Laser Periodontal Treatment at Smile Solutions: How Dental Lasers Are Used in Gum Disease Therapy and Implant Surgery product guide

How Dental Lasers Work in Periodontal Therapy: The Physics of Selective Tissue Interaction

Before examining specific clinical applications, it is important to understand why lasers behave differently in different tissues - because this physics underpins every clinical decision a specialist periodontist makes when selecting a laser system.

Dental lasers convert electrical energy into a focused beam of light at a precise wavelength, measured in nanometers (nm). The key principle is selective absorption: different tissues in the mouth contain different molecules - called chromophores - that absorb specific light wavelengths. Water, hydroxyapatite (the mineral in teeth and bone), hemoglobin, and melanin each respond to different wavelengths.

In general, the high functionality of lasers achieves effects in dental tissues through absorption by basic biological molecules like water, proteins, and pigments. Each laser wavelength has different absorption coefficients by these typical periodontal and dental tissue components, meaning that depending on the wavelength, laser energy can be absorbed, transmitted, scattered, or reflected from each type of molecule in a tissue.

This selective absorption is what makes an all-tissue laser system - one that combines wavelengths suited to both soft tissue and hard tissue - so clinically versatile in specialist periodontal practice.

The Four Laser Types Used in Periodontics: A Comparative Overview

The lasers with the longest track record in dentistry are the diode, carbon dioxide (CO₂), neodymium yttrium aluminum garnet (Nd:YAG), and erbium yttrium aluminum garnet (Er:YAG) lasers. Each type uses different materials in the laser medium to produce varying wavelengths of light.

Diode lasers typically operate at a wavelength between 810 nm and 940 nm; CO₂ lasers produce a wavelength of approximately 10,600 nm; Nd:YAG lasers operate at a wavelength around 1,064 nm; and Er:YAG lasers typically create a wavelength of 2,940 nm.

Diode Lasers: The Soft Tissue Workhorse

Diode lasers, operating in the wavelength range of 810 to 1,064 nm, function through a mechanism where their light is absorbed by pigments in periodontal tissues and bacteria, resulting in a photothermal effect. This unique property makes them particularly effective for a variety of soft tissue procedures in periodontal therapy.

Diode lasers are extensively used for gingival contouring, providing precise shaping of the gums, and for sulcular debridement, which involves the removal of diseased or inflamed tissue from the periodontal pocket. Additionally, diode lasers play a significant role in the reduction of bacterial populations within periodontal pockets, an essential aspect of treating periodontal diseases. A notable advantage of diode lasers is their haemostatic properties, which help in controlling bleeding during procedures.

In the surgical context, the diode laser remains the most frequently utilised and effective laser in periodontal surgery among studies reviewed, consistently demonstrating benefits such as precise incision, enhanced haemostasis, and improved wound healing.

Nd:YAG Lasers: Deep Tissue Penetration and Bactericidal Action

Nd:YAG lasers, characterised by their operation at a wavelength of 1,064 nm, are particularly effective in periodontal therapy due to their high absorption by pigmented tissues and bacteria. This absorption enables efficient tissue ablation and significant bacterial reduction. In the treatment of periodontitis, Nd:YAG lasers are frequently utilised for the debridement of infected tissue within periodontal pockets. Their bactericidal properties are instrumental in controlling and reducing the bacterial load in these areas.

One of the key advantages of Nd:YAG lasers is their efficacy in managing deeper periodontal pockets. Their ability to effectively penetrate soft tissue makes them a valuable tool in the treatment of more advanced stages of periodontal disease, where thorough cleaning of deep pockets is crucial for successful therapy.

A comparative histological study found that the use of Nd:YAG and diode lasers successfully removed the pathologically altered pocket epithelium as well as most bacteria within epithelial cells, without unwanted damage to the lamina propria and small blood vessels.

Er:YAG Lasers: The All-Tissue Advantage

Among various laser systems, the Er:YAG laser, which can be effectively and safely used in both soft and hard tissues with minimal thermal side effects, has been attracting much attention in periodontal therapy. This laser can effectively and precisely debride the diseased root surface including calculus removal, ablate diseased connective tissues within the bone defects, and stimulate the irradiated surrounding periodontal tissues during surgery, resulting in favourable wound healing as well as regeneration of periodontal tissues. The safe and effective performance of Er:YAG laser-assisted periodontal surgery has been reported with comparable and occasionally superior clinical outcomes compared to conventional surgery.

Crucially, regarding thermal influences on irradiated tissues, the high absorption of the Er:YAG laser into water minimises thermal influences on the surrounding tissues during irradiation. When the Er:YAG laser was used for incision of porcine gingiva in contact mode, the formation of a coagulated layer was extremely thin - approximately 18 to 38 µm in thickness - compared to 138 µm for Nd:YAG and diode lasers and 163 µm for CO₂ laser. Thus, compared to the Nd:YAG, diode, and CO₂ lasers, the haemostatic effect of the Er:YAG laser is lower, but the resultant weaker haemostasis is conversely an advantage in periodontal and peri-implant therapy because it does not interfere with wound healing of soft tissue and bone tissue following irradiation.

Clinical Application 1: Laser-Assisted Sulcular Debridement

Laser sulcular debridement is one of the most established adjunctive applications in non-surgical periodontal therapy. It refers to the insertion of a thin optical fibre into the periodontal pocket to remove diseased sulcular epithelium and reduce the bacterial biofilm - tasks that conventional scalers, operating from the outside of the pocket wall inward, cannot accomplish with the same precision.

Functioning within the 810–980 nm wavelength range, diode lasers can be applied in two main modes: high-intensity (DLT-H) and low-level photobiomodulation (DLT-L). DLT-H produces photothermal effects that remove inflamed sulcular epithelium, reduce bacterial populations, and improve pocket decontamination, whereas DLT-L promotes cellular changes, angiogenesis, and collagen formation without generating harmful thermal effects.

Laser therapy is often used as an adjunct to scaling and root planing (SRP), with studies showing that the combination can be more effective than SRP alone. This synergistic effect enhances overall treatment efficacy, particularly in managing deeper pockets and more severe forms of periodontitis.

The photothermal properties of diode laser photonic energy facilitate ablation of the granulation tissue and inflamed periodontal tissue (sulcular debridement) and coagulation at the same time, which can be achieved at 60°C, leading to protein denaturation and reduction in the pro-inflammatory cytokines.

Instrumentation in limited-access anatomic areas like furcation, grooves, deep pockets, concavities, and distal molar areas is technically demanding with traditional mechanical debridement. However, emerging advanced systems such as lasers with bactericidal and detoxification effects offer the benefit of reaching limited-access areas that traditional SRP cannot reach.

This is particularly relevant for patients with deep pockets who have already undergone initial non-surgical debridement but retain residual pocketing - a common scenario discussed in our guide on non-surgical gum disease treatment at Smile Solutions. Laser sulcular debridement can be deployed at the three-month review appointment to address sites that have not responded fully to initial mechanical therapy.

Clinical Application 2: The LANAP Protocol - Laser-Assisted New Attachment Procedure

LANAP is the most extensively studied laser periodontal protocol and represents a distinct surgical approach rather than a simple adjunct to conventional care.

What Is LANAP?

Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of periodontitis, intended to work through regeneration rather than resection. This therapy and the laser used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy.

The LANAP protocol is an FDA-cleared, minimally invasive laser treatment for moderate to severe periodontal disease.

In LANAP surgery, a variable free-running pulsed Nd:YAG laser at 1,064 nm wavelength is used by a dentist or periodontist to treat the periodontal pocket. The laser is intended to selectively remove diseased or infected pocket epithelium from the underlying connective tissue. The Nd:YAG laser has been shown to reduce levels of microbial pathogens in periodontal pockets and vaporise the pocket-lining epithelium without causing damage to the underlying connective tissue.

The LANAP Protocol Step-by-Step

The LANAP protocol follows a structured, multi-step sequence:

1. First laser pass: The Nd:YAG fibre is inserted into the periodontal pocket to remove diseased epithelium and reduce bacterial load
2. Ultrasonic debridement: Root surfaces are thoroughly debrided with a piezoelectric ultrasonic scaler to remove calculus and biofilm
3. Second laser pass: A second laser application at different pulse settings creates a stable fibrin clot to seal the pocket and promote re-attachment
4. Occlusal adjustment: Bite forces are carefully managed to protect the healing tissues
5. No sutures, no membranes, no grafts: The protocol is designed to achieve regeneration without exogenous materials

LANAP is performed using the Nd:YAG laser 1,064 nm. The first application of the Nd:YAG laser is performed under local anaesthesia for the objective of placing the laser's optical fibre in the gingival sulcus to remove the damaged epithelium of the periodontal pockets.

After thorough scaling and root planing, the fibre optic system of the Nd:YAG laser is applied for a second time inside the periodontal pockets with different power settings, aiming to obtain a fibrin clot and seal the periodontal pocket.

What Does the Evidence Show?

The LANAP evidence base is substantial, though the field continues to evolve.

Regeneration in a true sense refers to the formation of new bone, cementum, and periodontal ligament. It was observed that LANAP could initiate regeneration of the affected periodontal tissues in human beings, and new connective tissue attachment mediated by cementum could be seen. These findings were based on a study which confirmed replacement of diseased tissues of root with new cementum, bone, and periodontal ligament, which reflects periodontal regeneration.

A retrospective case series published in the Journal of Periodontal and Implant Science (Yukna, 2023) treated 22 consecutive patients with moderate to severe periodontitis (probing depths up to 11 mm) using the LANAP protocol. All 22 patients completed the 12- to 18-month follow-up. Probing depth, clinical attachment level, and furcation showed substantial improvement. Recession was minimal (mean 0.1 mm), while 93.5% of probing depth measurements were 3 mm or less at re-evaluation.

Of sites that could gain attachment, 54% gained at least 2 mm, a clinically significant amount. It should be noted that 4% of treatment sites lost attachment and 42% remained the same.

A 2023 study published in Diagnostics (Bechir, 2023) compared LANAP directly to scaling and root planing alone. The purpose was to evaluate the efficiency of two therapeutic procedures clinically and microbiologically in the management of periodontally affected teeth: scaling and root planing alone and LANAP. Molecular biological determinations of bacterial markers through polymerase chain reaction with standard PET tests were used for the quantification of three of the most important periodontal pathogens. Both nonsurgical periodontal therapies were proven effective in patients with chronic periodontal disease; however, LANAP was associated with a greater reduction in the targeted periodontal pathogens.

It is important to acknowledge the ongoing debate in the literature. European Federation of Periodontology guidance for treatment of stage I–III periodontitis states that lasers as an adjunct to subgingival instrumentation are not suggested.

A 2015 systematic review from the AAP regeneration workshop acknowledged peer-reviewed studies reporting periodontal regeneration, and further suggested that the LANAP protocol's minimally invasive nature may offer advantages in the regeneration of defects where minimal soft tissue change is required.

This nuanced picture underscores why LANAP is best delivered by board-registered specialist periodontists who can accurately assess patient suitability, rather than as a blanket alternative to conventional care (see our guide on periodontist vs. general dentist).

Clinical Application 3: Er:YAG Laser in Periodontal Flap Surgery

When non-surgical therapy has been exhausted and surgical access is required, the Er:YAG laser offers distinct advantages over conventional curettes for root surface and bone defect debridement during open-flap procedures.

Sculean et al. compared the healing of intrabony periodontal defects following conventional access flap surgery using the Er:YAG laser or hand/ultrasonic scalers for degranulation and root debridement in a randomised controlled trial. They reported that the application of the Er:YAG laser was equally effective and safe with significant clinical improvements at 6 months post-surgery. The laser group displayed a higher tendency for clinical attachment level gain, although the tendency was not statistically significant. They concluded that the Er:YAG laser may represent a suitable alternative for root surface and bone defect debridement in conjunction with periodontal surgery.

Based on the review of the literature, the erbium lasers are the most effective and efficient laser devices for tissue ablation during periodontal flap surgery as an alternative or adjunctive therapy to conventional mechanical treatment modalities. At present, the available clinical evidence for the promotion of periodontal wound healing/tissue regeneration by erbium lasers is still limited and insufficient. However, the erbium lasers offer a novel, effective technical approach during periodontal surgery, in particular, minimally invasive or flapless surgery.

A recent AAP consensus statement noted that although not conclusive, some evidence suggests that adjunctive use of Er:YAG or Nd:YAG lasers is superior to conventional periodontal therapy alone in the case of deep periodontal pockets.

This application is directly relevant to patients progressing to the surgical phase of treatment described in our guide on periodontal surgery at Smile Solutions.

Clinical Application 4: Laser Use in Peri-Implantitis and Implant Site Preparation

The management of peri-implantitis - the aggressive bone-destroying infection that can develop around dental implants - represents one of the most clinically demanding applications of laser technology in periodontics. The complex surface topography of titanium implants makes complete mechanical debridement extremely difficult, and this is where laser energy offers a meaningful adjunctive role.

Due to the lack of cementum and periodontal ligament as a protective system, dental implants are more susceptible to bacterial infections than natural teeth. Therefore, the elimination of plaque biofilm is crucial in the treatment of peri-implantitis; the biofilm formed after implant debridement may affect the treatment outcome and the long-term stability of the implant.

Implantoplasty reduces surface roughness and bacterial retention, whereas Er:YAG laser therapy provides precise decontamination with minimal thermal damage.

A 2025 study published in BMC Oral Health demonstrated that Er:YAG laser and water-mist Nd:YAG laser use does not adversely affect the surface morphology, roughness, and temperature changes of pure titanium and zirconia discs. The safety of laser use is higher, and it can efficiently remove the biofilm of plaque from the material surface, with effects superior to carbon fibre curettes. Irradiation with Er:YAG and water-mist Nd:YAG lasers can increase the proportion of dead bacteria in the reattached plaque.

A randomised controlled trial published in PMC (2023) investigating combined Nd:YAG and Er:YAG laser surgical therapy for peri-implantitis found that in the test group, Er:YAG laser was used for granulation tissue removal and implant surface decontamination, while Nd:YAG laser was employed for deep tissue decontamination and biomodulation.

The combined Nd:YAG–Er:YAG laser surgical therapy of peri-implantitis seemed to lead to more favourable improvements in regard to bleeding on probing six months after treatment compared to the conventional mechanical decontamination of the implant surface.

A systematic review with meta-analysis examining surface decontamination protocols for peri-implantitis surgery found that Er:YAG laser resulted in an added effect of 0.8 mm in mean probing pocket depth reduction at 6-months follow-up compared to sham laser application, when both were used in addition to ultrasonic scalers and steel curettes.

The clinical complexity of peri-implantitis management - and the reason why specialist periodontist involvement is essential - is explored in detail in our guide on peri-implantitis treatment at Smile Solutions.

Why an All-Tissue Laser System Matters in Specialist Practice

Not all dental practices have access to both hard-tissue and soft-tissue laser capability. Many general dental practices may have a diode laser for simple soft tissue procedures, but lack the Er:YAG wavelength required for root surface debridement, bone surgery, and implant surface decontamination.

Lasers can broadly be classified, based on the type of tissue adaptability, into hard-tissue lasers - such as Nd:YAG, Er:YAG, and carbon dioxide - and soft-tissue lasers, such as diode lasers. While hard-tissue lasers are more versatile in their application, they are more costly and carry a risk of causing thermal injury to the pulp if used incorrectly.

This is why all-tissue laser systems - which combine Er:YAG and Nd:YAG wavelengths in a single platform - are the gold standard in specialist periodontal practice. The clinical decision about which wavelength, pulse duration, and energy setting to use in a given situation requires the kind of advanced training and case experience that a board-registered specialist periodontist brings to every procedure.

Further refinements in laser wavelengths and pulse modes have enabled more precise control over laser–tissue interactions, significantly reducing collateral tissue damage and improving patient comfort.

What Patients Experience: Laser Periodontal Treatment vs. Conventional Surgery

One of the most clinically meaningful advantages of laser periodontal therapy is the patient experience - particularly for individuals who have delayed treatment due to anxiety about conventional surgical procedures (see our guide on gum disease symptoms and why early treatment matters).

LANAP offers a more comfortable regenerative treatment experience for patients and faster recovery compared with traditional osseous surgery.

Studies comparing LANAP to traditional osseous surgery have generally found comparable or superior clinical outcomes for LANAP, with the additional advantage of significantly less post-operative discomfort and faster recovery.

Patients overwhelmingly accept treatment using the LANAP protocol compared with just 33% of patients who accept traditional osseous surgery.

According to the Academy of General Dentistry (AGD), benefits of dental lasers include: reduced symptoms and healing times associated with traditional therapies; reduced amounts of bacteria in both diseased gum tissue and in tooth cavities; and control of bleeding during surgery.

Key Takeaways

• Laser wavelength determines tissue selectivity. Er:YAG (2,940 nm) targets water and hydroxyapatite for hard and soft tissue applications; Nd:YAG (1,064 nm) penetrates deeply into soft tissue for pocket debridement and bacterial reduction; diode lasers (810–980 nm) are optimised for sulcular debridement and haemostasis.
• Lasers are adjunctive tools, not replacements for mechanical debridement. The evidence supports laser use as a complement to scaling and root planing and surgical debridement - not as a standalone substitute in most clinical scenarios.
• LANAP is the only laser periodontal protocol with FDA clearance for true periodontal regeneration, supported by human histological studies demonstrating new cementum, periodontal ligament, and alveolar bone formation on previously diseased root surfaces.
• Er:YAG laser is particularly valuable in peri-implantitis surgery, providing precise implant surface decontamination with minimal thermal damage to the surrounding titanium - an advantage that mechanical instruments alone cannot replicate.
• All-tissue laser capability requires specialist-level training and equipment. The clinical decision-making around laser parameter selection, pulse duration, and application technique demands the advanced training of a board-registered specialist periodontist.

Conclusion

Dental laser technology has meaningfully expanded the clinical toolkit available to specialist periodontists - not by replacing the foundational principles of periodontal therapy, but by enhancing them. From diode-assisted sulcular debridement in the non-surgical phase, to Er:YAG-facilitated root surface conditioning during flap surgery, to combined Nd:YAG and Er:YAG protocols for peri-implantitis management, the evidence base supports laser use as a precision adjunct that reduces surgical trauma, improves bactericidal outcomes in anatomically challenging sites, and supports faster patient recovery.

What distinguishes specialist periodontal practice is not merely access to advanced laser technology, but the clinical expertise to deploy it appropriately. Selecting the right wavelength, energy setting, and protocol for a given patient's disease severity, anatomy, and risk profile is a decision that requires the depth of training and case experience that board-registered specialist periodontists bring to every consultation.

For patients in Melbourne considering laser periodontal treatment, the next step is a specialist periodontal consultation - including full periodontal charting, pocket depth assessment, and radiographic bone-level evaluation - to determine whether laser-assisted therapy is appropriate for their clinical situation. To understand what that initial appointment involves, see our guide on your first periodontist appointment at Smile Solutions. For patients already in the maintenance phase following active treatment, our guide on periodontal maintenance and long-term supportive therapy explains how laser adjuncts may also play a role in managing residual or recurrent pocketing at recall visits.

Smile Solutions has been providing specialist periodontal care from Melbourne's CBD since 1993. Situated at the Manchester Unity Building, Level 12 and Tower, 220 Collins Street, Smile Solutions brings together 60+ clinicians - including 25+ board-registered specialists - who have cared for over 250,000 patients across Melbourne and beyond. No referral is required to book a specialist appointment. Call 13 13 96 or visit smilesolutions.com.au to arrange your specialist periodontal consultation.

References

• Yukna, R.A. "Clinical evaluation of Laser-Assisted New Attachment Procedure® (LANAP®) surgical treatment of chronic periodontitis: a retrospective case series of 1-year results in 22 consecutive patients." Journal of Periodontal and Implant Science, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10315259/

• Bechir, E.S. "The Clinical and Microbiological Effects of LANAP Compared to Scaling and Root Planing Alone in the Management of Periodontal Conditions." Diagnostics, 13(14):2450, 2023. https://doi.org/10.3390/diagnostics13142450

• Aoki, A., et al. "Current status of Er:YAG laser in periodontal surgery." Japanese Dental Science Review, 2023. https://www.sciencedirect.com/science/article/pii/S1882761623000388

• Kamath, D.G., et al. "Laser Technology in Periodontal Treatment: Benefits, Risks, and Future Directions - A Mini Review." PMC / National Library of Medicine, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11943112/

• Giouroglou, A., et al. "Evaluating the Efficacy of Various Laser Types in Periodontal Treatment: A Narrative Review." Dentistry Journal, 5(3):49, 2024. https://www.mdpi.com/2673-6373/5/3/49

• Giouroglou, A., et al. "Laser Application for Periodontal Surgical Therapy: A Literature Review." Dentistry Journal, 5(1):11, 2025. https://www.mdpi.com/2673-6373/5/1/11

• Tasdemir, Z., et al. "Surgical Treatment of Peri-Implantitis Using a Combined Nd:YAG and Er:YAG Laser Approach: Investigation of Clinical and Bone Loss Biomarkers." PMC, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10046921/

• Wang, J., et al. "Effect of laser on the decontamination ability and plaque reattachment on the surface of implant restoration materials." BMC Oral Health, 2025. https://link.springer.com/article/10.1186/s12903-025-07332-0

• Meza-Mauricio, J., et al. "Advancing Peri-Implantitis Treatment: A Scoping Review of Breakthroughs in Implantoplasty and Er:YAG Laser Therapies." PMC, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11898008/

• Milosevic, M., et al. "Clinical applications of lasers in conventional periodontal care." Journal of Laser Applications, AIP Publishing, 2023. https://pubs.aip.org/lia/jla/article/35/1/011201/2871536/

• Yu, Y.H., Nevins, M.L. "Tooth Retention and Clinical and Radiographic Long-Term Results Among Patients Treated with the Full-Mouth Laser-Assisted New Attachment Procedure (LANAP): A Case Series." International Journal of Periodontics & Restorative Dentistry, 43(2):181–191a, 2023.

• Millennium Dental Technologies, Inc. "LANAP Protocol." LANAP.com, 2024. https://www.lanap.com/protocols/lanap/