Peri-implantitis Manifested as Food Impaction; Open Contact is the Culprit

A 42-year-old man returns 3 years 10 months post implant crown cementation with chief complaint "food impaction is getting worse".  In fact, the tooth #18 is lost due to chronic peridontitis (Fig.1).  A 6x14 mm tissue-level implant is placed 4 months post extraction (Fig.2).  Follow-up PA is taken 5 months postop before restoration (Fig.3). 

The patient returns once 2 years 3 months post cementation, because the tooth #14 needs crown.  A PA is taken for the implant (Fig.4), but the incipient mesial bone loss (arrowheads) and open contact are ignored.

The patient has never made an appointment for perio maintenance since implant placement.  The most recent PA shows peri-implant bone loss increases mesially and extends distally (Fig.5 arrowheads).  The open contact remains (*).  Although there is no gingival erythema around the implant, the pockets appear to be deep.

It appears that a new crown is required to fix the open contact and that debridement of the coronal implant threads with bone graft is necessary.

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Xin Wei, DDS, PhD, MS 1st edition 02/12/2015, last revision 02/13/2015