Part of the LANAP Laser Therapy guide
If you have been told you need gum surgery, you may have come across LANAP as an alternative. Neither is the right choice for everyone. This guide compares them honestly, using the American Academy of Periodontology's review of the evidence.
01
Why gum surgery is sometimes needed
Scaling and root planing is the first treatment for most periodontitis. When pockets stay deep afterward, bacteria remain out of reach of brushing and professional cleaning, and the disease can continue to destroy bone. At that point a periodontist may recommend a procedure that reaches deeper: traditional flap (osseous) surgery, the laser-assisted LANAP protocol, or a regenerative procedure.
02
How traditional flap and osseous surgery works
In flap surgery, the periodontist makes incisions and folds the gum back to see the roots and bone directly. Deposits are removed under direct vision, and the bone can be reshaped (osseous surgery) to remove craters and ledges where bacteria collect. Where a defect is suitable, bone grafts or membranes can be placed to encourage regeneration. The gum is then repositioned and closed with sutures.
The strength of this approach is access: the surgeon can see and correct the anatomy. The trade-off is that incisions and sutures typically mean more swelling and a longer initial recovery, and the gum is often repositioned lower, which can expose more of the root.
03
How LANAP works
LANAP treats the pocket from within. A laser fiber is passed into the pocket to address diseased pocket lining and bacteria, the root surfaces are cleaned with ultrasonic and hand instruments, and the laser is used again to help form a stable clot that seals the pocket while healing begins. There is no traditional flap incision and typically no sutures.
The protocol has FDA 510(k) clearance for a periodontal-regeneration claim, based on human histologic evidence. For the full picture of the procedure, see the complete LANAP guide.
04
Side by side
| LANAP | Traditional flap / osseous surgery | |
|---|---|---|
| Access to roots and bone | Through the existing pocket | Direct view after opening a flap |
| Incisions and sutures | No traditional flap incision; typically no sutures | Incisions and sutures |
| Bone reshaping | Not part of the protocol | Yes, where needed |
| Grafts and membranes | Not part of the protocol | Can be placed in suitable defects |
| Gum position after healing | Aims to preserve existing tissue | Gum is often repositioned lower |
| Initial recovery | Many patients resume ordinary activity within about a day | Typically longer, with more swelling |
05
What the evidence says about results
Lasers as an addition to conventional therapy
The American Academy of Periodontology's 2018 best evidence consensus statement concluded that appropriate laser therapy used alongside conventional periodontal therapy may provide a modest additional benefit of less than 1 mm in probing depth and clinical attachment level for moderate to severe periodontitis. For pockets of 5 mm or more remaining after at least a year of conventional therapy and maintenance, it found the evidence inadequate to show an added benefit.
Regeneration with LANAP
The 2012 human study by Nevins and colleagues found some periodontal regeneration in 5 of 10 analyzed teeth nine months after LANAP. It was a small, eight-patient study without a surgical comparison group, and the authors called for longer comparative trials.
In other words, the evidence does not show that either approach is better for every patient. The differences that matter most to many patients are in how treatment is delivered and how the first days of recovery feel, while long-term results depend heavily on case selection and maintenance.
06
How a periodontist decides
LANAP may be favored when:
- Pockets are suitable for treatment through the pocket
- Preserving gum height matters, for example in visible areas
- The patient prefers to avoid incisions and sutures
Traditional surgery may be favored when:
- Bone needs reshaping or a defect calls for a graft or membrane
- Anatomy requires direct visualization to treat the root properly
- Additional procedures are planned at the same site
Questions to ask
Why is this approach recommended for my pockets? What would the alternative involve? What results should I expect, and what maintenance will I need afterward?
“Your first visit is a conversation, not a procedure. We send your plan in writing after, so you can think it over at home.”
Compare costs in LANAP cost, or call Sterling Periodontics at (310) 278-3666 to arrange an evaluation.
07
Frequently Asked Questions
Is LANAP less painful than gum surgery?
Because LANAP avoids a flap incision and sutures, many patients find the first days easier. Comfort still varies with the extent of treatment and the individual.
Is LANAP as effective as osseous surgery?
The evidence does not show either approach is better for every case. The AAP's 2018 review found lasers used alongside conventional therapy may add a modest benefit of less than 1 mm. The right approach depends on your pockets and bone defects.
Can LANAP be used if I already had gum surgery?
It can be considered for persistent or recurrent pockets after previous treatment. Your periodontist will evaluate the area before recommending it.
Does traditional surgery cause gum recession?
Flap and osseous surgery often reposition the gum lower to reduce pocket depth, which can expose more root. Your periodontist can explain the expected result for each area.
Which approach costs less?
Costs depend on how many areas are treated and the complexity of the case, so there is no single answer. Sterling provides an individual written estimate after evaluation.
Sources
- Mills et al., 2018: AAP best evidence consensus statement on laser therapy for periodontitis (J Periodontol) pubmed.ncbi.nlm.nih.gov/29693260/
- FDA 510(k) summary K151763 (PerioLase MVP-7, LANAP protocol) www.accessdata.fda.gov/cdrh_docs/pdf15/K151763.pdf
- Nevins et al., 2012: Human clinical and histologic evaluation of laser-assisted new attachment procedure pubmed.ncbi.nlm.nih.gov/22754897/
- American Academy of Periodontology: Non-surgical treatments www.perio.org/for-patients/periodontal-treatments-and-procedures/non-surgical-treatments/
This article is general education and does not replace a diagnosis or individualized treatment advice.
