Surgical Management of Severe Peri-Implantitis in the Esthetic Zone: A Case Report With a 6-Year Follow-Up

Figure 1. Pretreatment photograph of the ailing #8 and #9 implants. Deep probing depths, bleeding on probing, and mucosal recession were observed. Figure 2. Preoperative radiographic bone loss around the implants. Figure 3. Decontamination of the implant surfaces with air-abrasives following granulation tissue removal and implantoplasty. Figure 4. The peri-implant defects were augmented with autogenous bone and xenograft and then covered with a resorbable collagen membrane. Figure 5. Periapical film taken just after the bone augmentation surgery.

Figures 6–8. Eight-month reentry surgery and soft tissue augmentation. Figure 6. Bone regeneration around the implants with minor grafting remains. Figure 7. A subepithelial connective tissue graft was secured to the #8 and #9 implants. Figure 8. Primary closure of the wound. Figures 9 and 10. Four months after the reentry surgery. Figure 9. The keratinized tissue around implants #8 and #9 was increased and matured. Figure 10. The impression copings indicating the unfavorable implant axes with excessive labioversion.

Figures 11–13. The definitive metal-ceramic crowns on implants #8 and #9. Figure 11. Peri-implant health was achieved. Pink porcelain was used to simulate the texture of the adjacent soft tissue. Figure 12. The harmonious smile view. Figure 13. Radiograph revealing the increased radiopacity in comparison with the initial film. Figures 14 and 15. The 6-year follow-up. Figure 14. The peri-implant tissues remain stable without progression of peri-implantitis. Figure 15. Radiograph showing further bone maturation.