The Modified Annapolis Method of Laser-Assisted Periodontal Surgery


Lawrence A. Nurin, D.D.S.

Modified Annapolis Method of Laser Assisted Periodontal Surgery (Shallow Pocket Therapy) for the Waterlase iPlus Utilizing a Radial Fireing Tip
For the treatment of 4 to 6 mm pockets

I developed a routine for treating 4 to 6 mm pockets using the laser in 1995 for reduction of pocket depth and treatment of periodontal disease. This technique was modified in 2010 to reflect the development of the gold handpiece and the new Radial Fireing Tip.

Basically there are 3 steps plus an occlusal adjustment and/or night guards or retainers- if necessary.

1 a. Sucular Debridement: with injected anesthesia or oraquix topical anesthesia with the Radial Fireing Tip, run the laser in the sulcus, quadrant by quadrant-slowly-connect all the dots. I place the tip at the bottom of the pocket, withdraw about 1 mm and activate the laser and withdraw in a sweeping motion-section by section.

b. Removal of Epithelial Lining

c. Gingivectomy or gingivoplasty : trim away any diseased or excess tissue.
d. Deepithelization: This step is to remove a band of the epithelium on the marginal gingiva of 5 mm.

Settings: 1.5 watts, 40% air and 50% water, 30 Hz, 1.5 watts and H mode


2. Root Preparation: traditional ultrasonic and hand scaling to remove any and all calculus and deposits on the teeth or implants, etc.


3. Root Modification and Cauterization: I run the laser across the marginal gingiva and remove any tissue tags, cauterize any bleeders, and make sure there is a zone of deepithelization of a margin of 5 mm around the teeth.
Then run the laser across and up and down the root surface and "connect the dots". This desensitizes the roots, removes the smear layer, kills bacteria, and micro etches the roots.

All of this is done with the RFT 9 or 14 mm tip,

Give this all 6 months to heal and then reevaluate and rechart.

Of course you improve the patients' home care (I like the Sonicare toothbrush) and then, at 3 months, do a prophy---to polish and remove the toxins on the root surfaces.

NOTE: do not scale or probe during the 6 month healing time.

Recalls may have to be every 3 to 4 mos. instead of the usual 6 months.

Antibiotics as may be necessary---Doxycycline 50 mg twice a day for 10 days or Periostat 60 tabs, 1 pill twice a day with 2 renewals.

If the pockets remain---retreat with the modified AMLAPS/SPT, or surgery as necessary, or time to send the patient off to the periodontist. But this should do it for most cases without too much discomfort.


Good luck,