What This Guide Covers and Who It Is For
This guide explains LAPIP laser treatment for dental implants affected by peri-implantitis. Peri-implantitis is an inflammatory condition that destroys the bone and soft tissue supporting a dental implant. Left untreated, it can cause the implant to loosen and eventually fail. LAPIP (Laser-Assisted Peri-Implantitis Protocol) offers a way to treat this infection without traditional surgery.
This information is for anyone who has a dental implant and has been told they have peri-implantitis or signs of bone loss around their implant. It is also useful if you are considering implants and want to understand the risks and treatment options if problems develop later. A periodontist is the specialist most likely to diagnose and treat peri-implantitis.
You will find details on how the procedure works, what recovery looks like, approximate costs, and how to know when it is time to see a specialist. The goal is to give you enough information to have a productive conversation with your dental provider about whether LAPIP is right for your situation.
Understanding Peri-Implantitis and LAPIP
Peri-implantitis is the leading cause of late dental implant failure. It begins when bacteria colonize the surface of the implant and trigger an immune response that breaks down surrounding bone.
What Is Peri-Implantitis?
Peri-implantitis is a bacterial infection of the tissues around a dental implant. It is similar to periodontitis (gum disease) around natural teeth, but it tends to progress faster because the seal between an implant and the gum tissue is weaker than the seal around a natural tooth root. [2]
The condition typically starts as peri-implant mucositis, which is inflammation of the soft tissue only. At this stage, there is redness, swelling, and bleeding around the implant but no bone loss yet. When the infection advances to involve the supporting bone, it becomes peri-implantitis. Research indicates that peri-implantitis affects roughly 12% to 22% of implant patients, though estimates vary depending on the study population and diagnostic criteria used. [2]
Risk factors include a history of periodontal disease, smoking, diabetes, poor oral hygiene, and implants placed in areas with insufficient bone. Some patients develop peri-implantitis within a few years of implant placement. Others may not show signs for a decade or more. Regular follow-up appointments with your dentist or periodontist are the best way to catch it early.
How LAPIP Works
LAPIP stands for Laser-Assisted Peri-Implantitis Protocol. It uses the PerioLase MVP-7, a free-running pulsed Nd:YAG laser. This is the same laser platform used in the LANAP protocol, which treats periodontitis around natural teeth. However, LAPIP has been adapted specifically for the titanium surface of dental implants.
The Nd:YAG laser operates at a wavelength of 1,064 nanometers. At this wavelength, the laser energy is absorbed by dark-pigmented bacteria and inflamed tissue but passes through water and healthy tissue with minimal damage. This selectivity is what allows the protocol to remove infected tissue while preserving the healthy tissue needed for healing.
The laser energy also forms a stable blood clot at the treatment site. This clot acts as a natural scaffold that the body can use to regenerate bone and reattach soft tissue to the implant surface. A retrospective study of laser-assisted peri-implantitis treatment found improvements in clinical attachment levels and reductions in probing depths following treatment. [1]
LAPIP Compared to Traditional Surgical Approaches
Traditional treatment for peri-implantitis typically involves open flap surgery. The periodontist cuts and lifts the gum tissue away from the implant, cleans the implant surface mechanically or chemically, places bone graft material, and sutures the tissue closed. This approach has a long track record and is well studied.
LAPIP differs in several ways. There are no scalpel incisions and no sutures. The laser fiber is thin enough to be inserted between the gum tissue and the implant. Because the tissue is not cut open, post-operative pain and swelling are typically reduced. Many patients return to normal activities within a day or two.
Both approaches aim to decontaminate the implant surface and encourage new bone growth. Neither approach guarantees success, and results vary based on the severity of bone loss, the patient's overall health, and how well the patient maintains oral hygiene after treatment. Your periodontist can help you weigh the pros and cons of each option for your specific case.
What You Should Know Before Considering LAPIP
LAPIP is not appropriate for every failing implant. Several factors determine whether you are a good candidate.
Who Is a Good Candidate?
The best candidates for LAPIP are patients who have been diagnosed with peri-implantitis but still have enough remaining bone to support the implant. If bone loss is too severe, the implant may already be too loose to save, and removal may be the better option.
Your periodontist will evaluate your case with dental X-rays or a cone beam CT scan (a 3D X-ray). They will measure the depth of the pockets around the implant, check for bleeding and pus, and assess how much bone remains. Good candidates typically have moderate bone loss, not catastrophic loss.
Patients with uncontrolled diabetes, active smoking habits, or other conditions that impair healing may have lower success rates with any peri-implantitis treatment, including LAPIP. Quitting smoking and managing systemic health conditions before treatment can improve outcomes.
Timing and Preparation
Early treatment produces better results. The longer peri-implantitis goes untreated, the more bone is lost and the harder the condition becomes to manage. If your dentist notices bleeding, deepening pockets, or bone loss around your implant during a routine visit, ask for a referral to a periodontist promptly. [2]
Before the LAPIP procedure, your periodontist may recommend a professional cleaning to remove plaque and calculus (hardened plaque) from accessible areas around the implant. You may also receive instructions about medications. Some providers prescribe antibiotics before or after the procedure, though practices vary.
There is no specific age restriction for LAPIP. Any adult with a dental implant affected by peri-implantitis may be a candidate if the clinical criteria are met. The procedure is performed under local anesthesia (numbing), so the preparation is similar to what you would experience for a deep cleaning.
Provider Training Requirements
Not every dentist or periodontist offers LAPIP. The protocol requires completion of a training program through the Institute for Advanced Laser Dentistry (IALD). This training covers the specific laser settings, technique, and post-operative management unique to the LAPIP protocol.
The PerioLase MVP-7 is the only laser cleared by the FDA for the LANAP and LAPIP protocols. It is important to note the distinction: the FDA has granted 510(k) clearance to this device, which means it has been determined to be substantially equivalent to an existing legally marketed device. This is different from FDA approval, which involves a more rigorous review process typically reserved for higher-risk devices.
When searching for a provider, ask whether they have completed IALD training and how many LAPIP procedures they have performed. Experience matters with any technique-sensitive procedure.
What to Expect During and After LAPIP
The LAPIP procedure is typically completed in one visit per affected implant. Here is what the process looks like step by step.
During the Procedure
Your periodontist will numb the area around the implant with local anesthesia. Once you are comfortable, a thin laser fiber (about the width of three human hairs) is inserted into the pocket between the gum tissue and the implant. The laser is used to remove the infected and inflamed tissue lining the pocket. Bacteria on the implant surface are also targeted.
Next, the periodontist uses ultrasonic instruments to clean debris and calculus from the implant surface. The implant threads are carefully decontaminated. This mechanical cleaning step is important because the laser alone may not remove all hardened deposits.
The laser is then used a second time at a different setting. This second pass helps form a stable fibrin blood clot that seals the pocket. The clot serves as the foundation for tissue regeneration. In some cases, the periodontist may place bone graft material into the defect before forming the clot. The entire procedure typically takes 1 to 2 hours, depending on the number of implants being treated.
Recovery and Aftercare
Most patients report mild soreness for a day or two after LAPIP, similar to what you might feel after a deep cleaning. Over-the-counter pain medication is usually sufficient. Because there are no incisions or sutures, swelling is generally less than with traditional flap surgery.
You will typically be placed on a soft food diet for the first week or two to avoid disturbing the blood clot at the treatment site. Avoid hard, crunchy, or sticky foods during this period. Your periodontist will give you specific instructions about brushing and flossing around the treated implant.
Follow-up appointments are scheduled to monitor healing. Bone regeneration is a slow process. It may take several months before X-rays show measurable improvement in bone levels. Your periodontist will check pocket depths and tissue health at these visits. Consistent oral hygiene at home and regular professional maintenance visits are critical for long-term success.
Success Rates and Expected Outcomes
A retrospective cohort study examining laser-assisted treatment for peri-implantitis reported improvements in probing depth reduction and clinical attachment levels in treated patients. [1] However, the evidence base for LAPIP specifically is still growing. Most published research on peri-implantitis treatment involves traditional surgical methods, and long-term randomized controlled trials comparing LAPIP directly to conventional surgery are limited.
Outcomes vary depending on several factors: the severity of bone loss before treatment, the patient's overall health, smoking status, and adherence to maintenance care. In many cases, LAPIP can stabilize the implant and allow new bone to fill in around it. In some cases, the bone loss may be too advanced for any treatment to fully reverse.
It is also possible for peri-implantitis to recur after treatment if the underlying risk factors are not managed. Ongoing maintenance, typically every 3 to 4 months for the first year, is a key part of preventing recurrence.
Cost Factors for LAPIP Treatment
LAPIP costs vary by location, provider, and case complexity. There is no single price that applies to everyone.
Typical cost estimates for LAPIP range from $1,500 to $4,000 per implant. This range reflects differences in geographic location, the extent of bone loss, whether bone grafting is included, and the provider's experience. Some cases involving multiple implants may have a different per-implant cost structure.
Dental insurance coverage for LAPIP is inconsistent. Many insurance plans cover treatment for peri-implantitis under periodontal benefits, but they may not specifically cover laser-based protocols. Your provider's office can submit a pre-authorization to your insurance company to find out what portion, if any, is covered. Ask about the specific procedure codes being submitted.
Some practices offer payment plans or work with third-party financing companies. If cost is a concern, discuss all available options with the provider's office before scheduling treatment. The cost of LAPIP should also be weighed against the cost of implant removal and replacement, which typically costs significantly more. [3]
When to See a Periodontist About Your Implant
See a periodontist if you notice any signs of trouble around your dental implant. Early intervention gives you the best chance of saving the implant.
Specific warning signs include bleeding when you brush or floss around the implant, redness or swelling of the gum tissue, a bad taste or odor coming from the implant area, or the feeling that the implant is slightly loose. Your general dentist may also detect problems during routine exams and X-rays before you notice any symptoms. [2]
A periodontist is a dentist who has completed an additional 3 years of specialty training in the prevention, diagnosis, and treatment of gum disease and in the placement and maintenance of dental implants. They have the training and tools to measure pocket depths around implants, interpret bone loss patterns on X-rays, and recommend the most appropriate treatment. You can learn more about what periodontists do on the periodontics page.
If your general dentist recommends monitoring the situation, ask how often they plan to re-evaluate. Peri-implantitis can progress quickly. If you are uncomfortable with a watch-and-wait approach, requesting a second opinion from a periodontist is a reasonable step.
Find a Periodontist Trained in LAPIP
Because LAPIP requires specific training through the Institute for Advanced Laser Dentistry, finding a qualified provider may take some research. Use our directory on the periodontics page to search for periodontists in your area. When you contact a provider, ask whether they are IALD-trained and how many LAPIP procedures they have performed. A qualified periodontist can evaluate your implant, explain all available treatment options, and help you decide on the best path forward for your situation.
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