It is exciting times for our office and for the treatment of gum disease.  According to the  World Health Organization over 85% of the adult population have some form of periodontal disease (gum disease).  To simplify, periodontal disease is caused by bacteria living around the necks of the teeth which pour out their waste products into the gums making them sick.  When the tissues of the body get sick they swell and blood flow increases to help fight against infection.  Between the teeth there is not very much room for the blood vessels to move in to, so as a consequence the underlying supporting bone dissolves away to make room. When this happens, you have periodontal disease.

In the past, dentistry has treated periodontal disease with cleanings, scaling/root planing, medications and surgery.  Recently, dentists have looked for advanced technologies to help treat periodontal disease and one such treatment that has shown excellent results is the Er:YAG/Nd:YAG laser.  We are proud to be able to provide our patients with a new periodontal treatment called Wavelength-optimized Periodontal Therapy (WPT invented by Dr. Robert Barr).  Sometimes this procedure is confused with another dissimilar, less evolved procedure called Laser-Assisted New Attachment Procedure  (LANAP), but whatever you call it, it works!

Laser perio surgery is different from regular surgery in that instead of a sharp knife to peel the gums off of the bone (or teeth) to treat the infected gums (or teeth), a thin laser quartz, glass, or saphire fiber is inserted between the tooth and gum-line to remove the diseased gum tissue, remove the tartar (calculus/plaque), decontaminate the root surfaces, and sterilize the pockets.  In addition to performing the surgery, the laser causes minimal swelling and the added affect of  “Nd:YAG Biostimulation” to help assist in the healing and calming of the treated area.

I’ve written a pretty neat CareStream/Kodak PracticeWorks note for the WPT procedure that is segmented into Early WPT, Moderate WPT, and Advanced WPT.  I’ll show you the advanced note first because the others are just dumbed down versions of the first.

This is the code for Advanced WPT:

<HlthHx> <Consent> The patient has <WPTadv> <Quadrant1> <WPTadv> <Quadrant1> <WPTadv> <Quadrant1> <WPTadv> <Quadrant1> and we will used advanced Wavelength-optimized Periodontal Therapy to treat the patient’s periodontal disease.First Pass: Disease epithelial tissue removed with the Nd:YAG laser (100us pulse, 20Hz, 2.0W) through the sulcuses. Starting at the top of the sulcus with a sweeping motion the diseased epithelium was removed to within 1mm of the bottom of the sulcus.Second Pass: Calculus removal with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u flat quartz tip. With light up and down forces the laser tip was used like an explorer to first detect and then remove the calculus off of the surface of the roots. This was done paying particular attention to leave the cementum layer intact for future reattachment of bone. Supplemented where necessary with hand scalers.Third Pass: Dentin/cementum surface modification/detoxification with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u radial WPT/PIPS quartz tip. Starting at the top of the sulcus with sweeping motions to the bottom of the pocket dissecting the fibrous attachment to the bone of the 6+mm pockets.Decortication of the 6+mm pockets with an endo explorer 5 to 10 times depending on the size of the pocket to release the osteoblastic stem cells into the clot.Fourth Pass: Clot formation in all pockets >5mm with the Nd:YAG laser (650us pulse, 20Hz, 4.0W). Starting at the bottom of each pocket, activating the laser and drawing it out taking 1-2 seconds, repeating 3-5 time until the blood clot just begins to turn darker.Placed pieces of <membrane> into all the decorticated sites to create a 3 dimensional clot to stabilize, protect the clot from bacterial invasion, and to create a matrix for bone regeneration.Post-op defocused biostimulation with Nd:YAG (650us pulse, 20Hz, 4.0W) X 20-30 seconds per site. <Tolerated> <OHI> Topical anesthetic <Topical> with <AnesNumMg> of <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin> local anesthetic<CompuDent> <addAnesth> <AnesNumMg>  <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin><CompuDent> Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.  <OraVerse> <Next Visit><secNV><secNV><secNV>
Post-op instructions: Peridex mouth rinse b.i.d. after the second day x 2 weeks. The patient was told that this will stain their teeth and that it is easily removed with a post-op prophy. Soft diet X 1 week.  No smoking for 6 weeks post-op.Post-op 2-3 minute biostimulation is included with this procedure and is to be done on days 1, 2, 4, 7, and 14.This is considered critical to the overall success of the WPT.

This is the noted filled out as it appears in the patient chart:

Reviewed health history, Informed Consent, The patient has < four 6+mm pockets upper left quadrant, >= four 6+mm pockets lower left quadrant, < four 6+mm pockets upper right quadrant, >= four 6+mm pockets lower right quadrant, and we will used advanced Wavelength-optimized Periodontal Therapy to treat the patient’s periodontal disease.
First Pass: Disease epithelial tissue removed with the Nd:YAG laser (100us pulse, 20Hz, 2.0W) through the sulci. Starting at the top of the sulcus with a sweeping motion the diseased epithelium was removed to within 1mm of the bottom of the sulcus.
Second Pass: Calculus removal with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u flat quartz tip. With light up and down forces the laser tip was used like an explorer to first detect and then remove the calculus off of the surface of the roots. This was done paying particular attention to leave the cementum layer intact for future reattachment of bone. Supplemented where necessary with hand scalers.
Third Pass: Dentin/cementum surface modification/detoxification with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u radial WPT/PIPS quartz tip. Starting at the top of the sulcus with sweeping motions to the bottom of the pocket dissecting the fibrous attachment to the bone of the 6+mm pockets.
Decortication of the 6+mm pockets with an endo explorer 5 to 10 times depending on the size of the pocket to release the osteoblastic stem cells into the clot.
Fourth Pass: Clot formation in all pockets >5mm with the Nd:YAG laser (650us pulse, 20Hz, 4.0W). Starting at the bottom of each pocket, activating the laser and drawing it out taking 1-2 seconds, repeating 3-5 time until the blood clot just begins to darken.
Placed pieces of Healos, into all the decorticated sites to create a 3 dimensional clot to stabilize, protect the clot from bacterial invasion, and to create a matrix for bone regeneration.
Post-op defocused biostimulation with Nd:YAG (650us pulse, 20Hz, 4.0W) X 20-30 seconds per site.
Treatment was tolerated well. Oral Hygiene Instructions, Topical anesthetic 20% lido/4% Tetra/2% phenylephrine with 5 carpules (180mg/8.5ml)* of 2% Mepivacaine/1:20,000 NeoCobefrin infiltration, mandibular nerve block,     local anesthetic additional anesthetic used  2 carpules (136mg/3.4ml)  4% Articaine w/1:100000 epi infiltration,  Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.  OraVerse 1.6mg. Next Visit: Post-op Biostimulation

Post-op instructions: Peridex mouth rinse b.i.d. after the second day x 2 weeks. The patient was told that this will stain their teeth and that it is easily removed with a post-op prophy. Soft diet X 1 week.  No smoking for 6 weeks post-op.Post-op 2-3 minute biostimulation is included with this procedure and is to be done on days 1, 2, 4, 7, and 14.  The patient was informed that this is considered critical to the overall success of the WPT.

See “How to Write Carestream/Kodak PracticeWorks Dental Notes: Local Anesthetics” for more information on the anesthesia portion of this note.

Screen shot 2010 12 14 at 7.34.30 PM Wavelength Optimized Periodontal Therapy   WPT: Laser Periodontal Surgery

Screen shot 2010 12 14 at 7.35.51 PM Wavelength Optimized Periodontal Therapy   WPT: Laser Periodontal SurgeryScreen shot 2010 12 14 at 7.36.15 PM Wavelength Optimized Periodontal Therapy   WPT: Laser Periodontal Surgery

This is the code for the Moderate WPT note:

<HlthHx> <Consent> The patient has <WPTmod> <Quadrant1> <WPTmod> <Quadrant1> <WPTmod> <Quadrant1> <WPTmod> <Quadrant1> and we will used moderate Wavelength-optimized Periodontal Therapy to treat the patient’s periodontal disease.

First Pass: Disease epithelial tissue removed with the Nd:YAG laser (100us pulse, 20Hz, 2.0W) through the sulcuses. Starting at the top of the sulcus with a sweeping motion the diseased epithelium was removed to within 1mm of the bottom of the sulcus.

Second Pass: Calculus removal with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u flat quartz tip. With light up and down forces the laser tip was used like an explorer to first detect and then remove the calculus off of the surface of the roots. This was done paying particular attention to leave the cementum layer intact for future reattachment of bone. Supplemented where necessary with hand scalers.

Third Pass: Dentin/cementum surface modification/detoxification with the Er:YAG laser (50us pulse, 40Hz, 20 mJ) with the 600u radial WPT/PIPS quartz tip. Starting at the top of the sulcus with sweeping motions to the bottom of the pocket.

Fourth Pass: Clot formation in all pockets >5mm with the Nd:YAG laser (650us pulse, 20Hz, 4.0W). Starting at the bottom of each pocket, activating the laser and drawing it out taking 1-2 seconds, repeating 3-5 time until the blood clot just begins to turn darker.

Post-op defocused biostimulation with Nd:YAG (same settings) X 20-30 seconds per site. <Tolerated> <OHI> Topical anesthetic <Topical> with <AnesNumMg> of <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin> local anesthetic<CompuDent> <addAnesth> <AnesNumMg>  <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin><CompuDent> Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.  <OraVerse> <Next Visit><secNV><secNV><secNV>

This is the code for Early WPT note:

<HlthHx> <Consent> The patient has generalized soft tissue inflammation in the <Quadrant1> <Quadrant1> <Quadrant1> <Quadrant1> and we will used early Wavelength-optimized Periodontal Therapy to treat the patient’s periodontal disease. Disease epithelial tissue removed with the Nd:YAG laser (100us pulse, 20Hz, 2.0W) through the sulcuses.  Post-op defocused biostimulation with Nd:YAG (same settings) X 20-30 seconds per site. <Tolerated> <OHI> Topical anesthetic <Topical> with <AnesNumMg> of <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin> local anesthetic<CompuDent> <addAnesth> <AnesNumMg>  <Anesthetic> <AnesthFil> <AnesthBlock> <AnesthMental> <AnesthPulp> <AnesthLig> <AnesthAkin><CompuDent> Pt informed not to eat food, bite or chew on lips or tongue while anesthetic is still working.  <OraVerse> <Next Visit><secNV><secNV><secNV>