What This Guide Covers and Who It Is For
This guide is for periodontists evaluating whether to add LANAP to their clinical offerings. It covers training, costs, case selection, billing, and patient communication.
LANAP stands for Laser-Assisted New Attachment Procedure. It uses a specific Nd:YAG laser called the PerioLase MVP-7 to treat periodontal disease, which is infection and inflammation of the tissues surrounding the teeth. [1] The protocol received FDA clearance for "true regeneration" of the attachment apparatus, including new cementum, new periodontal ligament, and new alveolar bone. FDA clearance means the device was reviewed and found to be substantially equivalent to a legally marketed device. This is different from FDA approval, which involves a more rigorous review process.
Periodontal disease affects a significant portion of the adult population and ranges from mild gingivitis (gum inflammation) to severe periodontitis (bone loss around teeth). [1] Many patients who need treatment decline traditional osseous surgery due to anxiety about scalpels, sutures, and recovery time. LANAP offers an alternative approach that some patients find more acceptable. Understanding the clinical evidence, logistical requirements, and financial implications is essential before making this investment.
Core Information About LANAP for Practice Owners
Adding LANAP involves a significant financial and educational commitment, but it can expand your treatment options and appeal to patients seeking less invasive care.
Training and Certification Requirements
LANAP certification is obtained through the Institute for Advanced Laser Dentistry (IALD). The program is the only training pathway authorized for the LANAP protocol. It includes didactic instruction covering laser physics, tissue interaction, and the specific parameters of the PerioLase MVP-7.
The hands-on portion of training involves performing the LANAP procedure on live patients under direct supervision. Clinicians must demonstrate competency with the laser before receiving certification. The full training process typically takes several months from initial coursework through supervised clinical cases.
Continuing education is also part of the program. Certified clinicians have access to ongoing training, case consultation, and protocol updates. This support structure helps practitioners refine their technique during the early learning curve. Many periodontists report that their confidence and efficiency with the laser improve substantially over the first 20 to 30 cases.
Clinical Evidence and Outcomes
The evidence base for LANAP includes histological studies showing true periodontal regeneration. These studies demonstrated formation of new cementum, new periodontal ligament, and new bone on previously diseased root surfaces. This type of regeneration is the gold standard outcome in periodontal therapy.
Published case series and comparative studies have reported clinical attachment level gains and probing depth reductions following LANAP. Results vary based on defect morphology, patient health, and operator experience. Vertical or infrabony defects, which are bone loss patterns that create a pocket along one side of a tooth root, tend to respond more favorably than horizontal bone loss patterns.
It is worth noting that the body of randomized controlled trial data comparing LANAP directly to traditional osseous surgery is still growing. Periodontists should review the current literature carefully and form their own clinical judgment. The American Academy of Periodontology recognizes laser therapy as a treatment modality and encourages evidence-based evaluation of laser protocols. [1]
Case Selection Criteria
Proper case selection is one of the most important factors in LANAP success. The protocol works best on patients with moderate to severe chronic periodontitis who have vertical (infrabony) bone defects. These defect types create a contained environment where the laser can remove diseased tissue and promote clot formation against the root surface.
Patients with primarily horizontal bone loss, aggressive periodontitis, or significant systemic health issues may not be ideal candidates. Smokers typically have poorer outcomes with any periodontal procedure, and this applies to LANAP as well. A thorough periodontal examination, full-mouth radiographic series, and medical history review are essential before recommending LANAP.
Good candidates are generally patients who have declined traditional surgery, patients with medical conditions that make conventional surgery higher risk (such as patients on blood thinners), and patients whose defect patterns align with the protocol's strengths. Presenting LANAP as one option among several, including traditional osseous surgery and guided tissue regeneration, allows the patient to make an informed decision. [2]
Practical Details for Implementation
Integrating LANAP into an established periodontal practice requires planning around equipment, staffing, scheduling, and patient communication.
Equipment and Operatory Setup
The PerioLase MVP-7 is the only laser approved for the LANAP protocol. It is a free-standing unit that requires a dedicated space in the operatory but does not need special electrical wiring or plumbing. The laser uses disposable fiber tips, and staff need training on proper laser safety protocols, including protective eyewear for the clinical team and the patient.
Most practices can incorporate the PerioLase into an existing operatory. Some practitioners designate one room as their laser treatment room to streamline workflow. Setup time for the laser is minimal once staff are trained. Laser safety protocols must comply with OSHA and ANSI standards, including posting warning signs and using appropriate protective eyewear.
Staffing and Scheduling Considerations
LANAP procedures typically take longer per appointment than traditional scaling and root planing but may require fewer total visits. A full-mouth LANAP treatment is usually completed in two sessions, each treating one side of the mouth. Each session typically lasts 1.5 to 2.5 hours.
Assistants should be trained on laser safety, instrument setup, and the specific workflow of the LANAP protocol. Having a dedicated assistant who becomes proficient with the procedure can significantly improve efficiency. Most periodontists find that after an initial learning period, LANAP cases integrate smoothly into the daily schedule.
Patient Communication and Marketing
Patients searching for alternatives to gum surgery often find LANAP through online research. Building a strong online presence around laser periodontics keywords helps attract these patients. Educational content on your website, including procedure descriptions and frequently asked questions, supports informed decision-making. [2]
Referral partner communication is equally important. General dentists who refer periodontal cases to your practice need to understand which patients are good LANAP candidates. Providing referring doctors with a simple case selection guide, such as a one-page summary of ideal defect types and patient profiles, can increase appropriate referrals.
When discussing LANAP with patients, focus on what they care about most: reduced discomfort, faster healing, and minimal gum tissue removal. Be honest about limitations. Not every case is appropriate for LANAP, and outcomes vary. Patients appreciate transparency, and it builds trust in your clinical recommendations.
What the LANAP Process Looks Like Step by Step
The LANAP protocol follows a specific sequence of steps designed to remove diseased tissue, clean root surfaces, and promote regeneration.
First, the periodontist measures probing depths around each tooth to document the baseline severity of disease. Local anesthesia is administered. The PerioLase laser fiber is then inserted into the periodontal pocket. The first laser pass uses specific wavelength settings to selectively remove diseased epithelial lining and reduce bacterial load without affecting healthy tissue or bone.
After the initial laser pass, ultrasonic scalers and hand instruments are used to remove calculus (tarite deposits) from the root surfaces. This step is similar to conventional root debridement. The laser's ability to remove the diseased pocket lining first makes it easier to access and clean the root surface thoroughly.
A second laser pass follows the mechanical debridement. This pass uses different settings to create a stable fibrin clot at the surgical site. Fibrin is a protein involved in blood clotting. This clot acts as a biological seal, holding the gum tissue against the clean root surface and providing a scaffold for healing. No sutures are typically needed.
The bite is then adjusted using articulating paper to reduce trauma to the treated teeth during healing. Patients receive post-operative instructions, including a soft diet and modified oral hygiene routine. Follow-up appointments are scheduled to monitor healing, typically at one week, one month, and three months after treatment.
Investment Costs, Billing, and Return on Investment
The total investment for adding LANAP includes equipment, training, and ongoing consumables. Costs vary by location, provider, and case complexity.
The PerioLase MVP-7 laser costs approximately $80,000 to $100,000. Financing options are typically available through Millennium Dental Technologies, the manufacturer. Training costs through the IALD program are usually included in the equipment purchase or bundled as part of the acquisition package. Ongoing costs include disposable fiber tips, laser maintenance, and continuing education.
LANAP cases are billed using standard ADA periodontal procedure codes. The correct codes are for osseous surgery: D4260 (osseous surgery, four or more contiguous teeth or bounded teeth spaces per quadrant) and D4261 (osseous surgery, one to three contiguous teeth or bounded teeth spaces per quadrant). These codes are used because the procedure targets bone regeneration and is considered a surgical intervention. [3] Using incorrect procedure codes, such as gingival flap codes, can lead to claim denials and reimbursement delays. Most insurance carriers reimburse LANAP at rates comparable to conventional osseous surgery because the procedure codes are the same. However, reimbursement rates vary by carrier and plan. It is good practice to verify benefits before treatment and communicate expected out-of-pocket costs to patients clearly.
Return on investment depends on case volume, fee schedules, and how effectively the practice markets the service. Many practices report that the increased case acceptance from offering a minimally invasive option helps offset the equipment cost within one to two years. Some practices also see an increase in new patient referrals from general dentists and from patients specifically seeking laser periodontal treatment. These figures are practice-dependent and not guaranteed.
When Patients Should See a Periodontist for LANAP
Patients with moderate to severe gum disease who have not responded to non-surgical treatment should consult a periodontist to discuss their options.
General dentists typically manage early-stage gum disease with professional cleanings and patient education on oral hygiene. [1] When disease progresses to the point where bone loss is evident on radiographs and probing depths exceed 5 millimeters, referral to a periodontist is appropriate. The periodontist can evaluate whether LANAP, traditional surgery, or another approach is best suited to the patient's specific defect patterns and health profile.
Patients who are anxious about traditional surgery, those on anticoagulant medications, and those with medical conditions that increase surgical risk may be particularly good candidates for a LANAP evaluation. However, the periodontist should assess each case individually. Not every patient with gum disease is a candidate for LANAP, and a thorough evaluation ensures the patient receives the most appropriate treatment. [2]
Red flags that warrant prompt periodontal referral include teeth with increasing mobility, persistent deep pockets despite scaling and root planing, radiographic evidence of progressive bone loss, and gum abscesses. Early referral to a periodontist gives patients the best chance of preserving their natural teeth. [1]
Find a Periodontist Offering LANAP
If you are a periodontist looking to expand your practice offerings, or a patient searching for a specialist who provides laser periodontal treatment, visit the periodontics page on My Specialty Dentist. You can search by location to find qualified periodontists in your area and learn more about the treatments they offer.
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