84 current users of the Periolase MVP-7 Nd:YAG laser responded to a survey from CRA. 39 indicated they had experienced failures with Laser Assisted New Attachment Procedure (LANAP). Their written responses follow:
| 1 tooth severely periodontally involved; recession of gingival tissue. |
| Attempting to save hopeless teeth did not happen but patient was advised of probability of tooth loss before starting treatment. |
| Doesn't work 100%, in my hands approx 80% might have left calculus, positive patient compliance issue, one was a fractured tooth. |
| Early phases I over treated, had some gingiva repression, root exposure which in traditional surgery would be acceptable, but not to my current expectations. |
| Failure to reduce pocket depth & bleeding, this occurs infrequently. |
| Had a defective head, laser not at full power, sent in for repair. |
| Heavy smokers needed some retreatment; Non compliance w/ perio maintenance protocols; Occlusal interferences usually healing resumed as soon as the interference were corrected. |
| Hopeless teeth 12 mm pocket w/ severe bone loss, I have removed 10% of those I have tried to save. |
| I had some areas that I over treated w/ the laser, resulted in some areas where the tissue collapsed interproximally & there was also some boney sequellae. |
| I have had pockets that would not resolve, most always seems to be an occlusal factor associated w/ these, retreat w/ laser adjust the interference. |
| In a full mouth of teeth one or two did not get similar resolution to all others, no - localized failures in the same patient. |
| Inadequate pocket reduction; relapse of inflammation; no new attachment. |
| Infection still present. |
| Isolated teeth where splinting is impossible, an implant case has not responded well, patients who cannot follow post-op instructions. |
| Loss of attachments, Pockets coming unzipped, Smokers have a higher failure rate. |
| Marginal new attachement; tissue shrinkage; marginal pocket reduction. |
| Most cases where the response wasn't as good as other cases, it was because the occlusal adjustments were not done thorough enough on my part. |
| Most failures are on teeth cracked or needing endo. |
| Most of the time when there is a remaining pocket it is not inflamed as it was when originally treated. |
| Most of them were 10+ mm pockets. |
| New attachment for some smokers has been less than desired, still achieved healthier tissue but pocket decrease has not been as good for some. |
| No bone support, compressible in socket only in 3 cases, but others that have been similar seem to be responding to treatment albeit short term. |
| Not failures, I have had some cases endo, early in learning curve. |
| Not yet, but the procedure requires no probing for 6 months. |
| On frenectomy, over heated & sluff the tissue & bond. |
| On some patients have not had the regeneration I would have liked, could be due to poor compliance or operator. |
| Only failures so far have been that we did not get success hoped for on treated apthous ulcers. |
| Partial, few areas needed work a second time. |
| Patient's non-compliance, smokers, about 20% failure rate. |
| Refractory perio cases that improved initally but have regressed. |
| Retreats of isolated preps have been infrequent, however once over the learning curve my unresponsive sites have become fewer & fewer. |
| Several teeth have not responded as anticipated, my impression is that I was not aggressive enough while treating. |
| Smokers who won't quit, 50% less pockets reduction. |
| Some deeper than 9 mm pockets may require retreatment. |
| Some patients have not responded as well to perio surgery. |
| Some teeth didn't get pocket reduction, small minority, may be due to operator error. |
| Some teeth, especially focally involved upper molars are difficult but LANAP reduces inflammation to the point where patient is able to maintain pain. |
| Some, mainly due to noncompliance w/ recall, patients that expected a less than ideal result are much more likely to allow me to retreat the area. |
| Teeth due to occlusion unable to stabilize; too advanced perio. |
| Teeth needing perio-endo should be treated together, operator scheduling problem. |
| Teeth w/ gross bone loss, even splint them were not possible to keep them. |
| Teeth w/ root fractures wouldn't resolve, redid to be extracted. |
| The poor out comes are so far better than any other treatment, modality that I really can't consider it failure, I work harder at performing the procedure. |
| Typically poor attitude & follow through by patients, perio behavior, I think any procedure would have led to the same mediocre result. |
| Usually residual calculus, root fractures, enamel pearls, root projections that are not related to the LANAP protocol. |
| W/ teeth greater class II inability that were not used to splint. |