Cadaver Bone for Grafting?

Dr. S, from Los Angeles, asks us:

As I’m sure everyone is aware there has been alot of controversy surrounding grafts made from cadaver bone, following the recent stolen body parts scandal. As such, I wanted to get a consensus view from OsseoNews readers about the current state of affairs.

How much danger is there really in using cadaver bone for bone grafting? Many
of my patients are concerned they may contract a communicable disease.
But what are the chances of this? Are most of you just switching to synthetic materials because of this bad PR? But, are the synthetic grafting materials a good and predictable alternative? What are the pros and cons? What are the alternatives and where is your practice headed? Thanks.

136 thoughts on “Cadaver Bone for Grafting?

  1. Very simply:

    There has never been a reported case of any disease transfer for PROCESSED BONE ALLOGRAFT. Also be sure to use only tissue banks that are members of the AATB.

    There have been reported case of HIV in FRESH FROZEN ALLOGRAFTS, but these are not
    used in dentistry. Synthetic grafts (alloplasts) have a very poor track record with regard to regenerative potential.

  2. Cadaver treated bone is safe, there has never been to my knowlegde a single case of a tranmited disease related to a dental graft. Just be sure what you buy.
    Bone has a much better record than synthetics. I dont really give my patients a choice… I use human bone for grafts.

  3. Want a win/win? We have used xenografts in our practice for over 10 years for all grafting procedures. We also use them at the dental school. Better patient acceptance and proven histology.

  4. for bovine graft you need more maturation time than human bone graft.
    if you reenter site prematurely you will be surprised to find your graft still looking at you instead of new bone.
    synthetic grafts used alone do not match the succes of humane bone graft.

  5. Mad Cow disease? Has there ever been a documented case in the US? I believe that bovine is FDA approved for bone grafts. Is human cadaver?

  6. So if I understand Satish Joshi’s comment, human bone remodels very quickly. Is that a good thing?

  7. I use patient’s own bone for grafting. More painful but better. If some one was placing a bone graft in my jaw , I would prefer the temporary extra pain from donor site ,rather than worry about possible infection from dead human or dead animal source.

  8. of course, autogenous is best bone, but wait until you hit a site where you won’t have enough graft unless you look for out side the mouth.

  9. Seven Plead Guilty in Stolen Body Parts Case
    By TOM HAYS, AP

    NEW YORK (Oct. 18) – Seven funeral home directors linked to a scheme to plunder corpses and sell the body parts for transplants pleaded guilty to undisclosed charges and have agreed to cooperate with investigators, prosecutors announced Wednesday.

    The unidentified directors secretly pleaded guilty in the probe of what investigators say was a plot to harvest bone and tissue and sell it to biomedical supply companies, Brooklyn District Attorney Charles Hynes said.

    “It is clear that many more funeral home directors were involved in this enterprise,” Hynes said at a news conference.

    The seven entered their pleas in closed courtrooms and their names were withheld, but defense attorneys said that among those cooperating was the director of a funeral home that took parts from the body of “Masterpiece Theatre” host Alistair Cooke, who died in 2004.

    The four original defendants in the case pleaded not guilty on Wednesday to enterprise corruption, body stealing and other charges in the new indictment. If convicted, they face up to 25 years in prison. All remain free on bail.

    Prosecutors allege Michael Mastromarino, a former oral surgeon, and three other men secretly removed skin, bone and other parts from up to 1,000 bodies from funeral homes, without the permission of families.

    What The Corpses Fetch

    They were charged in February with counts including body stealing, unlawful dissection and forgery in a case a district attorney called “something out of a cheap horror movie.”

    All the defendants pleaded not guilty before being released on bail.

    Mastromarino, owner of Biomedical Tissue Services of Fort Lee, N.J., allegedly made millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants and hip replacements, prosecutors said.

    At the time, prosecutors said they had unearthed evidence that death certificates and other paperwork were falsified. In Cooke’s case, his age was recorded as 85 rather than 95 and the cause of death was listed as heart attack instead of lung cancer that had spread to his bones.

    Other evidence includes X-rays and photos of exhumed cadavers show that where leg bones should have been, someone had inserted white plastic pipes – the kind used for home plumbing projects, available at any hardware store. The pipes were crudely reconnected to hip and ankle bones with screws before the legs were sewn back up.

    Copyright 2006 The Associated Press.

  10. Mastromarino, owner of Biomedical Tissue Services of Fort Lee, N.J., allegedly made millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants

  11. “rather than worry about possible infection from dead human or dead animal”

    Uh..duh! I ate a dead animal tonight for dinner tonight.

  12. amalgum is a long used very effective dental material but we dont use it primarily due to patient concerns.Patients through using the internet are aware and more often than not unneccessarily scared about what they read.
    Synthetics are the future and with more development and improved techniques in use will become the “gold Stanadrd”.Having only used synthetics in all my sinus lift cases for the last 18 months I now see the clear benefits to both the dental surgeon and patient alike

  13. 18 months are you kidding me, you are going to say that synthethetic bone is the gold standard. are you using amalgam in your sinus grafts. since your are doing an amalgam at the same time as a subantral augmentation you might as well you have the amalgam out. Please let us know how those implants in the synthetic sinus are going in 5 years.

  14. Find yourself a reputable bone bank that advertises Alistar- Cook-free bone and you should be OK. I believe only Puros was affected. FDB is effective and convenient. Obviously autograft is the gold standard, but harvesting it has it’s morbidity and FDB works just as well. And remember bovine source products are no longer bone…just HA. If mad cow can live after being sinistered then more power to it.

  15. With regard to the cadaver bone issue, The FDA has had several recalls in the last year and a half. It has impacted 6 major bone bank suppliers. There are continuing concerns about allograft processing and donor verification records. These recalls continue to highlight a very unregulated industry that is fraight with potential problems. Graft materials, at the basic level, simply act as a scaffold for the ingrowth of host bone. What we should really be interested in length of time of turnover and amount of graft material left at time of implant placement. Over a decade of international research suggests that alloplasts, specifically beta TCP, is the only graft material that completely resorbs and does so at the same rate of new bone formation. Issues of potential transmission of disease are completely absent and these materials are easy to handle. My patients constantly ask me about tissue bank bone and are relieved when we explain that we no longer use them. If we can get the identical results with TCP as with autogenous bone, then why do we even need to consider allografts? We are now engaged in research using growth factors with TCP and getting results that we now call the “platinum standard” for bone grafting. While we can joke about the court case issues surrounding these problems, I can assure you that our patients DO NOT find this amusing. Get over it and start using these materials based on intellectually honest research rather than emotion.

  16. FDA has setup a task force to review the issue of tissue donation and the problems that have developed in the sale of donated tissues. There has been at least one case of Hepatitis C transmited to a patient via donated tissue. However that was not from bone grafting materials. As far a mad cows disease, no documented cases have occurred from graft materials. But 40 years ago we didn’t know what a prion was. That is the fear regarding xenografts, not what we know but what we don’t know.

    Here is a link to the FDA on this topic. http://www.fda.gov/cber/safety/drs083006.htm

  17. Well said Dr. Miller ,it is time to move on.Those who have ,know and it sure puts the patients at ease

  18. PDGF + TCP is not the “platinum standard” when most doctors buying this product are not using the TCP and are waiting for PDGF to be available with another graft material like DFDBA. Research regarding TCP along with clinical experience using this graft material is the reason it is not being used in conjunction with the co-packaged PDGF. That hardly jumps it over the “gold standard” of Autogenous. Besides if you love growth factors why not use Emdogain which stimulates a variety of growth factors and not limit yourself to only one?

  19. “millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants”

    Does this include DFDBA and FBDA?

  20. Thousands of patients who underwent tissue, bone and organ transplants are at risk of developing serious diseases due to the use of untested body parts. Recent criminal charges detailed the illegal sale of untested body parts and tissue to hospitals, distributors and medical device manufacturers. The FDA is concerned that the recipients of untested body parts and tissues are potentially at risk of developing HIV, Hepatitis B, Hepatitis C, Syphilis and other infectious diseases.

    The untested body parts and tissue scandal centers around Biomedical Tissue Services, which allegedly acquired body parts without donor permission and sold them for use in transplants performed at hospitals and other medical facilities within the United States. The owner and three other employees of Biomedical Tissue Services have been indicted in Brooklyn, New York for taking body parts without legal consent and without proper screening. It is believed that funeral home operators accepted money from the company in exchange for ignoring obviously forged death certificates and consent forms. The body parts and tissue in question have been distributed throughout the country and used in thousands of operations.

    Biomedical Tissue Services sold these illegal body parts to several large companies including Lifecell Corp., Regeneration Technologies, Inc., Tutogen Medical, Inc., Lost Mountain Tissue Bank and Blood & Tissue Center of Central Texas. The FDA and most of the companies involved have not disclosed the number of patients that received the untested parts and tissue.

    Untested Body Parts Scandal – Timeline

  21. This article is patently false. All of the BTS-sourced tissue have gone through the required FDA, AATB and/or specific tissue bank testing. The tests include; HIV 1 and 2 Antobodies,HIV and Hep C, HTLV1/2Ab, HbsAg – Hep B test, HbcAb, HCVAb, RPR/STS – Syphilis test. In the case of the BTS scandal, the screening and recovery of tissues was compromised due to the falsification of records and consents. All of the serological and processing tests were performed by the respective tissue processors.

    None of the affected BTS tissues have proven to result in a virally transmitted disease. In fact, no demineralized bone tissue has ever been proven to result in virally transmitted diseases.

  22. You wrote: “rather than worry about possible infection from dead human or dead animal. Uh..duh! I ate a dead animal tonight for dinner tonight.”

    Wouldn’t your stomach acid kill anything from the dead animal? Now compare that to something implanted directly into your sinus cavity.

  23. Your right, human tissue in the sinus is not very effective for augmentation. You need something that will slowly remodel.

  24. In the 1980’s we only screened donated blood for Hepatitis A and B with the belief that this would end the transmission of hepatitis through blood transfusions. It was what we didn’t know that allowed individuals to contract Hepatitis C through dontated blood products for anther 10-15 years. Now all donated blood is screened for Hep A, B and C. Bone products go through a process where any viral disease should be destroyed. But all the companies that received Graft material from BTS, recalled those products. Puros being an example of a bone graft material that was recalled. They also had Doctors contact patients regarding the possiblity of a complication. Commendable actions which were needed as the first rule in tissue processing is to not use tissues that are known to have disease. But even while Zimmer describes the chance of disease transmission as being so remote that the number starts with a decimal point and goes out to an order of 10, they still don’t actually say it is impossible. They are smart enough to realize that maybe they don’t know everything that is possible.

  25. I know the risk might be very small, but try having to call your patient and tell them that they have to be tested. I am sure they will not be calling you again. you better be using a tissue bank that you can trust. There is much more to look at than if the tissue bank is a member of the AATB. Some tissue that banks reject is still accepted by other banks. Also the processing of the tissue is very important and not everyone does it the same. Not to mention that the testing is not the same, some banks go above the testing required by the FDA and the AATB.

  26. To Dr. Miller,
    I have had some extraordinary results (in my eyes) in periodontal regeneration using GEM 21; I know Dr. Simion showed some cases where he used Bio-Oss and rPDGF with good success;
    you mention that you are currently using TCP Bloks with rPDGF.
    Is there any data available to the public? Case series? Case reports?

  27. GEM21 has only one element of regeneration – rhPDGF. As mentioned in another post, if you’re going to go that route, use Emdogain since it elicits a greater number of growth factors from the body – with dozens more supporting studies that GEM21’s single study.

    Now I see that Straumann has a combo of Emdogain and their HA/TCP substitute. Any thoughts on its potential?

  28. One must question the source of Emdogain. Also, I question the quality of the studies. Read them very carefully. I’m not impressed.

    DG

  29. I have been using custom made bTCP blocks for the past 8 months. Our preliminary research is extremely promising and we will publish our findings after we have a statistically significant number of cases. You are right in your early observations with GEM 21. The advantage of the blocks is that it maintains the correct architectural ridge form without migration as the graft is being resorbed. It will certainly become the future preferred modality for grafting over autogenous blocks.

  30. In response to DG,

    If you are not impressed by both the volume and quality of research on Emdogain (EMD), then that says more about you than about Emdogain. Which of the 300+ studies on Emdogain are you not impressed by? Maybe you read an EMD + SRP study and didn’t realize that EMD is not approved for SRP. It has never been promoted for that use in the 9 years it has been used in a majority of Periodontal offices. Although Dr. Mellonig has shown some great results in this application. Or maybe you read one of the bacterial effects studies where a researcher attempted to keep the proteins in solution despite all prior research that shows EMD sets up on a surface and effects perio-pathogens in a contact inhibition way. A variety of studies have demonstrated that EMD is equivalent to DFDBA, Membranes, combo therapies etc.. in the treatment of 1,2,3 wall defects. I could go on regarding other procedures with equivalency but some do exactly what they learned in school and only question research when they don’t want to change their treatment protocols. EMDOGAIN works, and patients report less discomfort and pain in split mouth studies where one side is treated with EMD and the other is not. Many are reporting the same results with rhPDGF. If you had read all of the research on EMD then you would know that EMD upregulates the release of other growth factors besides PDGF. TGF beta, VEGF…. but that only proves my earlier statement.

    As for the source of the Enamel Matrix Proteins, would you prefer if Biora had acquired the unerupted tooth buds from bottle nosed dolphins instead of pigs? Or maybe you would prefer if Biora had made a rh Amelogenin product so you wouldn’t wonder why other events besides cementum formation occur. I mean who wants fibroblasts and osteoblasts to differentiate or proliferate by signaling from some random Protein contained in this Enamel Matrix Derivative.

    Although I guess you missed all of those studies.

    Post By: Straumann Rep

  31. I had a dental implant about 5 years ago and have problems with swelling, pain, and bone irregularties on the buccal side. I know a graft was used and wonder what material and if I could be rejecting the graft. Since having the implant I have been diagnosed with chronic Lyme disease and wonder if this can contribute to the problem with the implant. I am on IV antibiotics for the Lyme disaese but the implant area still is a problem.

  32. My husband had Bovine Bone Graft 2 1/2 years ago, in his Left upper jaw bone. Six months later he was diagnosed with Nead & neck cancer, primary tumor in Left Tonsile. I always wonder if there was a connection?

  33. I’m also wondering about connections. My daughter had a bone grafting done about 2 years ago . Last june she was diagnosed with a rare krukenberg tumor , signet ring cell cancer with bone metastasis. They were unable to find a primary site. this type of cancer is usually found in older women. So it always crosses your mind… was it the bone graft for the implant that started it all????

  34. I have just come from an appt with an endodontist. My dentist referred me because of a shadow on my x-ray that was not there last year. The endo did the number test, going around counting pocket depth. My numbers were 1’s and 2’s everywhere, with the exception of where the shadow is. It’s a 7.! I realize the higher the number, the worse off. The endo says there’s significant bone loss and doesn’t understand why it’s just there, and nowhere else, and possibly could be from adult braces, which were removed 5 years ago. He is telling me that a bone graph is the easiest thing for me to do and even showed me the donor bone. It really freaks me out to have this as my only option! I’d rather lose the tooth, seriously, than have somebody, or somethings bone in my mouth. The endo also told me that the healing is a good month and that there’s never been a case of any disease contracted by donor bone. After researching and reading some of the comments on here, I’m very nervous about this procedure. Would anybody have any other site where I could do more research? I need to know! Thank you!

  35. As I have only used synthetics in sinus lift procedures for the last few years the benefits , no post operative pain or swelling ( not even a mild pain killer) are now well understood and with 5 year promising core samples now avilable the future is promising. unfortunately change takes time..

  36. Donna, find a local periodontist who has a laser. A new procedure (LANAP)allows for the pocket to be laser sterilized and new bone remodeling to take place. Just another option for you to consider.

  37. The Gold Standard in BG procedures is Autogenous Bone… easily harvested from the anterior iliac crest, via a trephine or open technique… lots of volume… can also go to the proximal tibia for some good volumes… adequate for most Oral procedures and needs… if you need more, than you should be going to see a surgeon for more comprehensive treatment/care… everything else is, well, “ok.”
    I use tuberosity, vertical ramus, the chin, the anterior iliac crest, proximal tibia, posterior iliac crest and finally the fibula… for the fibula I invite my plastic colleagues… I will mix some cadaveric crushed cancellous bone from the univ of miami tissue bank, occasionally use grafton(r), and also BioOss… when mixed for additional volume these are not bad… but the bulk of the bone I use comes from the patient themselves… that is what I would want and that is what I encourage… my results speak for themselves… and my patients’ are my best source of referrals.
    Best,
    MJM

  38. Regarding Donna’s tooth with the isolated deep pocket, I hope the endodontist has considered the possibility of a vertical root fracture. A fractured root is not a candidate for bone grafting no matter which techniques or materials are used. Treatment of bone loss and pocketing around a tooth may be more successfully treated by another specialist, a periodontist.

  39. Everyone tells me to get an implant. I lost my lateral and 3 teeth behind the canine(upper right) The thought of cadaver bone in my mouth makes me sick. On both side of the lateral I have crowns. I wanted to have the crowns remade with a pontic in the middle, but was told the canine would not support the 3 unit bridge very well. I am so confused. I’ve been without a front tooth for months. I really don’t care about the side teeth because I have a small smile. Should I insist on the 3 unit bridge on the front and just be very careful not to bite with those teeth? If it failed, then could I have the two crowns replaced alone and then maybe a Flexible partial for the one front tooth? I paid $400 to a dental school for CT scan and surgical template only to find out they insisted on using cadaver bone because they have to split my bone and fill it in. I am 62 yrs.old

  40. The school insisted on using cadaver bone because it is cheap…there are alternatives that work better and have none of the issues associated with cadaver.

  41. Osteo-promotive substances appear to have enough evidence to support their current use in implant dentistry. Osteoconductive materials have no inherent ability to induce bone formation themselves since they provide only the scaffolding necessary for the formation of new bone and should be used primarily as graft extenders in combination with osteoinductive materials. Some studies have shown that osteoinductive materials may be used as stand-alone graft material in achieving a bone defect reconstruction. Current studies show that autograft and rhBMP have similar osteogenesis rates and similar clinical outcomes, with the exception of sometimes persistent donor site pain or numbness in the autograft group. The importance of the carrier delivering a metered in-situ dose of BMP into the surgical site has resulted in the development of engineered carriers specific for the grafting location. These carriers serve as osteoconductive scaffolding for the mesenchymal stem cells and pre-osteoblasts to form new bone. It is the critical combination of these specific carriers with rhBMP that is important in achieving a successful bone formation, since these combinations most closely duplicate the qualities of autograft, which is both osteo-conductivity and osteo-inductivity. The one key advantage of the rhBMP/carrier combinations have when compared with autograft, is the dramatically elevated quantity of available rhBMP which results in an exponential increase in its osteo-inductivity.

  42. ‘Anonymous’ previously posted:
    PDGF + TCP is not the “platinum standard” when most doctors buying this product are not using the TCP and are waiting for PDGF to be available with another graft material like DFDBA. Research regarding TCP along with clinical experience using this graft material is the reason it is not being used in conjunction with the co-packaged PDGF. That hardly jumps it over the “gold standard” of Autogenous. Besides if you love growth factors why not use Emdogain which stimulates a variety of growth factors and not limit yourself to only one?

    I would be so grateful to recieve some response/ opinions to the use of TCP in Bone Grafts as I have had two failed bone grafts with this kind of synthetic material and have been told by other Dental Implant Specialists that the use of TCP is antiquated and usually yields very bad results. Any comments would be very helpful.

  43. Donna: Yes, find a periodontist, but one with a blade instead of a laser. The LANAP is fiction and will go to the same resting place as the ENAP.

  44. My son-in-law (age 34) recently died and one of the things found during the autopsy was bovine collagen in his lungs. He had 2 different surgeries for a broken leg during the past year. Has anyone ever heard of this happening? I know some form of grafting material was used, but I don’t know what it was( I think it strated with opa but I’m not sure). The lung tissue was sent to the Iowa State University Ag Lab by the medical examiner. We are still waiting for a cause of death ruling.

  45. I need a dental implant. I am 62 and had tooth absorption in a tooth. I am worried about cadava bone. Would it be ok to use bone from my mouth. I also have mild ostoperious.

  46. Susie,
    Bone from your mouth is absolutely okay. Actually, we call this autogenous bone (or bone from the host) which is the “gold standard.”

    Cadaver bone is very safe and effective with a long history of success. However, if you don’t feel comfortable with it you can make that decision.

    mild osteoporosis shouldn’t be an issue but it is always good to have a physician involved just in case.

    Good luck,

    Dr Katranji

  47. Periodoc wrote

    LANAP study: six teeth, two patients…statistically insignificant.

    IF YOU CONSIDER THE THIRD LARGEST _HUMAN_ HISTOLOGICAL STUDY IN THE PERIODONTAL LITERATURE INSIGNIFICANT THEN WHAT WOULD BE SIGNIFICANT IN YOUR MIND?

    NO IT WAS NOT 2 PATIENTS BUT 6 AND TOTAL TEETH WERE 12, 6 LANAP 6 SRP. I WOULD RECOMEND YOU TAKE A CAREFULL LOOK AT THE HISTOLOGY AND YOU WILL SEE THAT THE LANAP SIDE HAD -100%- NEW CEMENTUM MEDIATED ATTACHEMENT IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM AT 3 MONTHS AND THE SRP SIDE HAD -0%- REATACHEMENT.

    THIS ONLY SHOWS PROOF OF PRINCIPAL THIS CAN THEN BE EXTRAPOLATED TO PROOVE WHAT IS HAPENING IN THE THOUSANDS OF X-RAYS MANY CLINICIANS HAVE SEEN IN THEIR OWN PRIVATE PRACTICES. ASIDE FROM OTHER PEER REVIEWED LITERATURE.

    HOW ABOUT IT’S RATING OF 9.7 OUT OF 10 THAT CRA GAVE THE PERIOLASE. DO YOU KNOW THAT NO OTHER DENTAL PRODUCT HAS EVER RATED SO HIGH?

    HOW ABOUT EVERY PERIOLASE OWNER HAS A 6 MONTH MONEY BACK GUARANTEE AND IN THE 450 LANAPERS ONLY ONE IN THE HISTORY OF THE COMPANY HAS EVER EXERCISED THAT OPTION.

  48. Perioguy said

    Donna: Yes, find a periodontist, but one with a blade instead of a laser. The LANAP is fiction and will go to the same resting place as the ENAP.

    Donna:

    I do not agree with Perioguy. I would highly recommend you see a dentist with a Periolase to have LANAP. Fortunately for many people the thought of regeneration is true, so true that the FDA has given the Periolase the authorization to claim “cementum mediated new attachment to the root surface in the absence of long junctional epithelium” for a lay definition that means we can now reverse gum disease.

    One of the nice things about this type of regeneration is that the concerns of this thread will not pertain to you because, the Periolase does not use cadaver, cow, pig, or any other foreign substance.

  49. Donna: My response would be to go to a guy/gal that you trust. Lasers have not been shown to be superior to current treatment modalities. Although, there is some evidence (not definitive,but a suggestion) that the use of a laser WITH standard perio treatment MAY have additional benefit. Go to google scholar and look up a literature review of lasers by Charles Cobb. He was charged by the American Academy of Periodontology to look at all of the papers talking about the use of lasers for gum problems, throw out the bad ones and see what kind of evidence there is availible. If someone tells you that lasers will help you avoid surgery they’re right…but so will brushing your teeth. If you can’t afford the treatment, it is a moot point, but there are other practioners out there that will be happy to treat you.

    PS: CRA is an independent “Consumer Reports” type outfit that looks at how machines work. While I am sure that the lasers are well made, I am sure most periodontists would be hesitant to make treatment decisions based on CRA reports. Most would look at the literature and then, if they decided it was worth it, they would go to CRA to see which was the “best machine”

    PPS: A money back guarantee for the purchaser isn’t the same as efficacy of treatment. Most periolase owners aren’t periodontists, they are general dentists that don’t want to refer and have found a new revenue stream.

    PPS: you touched on a sore subject…good luck

  50. JW SAID

    Donna: My response would be to go to a guy/gal that you trust. Lasers have not been shown to be superior to current treatment modalities. Although, there is some evidence (not definitive,but a suggestion) that the use of a laser WITH standard perio treatment MAY have additional benefit. Go to google scholar and look up a literature review of lasers by Charles Cobb.

    WHEN CHARLY COBB DID A REVIEW OF THE LITERATURE HE FORGOT OR CHOSE NOT TO INCLUDE THE THIRD LARGEST HUMAN HISTOLOGY IN THE PERIODONTAL LITURATURE. I WONDER WHY? EVEN THOUGH IT IS GOOGLE AVAILABLE. SO WHY DID HE NOT SITE THE YUKNA STUDY?

  51. Donna: My response would be to go to a guy/gal that you trust. Lasers have not been shown to be superior to current treatment modalities. Although, there is some evidence (not definitive,but a suggestion) that the use of a laser WITH standard perio treatment MAY have additional benefit. Go to google scholar and look up a literature review of lasers by Charles Cobb. He was charged by the American Academy of Periodontology to look at all of the papers talking about the use of lasers for gum problems, throw out the bad ones

    IF THIS IS TRUE THEN WHY WOULD THE FDA REASERCHERS ONLY WANT TO WORK WITH ONLY 3 PERIODONTISTS JEFFCOAT, BOWERS OR YUKNA? MAYBE IT’S BECAUSE THESE RESEARCHERS ARE BEYOND REPROACH.

    and see what kind of evidence there is availible. If someone tells you that lasers will help you avoid surgery they’re right…but so will brushing your teeth. If you can’t afford the treatment, it is a moot point, but there are other practioners out there that will be happy to treat you.

    PS: CRA is an independent “Consumer Reports” type outfit that looks at how machines work. While I am sure that the lasers are well made, I am sure most periodontists would be hesitant to make treatment decisions based on CRA reports.
    Most would look at the literature and then,

    SO WHY HAS THE AAP THE ORGANIZATION THAT IS SUPPOSED TO REPRESENT PERIODONTISTS CHOSEN TO NEVER PUBLISH THE FDA CLEARENCE THAT STATES “NEW CEMENTUM MEDIATED ATACHEMENT TO THE ROOT SURFACE IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM” YOU WOULD THINK THAT SUCH A MONUMENTAL FDA CLEARENCE PERTANING DIRECTLY WITH IT’S CONSTITUETS BE PUBLISHED?

    if they decided it was worth it, they would go to CRA to see which was the “best machine”

    PPS: A money back guarantee for the purchaser isn’t the same as efficacy of treatment. Most periolase owners aren’t periodontists,

    DO YOU KNOW THAT 16% OF PERIOLASERS ARE PERIODONTISTS AND THE RATIO OF PERIODONTISTS TO DENTISTS IN THE GENERAL POPULATION IS 6%.

    they are general dentists that don’t want to refer and have found a new revenue stream.

    I’M SURE IT IS NOT A REVENUE STREAM IN YOUR PRACTICE.

    PPS: you touched on a sore subject…good luck

  52. Donna,
    As Dr. R was saying Lanap is an alternative that does not require cadaver (dead people powder), Bovine (cow), or Emdogain (“Swedish baby pig teeth juice” direct quote from a Strauman Rep).

    So yes, Lanap is a great alternative that does not require any foreign substance. Another amazing thing that I have found is that patients experience very little discomfort.

    Too your health,
    John

  53. As a laser investigator for the past 17 years, I have had the opportunity to work with CO2, Nd:Yag, diode, and Er,Cr;YSGG lasers. I have also reviewed the AAP position paper on the efficacy of lasers. While I respect the scientific method and literature of the AAP, I must take issue with the conclusions that were reached, especially since most of the literature is, at least, several years old. With respect to this paradigm, some of these papers are to be considered ancient! Unfortunately, it will be many years before this discipline is revisited by the AAP. Current literature is far more advanced than that which was reviewed. Some of the areas that were not adequately covered by the position paper are root conditioning, ablation of diseased epithelium, removal of calculus, reduction or elimination of the inflammatory response, bacteriodidal properties, inhibition of production of matrix-metalloproteanases (collagenase, elastase, gelatinase), and biostimulation of target tissue which increases metabolic rate of mitochondria thus shortening healing time. For those of you in a scalpel dominated world, you will all soon understand and ultimately incorporate laser technologies in your practices. And it will be the LITERATURE that drives you to do so. Better yet, attend the World Clinical Laser Institute meeting in San Diego in March. THEN post your comments.

  54. Donna
    Jw wrote
    “Most periolase owners aren’t periodontists, they are general dentists that don’t want to refer and have found a new revenue stream.”

    As I’ve said before there are more Periodontist by Percentage that use and recommend the Periolase.

    The part about “GPs have found a new revenue source” is completely misleading I think it is the other way around. I have attended many lectures geared to periodontists and all they talk about are implants they have given up on saving teeth. If you look at the cost of saving a quadrant of teeth that’s 8 teeth with lanap it comes out to about $1000, compare that to 8 implants, now you’re talking about $3000 to $6000 a tooth.

    So where is the revenue stream?

  55. Johndds, Are you saying a single periolase treatment will “save” periodontally poor teeth? My understanding is that a single treatment may help these teeth when combined with excellent oral hygiene and rigorous 3 month maintenance hygiene intervals. Same as properly performed rootplaning combined with the same level of personal and professional maintenance care.

  56. Anectdotally, Lanapers have found that even with poor patient complience the results are exellent. Of course a well controlled patient does even better.

  57. Johndds, Are you saying a single periolase treatment will “save” periodontally poor teeth?

    It’s not that only I am saying it, the FDA clearence is “NEW CEMENTUM MEDIATED ATTACHEMENT IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM”

  58. Johndds,

    You seem to know a low about healing and lasers. Can you explain how lasers create new cementum. Also, please explain how it reverses gum disease as this is ground breaking information. Finally, please indicate any conflicts of interests you may have. Thank you.

  59. New cementum is created by the patients own system. See Yukna’s histology. The laser does not create cementum. The FDA clearance is ” cementum mediated new attachment to the root surface in the absence of long junctional epithelium” so my lay translation is that it reverses gum disease. As far as conflict of interest, I have owned the Periolase for about a year and a half, though my first patient, had the procedure done 9 years ago; I have seen first hand the reversal many times. The results are exactly what the manufacturer has claimed. So yes my patients have compensated me well for the service. As far as compensation from MDT I have helped at their booth during the AGD I received less than a third of my daily production for my time. Though the compensation knowing that someone else who has no knowledge of the outcome and may just stumble on it here is priceless! Because they would then be able to see the results all LANAPERs have experienced which would trickle down to all the patients who would benefit in saving their teeth. :-)

    I have never been compensated for any lasers sold.
    Kick backs % of sales etc… MDT is not public, and I am not an owner of the company. Again I have been compensated many times by the patients outcomes.

    If you would like to see some of my cases I have posted many on another forum that has something to do with a Town, it may have something to do with Dental;-)

  60. Seamentum,
    If anything that I have said is true don’t you owe it to your patients to at least call Millenium and ask them for other DDS’s and Periodontists phone numbers and ask them “Have you reversed gum disease?”

    Ask your patients what they want. Most want to keep their teeth and not get screwed.

  61. Johndds,

    I’m always looking for ways to help my patients out. I think everyone here is ethical and interested in patient care.

    I currently own three lasers (1 periolase) and have been using them for some time but I don’t claim them to be the holy grail. They have their indications but do not regenerate the periodontium. They may help in making shallower pockets with proper home care and treatment but lanap isn’t what some people say it is.

    I have an evidence based approach to my therapy as I’m sure you feel you do, too. The literature is current and published in peer reviewed journals in the US and Europe. I focus my attention on these journals. Stating the review article by Cobb is wrong doesn’t hold any weight without evidence and research.

    Why would independent reviewers from so many different journals repeatedly make the same claim that there is minimal effect with lasers. There is no conspiracy I promise. Like I said, I have lasers and like using them for certain procedures but I won’t claim regeneration or new attachment or anything unproven.

    Reversing gum disease may mean something different to you. Gum disease can be arrested predictably with treatment (laser or otherwise) but reversing it means regenerating lost structures. This can occur for contained defects but certainly not in most cases. Not predictably at least.

    Just to address your final statement…I assume most dentists and specialists are trying to save their patients teeth if possible. Nobody is trying to screw the patient…they may genuinely feel they are doing the best for them. Let’s not accuse each other of malpractice because we don’t use the same techniques or instruments.

  62. Seamentum

    I am intrigued and amazed you are the first Lanaper I have ever found who does not think Lanap is incredible. Please let us know what your experience has been?

  63. You are correct in balancing reversal of the disease process with the concept of tissue regeneration. It reminds me of lectures I have attended on treatment of peri-implantitis where the defect was never grafted. You may be able to eliminate bacterial flora, stop bleeding/exudate, and restore tissue to normal color. But what you are left with is the same defect you started with. This “ailing” implant is then predisposed to breakdown once again. Lasers of several wavelenths are indicated for soft and hard tissue pathology. But they DO NOT take the place of traditional procedures to augment the deficient ridge/implant/pocket. The use of lasers in combination with more traditional therapy gives us stellar results, sometimes dramatically shortening healing time. Almost complete bacteriocidal kill, reduction of matrix-metalloproteanases, increase in inhibitors of the inflammatory cascade, and biostimulation just cannot be achieved by cold surgical steel/antibiotics alone. Ray Yukna’s work is a great starting point for periodontal therapy but not the definitive study we have been waiting for. Like any new modality, it will have it’s early detractors. But the quality of papers published in just the past two years tells us that this is a bona fide modality, with implications that we are just now starting to appreciate. RJM

  64. seamentum wrote

    Just to address your final statement…I assume most dentists and specialists are trying to save their patients teeth if possible. Nobody is trying to screw the patient…they may genuinely feel they are doing the best for them. Let’s not accuse each other of malpractice because we don’t use the same techniques or instruments.

    My coment had nothing to do with malpractice but the screwing in of Titanium.

  65. seamentum wrote

    Reversing gum disease may mean something different to you. Gum disease can be arrested predictably with treatment (laser or otherwise) but reversing it means regenerating lost structures. This can occur for contained defects but certainly not in most cases. Not predictably at least.

    Coming from a fellow Lanaper this comment is so strange to me. Are you sure you have a Periolase?
    All the Lanapers I know have had consitent results.

  66. seamentum wrote

    I currently own three lasers (1 periolase) and have been using them for some time but I don’t claim them to be the holy grail. They have their indications but do not regenerate the periodontium. They may help in making shallower pockets with proper home care and treatment but lanap isn’t what some people say it is.

    ARE YOU SURE YOU OWN A PERIOLASE?
    MAYBE A SALESMAN SOLD YOU SOMETHING “AS GOOD AS” THE PERIOLASE OR THEY TOLD YOU “A YAG IS A YAG IS A YAG”? AND YOU TRYING TO SAVE A FEW $ FELL FOR IT.

    WHAT DO YOU MEAN THAT “LANAP ISN’T WHAT PEOPLE SAY IT IS”?

    I AM VERY CONFUSED FOR I HAVE NEVER HEARD OF A PERIOLASER SAY ANYTHING OTHER THAN THEY HAVE HAD AMAZING RESULTS?

  67. seamentum said

    I have lasers and like using them for certain procedures but I won’t claim regeneration or new attachment or anything unproven.

    Are you saying that Laser Assisted New Attachement Procedure is unproven and at a minimum false up to basically a lie? Which is it? Either it is creating a New Attachement, or it isn’t. Why do you have a Periolase if you think 3/5 of your training you get with it is a lie? You are obviously free to think what you like, but it seems the histological studies show diferent. I guess I don’t understand much. I don’t claim anything that the FDA clearence doesn’t.

  68. JohnDDS,

    Just because new attachment is in the name doesn’t mean it’s fact. When I say LANAP isn’t what people say, I mean people like you that say it reverses periodontal disease. The FDA doesn’t support this but it supports the EQUIVALENCE of other devices on the market the have been cleared for LANAP.

    High impact research has not shown results that you purport. Until it does, evidenced based dentists will not claim nonpredictable results.

    I have a periolase and other lasers in my office. I am not AMAZED by the results just because I bought the machine. I also have a piezosurgical unit that I am not AMAZED with and a PRP machine that I am not AMAZED with.

    Finally, I respect your opinion and use of periolase. It is definitely NOT detrimental to the patient and often times makes the procedure easier for the patient…I do believe it can reduce pain and post-op bleeding.

    The cases you showed have great results and can be achieved with classic perio/regenerative surgery. Confined defects are predictable in nature. The issue is more with periodontally associated horizontal bone loss not localized vertical defects. localized vertical defects are predictably treatable.

  69. Seamentum wrote
    I have a periolase and other lasers in my office. I am not AMAZED by the results just because I bought the machine. I also have a piezosurgical unit that I am not AMAZED with and a PRP machine that I am not AMAZED with.

    WHY DIDN’T YOU RETURN IT FOR A FULL MONEY BACK GUARENTEE IF YOU DIDN’T GET AMAZING RESULTS?

    AGAIN YOUR THE FIRST AND ONLY OWNER NOT TO GET AMAZING RESULTS. WHY DO YOU THINK YOU ARE NOT GETTING RESULTS?

  70. Seamentum wrote

    Just because new attachment is in the name doesn’t mean it’s fact.

    THIS IS THE MOST UBSURD THING I HAVE EVER HEARD A PERIOLASE OWNER SAY!

    DID YOU NOT GO TO BOOT CAMP?

    WERE YOU PAYING ATTENTION?

    DID YOU NOT SEE THE HUMAN HISTOLOGY?

    DID DR. YUKNA NOT GET NEW CEMENTUM MEDIATED ATTACHMENT IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM ON 100% OF THE TEETH AND THE CONTROL SRP 0% ??? AND THIS WAS AT 3 MONTHS, WHAT IF HE HAD WAITED 6 MONTHS OR A YEAR?

    DO YOU NOT REMEMBER SEEING THE HUMAN HISTOLOGY?

    MAYBE YOU DO NOT KNOW WHAT HUMAN HISTOLOGY IS? IF THIS IS THE CASE LET ME KNOW. I WOULD REALY LIKE TO HELP YOU HERE.

  71. Seamentum wrote

    High impact research has not shown results that you purport. Until it does, evidenced based dentists will not claim nonpredictable results.

    I have a periolase

    I AM TOTALY CONFUSED BY THESE TWO STATEMENTS FOR THEY ARE SO INCONGRUENT.

    I AM JUST GOING TO TAKE YOU AT YOUR WORD THAT YOU HAVE A PERIOLASE. THERFORE THE ONLY CONCLUSION I CAN MAKE IS THAT YOU DO NOT UNDERSTAND WHAT HUMAN HISTOLOGY MEANS. SO I WILL TRY AND INFORM YOU WHAT HUMAN HISTOLOGY MEANS.

    HISTOLOGY IS THE STUDY OF TISSUES. WHAT DR YUKNA DID WAS HE SECTIONED OUT IN BLOCK TEETH, GUMS, AND BONE ON 6 PEOPLE THAT IS DIFERENT THAN SACRIFICING A DOG CAT ETC… THESE ARE “PEOPLE” “HUMAN BEINGS” THIS IS THE THIRD LARGEST HUMAN HISTOLOGICAL STUDY IN THE PERIODONTAL LITERATURE. IF YOU LOOK AT THE HIGHERARCHY OF SCIENTIFIC EVIDENCE THIS IS ABOUT AS HIGH AS IT GETS. WHAT I MEAN BY THAT IS MY X-RAYS WOULD BE CONSIDERED ANECDOTOTAL ALL OTHER PERIOLASE OWNERS, EXCEPT FOR YOU OF COURSE, WOULD BE ANECTDOTAL CLINICAL OBSEVATIONS. THESE CLINICAL OBSERVATIONS WOULD NOT HOLD AS HIGH A WEIGHT AS HUMAN HISTOLOGY.

    I WILL LOOK AROUND AND SEE IF I CAN POST THE SLIDES ON THIS SITE.

  72. JohnDDS,

    Please refrain from insults and accusations. This is a forum for debate and education and I won’t continue if you do not respect that.

    The study you mention was presented at the 2003 IADR and sponsored by Millennium Dental Technologies (conflict of interest). The study did consist of 6 teeth but 3 were control. All teeth were scaled and RP, triple Abx placed, and given doxycycline and anti-inflammatories.

    These were all single rooted teeth with vertical defects. The patients seen q10 days for first month and then at 2nd and 3rd month. Blocks were taken.

    The results showed 2/3 specimens with regeneration. Rosling showed regeneration of similar defects with SC/RP alone with 2 wk maintenance. Yukna is showing a proof of principle in the study and never states a reversal of periodontal disease. Listgarten published a case many years ago of attachment over calculus…this doesn’t mean it’s true.

    In my opinion this is not concrete evidence. I don’t fall in love with products just because I have it. The reps are very good but I don’t believe everything a rep says, especially when I get better results with proven treatment modalities.

    Finally, Randomized Clinical Trials with power calculations determining the n are more powerful fact producing studies than a proof of principle study with histology. Especially when the n=3 in an uncontrolled environment.

  73. Seamentum,

    The insults started when you claimed you were a Periolase owner. Then go on to insult a procedure that CRA has given a 9.7 out of 10 NO other dental product has EVER received as high a rating. Those that were interviewed 100% said the ethics of the company were good, 100% said they would buy again, 100% said patients have accepted treatment, 100% felt the marketing of the company was acceptable.

    Again you are wrong, Yukna sectioned out 12 teeth 6 control. 6 out of 6 had NEW CEMENTEM MEDIATED ATACHEMENT TO THE ROOT SURFACE IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM. The SRP had 6 out of 6 with long junctional epithelium.

    You accused Ray Yukna as being a “hired gun”, to put it nicely. He responds by saying that he is….that he will conduct research on most any product or device that a company wants to investigate. BUT, the results that he reports are the results that he gets. No data doctoring. That would be flushed out in the peer review process. That would also suggest that while at LSU–where the Mock Boards for AAP Diplomat status are held (the only location in the world) that he and his fellow researchers like Gerald Evans, Sam Vastardis and Ronnie Carr, are also part of his schemes to doctor the research.

  74. JohnDDS,

    I’m not sure how owning a periolase is an insult to you. It is a commercially available unit and other people owning it should have no effect on you. Also, my claim is that it does NOT reverse periodontal disease like you claim. I think this point is the most crucial in our debate.

    I was looking at the 2003 poster presentation that had 3 teeth but 6 teeth (2004 poster presentation) still make it a proof of principle study. Also, Yukna didn’t find it important enough to send to a peer reviewed journal (I can’t find it published in any journal…if you have it please tell me where). Peer reviewed literature and reviews have all come to the same conclusion and Cobb concludes,

    “Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current evidence does suggest that use of theNd:YAGor Er:YAGwavelengths for treatment of chronic periodontitismay be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations.”

    Yukna’s research isn’t used because it’s not published in peer reviewed journals. Romanos, a proponent of lasers, doesn’t use Yukna’s findings in his rebuttal to Cobb.

    I haven’t accused Yukna of anything so don’t put words in my mouth or quote me improperly. I respect him and attended his lectures in the past. I have no idea what your last paragraph (accusations) is about. Doctoring research and mock boards??? I’m not following the connection to our debate.

  75. Seamentum,

    As a Periolase owner I would think you would know that Yukna’s research and full manuscript on his IADR published LANAP histology is being published in one of THE most prestigious peer reviewed/refereed perio journals in the world (published in 7 languages) this December in the International Journal of Periodontics and Restorative Dentistry (IJPRD). I guess that means Dr. Myron Nevins–a Harvard periodontist and Editor of the IJPRD–is just one of the many fooled by Dr. Yukna’s corrupt research—or maybe Prof Nevins, as well as the FDA’s chief periodontist—are all part of the fraud?

  76. Seamentum wrote,
    please indicate any conflicts of interests you may have.

    I have answered your question above. Why don’t you answer the same question? It is easy to throw stones when you hide behind anonimity.

  77. Johndds,

    You seem to believe that I don’t trust Yukna or his research or I am calling him a fraud. Please, refrain from childish accusations and claims. When I see Yukna make the same claim as you, that periolase REVERSES PERIODONTAL DISEASE, then I will question his research.

    As of yet, you have proven nothing other than you are a periolase owner. That doesn’t defend your claim that it reverses periodontal disease. Just naming researchers or future publication is a waste of time. If you don’t have evidence than you aren’t practicing evidence based dentistry, which is your right.

    However, when somebody presents a question in a forum about bone grafting and you make an argument that LANAP is the solution, you will be asked to defend your claim.

    Obviously, this debate is going nowhere and the level of discourse has been dragged down. It would be nice to debate this with real evidence and at a higher level of respect for each others opinion. If you can’t do that, then I will discontinue this discussion.

    I own no stock or speak for any company. I am a board certified periodontist and educator.

  78. As for Gem21….I love the growth factor, but the synthestic graft does not work for me if implant is treatment plan for a later day. I try and have four failures. Emdogain is great….Too bad I can’t get it any more.

    Periolase is awesome. I have a lots of adult perio patients, and I perform perio-surgery and referring quit a few over the years. I will use periolase over a blade any day for most perio-treatment.
    Remember when Lasik first come out…..That is how I feel about periolase. I hope no one else have a periolase around me…..So I can be happy LANAPing every day. I like it and my patient love it

  79. As far as childish claims I think your claim of being a Periolase owner has been childish and I would ask you to retract it.

    As a Periodontist I hope you will be able to attend the AAP Meeting in October you may want to see.

    GS02: LASERS: CLINICAL AND RESEARCH MODALTIES
    8:00 – 10:00 am
    Program Track: Therapies to Obtain/Maintain a Healthy Periodontium
    Moderator: Robert M. Pick
    Speakers: Charles M. Cobb, Samuel B. Low, Raymond A. Yukna
    Lasers have entered the field of periodontics and when used properly offer the clinician a wonderful alternative to the scalpel. Clinically lasers offer the following advantages: A relatively bloodless operative and postoperative course, coagulation, vaporization or cutting, minimal swelling and scarring, usually no suturing, reduced to absent postoperative pain and high patient acceptance. Lasers have always caused controversy among periodontist’s, although this appears to be changing. Recent evidenced based research shows that certain lasers may be efficacious in guided tissue regeneration. This presentation will discuss ethical and efficacious uses, current controversies and the lasers future.

    Educational Objectives:

    Learn the process of guided tissue regeneration with the laser for the practice of periodontics.
    Discuss the current clinical uses that the laser can be used for.
    Evaluate the advantages in using the laser in practice.

    Also in case anyone does not know Samuel Low
    is scheduled to be AAP president soon and has recently audited the Periolase training.

    Please pay close attention to the

    Educational Objectives:

    Learn the process of guided tissue regeneration with the laser for the practice of periodontics

  80. You two guys should be more considerate of this sight and the folks that come here to seek help with “Cadaver Bone for Graphing?” …. surely there’s another sight you can go beat the professional crap out of each other…

    I got kicked in the jaw durring a football game in high school (40 years ago). A few months later I lost a tooth and had a bridge installed. I went through 3 bridges and after breaking the third one I never had it replaced.

    It has been 15 years since I wore a bridge and my dentist tells me I need 2 implants to cover the gap but first I would need a cadaver bone graph.

    A tooth next to the gap is getting very loose now and I am concerned that I need to do something quickly or I may loose it and need a third implant.

    Is a cadaver bone safe?
    Do I have alternatives?
    Are there better alternatives?
    If he uses my own bone – where will he get it?

  81. ALBullock Says:

    Is a cadaver bone safe?

    Yes, recent public media attention has cleaned up the industry. The problem has been more demand than supply.

    Do I have alternatives?

    Yes, as you have mentioned they can use your own bone which would be ideal.

    Are there better alternatives?

    Your own bone is ideal.

    If he uses my own bone – where will he get it?

    The surgeon knowing your case should determine the amount necesarry. They can harvest it from your chin, ramus (lower jaw), Ilac crest (hip).

    Please excuse the behavior “beat the professional crap out of each other”

  82. ALBullock Says:

    how much should I expect to pay for the bone work and 2 implants?

    This is a difficult question to answer over the Internet without seeing your case. I would recommend you see your dentist and ask for a referral. Then take your records to different Oral surgeons, Periodontists, General dentists, and now even endodontists are placing. Get a feel for the practice and the surgeon and then make your decision. If economics are a concern check out your local dental school.

  83. I use LifeNet Health for all cadaver bone. Trusted and well respected in the industry. Very safe allograft provider.

  84. SeaMentum Says on another thread

    http://www.osseonews.com/bridge-or-implant/

    If you ask 10 dentists you’ll get ten different answers. Laser treatment is questionable at best according to published, peer-reviewed articles but some clinicians swear by it.

    sementum

    You wrote that on another thread.

    Why do you continue to doubt your own results?

    I do not get it? Are you a Periolase owner or not?

    If you are not, please retract your statements!

  85. Sementum

    You claim to be a periodontist and a periolase owner.

    I hope you go to the AAP meeting and ask Ray in the open forum

    “When I see Yukna make the same claim as you, that periolase REVERSES PERIODONTAL DISEASE, then I will question his research.”

    Notice that the objectives of the course will be:

    Educational Objectives:

    Learn the process of guided tissue regeneration with the laser for the practice of periodontics

    Please, I am just a lowly GP could you please explain what “guided tissue regeneration” means since you are a periodontist and an educator?

    While you are at it could you explain the FDA clearence that says New cementum mediated new periodontal ligament attachement to the root surface in the ABSCENCE OF LONG JUNCTIONAL EPITHELIUM?

  86. JohnDDS,

    I really hope you were at the AAP meeting. I actually thought about you during the Q&A session. If you were objective at all you would understand now why investigators have the same reservations as me when it comes to the claims made by millenium.

  87. This is an update I found.

    It was quite a presentation. Dr Cobb went first comparing apples to oranges (diodes to LANAP).

    Sam Low was very impressive and stated 4 things that he was pleased with saying:

    1. The idea of a stble fibrin clot intrigues him
    2. Biostimulation is an exciting area to explore
    3. “You can’t change physics”
    4. If you’re gonna use a laser, follow a specific and scientifically based protocol (as he was showing the LANAP steps).

    Then Dr. Yukna came up and gave the most resolved and emphatic presentation in support of LANAP.

    He then said in clonclusion, “I have not rasied a surgical flap to treat periodontistis in 1 1/2 years.” And many of us heard gasps in the room.

    By the way…..the estimated attendance was 1500-1600 periodontists in the room

    MDT signed a record number of orders at any trade show in the history of the company….and specifically periodontists

  88. JohnDDS,

    I’m not sure how Dr. Cobb was comparing apples to oranges. He showed a wonderful review of the literature and during the Q&A session pretty much silenced Dr. Yukna. Even Dr. Low had a hard time with what Yukna was presenting.

    If anyone was comparing apples to oranges it was Yukna. Most people in the audience had an easy time pointing to the different defects being treated. Even in the soon to be published report, the control side was a defect on the distal of a tooth (abutment on a bridge with difficult access) with visual radiographic bone loss to the apex. The test was a 5-6 mm pocket with easy access and no adjacent tooth.

    As a periodontist I am always looking for the best treatment modality for my patients, and I remind you that I own this specific laser, but I don’t agree with your notion that this cures periodontitis. If it did, why is Dr. Yukna the only one supporting this “revolutionary” procedure.

  89. Ahhhh yes the laser (Can someone please get me some sharks with some freakin laser beams on there head).

    Here we have yet another ploy for general dentists to find a way to refer less and make more money for there practice. I heard from a peridontist that I refer to that one of the lasers they showed (not the LANAP laser) was successful at making a nice trough around the tooth. This is the same laser that they are advocating to do closed crown lengthening procedures by the general dentist. Anyone see a problem with that?

    Does anyone ever ask what is best for the patient or have we turned ourselves into lets make as much money from he patient as possible.

    Im not a specialist, I am a generalist, personally in my practice I spread the wealth and the liability. Its foolish not to. Ask yourself the next time your treating a patient, if I had a heart problem would I want that problem treated by a family practice doc or a cardiologist. Im not saying we need to send everything out, but do whats right for the patient and not whats right for your pocket book.

    Watch Doctors who make claims on these products most people have finacial interests in thier claims. The problem is one day patients will wake up and realize that they are not being treated with thier best interest in mind and thats when they contact a lawyer.

    Just look at the dentist recently in the news being sued for 750,000 dollars.

    Enough said sorry about my ramble.

  90. Dr Pratt

    I agree with you closed crown lengthening should not be done. The periolase is an ND;Yag and can not do that procedure for it is a soft tissue laser.

    Your remark “Here we have yet another ploy for general dentists to find a way to refer less and make more money for there practice” I feel is completely unfounded when you consider that the #1 cause of tooth loss in adult Americans is Periodontal disease. The Periolase is the only FDA cleared laser that can reverse periodontal disease.

    If you consider the alternative Implants then consider the cost difference between the two then ask yourself “SHOW ME THE MONEY” then it is a no brainer The periolase saves THOUSANDS to the patient and allows them to KEEP THEIR TEETH. I hope you understand that it allows the patient to KEEP THEIR TEETH!!! and not get SCREWED!!!

  91. Dr Pratt
    I would like to challenge you to ask a Periolase owner if the claims made by Millennium are false? Except for seamentum of course, who I doubt is an owner. If he were he would not have to hide behind anonymity.

    Or you can look it up in the CRA evaluation where 100% of the respondents said the marketing claims made by MDT are true, 100% of the respondents would buy again, 100% of the respondents said the ethics of the company was good and they gave it a 9.7 out of 10 No other dental product has EVER gotten a 9.7 out of 10 in the history of CRA.

    As far as the best interest of the patient, I know that LANAP is the best treatment modality and soon to be the standard of care in the fight against periodontitis.

    Dr Pratt wrote
    “Watch Doctors who make claims on these products most people have finacial interests in thier claims. The problem is one day patients will wake up and realize that they are not being treated with thier best interest in mind and thats when they contact a lawyer.”

  92. JohnDDS You either work for Millenium or you are trying to justify ways to not refer to a specialist because you want to milk your patient for all hes worth. You shouldnt be talking about anonymity your not using your full name either.

    First off LANAP is just a fancy name for ENAP which yukna study in the 80’s now hes doing it again with a LASER.

    EXCISIONAL NEW ATTACHMENT PROCEDURE ENAP Yukna, et al. 1980:

    The ENAP is essentially subgingival curettage performed with a knife. The scalloped, internally beveled incision extends from the free gingival margin to the base of the pocket. Debridement, root preparation and primary wound closure with sutures and dressing follow The modified ENAP essentially involves the following modifications: 1) The initial incision is directed at the alveolar crest. 2) The complete removal of all the healthy connective tissue, granulation tissue and epithelium coronal to the bone. The modified ENAP is easier to perform, affords better access and more effectively utilizes the healing potential of the periodontal ligament. A disadvantage is the removal of intact connective tissue fibers with potential for attachment loss.
    Indications The ENAP and modified ENAP are limited to treatment of suprabony pockets with firm, fibrous pocket walls within a zone of adequate keratinized gingiva and areas of convex root anatomy which facilitate good soft tissue adaptation
    Clinical Studies: Examined the clinical results of the ENAP after 5 years in 56 surgical sites in human subjects, reporting an overall mean PD decrease of 1.8mm for the ENAP at 5 years. This was the same as that reported for the MWF and 0.5mm better than that following curettage of lesions of similar severity at 5 years postoperativerly. The mean amount of new attachment retained at the 5 year period was 1.5mm, comparing favorably to the 0.4 mm and 0.5 mm gains accompanying curettage and the MWF respectively (Yukna, et al., 1980).

    These studys where later refuted by
    Lindhe and Nyman published 5-year results of an evaluation of 1620 teeth in 75 patients who had advanced periodontal disease and were treated with surgical pocket elimination (OSSEOUS SURGERY). Prior to surgery 113 of 247 teeth with furcation invasion (45%) were extracted. The remaining 134 teeth with furcation invasion were treated aggressively; i.e., 41% had scaling/root planing or furcation odontoplasty, 51% had root resections and 7% had tunneling procedures. All patients had excellent oral hygiene and were recalled every 3 to 6 months for 5 years. At 5 years:
    1. plaque and gingival index scores were decreased;
    2. pocket depths decreased from a mean of 5.7 mm to less than 3 mm;
    3. radiographic bone scores indicated no further bone loss;
    4. mobile teeth decreased from 57% to 26%; and,
    5. no teeth were lost.

    and

    Kaldahl et al. reported on the 7-year results of a longitudinal study comparing coronal scaling, root planing, ENAP, modified Widman flap and flap with osseous resective surgery in 82 patients. The results were as follows:
    1. all therapies reduced probing depth;
    2. osseous resection was the most effective in reducing probing depth;
    3. probing depths were reduced in direct proportion to the depth of the pocket;
    4. osseous resection produced loss of clinical attachment in the 1-4 mm pocket;
    5. modified Widman flap and root planing produced the greatest gain of clinical attachment in 5-6 mm pockets; and,
    6. osseous resection resulted in the most recession.

    BOTH SHOWED FLAP OSSEOUS IS MORE EFFECTIVE AT MAINTAINING TEETH LONG TERM AND THERE IS COUNTLESS OTHER STUDYS TO SUPPORT FLAP OSSEOUS OVER ENAP OR LANAP OR WHATEVER YUKNA WILL CALL IT THESE DAYS.

    TRY TO REMEMBER YOU NEED TO PRACTICE EVIDENCE BASED DENTISTRY BEFORE YOU MAKE CLAIMS LIKE: JOHNdds”As far as the best interest of the patient, I know that LANAP is the best treatment modality and soon to be the standard of care in the fight against periodontitis.”

    ARE YOU BASING THE YOUR ABOVE STATEMENT BASED ON ONE STUDY, DO YOU BOTHER TO LOOK AT OTHER STUDYS OR DO ANY RESEARCH ON YOUR OWN, OR YOU DO YOU BUY EVERYTHING THAT THE COMPANY CLAIMS.

    I GUESS YOUR ONE OF THESE GUYS THAT TELLS HIS PATIENTS NOT TO FLOSS BECAUSE LISTERINE FOUND THAT RINSING IS JUST AS EFFECTIVE AS FLOSSING.

    SAD IF YOU DO.

    JOHN TRY TO REMEMBER YOUR A DOCTOR, AND TRY NOT TO BASE ALL YOUR TREATMENT BASE ON ONE STUDY THAT THE COMPANY IS PUSHING.

    BUT WHAT DO I KNOW IM JUST A GENERAL DENTIST, FEEL FREE TO LOOK ME UP. I WOULD LOOK YOU UP IF YOU USED YOUR WHOLE NAME.

  93. Seamentum
    Part of the AAP emblem is Cooperation, collaboration, and advancement, I’d like to see all 3 especially the advancement of the treatment of periodontitis. The AAP has not invested $1 to LANAP research to disprove the claims by the FDA. On the contrary they sent out a hit piece against the Periolase last year. Don’t you think that if anyone should advance the treatment of Periodontitis it should be Periodontists.

    My opinion is that periodontists have given up on saving teeth and are now bowing down to the Implant god. So of course it is now the obligation of GP’s to help their patients KEEP THEIR TEETH!!!!

    As far as your question “Why is Dr. Yukna the only one supporting this “revolutionary” procedure.” I would recommend you ask yourself, Why you did not return your Periolase??? You had a 6 month money back guarantee. In the history of MDT only one clinician has ever exercised that option. Why have all the periodontists that have the periolase none of them have ever returned it? Did you know that over 15% of periolase users are periodontists and the ratio of GP’s to periodontists in the general population is less than 5%.

  94. John

    Impressive website. But you havent addressed the sound research I presented and the claims you are making.

    You need to be careful when you list stuff like this on your website:

    “Laser Gum Therapy We can now reverse gum disease Gingivitis and Periodontitis. For more information see below”

    You cant reverse periodontal disease, you can maintain and prevent further and even regenerate but a patient will have periodontal disease for life unless you maintain them.

    I agree with you that we as a profession our pulling teeth far to quickly in replace of implants. But you my friend our contributing to the problem, not referring you patients to a perio specialist who provide therapy backed by research. Instead you choose not to refer and provide laser treatment that is backed by little research and evidence. Look at the millenium website, most of the articles are in dentistry today. I see very few articles in perio journels, Jada, etc.

    Unfortunately most periodontist I talked to have to do implants to just stay afloat, thats because to many general dentists are lasering and arestining there patients instead of referring them to get the patients proper treatment.

    Once again Dr John, that piece of paper you hang on the wall should give you the knowledge and tools to look at the research and provide therapy that is evidence based. One article is not enough for you to make claims to your patients that you can reverse peridontal disease.

    You owe your patients more, we all do. Dont get blinded by the dollars your making and the claims a company makes.

    JOHN TRY TO REMEMBER YOUR A DOCTOR, AND TRY NOT TO BASE ALL YOUR TREATMENT BASE ON ONE STUDY THAT THE COMPANY IS PUSHING. AFTER SEEING YOUR WEBSITE I SEE THATS WHAT YOU ARE DOING.

    Im not saying you have to refer all your patients, I certainly dont, but I certainly refer the cases that are beyond my scope. Which is alot of cases, thats why the ADA and AMA created specialist.

  95. Dr Pratt

    Why should I refer for an inferior service? I have seen the results first hand the reversal of the #1 cause of tooth loss in adult Americans!! I have slashed periodontal pockets in half consistently. 12mm infected and inflamed pockets to 2mm sulci over & over & over & over again with little or NO pain, with out screwing down the patient!

  96. Dr Pratt

    I googled you & nothing.

    As far as comparing ENAP to LANAP they are two different modalities.

    Here is another article in the Peer reviewed General Dentistry.

    Laser-assisted new attachment procedure in private practice

    David M. Harris, PhD
    Robert H. Gregg II, DDS
    Delwin K. McCarthy, DDS
    Leigh E. Colby, DDS
    Lloyd V. Tilt, DDS, MS, PC

    Three private dental practices conducted a retrospective analysis of patients receiving the laser-assisted new attachment procedure (LANAP). Retrospective results were compared to clinical trial data from the University of Texas Health Sciences Center in San Antonio (UTHSCSA) to determine if outcomes from a controlled clinical trial can be duplicated in private practice. Results also are compared with published results of other surgical and nonsurgical therapies for inflammatory periodontal disease.

    Received: March 1, 2004
    Accepted: April 19, 2004

    General Dentistry, September/October 2004, Volume 52, Number 5

  97. Pretty sad John. You obviously dont see my point. I truly wonder if you are being paid by the company, my thought is you are. No matter, this will catch up with you eventually.

    I wonder how the California peer review would view your thoughts.

    BTW isnt putting your patients on Utube a hippa violation?

    Good luck to you.

  98. Here is one of your statements from above posts;

    “As far as compensation from MDT I have helped at their booth during the AGD I received less than a third of my daily production for my time.”

    So the company is paying you.

    What would your patients think if they found out that you were pushing a therapy that the company is paying you to push at a convention?

    Hmmmmmm anyone else see a problem?

  99. Dr Pratt

    You said
    “What would your patients think if they found out that you were pushing a therapy that the company is paying you to push at a convention?”

    I think that my patients would be very proud of their dentist standing behind his beliefs.

    I am sure you call what you do “Pushing” your patients into treatment, I prefer to call it educating. You imply that I am doing something wrong in helping my patients save their teeth.

    You may like to push your patients into screwing them down, I do not!

  100. Wonderful you are educating your patients to undergo a treatment that essentially has very little evidence behind it.

    Im glad you can stand by that because I myself wouldnt be able to sleep at night.

    BTW I place very few implants in my general setting, most I refer out to surgeons. I look to save teeth whenever possible, thats why I refer to specialist because it is in the best interest of my patients. Endo, Perio, Oral surgery, etc and even with all I refer I still do very well because my patients understand that I have thier best interest at heart.

    I dont disagree with you that we move to fast to implants, however there are countless studys to support that.

    Where is the evidence?

    By the way, how much do you charge for this wonderful cure for perio disease that your so proud to stand behind (and get paid for by the company)?

    Better yet, look into a word called ethics.

  101. Dr Pratt said Better yet, look into a word called ethics.

    I hope you have the ethics to offer your patients LANAP. According to Ed Zinman DDS MS JD this is within the standard of care since it has FDA clearance to provide “NEW CEMENTUM MEDIATED ATTACHEMENT TO THE ROOT SURFACE IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM”. Therefore, patients who are not told about this alternative do not have full informed consent.

  102. As far as the investment to save peoples teeth for 32 teeth we charge $4600 about the cost of one graft, one implant, for one tooth.

  103. Johndds said “As far as the investment to save peoples teeth for 32 teeth we charge $4600″

    LOL you charge 4600 dollar for essentially a laser scaling and root planing. If you look up ethics, you will not see yourself there. By the look of your website you are proud of it.

    Im done with this debate, shame we have guys like you in our profession.

    Evidence based dentistry, look into it. Its not what you are practicing.

    The company made a wise investment in paying you to push thier product.

  104. “If you look up ethics, you will not see yourself there. By the look of your website you are proud of it.”

    YES! I am very proud to offer this service! I recomend that the next perio case that you think is hopeless you at least inform your patient that it is available. That would be the ethical thing to do.

  105. Im sure you are proud of making 4600.00 for technology that has little evidence. The ethical thing for you to do is inform patients of the long term studys that are out there, I hope you are informing you patients that the laser your using while FDA approved has very little evidence to support your 4600 dollar fee. But Im sure your more of a salesman then a professional. Dont get blinded by the FDA, a device is very easy to get approved. Remember this is the same FDA that approved drugs like Vioxx etc.

    Before I condemn a tooth hopeless for perio reasons I usually send them to the specialist because thats the right thing to do. I do the same for endo. Believe me I have been corrected many times in what I feel is hopeless actually isnt in the right hands.

    You sound like a know it all with a magic laser wand in his hands that will cure all, and I have failed to get you to see any reason in what evidence based dentistry is about.

    Good luck to you.

  106. I must admit I was just as or more skeptical than you, when I first looked at the Periolase. You might even have called me a doubting Thomas.

    I referred a patient to my periodontist (one of the best in LA, teaches at USC) I knew this patient needed his teeth removed it was confirmed by the perio that he needed implants, and for all the training I had it was a good recommendation.

    But the patient didn’t agree he searched for an alternative and found the creator of the LANAP procedure, & had the LANAP done. That was 10 years ago; those loose teeth that I knew needed to be removed are still there and firm. So every 3 months this guy would come into the office I couldn’t deny it had worked for him.

    So I started to look into it, because as you know Periodontitis is the #1 cause of tooth loss in adult Americans. And I being a dentist, by definition a dentist doesn’t exist without a patient, and after asking my patients what they wanted from me, the usual response over and over again was “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, so for me it was a patient driven search.

    So my journey took me to Dentaltown an online community where 40,000 dentists are signed up and discuss things like perio. Being a doubting Thomas I searched out “The Guy” you know the one “The guy” who always has something negative to say about every procedure or dental product you know “the guy” who always says “it didn’t work for me”. Well after many years of looking for “The Guy” I still haven’t found him. Still looking.

    Fortunately the two knuckleheaded Gp’s that developed the LANAP protocol practice nearby so I would refer my hopeless cases to them every time it got harder and harder to refer, they would always try and sell me a laser, but I DIDN’T WANT A LASER!, I wanted to help my patients keep their teeth.

    Then after seeing and understanding Ray Yuknas HUMAN histology, the FDA clearance that says “NEW CEMENTUM MEDIATED ATTACHEMENT IN THE ABSENCE OF LONG JUNCTIONAL EPITHELIUM” the CRA 9.7 out of 10, never finding “THE Guy” on DT to say anything negative about the procedure or the laser, not being able to refer to anyone who had the laser, seeing my anecdotal case walk in the door every 3 months, I decided, I too wanted to help people keep their teeth. The rest is history you can go on this site to see my x-rays you would be shocked at what my perio readings are 12mm bleeding suppurating pockets going to 2mm healthy sulci, again INCREDIBLE RESULTS time after time. This is why I have NO problem recommending to my colleges this procedure. So you can continue to sit around while your patients lose their teeth & waiting for more dog studies. Good luck with your wait.

  107. To Johndds. It seems you are not really in to the laser. Maybe you should follow some lecture and understand the principles from the lasers. There are a lot of papers about lasers, but first every wavelength have it’s own limitations and indications and even when we have for instands two er-yag or nd-yag lasers from different factories the setting will not be the same, because it is all about the output energy and the pulsedurations. So it is very difficult to compare results from different papers to each other because of all the difference there is. I use 810nm laser, nd-yag laser and er-yag laser. My patients like the treatment a lot because healing is faster and the pain afterwards is less. Even the results seems to be better then without laser, but a real explanation for this we cannot give yet. With the er-yag one can do also flapsurgery with deëpithalisation giving an advantage to become less long epithelic attachment and therefor some regeneration. It will not cure periodontics because periodontics is a multifactorial desease:bacteria, genetics, etc. So once a periodontic patient one stays a periodontic patient, but that doesn’t mean we cannot stabalise it or improve it.About lasers there is a very good book “oral laser applications”by “moritz”.

  108. DR T I agree there is a place for lasers. Soft tissue, hard tissue, and restorative aspects. But the research isnt there yet, and as you said perio disease is multi factorial, patients require many different approaches in treating the disease that is evidence based. JohnDDS has gone as far as saying he can cure perio disease with his laser based on one study. Just go to his website. Im glad someone with sense replied to this thread. Im just a gen dent so I feel that I need to do whats best for my patients and I refer whenever possible. But when you got guys like JohnDDS you make claims to his patients that he can cure perio disease and poo poo specialists it gives our profession a bad name.

  109. Dr Pratt
    Please refrence where I have said “I can Cure it”
    IMHO I can reverse it. Diferent statement.

  110. Oh, and I don’t do Ortho and will throw a bone to the Endo, not that he needs it he’s always so busy ;-)

  111. JohnDDS says
    “I referred a patient to my periodontist (one of the best in LA, teaches at USC)”

    “Why should I refer for an inferior service? I have seen the results first hand the reversal of the #1 cause of tooth loss in adult Americans!! I have slashed periodontal pockets in half consistently.”

    Im sure you buddy at USC would like to know that he provides an inferior service for you.

  112. John – I’m just a mini implant guy, not a periolase guy yet, but I find it fascinating that you have the same problems on this forem that I have on the mini implant forems. Some doctors just want to wait for 10 or 20 years for “evidence based” dentistry. In the meantime someone has to do the work so they will have some evidence to look at someday. I think it’s genetic – some of us want to move forward, some want to look backward. Dentistry needs all of us, in my opinion. Best of luck to you, and I’m looking into LANAP. Sounds like the lack of trauma to the bone might make the Biolase unit just the thing to make the starter holes for the min implants, and give me quicker healing around the gingiva as well.

  113. Ken
    I also have a mini thread going on DT you might want to check it out it’s called “Anyone really using mini implants?” On that thread I combine Mini’s & Lanap together. If you think they were rough on me here this was nothing I had at least 3 perios a prostho and several GP’s dog pilling on me over there.

  114. Ken
    Before you go out and get a Biolase make sure you do your due diligence. Look on Ebay you’ll find many on the resale market. I have never seen a periolase in any dental clasified section.

  115. JohnDDS,

    remedial training for what? Periolase? or my periodontal training? I’m an instructor at a university and hopefully I don’t need remedial periodontal training. jk

    Seriously, john it is hard to discuss this with you since you are not objective. You keep accusing me of not owning the laser and not knowing how to use it. You have basically stated that periodontists don’t know anything about periodontal treatment because we don’t use your machine. You have thrown out peer reviewed statements and opinion papers. I realized that you repeat the same argument no matter the point being made…and you have already stated you have a conflict of interest.

    Yukna tried to point out the laser needs to contact the whole root surface to work…he mentioned that lasers are advantageous to work with when reaching micro-crevices on the root. I buy that, but in my hands I can scale away much of the diseased cementum…like most periodontists and GPs. Plus, $4,600 is more than I charge for full mouth OFD.

  116. Ken Clifford,

    The argument “it works in my hands” is not a scientific one. If you feel you are doing what is best for your patient then more power to you. However, predictable treatment in the hands of the masses NEEDS to be evidenced-based. My suggestion is follow your patients with an objective eye and publish your finding in a few years. I don’t think anyone is against mini implants. We have an ongoing study at the U looking at immediate load mini implants. The patients are informed that this is not a standard of care and will be (have been) treated free of charge during complications.

    The cavalier dentists (incl specialists) always think they are ahead of everyone and the whole world is against them. Experimenting on your patients without their knowledge is not ethical.

  117. Seamentum

    You seem to think that $4,600 is a lot of money.

    I beg to differ. I think it is a bargain.

    Do you know that the average American drives around in a $20,000 piece of sheet metal and rubber that will be obsolete in 5 years?

    I’m sure you have seen the devastation of a patient in dentures. When a person gets older what joy do they have? Usually it is sitting around the table with their friends and family enjoying a good meal. This measly $4600 allows my patients that future JOY.

    Not to mention what Aetna medical insurance found that they will save about 16% on future medical bills.

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