Implant Periapical Lesions: Etiology and Treatment Options
Implant failures due to apical pathology are conditions that have not been extensively studied nor reported in the literature. The implant periapical lesion (IPAL) has different symptoms, and several etiologies have been proposed in the literature. This article reviews cases of IPAL reported in peer-reviewed journals and presents possible treatment options. Analysis of the data collected was performed based on diagnosis, cause of extraction of the natural tooth, location, period of implant placement, implant surface, and treatment approach. Even the data presented in this review are based on few reported cases the etiology of these lesions seems to be multifactorial or with an unknown origin. Contamination of the implant surface, bone overheating during surgery, excessive torquing of the implant, poor bone quality, perforation or thinning of the cortical bone, premature or excessive load over the fixture, fracture of the bone inside the hollow portion of the hollow implant, and an implant placement in an infected maxillary sinus have been discussed. In general, areas around endodontically compromised teeth should be carefully analyzed prior to implant placement to prevent implant failures.Abstract
Figure 1. Schematic transversal view of an implant periapical lesion (IPAL). Figure 2. Four-month postoperative radiograph of an implant apicoectomy (#4) in order to treat an IPAL. Figure 3. Preoperative radiograph of implant sites adjacent to endodontically treated tooth. Figure 4. Postoperative radiograph taken several months after the implants have been restored. Patient presented with swelling at the apex of the implant in the # 4 site. The infection did not respond to antibiotic and was removed. Figure 5. Postoperative radiograph taken after adjacent tooth was removed. The lesion at the apex of the endodontically treated tooth has spread to the apex of the implant as indicated with a gutta percha point inserted into the fistula.
Figure 6. Clinical view of a fistula remaining after the adjacent tooth was removed. Figure 7. Clinical view after the implant was removed showing bone defect remaining after the implant was removed. Figure 8. Apical half of the implant body had little or no apical bone remaining. Because of the extent of the involvement, an apicoectomy was not recommended as the treatment of choice.
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