Dental Policy Bulletins

Number: 035

Subject: Laser-Assisted New Attachment Procedure (LANAP)

Date: October 4, 2010

Important Note

This Clinical Policy Bulletin expresses our determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information including:
  • Clinical outcome studies in the peer-reviewed published medical and dental literature
  • Regulatory status of the technology
  • Evidence-based guidelines of public health and health research agencies
  • Evidence-based guidelines and positions of leading national health professional organizations
  • Views of physicians and dentists practicing in relevant clinical areas
  • Other relevant factors
We expressly reserve the right to revise these conclusions as clinical information changes, and welcome further relevant information.

Each benefits plan defines which services are covered, excluded and subject to dollar caps or other limits. Members and their dentists will need to consult the member's benefits plan to determine if any exclusions or other benefits limitations apply to this service or supply. The conclusion that a particular service or supply is medically necessary does not guarantee that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that we consider medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members.

Policy

LANAP is a technique that provides debridement and scaling without flap reflection. This technique is indicated for patients with periodontal disease and is therapeutic in nature.

Despite the large numbers of publications available on LANAP, there is ongoing controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. Simply stated, there is presently insufficient evidence to suggest that any specific wavelength of laser is superior to traditional modalities of treatment or therapy. Current evidence does suggest that use of the Nd: YAG or ErYAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. There is limited scientific evidence that lasers used in an adjunctive capacity in conjunction with SRP (codes D4341, D4342) provide some benefit.

Due to insufficient evidence in current clinical publications and research articles, Aetna considers the LANAP technique as the clinical equivalent of SRP procedures.

Background

The LANAP is generally categorized as a dental technique to facilitate removal of inflamed pocket epithelium, as well as the removal of calcified plaque and calculus from diseased root surfaces. LANAP is often submitted for pocket reduction procedures utilizing flap reflection for access to root surfaces (D4260, D4261, D4240, D4241); however, this procedure is normally performed without flap reflection. The laser optic fiber is placed into the diseased pocket along the root surface. This is generally followed by ultrasonic or mechanical instrumentation and scaling and root planing of the diseased root surfaces. This process is usually repeated, without flap elevation, until the root surfaces are thoroughly treated and all mineral deposits are removed from the diseased root surfaces. The adjacent soft tissue is then compressed against the root surfaces to help seal the treated pocket and assist in the formation of a fibrin clot. The use of local anesthetic is usually optional with the LANAP technique.

Revision Dates

Original policy: October 4, 2010
Updated:
Revised:

The above policy is based on the following references:

1Yukna, RA, Bowers GM, Lawrence JJ, Fedi PF, Jr. A clinical study of healing in humans following the excisional new attachment procedure. J. Periodont. 1976; 47: 695-700.

2Millenium Dental Technologies, Inc. Dental Prod Report 1999; (May):40.

3Cobb CM. Seeing the light-the truth about soft tissue and nonsurgical periodontal therapy Nonsurgical pocket therapy. Mechanical. Ann. Periodont 1996;443-490.

4Mathews DC. Journal of the Canadian Dental Assn. (April 2010, Vol. 76:2, A30).

5 Karlsson MR, DIogo Lofgen CI, Jansson HM. The effect of laser therapy as an adjunct to non-surgical periodontal treatment in subjects with chronic periodontitis: a systematic review. Department of Periodontology, Center for Oral Health Sciences, Malmo University, Malmo, Sweden. J Peiodontol 2008;79:2021-2028.

6Slot DE,Kranendonk AA, Paraskevas S, Van der Weijden F. The effect of a pulsed nd: yag laser in non-surgical periodontal therapy. Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands. J Periodontol 2009 Jul; 80(7);1041-56..

7AAP Statement Regarding Use of Dental Lasers for Excisional New Attachment Procedure (ENAP) [article online] 2009. Available at: http://www.perio.org/resources-products/enap_laser.htm. Accessed October 4, 2010.

8American Dental Association. Current Dental Terminology, CDT 2011-2012.*

9Cobb CM. Laser in periodontics: A review of the literature. J. Periodont. April 2006; 545-564.



*Current Dental Terminology. Copyright 2010 American Dental Association. All rights reserved.

Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

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