Regenerative Therapy of Peri-Implantitis: Clinical and Radiologic Documentation of 16 Consecutive Patients With a Mean Follow-Up of 3 Years

Functional diagram of a patient's risk assessment according to Lang and Tonetti.33 According to this diagram, the presented patient was categorized in the high-risk group.

Initial clinical view of the diseased implant in area No. 29 before treatment.

Documentation of initial clinical parameters including probing depths, gingival recession, involvement of furcation defects, mobility, as well as bleeding on probing of 24%.

Figure 5. Periapical radiograph of the peri-implant defect around the implant in area No. 29 before treatment. Figure 6. Software calibration with the help of the known implant length (9.5 mm) to determine the preoperative depth of the peri-implant bone defects. Figure 7. Radiographic measurement of the depth of the mesial bone defect around the implant in area No. 29 of 6.1 mm. Figure 8. Radiographic measurement of the depth of the distal bone defect around the implant in area No. 29 of 6.3 mm. Figure 9. Intraoperative clinical view of the peri-implant bone defect after flap deflection and removal of granulation tissue. Figure 10. Intraoperative view of the implant after surface debridement and application of photodynamic therapy according to the therapy protocol as well as cortical perforation of the buccal plate of bone.

Figure 11. Application of a mixture of autologous and allogeneic bone, soaked with the second phase of platelet-rich growth factor, obtained from venous blood of the patient. Figure 12. Coverage of the augmented area with a slowly resorbable collagen membrane. Figure 13. Primary wound closure obtained with a 4.0 Gore Tex suture and a 6.0 Prolene as interdental suture. Figure 14. Periapical radiograph taken immediately after surgery. The augmentation of the peri-implant bone defect can be appreciated. Figure 15. Clinical view 5 years after treatment. The gingival tissues appear healthy, and the initial recession defect around the implant is covered. Figure 16. Radiographic evaluation of the implant in area No. 29 at 5 years after treatment. Figure 17. Measurement of crestal bone height mesially during 5-year follow-up after regenerative therapy. A remaining loss of 0.5 mm on the mesial aspect is visible, and the distal aspect of the implant is completely covered with bone.

Figure 18. Documentation of clinical parameters including probing depth, recession, and bleeding on probing of 9% at 5 years after regenerative therapy. Figure 19. Pre- and postoperative plaque and bleeding values. A significant reduction in the mean approximal plaque index (API) and bleeding on probing (BOP) after therapy can be appreciated. Figure 20. Pre- and postoperative clinical and radiologic parameters. A significant reduction in probing depth and recession can be appreciated as well as a significant gain in crestal bone level (CBL).
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