Diagnosis of Periimplantitis

A 57-year-old woman complains of bad smell while use of water flosser between 11 and 21 months post cementation of implant crown at #14 (Fig.1,2).  Bone loss is more obvious with CBCT (Fig.3,4), in spite of apparently normal gingiva around the implant after removal of the abutment and crown (Fig.5).  In fact the buccal (B) gingiva is fragile with easy access to the underlying implant plateau.  Following flap elevation, the bone loss is evident (Fig.6), but the implant plateau is slightly subcrestal (Fig.7 *).  The exposed implant threads are covered with the 1st round of bone graft (Fig.8).  After 2nd round of allograft (Fig.10-12) and collagen membrane, the flaps are approximated (Fig.9).  The wound is covered by acrylic dressing.  The latter is loose, but stays in place 1 week postop (Fig.13).  Due to short neighboring teeth, the acrylic dressing is able to be removed with wiggling; it appears that the wound is healing (Fig.14).  The dressing returns for another 2 weeks; some of the graft has been lost (Fig.15).  The dressing does not return 7 weeks postop, since the wound is healing (Fig.16).

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Xin Wei, DDS, PhD, MS 1st edition 04/12/2019, last revision 05/22/2019