Peri-Implant Mucositis and Peri-Implantitis: A Current Understanding of Their Diagnosis, Clinical Implications, and a Report of Treatment Using a Combined Therapy Approach

Figure 1. Preoperative orthopantomograph. Peri-implantitis defects are mainly visible on implants in position 2 and 4. Figure 2. Clinical view of the granulation tissue surrounding the implants in positions 2, 3, and 4. Figure 3. Mechanical decontamination of the implants' surfaces and biofilm disruption by means of titanium brushes. Figure 4. Antimicrobial photodynamic therapy consisting of phenothiazine chloride photo-activated by a low-level diode laser. Figure 5. Autogenous bone particles in direct contact with the decontaminated implants' surfaces.

Figure 6. Titanium mesh secured in the proper position with osteosynthesis screws. Figure 7. A nonresorbable membrane is placed above the titanium mesh to prevent the soft tissue ingrowth. Figure 8. Clinical view of the surgical wound after a 6-month healing period. A first intention sealing has been accomplished. Figure 9. Re-entry surgery after 6 months of healing time. Figure 10. Clinical view of the previously affected implants' sites. Bone overgrowth is clearly visible at the top of the implant head in position 3.

Figure 11. Clinical view of the newly formed bone, well integrated and indistinguishable with respect to the surrounding hard tissue. Figure 12. One-year recall from the connection of the definitive restoration. Wide spaces have been left between the prosthetic crowns, allowing the patient to properly perform ideal oral hygiene procedures. No signs of bleeding on probing or pathologic probing depths have been recorded. Figure 13. One-year peri-apical radiograph demonstrating the stability of the mesial and distal bone levels of all the implants. Figure 14. One-year orthopantomograph.