Up to 40% of all implants may be affected by peri-implantits and up to 80% with peri-implant mucositis according to the Consensus Report of the Sixth European Workshop on Periodontology. Robert H. Gregg II, DDS, the founder of Millennium Dental Technologies, co-developer of the PerioLase MVP 7, and the inventor of the LANAP and LAPIP protocols for treating teeth and failing implants believes there is a minimally-invasive, effective way to treat these failing implants.. (Dr Honigman re-phrases all of this below).
The LAPIP protocol with the PerioLase MVP-7 NdYAG laser is a less invasive procedure for eliminating the bacteria that involves no resectioning, surgical flaps, stitches, or other damage to the integrity of the oral tissues.
Dr. Allen Honigman, a periodontist practicing in Phoenix, AZ, has been using LAPIP for about 8 years and LANAP for 13 years. “You hope you never need to use it,” he says, “that’s the whole point. But I think in the last decade we’ve been seeing more and more cases of peri-implantitis.” He’s treating failing implants that have been in place for both a very short time and a long time. “It really varies,” he says. “I’ve treated cases where the implants had been in 7 years, and others over 12 years. My opinion is that we’ll start seeing failing implants that have been in 5-7 years more than those that have been in 15 years or more.”
Dr. Honigman suggests this is for a variety of reasons: the training and experience of the practitioners placing the implants, the dental lab’s expertise in implant restoration, the patients’ oral health, and the techniques and products used. “In the past, implants were used only in people who didn’t have teeth, so we weren’t too worried about periodontal disease,” Dr. Honigman explains. Now, Dr. Honigman worries that the biological envelope is sometimes being pushed to the limit when it might be advisable, for instance, to plan a bridge if that is a better long-term option for a patient.
According to Dr. Honigman, some of the numerous reasons implants fail include inadvertently leaving cement around the restoration, which causes a cascade effect?much like calculus does?that can lead to peri-implantitis. Cement supports bacterial growth and if patients don’t understand that even if they no longer have natural teeth, bacteria still builds up around implants supporting dentures and they can lose the implant if they aren’t brushing and having regular hygiene maintenance. “We have to consider these patients to be periodontal patients. They are high risk patients,” Dr. Honigman says. “If things start breaking down, the patient may lose the implant they paid $3,000-$5,000 for. This could take 5 or 6 years, so they must be encouraged to come in every 3 months, regardless of their insurance coverage, to save their investment.”
The LAPIP protocol involves using laser energy to vaporize bacteria in deep pockets, while also ablating diseased tissue, pathologic proteins, and contaminants. It also forms a stable fibrin blood clot that contains the viable proteins needed for regeneration of bone. “That’s the unique thing about the PerioLase, LAPIP, and LANAP,” Dr. Honigman says. “We’re not destroying the proteins that other laser procedures might. The bone morphogenetic proteins (BMPs) can still be used by the body to initiate the regeneration of tissue and bone. The laser also stimulates collagen synthesis, which results in thicker, denser tissue.”
Dr. Honigman explains that in situations where bone growth may not be as great doesn’t mean the case was not a success. “The goal of treating peri-implantitis, in my opinion, is not to grow bone back, it’s to stop the progression of the disease and have healthier tissue so the patient can maintain the implant. We’re able to give implants a second chance,” Dr. Honigman says. “We’re saving patients a lot of money and trauma because many may not be able to receive another implant without having to go through more extensive bone and tissue regeneration procedures, especially in anterior region.”
“The idea behind the LANAP and LAPIP protocols is to decrease the amount of bacteria so that we’re tipping the scales from the bacterial response back to the host response. Then the body’s immune system is not overwhelmed and it can now do its job—start the healing, reparative, and regenerative process,” Dr. Honigman says.
It has been shown that 95% of implants treated with the LAPIP protocol have not only stabilized but demonstrated bone growth from 3 up to 8 threads.
“We are very successful in our clinical practice of saving teeth that otherwise would be extracted,” says Dr. Gregg in a video you can view on the Millennium Dental Technologies website.