Surgical Treatment of Severe Peri-Implantitis Using a Round Titanium Brush for Implant Surface Decontamination: A Case Report With Clinical Reentry
The most common cause of peri-implantitis is the accumulation of plaque and the formation of a biofilm on the implant surface. Terminating the development of the disease requires the biofilm to be removed from the implant surface. This paper describes 2 cases of severe peri-implantitis lesions treated through surgical approaches. Complete mechanical debridement with a round titanium brush was mainly performed to detoxify and modify the affected implant surface. A regenerative approach was then performed. In both cases, the surgical procedure was effective in arresting the peri-implantitis, and clinical reentry revealed uneventful healing of the existing bone defect. No further radiographic bone loss was observed over the 2-year follow-up period. This technique has the advantage of effective cleaning the contaminated implant surface, producing positive clinical and radiological results. However, further studies involving more cases are necessary to verify the reliability and validity of this technique.
(a) Panoramic view after delivering the prosthesis in 2006. (b) Seven years later, reoperative radiograph showing a severe vertical peri-implant defect around the implant positioned at the maxillary left first molar.
(a) Intraoral view after removing the prosthesis. (b) After opening the flap, a large vertical defect without buccolingual bony walls was seen. (c) A protective cap was attached to protect the implant platform. (d) A round titanium brush with titanium alloy bristles (R-Brush) was used to decontaminate the implant surface at a rotation speed of about 8000 rpm for 30 sec per thread. (e) Three-dimensional view of the R-Brush instrument.
(a) The implant surface looked smooth and clean after debridement with the R-Brush. The original rough surface was removed and created by a new surface. (b) The bone defect area was filled with freeze-dried allograft bone. (c) The grafting material was covered by a protective collagen membrane. (d) Primary wound closure was achieved using interrupted sutures.
and 5. Figure 4. (a) Periapical radiograph obtained at 5 months after surgery. (b) Clinical view at 5 months after surgery. (c) Clinical view at reentry showing the formation of solid bone in the original bone defect. Figure 5. (a) Periapical radiograph obtained at 6 months showing that the bone density had increased. (b) Periapical radiograph obtained at 12 months, showing a stable alveolar bone height without any bone resorption. (c) Periapical radiograph obtained 2 years after surgery. No further radiographic bone loss was observed.
(a) Preoperative radiograph showing a crater defect around the implant positioned at the mandibular right second molar. (b) Granulation tissue around the implant was removed after opening the flap. (c) Debridement of the implant surface using the R-Brush. (d) View after debridement. (e) Utilization of a bone harvesting drill to harvest autogenous chip bone. (f) Autogenous chip bone harvested from the buccal shelf area of the second and third molars of the mandibular body. (g) Harvested autogenous bone was grafted into the defect. (h) The grafting material was covered by a resorbable collagen membrane. (i) Primary closure with interrupted sutures.
(a) Clinical view at reentry after surgery showing solid and newly formed bone over the cover screw. (b) Biopsy sample obtained from the grafted site (hematoxylin and eosin stain, ×20). The large piece of compact bone showed the new bone attached to the grafted autogenous bone (yellow arrows). This lesion was competent with favorable bony remodeling. (c) Periapical radiograph after the uncovering procedure and delivery of the prosthesis. (d) Periapical radiograph obtained at 24 months after the debridement surgery. (e) At the 24-month follow-up there was a probing depth of 3 mm on the buccal aspect. (f) The newly formed bone around the implant remained stable at the 24-month reentry.
(a) SEM image before R-Brushing (magnification, ×500). (b) SEM image after R-Brushing (magnification, ×500). (c) 3D surface display after R-Brushing.
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