.

Best of luck,+

Dr. Eric Linden

Q: I just came back from the dentist and was told I have advanced periodontal disease. The doctor I went to wants me to have one tooth pulled w/bone grafting. She then wants to do root/scale cleaning and then gum surgery to further clean I guess. I truly hate the dentist, hence the reason I’m where I’m at. Would laser surgery be something I could consider?

A: I would get an opinion from a well-qualified, experienced, Laser Periodontist (specialist) that is trained in the LANAP procedure before you do anything.  You should be presented with all your options.

Q: I just had osseous surgery for gum disease. Do I need to have scale planing too?

A: If someone has osseous surgery, they should not need scaling and root planing in the same location.

Q: I am missing two teeth lower teeth and am considering replacing a bridge with implants. I have been told that I will need to have bone harvested from the back of my mouth and inserted into my jaw to prepare it for implants. I will be under general anesthesia but am very nervous about this whole procedure. How painful will it be when I wake up?  How difficult is recovery from this procedure?

A: There are many different treatment options to consider when treating this area of the mouth. The anterior region of the lower (mandibular) jaw tends to have thinner bone. In many cases the ridge of bone is deficient for the placement of implants. In our office, we use local anesthesia and use either freeze dried bone (cadaver bone that is safe) or synthetic bone. We graft the sites as needed before implant placement. We would usually wait at least 3 months before the placement of the implants. We do not use general anesthesia. We do not have to harvest the bone from the back of your mouth. We try to keep the procedure as simple and conservative as possible. However, in very extreme and rare circumstances such as automobile accident cases or severe trauma, it might be necessary to refer you to a hospital trauma team. Many of those cases do require general anesthesia.

I am about to go in for osseous surgery for severe perio disease, but everything I can pull up about this treatment, will not guarantee the removal of the disease, only to say that of course, maintenance is the key. But my question is, I am 50 and the possibility of more surgeries in the future to obtain the look I want, would I be better off, physically and financially just to have teeth pulled and get full dentures?  I am so confused. I think my doctors are great, but maybe a little bias with the truth! Please help me decide. Thanks so much,,,, Carol

Dear Carol,

I would suggest that you get a second opinion about your plan for osseous surgery as soon as possible. I have done these procedures for over 25 years. I used to use a conventional surgical approach, but for the past six years I have used the laser approach for most cases. Both I and my patients love the alternative! The laser procedure is much less invasive, which means much less pain and faster recovery time. Again, get a second opinion before subjecting yourself to the scalpel.

Q: Can dry mouth result from osseous surgery or from aggravated TMJ problems due to osseous surgery?

A: There have been no documented cases that I am aware of in the periodontal literature of dry mouth from osseous surgery. The same is true of TMJ. However, dry mouth can occur if a patient has certain systemic diseases, or has been taking specific medications.