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Apical peri-implantitis: thoughts on this case?

Last Updated: Jul 28, 2014

I have a healthy 24-year-old female with unremarkable medical history who presented for routine periodic recall examination for #9 implant [maxillary left central incisor;21]. She lost tooth #9 due to trauma when she was a child. A Straumann RN 4.1mm implant was placed on type 4 (healed) bone and restored with a screw retained, ceramo-metal crown in late 2011. Tooth #8 [maxillary right central incisor; 11] was endodontically treated and restored with composite resin restoration in March 2013.

The patient presented with neither pain nor discomfort. A periapical radiograph was taken as part of her implant maintenance. The radiograph revealed a periapical radiolucent lesion on the apical portion of implant #9. The implant was not mobile and had stable peri-implant tissue. Further CBCT scan revealed the radiolucent lesion is in close proximity, with possible communication with the incisive canal.

I would appreciate any thoughts of this case.

CBCT CBCT
Periapical radiographs

10 Comments on Apical peri-implantitis: thoughts on this case?

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Robert J. Miller

7/27/2014

Is this a retrograde implantitis or is it actually the nasopalatine foramen? Seems that the implant apex is directed towards the midline and the radioluscency is more palatal than a granuloma from the tooth would have been. RJM

Peter Fairbairn

7/28/2014

With Robert on this one , you can see same anatomy on the other x-rays , just more some on the final , maybe angle or exposure change . Peter

CRS

7/28/2014

I am not sure that is the canal do you have a cone beam section which traces the canal at it's origin to verify? And do you have an original film of the endo tooth to see if there was any periapical pathology? One does not want to treat the X-ray!

Richard Hughes, DDS, FAAI

7/28/2014

Looks like anatomy. The nasopalatine foramen.

CRS

7/28/2014

Is there a cross sectional view which traces the nasopalatine canal from the floor of the nose to the palate. I like to scroll the images and find that view to identify the canal. That said if the radioluncency is not part of the canal then it is periapical implant pathology and needs to be treated with curettage and disinfection, since the bone loss can progress. If the original tooth had periapical pathology or failing endo that could be your source.

Michaelstn

7/29/2014

Is there an earlier CT for comparison? It could just be previously unnoticed anatomy.

Dime Sapundziev

7/30/2014

It is anatomy. Folow up for any changes. Pathology changes during time, simptoms may appear. Anatomy stay the same. Good luck! Dime

Gregori Kurtzman, DDS, MA

8/5/2014

Comparing the 3 periapicals I can see something in all three and doesnt seem to have changed over the time frame I dont think its anything to worry about and continue to monitor it

Ed Dergosits, D.D.S.

8/6/2014

What was the diagnosis that prompted endodontic treatment of tooth #8? Ed

R.MIRMOOJI

8/9/2014

I had a similar case with a lower molar,except my patient became symptomatic and i had to extract the implant.On your periodicals i do not see any change the implant is well integrated, personally i would keep an eye on it.

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