Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Aug 2004

Reversible and Irreversible Peri-implant Lesions: Report and Etiopathogenic Analysis of 7 Cases

DMD, MS, MSD, PD,
DMD,
DMD, PD, and
DMD, Prof Dr Med Dent
Page Range: 255 – 266
DOI: 10.1563/1548-1336(2004)30<255:RAIPLR>2.0.CO;2
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Abstract

The purpose of this report is to review the aberrations in the integration process of cylindrical endosseous implants, though such aberrations are seldom observed. These issues are treated according to the following scheme: (1) infectious lesions, which consist of peri-implantitis, intraosseous infectious foci, and septic voids; (2) transitory lesions; (3) lesions related to occlusal overload; and (4) healing defects. In this report, we illustrate these categories with patient histories and discuss the clinical findings and etiopathogenies.

Copyright: American Academy of Implant Dentistry
<sc>Figure</sc>
1.
Figure 1.

Patient KR, a 45-year-old man. (a) The missing lower-right molars were replaced with 2 hollow-screw implants. (b) After 3 years, a bony defect developed around the most posterior implant. (c) Conservative measures (ultrasonic curettage and chlorhexidine irrigation) failed to arrest the lesion's development, which, in 3 months, progressed to the state as shown. At that time, an open-flap debridement and disinfection was performed. (d) Eventually, the lesion healed to about 80% of the original bone level


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2.
Figure 2.

Patient JL, a 46-year-old woman. (a) A postanchored restoration had been placed about 10 years earlier. Then the mesial root fractured (b) and an implant was placed (c). Within 1 week, the patient developed an acute osteomyelitis, which motivated the removal of the implant after 14 days. (d) The pain subsided rapidly, but the 3-months postoperative exam disclosed a fistula as well as a radiolucency at the site of the former implant. (e, f) The patient was placed on several courses of antibiotics and underwent 2 sessions of surgical bone curettage. (g, h) Finally, the infection subsided and the site healed to near-previous levels


<sc>Figure</sc>
3.
Figure 3.

Patient GL, a 78-year-old woman. (a) Nine years after placement of a postanchored restoration, the upper-left lateral incisor developed pain on pressure, indicating a fissure of the root. (b) Five months after the tooth's extraction, a hollow-screw implant was placed, which allowing healing without complications. (c) After 6 months, a bluish coloration of the gingiva was noted and a radiograph revealed a lateral and periapical radiolucency. The implant was painless and clinically functional; hence, the implant was fitted with a provisional crown. However, 2 months after being informed of her situation, the patient elected not to pursue treatment at our office and was lost to follow-up


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4.
Figure 4.

Patient NU, a 68-year-old woman. (a) An implant was inserted into the mesial root alveolus of a lower-left molar extracted 4 months earlier. (b) After 3 months, the site developed symptomatologies (pain and swelling) and a radiograph disclosed a periapical radiolucency. The site was surgically debrided and disinfected and finally healed. (c) A 1.5-year postoperative radiograph


<sc>Figure</sc>
5.
Figure 5.

Patient SA, a 20-year-old man with multiple ageneses. (a) Among other implants, two 3.3-mm diameter implants were placed on each side of the symphysis. (b) After 2 weeks, the site became painful and, radiographically, a 10-mm lacuna had appeared. The patient was placed on antibiotics and the symptoms disappeared. (c) After 5 months, the site had remineralized


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6.
Figure 6.

Patient GA, a 51-year-old woman. (a) Three implants were placed in the lower-right sextant. (b) At 1-month postoperatively, a radiograph disclosed a radiolucency located midlevel of the root, and the patient remained symptom free. (c) No specific treatment was initiated, and the lesion disappeared spontaneously after 8 months


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7.
Figure 7.

Patient LE, a 45-year-old man. (a) Three fixtures were anchored into the lower-left molar area and (b) were loaded after 9 months via provisional restorations. (c) After 4 months, an increased mobility of the implants was noted clinically, and signs of loss of osseointegration were apparent. At this point, the provisional splint was altered to provide a 1- to 2-mm clearance. (d) Three months later, the implants had become firm and osseointegration had progressed. (e) After 6 months, the bone had healed close to its initial levels. (f) After 9 months, the patient was fitted with a 3-unit metalceramic restoration and provided with an occlusal splint


Contributor Notes

H. W. Anselm Wiskott, DMD, MS, MSD, PD, and Susanne S. Scherrer, DMD, PD, are research associates and

Bertrand Dubrez, DMD, is a board-certified periodontist and private practitioner, Lausanne, Switzerland.

Urs C. Belser, DMD, Prof Dr Med Dent, is a professor in and chairman of the Department of Prosthodontics, University of Geneva, Switzerland. Address correspondence to Dr Wiskott at the Department of Prosthodontics, University of Geneva, School of Dentistry, 19, rue Barthélemy-Menn, 1205 Geneva, Switzerland (Anslem@Wiskott.com).

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