Use of dental water irrigator following LANAP

Q: Yesterday, I went for my first periodontal planing and scaling (3 and 1/2 months after LANAP) session. I was shocked to hear from the periodontist that my back right molar still had a deep pocket depth on the buccal side. It was a 7-8 mm just before LANAP. Anyway, the hygienist said that a water irrigator would help. I said that I hope that it did not delay or stop the gingival reattachment process since the water force may further separate my gum from the tooth root. Then, the pocket will still remain. She did not think so. Is her suggestion for an irrigator credible? The Periodontist was too busy for me to ask.

A: In our specialty practice of Laser Periodontal Surgery, which includes LANAP, we sometimes see areas that have not responded as anticipated. If I understand you correctly, you have an isolated area of 7-8mm pocketing that has not changed since the procedure was performed. I would suggest speaking to the treating periodontist and discussing what the prognosis was pre-operatively and what can be done to enhance the results. In some instances, we do an isolated re-treatment of the area. There are many factors involved and it would be important that the periodontist speak with you when he is not so busy. The irrigator is helpful if there is plaque and if used correctly should not affect the LANAP process of healing. I am more concerned about the pocket and also the fact that we don’t probe LANAP cases until one year post LANAP surgery.

Q:

1. Yes, it is an isolated area.
2. In regard to not probing for one year—I feel that a planing and scaling at 3 months is, in effect, probing. The hygienist will never be so exact as to not detach new gingival re-attachment. Maybe, instead of a perio cleaning, there should be a regular cleaning only at and not under the gumline at 3months or even 6 months?
3. By the way, would you charge for a one tooth LANAP re-treatment? Thank-you for spending your time on this matter.

A: I would feel more comfortable if you spoke to your treating Periodontist and ask what he/she feels should or should not be done. However, please feel free to keep me informed of your progress.