A Two-Stage Surgical Approach to the Treatment of Severe Peri-Implant Defect: A 30-Month Clinical Follow-Up Report
With the advance of dental implant technology and the consequential increase in its success rate, the implant has become a highly predictable treatment method. Despite this, related complications are on the rise, with peri-implant mucositis and peri-implantitis being the most commonly observed. As in the case of conventional periodontitis, many patients experience peri-implant mucositis and peri-implantitis. In this case presentation, extensive bone loss occurred around the implant due to peri-implantitis, and the infection was first treated by applying chlorhexidine-soaked gauze and topical antibiotics. Then the guided bone regeneration procedure was performed using a bovine bone material and a collagen membrane, which resulted in the recovery of the lesion. With follow-ups of the healing process for 30 months, a successful outcome was observed that is reported herein.
Figure 1. At the first examination, gingival inflammation, swelling, and pus are seen around the implant prosthesis. Figure 2. Panoramic radiograph at the first examination. Radiolucency in a very wide area over the implant placed at the site of the mandibular right first molar is seen. A radiopaque object that was about 3–4 mm long is seen vertically along the distal surface of the implant body. Figure 3. Findings from the first surgery that was performed to remove the granulation tissue and treat the infection. A large amount of granulation tissue is seen around the implant. The thread of the implant at the site of the mandibular right second premolar is also shown. Figure 4. After removal of the granulation tissue. The object that was suspected to have caused the radiopacity in the radiograph taken during the first examination is shown. Figure 5. Given the texture and various features of this object, it was ascertained as a dead bone that remained on the surface of the implant without being absorbed. Figure 6. Injection of topical antibiotics onto the contaminated surface of the implant.
Figure 7. Immediately after the GBR procedure. The prosthesis was removed to confirm the degree of mobility and to ensure a favorable regenerative procedure. The bone particle in the GBR site is shown. Figure 8. Six months after the GBR. The radiopacity increased from that in the immediate post-operative period. The bone filling was observed around the implant. The prosthesis was made at this time. Figure 9. Radiographic view at 12 months postoperatively. Figure 10. Radiographic view at 30 months postoperatively. Figure 11. Clinical photo at 30 months postoperatively. No inflammatory finding around the implant was observed and the implant was well-maintained.
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