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The Symbiotic Relationship between Perioscopy and LANAP in the Treatment of Periodontal Disease: A New Paradigm in Therapy

Aug. 1, 2012
From their article, Suzanne Newkirk, RDH, and Robert Gottlieb, DDS, explore the protocol and outcomes of a periodontal office that uses the perioscopy system as the “gold standard” in nonsurgical periodontal therapy and the laser-assisted new attachment procedure (LANAP) system as the same standard in surgical periodontal therapy.

In the last decade, much has been written about various modalities of therapy for the treatment of periodontal disease. This article explores the protocol and outcomes of a pioneering periodontal office that utilizes the Perioscopy system for the “gold standard” in non-surgical periodontal therapy, and the LANAP system (also referred to as Laser Assisted New Attachment Procedure) introduced by Millennium Dental Technologies, Inc., as the gold standard in surgical periodontal therapy.

The Perioscopy system consists of a tiny fiberoptic camera which is able to visualize and magnify the dental hygienist’s operative field 24-48 times with intense illumination. The camera is attached to a dental probe (Perioscopy Explorer) and placed gently below the gum line.

The video image is immediately displayed on a chairside monitor disclosing the complete subgingival operative environment, including minute details that previously may have been undetectable. This allows the clinician to diagnose and treat subgingivally in the most minimally invasive way possible.

Since its inception more than a decade ago, users of the Perioscopy System have found that once the bioburden has been microscopically removed, the body then has a chance to heal, improving the health of the periodontium and in some instances regenerating the bone.

The LANAP protocol utilizes a digital dental laser called the PerioLase MVP-7 in a precise manner which reportedly stimulates osteoblast cells to begin laying down new bone at the base of the pocket. Designed and refined over ten (10) years, the LANAP procedure is the first laser protocol to be granted a U.S. Patent for periodontal surgery.

The periodontal office of Dr. Robert (Bob) Gottlieb has found that utilization of these two technologies produce remarkable outcomes for his patients.

Dr. Gottlieb said, “By combining Perioscopy and LANAP, we have created a protocol that is not only patient centered and process oriented, but is cost-effective for the patient. While Suzanne or my other hygienists are providing Perioscopy, I am able to see other patients. The patient saves money because the “doctor time” for the RPS portion of the LANAP procedure is decreased and the quality of the debridement is improved with the Perioscope over blind instrumentation.”

Traditional LANAP therapy does not involve the dental hygienist until after treatment has been completed and the patient returns for a supportive maintenance visit. Dr. Gottlieb has always felt that by allowing his dental hygienists to practice to their full scope of education and expertise, they would not only have more job satisfaction as co-therapists, but be more engaged in overall patient care.

In this manner, they will provide better care with better results, and create another powerful motivational relationship in the office for the patient to be empowered to make better choices for their health.

Dr. Gottlieb’s practice is located in Washington State, where dental hygienists can provide local anesthetic within their scope of practice.

“It’s a huge advantage for me (and the patient) if I am involved with the patient from the get-go,” Suzanne Newkirk, RDH, stated. “I not only have an opportunity to establish great patient rapport, but provide the anesthetic and initial RPS with the Perioscope.”

Ms. Newkirk feels that meticulous root instrumentation should be the first step in periodontal therapy regardless of whether it is a surgical or non-surgical procedure.

“I love having the advantage of using the Perioscope for instrumentation,” Newkirk stated. “By the time my doctor comes in, the patient is ready to go and Bob can focus in on what he does best … the surgical aspect of the treatment.”

Note: Dr. Gottlieb does perform the ultrasonic debridement during the laser therapy as described in the protocol, but realizes he is dealing with mostly pristine root surfaces.

“Seeing these patients post surgically for their first maintenance appointment is a treat, especially since I have a basis of comparison prior to surgical intervention,” Newkirk said.

Dr. Gottlieb feels that effective treatment planning should include careful consideration of risk reduction procedures when choosing the patients' preventive, as well as reparative interventions. The office utilizes the PreViser Risk Calculator for patient risk analysis which helps patients understand their disease, risk levels and improvement during the course of therapy.

Evaluating risk helps determine which patients are good candidates for non-surgical therapy alone versus a combination of Perioscopy and LANAP, because risk is an accurate predictor of a future disease state and worse risk states require more treatment.

* See other sections of this newsletter for three (3) clinical case studies.

Dr. Robert Gregg, the President and Co-Founder of Millennium Dental Technologies, Inc., had this to say of Dr. Gottlieb’s protocol utilizing both technologies concurrently: “The PerioLase MVP-7 and the dental endoscope are complimentary, not contradictory” when used in the treatment of periodontal disease.

Dr. John Kwan, the President and CEO of Perioscopy, Incorporated, also had this to say: “This case series is another among many which show positive results utilizing microvisual root debridement via the Perioscope. The addition of the minimally invasive surgical LANAP protocol may enhance bone regeneration seen in the last case. The rationale for combination therapy is certainly reasonable and deserves more comparison to non-surgical and surgical treatments.”

Clinical findings and the case studies presented show that these two technologies used independently, as well as together, not only reduce inflammation, but promote regeneration of bone with the most minimally invasive approach possible providing predictable, positive results.

Dr. Gottlieb’s minimally invasive approach to non-surgical and surgical interventions for the treatment of periodontal disease has produced not only extremely healthy patients, but happy ones.

For more information on using PreViser risk analysis go to:

For more information on The Perioscopy System go to:

Dr. Gottlieb and Suzanne Newkirk, RDH, may be contacted at [email protected].
Suzanne Newkirk, RDH, graduated from the University of Alaska, Anchorage, in 1981 and has dedicated the last 31 years to excellence in clinical dental hygiene and periodontics. Suzanne is a periodontal therapist, dental hygiene coach and mentor. She is also a Perioscopy instructor and speaker and is listed on the Seattle Study Club Speakers Bureau List. Ms. Newkirk is a member of the American Dental Hygienists' Association and Georgia State Dental Hygienists' Association.
Dr. Bob Gottlieb received his Certificate in Periodontics from the University of Washington. Practicing for 35 years, he was voted one of Seattle’s Best Dentists. Dr. Gottlieb mentors and directs numerous study clubs, as well as lectures extensively in California and Washington. To read more articles in RDH eVillage FOCUS from Suzanne Newkirk and Robert Gottlieb, go to Newkirk and Gottlieb.