Cosmetic Issue of Anterior Periimplantitis Surgery

Periimplantitis develops in the anterior region 6 months postop (Fig.1,2).  Predisposing factors include smoking, seniority, multiple missing teeth and bruxism.  Flap elevation reveals granulation tissue (Fig.3 *) and bony defect at #10 (Fig.4 arrowheads).  After granulation tissue removal (without Titanium brush) and copious irrigation, the affected sites are soaked with Metronidazole gauze (Fig.5 *).  The exposed implant threads look clean (Fig.6).  Exposure is more likely due to coronal placement (Fig.6) than buccal one, since there is buccal space (Fig.7 *).  In spite of the best effort of curettage, there appears to be residual infected tissue (Fig.7 ^).    Bone graft (cortical and cancellous) is placed in the defect area (Fig.8 *).

There appears more pain associated with the debridement surgery than implant placement.  More critical is papillary recession (Fig.9 >) with residual infection (*) 3 months post debridement.   Sharp instrument is used to break the mucosa for gentle curettage, Chlorhexidine irrigation and Arestin placement (Fig.10 yellow).  Fig.11 shows mild erythema (*) between these implants with light tenderness.  The patient is reluctant to receive further treatment because of potential cosmetic compromise.  Non-incisional approach seems to be necessary.  Finally the implant at #10 is loose.

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Xin Wei, DDS, PhD, MS 1st edition 02/22/2016, last revision 01/19/2018