Laser-Assisted Treatment of Peri-Implantitis With LAPIP™ and AI Radiographic Analysis

Preoperative radiograph demonstrating peri-implant bone loss around implant No. 13. A radiopaque foreign body, consistent with retained cement, was noted adjacent to the restoration extending apically along the abutment onto the implant body. A radiolucent defect and associated bone loss pattern appeared to follow the outline and origin of the foreign material.

The radiopaque foreign body was identified and removed during debridement. A postoperative radiograph was taken to confirm its absence following retrieval of the cement retained crown, peri-implant debridement, and implant surface decontamination during the LAPIP protocol.

The foreign body identified radiographically was confirmed clinically as retained cement. The fragment measured approximately 4 mm x 2 mm; here, it is displayed adjacent to a periodontal probe for reference. Per the LAPIP protocol, treatment was completed in a minimally invasive manner that supported favorable healing with little postoperative discomfort, bleeding, or swelling. Occlusion was adjusted to reduce functional loading during healing, and the patient was maintained in a provisional restoration, monitored, and re-evaluated at 1 year.

One-year postoperative radiograph demonstrating improved peri-implant bone levels and increased radiographic density surrounding the implant. A new crown was delivered following healing, with complete resolution of bleeding on probing and suppuration.

Preoperative radiograph evaluated with Overjet AI. Note that bone loss on the mesial aspect of the implant relative to the implant–abutment interface was 43%. (Note: In Fig 5 and Fig 6, the percentage numerals have been enlarged for legibility. These images powered by Overjet AI.)

One-year postoperative radiograph evaluated with Overjet AI. Comparing the preoperative radiograph (Fig 5) with this postoperative radiograph provided an objective, quantitative comparison of peri-implant bone level changes following removal of the retained cement and completion of the LAPIP protocol. Because implants lack natural cementoenamel junction and root anatomy, in this case the implant–abutment interface and implant apex served as analogous radiographic reference points. One-year postoperative radiographic evaluation demonstrated significant improvement in peri-implant bone levels, including approximately 42% radiographic defect resolution on the mesial aspect of the implant, with bone loss relative to the implant–abutment interface improving from 43% to 25% at 1-year follow-up.

Private Practice, Connecticut, New York, and New Jersey; Diplomate, American Board of Periodontology