(79) Successful treatment of peri-implantitis through the use of non-surgical and surgical therapy

Introduction: Although modern implant dentistry provides a safe and effective treatment for edentulism, it is not without complications. Implant failure rates reported in the existing literature vary from 6% over four years, to as high as 14%. Inflammatory conditions affecting the peri-implant hard and soft tissues (peri-implantitis) are now recognized as major causes of implant failure. Thus, current efforts are aimed at early detection of such conditions and identification of their etiologic factors in an effort to reduce the overall incidence of implant failures. Treatment approaches for the management of peri-implantitis (as defined in the 2017 world workshop) range from non-surgical mechanical and chemical disinfection of the implant surface to regenerative surgical procedures performed with the intention of inducing re-integration of the implant surface through the use of membranes and bone grafts. This case report demonstrates the successful treatment of peri-implantitis using multiple treatment modalities with a nine-month follow-up period.

Methods: History of Present Illness: The patient presented with an implant in site #13 that was placed four years earlier. The implant is the distal abutment of a three-unit implant-supported fixed dental prosthesis (FDP). Based on clinical and radiographic findings, implant #13 was diagnosed with peri-implantitis (per the 2017 world workshop). Non-surgical therapy was completed and the patient was placed on 20 mg doxycycline hyclate b.i.d. (Periostat) for 2 months.
Treatment: Surgical intervention was as follows. The FDP was removed and a full-thickness mucoperiosteal flap was elevated around the implant in site #13. After degranulation, radiographic findings were confirmed: obvious bone loss was present circumferentially around the coronal one-third of the implant body. Chemical decontamination of the implant surface was achieved by application of hydrogen peroxide and povidone-iodine followed by laser decontamination with a Nd:YAG laser. The bone surrounding the defect site was decorticated, a bone allograft (PurOs) was placed and covered with long-lasting cross-linked collagen membrane (Osseoguard). After suturing, the implant-supported prosthesis was reinserted.

Results: Radiographic follow-up after 9 months shows obvious bone fill within the bony defect. Clinical exam shows no suppuration, no bleeding-on-probing, and probing depths around the implant ranging from two to three millimeters.

Conclusions: This case report demonstrates that successful treatment of peri-implantitis requires early intervention that includes both non-surgical and surgical components.

Lead Author's Contributions to the Research Project. : Lead author performed the surgery described above.