Treatment of Retrograde Peri-Implantitis Originating From Apical Periodontitis of an Adjacent Tooth: A Clinical Case Letter
This report aims to present a treatment of retrograde peri-implantitis originating from apical periodontitis of an adjacent tooth in an 84-year-old male. Apical periodontitis of the maxillary left central incisor (#9) extended to the apex of the maxillary left lateral incisor implant (#10), which had been functioning for 16 years. Root canal treatment for #9 was performed, followed by root end surgery to treat the apical periodontitis, which showed a periapical radiolucency measured 1 cm in its greatest dimension. After the root end filling was placed, neither bone substitute materials nor barrier membranes were used to fill and cover the bony defect area. A 2-year postoperative radiograph confirmed the osseous healing around the apices of #9 and #10.
Preoperative evaluation. (a) Radiograph exhibiting periapical radiolucency (PARL) around teeth #7 and #8 in 2021. (b) Radiograph exhibiting PARL around tooth #9 and implant #10 in 2021. (c) Radiograph exhibiting normal appearance around the apex of implant #10 in 2012. (d) Cone beam computerized tomography (CBCT) images showing the extent of apical periodontitis around tooth #9 in 2021. Arrows indicate the thinning of the labial and palatal cortical plates. (e) CBCT image showing the extent of radiolucency around the apex of implant #10 (arrows) in 2021.
Surgical root canal treatments for teeth #8 and #9. (a) Clinical photograph right before root end surgery. (b) Osteotomies were made around root apices of #8 and #9. The yellow arrow indicates the exposed implant surface. (c) After root end resection. The green arrow indicates the incisive nerve. (d) After root end sealing is placed. (e) Radiograph immediately after completion of root end surgery.
Follow-ups and cone beam computerized tomography (CBCT) evaluations. (a) A screw-retained, implant-supported crown was inserted for implant #7. (b) Baseline CBCT before root canal therapy for #9. (c) Baseline coronal section image of implant #10. (d) Twenty-four-month follow-up CBCT after root end surgery of #9. (e) Twenty-four-month follow-up coronal section image of implant #10.
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