Utilization of Low-Magnitude High-Frequency Vibration (LMHFV) as an Aid in Treating Peri-Implantitis: Case Presentations
Peri-implantitis is an inflammatory process initiating in the soft tissue and then progressing to the hard tissue surrounding dental implants leading to loss of osseous support and potential loss of the implant if not identified early in the process. This process initiates in the soft tissue, which become inflamed spreading to the underlying bone leading to decreases in bone density with subsequent crestal resorption and thread exposure. In the absence of treatment of the peri-implantitis, the bone loss at the osseous implant interface progresses with inflammatory mediated decrease in the bone density that moves apically, eventually leading to mobility of the implant and its failure. Low-magnitude high-frequency vibration (LMHFV) has been shown to improve bone density, stimulate osteoblastic activity, and arrest progression of peri-implantitis with improvement of the bone or graft around the affected implant with or without surgery as part of the treatment. Two cases are presented using LMHFV to augment treatment.
The PTech5 (PerioTech, Ossining, NY) LMHFV device.
Before treatment with crestal loss of bone due to periimplantitis around the distal implant to middle of the implant with no mobility noted. Note the color around the crestal aspect of the distal implant is low or absent density (purple) compared with higher density (blue) and very high density (green).
Following surgery to debride the area of bone loss around the implant and placement of graft. The graft material has increased density and compares with adjacent healthy bone (blue).
Two months after graft placement and PTech5 use demonstrating an increase in density of the previously placed graft material with overall very high density around both implants as signified by green coloration comparable to the dense bone of the adjacent zygoma.
Five months after graft placement and use of PTech5 demonstrating stability of the placed graft to correct bone loss related to periimplantitis with stable dense bone that is higher quality around the implants and a distance away related to the LMHFV use during the postoperative 5-month period.
Forty-month recall radiograph (left) and colorized radiograph (right) demonstrating high bone density associated with the implants and adjacent bone with continued daily use of the LMHFV device.
Failure of the prosthetic screw retained crown by separation of the ceramic crown from the ti-base that led to crestal bone loss over time on the mesial implant. A cover screw has been placed into the implant being treated.
An immediate radiograph was taken following graft placement and site closure to document the treatment.
A radiograph at 4-month grafting placement at implant uncovery and after implant restoration demonstrating denser bone crestally.
Twenty-seven-month recall radiograph (left) and colorized radiograph (right) demonstrating high bone density associated with the implants and adjacent bone with continued daily use of the LMHFV device.
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