Board Certified Periodontist

14 – Active Therapy Options

You are listening to the Perio Hygienist Podcast – a podcast centered on the intersection between the specialty of periodontics and the profession of dental hygiene. My name is Dr. Ben Young. I’m a practicing periodontist in San Antonio, Texas.

Today I would like to talk about the LANAP Protocol, what it is, how it works, and why I believe it has the potential of dramatically changing relationships between general dentistry and periodontics – at least as far as my practice is concerned.

To get to all of this, I need to simply share with you my journey as to how I became a LANAP periodontist.

Back in 2013 I was attending a periodontics regional meeting. It was a weekend event, and one of the things we as periodontists, like all dentists and other meeting attenders, enjoy is the opportunity of seeing old friends. At this particular event I was told by three different periodontists I trained along side, that I should check out LANAP. Now mind you, they didn’t come up as a group. On three different occasions over a two-day period, three periodontists I know well told me essentially that I needed to check this out and that they were finding great response to treating periodontal disease. I’ve never had this happen to me before about any particular instrument or technique.

Well, I’m a classically trained periodontist, well immersed in the literature with a high bar of skepticism built in. I am familiar with all of the techniques and gadgets that have been promoted over the years and how most of them don’t work as advertised. I want to see studies and they can’t be from the company selling the product. They have to be independent and well designed. In addition, I do want to see that others are thinking along the same lines and that decisions are rationally based, not financially motivated. Ultimately as healthcare practitioners, we want to be able to offer our patients well tested and effective therapies that have a good established track record. The point is I’m trained to be cautious in matters such as this. Also, I was not looking for something else to learn, let alone spend the time and money necessary, unless it was something important.

To make a long story short, I went the years training with Millennium Dental on the PerioLase MVP7 NdYAG laser and I made sure I was trained under a clinician/researcher I respect by the name of Ray Yukna. He had published histology showing regeneration using this particular laser. Now why this laser works and others do not is too long to get into here. Suffice it to say, I trained and learned the necessary techniques to be able to provide safe and effective care with patients and I began to use this protocol as often as I could.

I put it this way, that I used it as often as I could, because I ran into a snag upon returning to my practice. Dental Insurance companies do not recognized the LANAP Protocol. In the training this was discussed a bit and different practitioners had different methods of addressing this problem. Most of them did what I began doing and that was utilizing the periodontal procedure codes that they thought came closest to describing the procedure. But this resulted in problems because it was not uncommon for insurance companies to deny reimbursement. Some stated the laser to be experimental. Well that isn’t true. It might have been fifteen or so years ago, but there is a good deal of experimental literature available today. Other insurance companies would deny surgical codes if scaling and root planing codes had not been used earlier. And when going to provide the scaling and root planing it was not unusual for some insurance companies to limit the number of quadrants one could scale and root plane in one appointment, even though there are studies that indicate that accomplishing the entire procedure in one sitting has benefits.

I wish I could tell you that I figured this problem quickly. I did not. The end result has been that I have tried to simply incorporate the benefits of the laser into conventional care, meaning that if an insurance company insisted their patients have scaling and root planing followed by a periodontal reevaluation before treatment planing any surgical procedures where I then could use the laser as a benefit to the procedures I then would be allowed to perform and be reimbursed for, then that’s what I did. Until I finally had it. I looked at what I could do for patients and how the dental insurance companies were blocking this level of care and decided that I would from now on admit and declare that LANAP is not covered by dental insurance.

Of course, at first, this sounds like a problem. Patients with dental insurance would not be able to afford LANAP, until you begin to understand the real choices to be made here and why those with dental insurance would actually end up better off than before.