Resolution of an Active Peri-Implantitis in a Chronic Steroid User by Bone Augmentation With PepGen P-15 and a Barrier Membrane
Dental implant treatment can be complicated with infection. A list of possible causes includes overheating during the osteotomy, bacterial contamination from an adjacent tooth, residual bacteria from the infected tooth that previously occupied the site, bone microfractures from overloading or loading too soon, and residual space left around the implant after it is seated. Most treatments entail surgical debridement of the lesion and chemical detoxification of the apical or exposed portion of the implant surface with citric acid, tetracycline, or chlorhexidine gluconate as well as guided tissue regenerative or guided bone regenerative procedures. This article describes the case of an active labiolateral peri-implantitis from a previous infectious site at tooth 12 in a patient who was a chronic steroid user. The patient was treated with surgical debridement and no implant surface detoxification and regenerative procedures with xenograft of PepGen P-15 and an absorbable collagen membrane. The patient was advised to discontinue steroid therapy. This resulted in resolution of the associated signs and symptoms of infection and new bone formation in the radiograph. The negative effect of corticosteroids on calcium metabolism and bone regeneration is discussed. The potential implications of steroid use for implant dentistry are critically appraised, and guidelines are proposed for pre- and postoperative management that may assist in the successful implant-supported rehabilitation of this patient category.Abstract

(A) A labial fistula at tooth 12 developed for 1 week. (B) A dominant radiolucent lesion around the mid-labiolateral portion of tooth 12 root. (C) A labial root perforation of tooth 12 was found. (D) Implant was placed into the full length of the osteotomy 2 months after removal of tooth 12.

(A) Two weeks after implant insertion, a mid-labiolateral peri-implantitis lesion close to the previous radiolucent lesion of tooth 12 developed, and the implant showed percussion pain and slight mobility. (B) The labiolateral bone loss greater than 50% of the implant length was found. (C) Guided tissue regenerative procedures with xenograft, PepGen P-15 was packed around the peri-implant defect and covered by a piece of Bio-Mend, absorbable membrane. (D) Three weeks after the GBR procedure, the implant did not show any tenderness or mobility. The PepGen p-15 particulates appeared as radiopaque.

(A) Two months after the GBR procedure, complete resolution of inflammation can be found. (B) Four months after the GBR procedure, dominant radiographic bone fill can be found. (C and D) A customized abutment with tooth-colored ceramic and ideal emergence profile from the implant body was made with good result. (E and F) The stable bone levels and gingival profile were evident 1 year later.
Contributor Notes
Shin-Yu Lu, DDS, the operating surgeon on this case, is the director of the Department of Family Dentistry, and Chih-Cheng Huang, DDS, the prosthetic doctor on this case, is the director of the Department of Prosthetic Dentistry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Da Pi Road, Niaosung, Kaohsiung, Taiwan, ROC. Address correspondence to Dr. Lu (jasminelu@adm.cgmh.org.tw).