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Peri-implantitis
A 57-year-old man has history of chronic periodontitis. The tooth #3 had been lost and the teeth #4 and 5 were extracted 5 years ago. CT taken post extraction shows a palatal defect at #4. The implants at #3 and 5 were placed a month prior to that at #4 (Fig.2 (4.5x14 mm); 2 years ago). A splinted provisional was fabricated between #3 and 5, half month post #4 implant placement. Final restorations were cemented 4 months later.
There is mild bone loss around the implant at #4 22 months post cementation (Fig.3). Two months later, the patient complains of bleeding. Exam reveals deep pocket between #3 and 4 (palatal) with bleeding on probing.
A palatal gingival sulcus incision is made to expose the denuded implant threads. Use Titanium brush, EDTA, NS, H2O2, and Chlorhexidine to clean the threads. Metronidazole will be used for soaking. Allograft and Osteogen will be used. If the neighboring bone is exposed large enough, use bone scraper to collect autogenous bone. A 6-month collagen membrane will be used.
The patient feels better postop without gingival bleeding from the previously affected area.
Xin Wei, DDS, PhD, MS 1st edition 11/15/2015, last revision 02/10/2016