Peri implantitis: How to treat? What’s the cause?

I placed an implant in maxillary left first molar site in a 33 year old male smoker (12 cigarettes a day habit). I did a crestal sinus lift. At the 6 month recall, his cover screw was exposed but there was no suppuration or exudate. I elevated a flap and removed the fibrous and granulation tissue around the implant. The implant is not mobile. The bone loss around the implant is about 2.5mm. How do you recommend that I proceed with this case?



14 Comments on Peri implantitis: How to treat? What’s the cause?

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peterFairbairn
3/4/2016
Was there a spontaneous exposure of the soft tissue ? as this patient ( smoker , possibly poor host response ) would be prone to this issue . Another thing is the lift , shows a still clearly demarcated crestal line shoeing graft non turnover in the sinus .... so maybe an issue there ........ not a real crestal fan myself .. Maybe a re-graft if well integrated , Osstell readings ??? Good luck Peter
greg steiner
3/6/2016
Your clinical findings do not support the diagnosis of periimplantitis. The breaking up up of the surrounding alveolar bone, the radioleucency separating the native bone and the bone graft and the migration of bone graft chips out of the gingiva indicate sclerotic bone failure of a cadaver bone graft. This is not uncommon in these cases because when sinus augmentation is need dentists commonly under prepare the osteotomy to gain stability and when this is done in cadaver bone it breaks up. In my opinion this implant cannot be repaired and you start over. Greg Steiner Steiner Biotechnology
Gregori Kurtzman, DDS, MA
3/8/2016
I think we can see breakdown in the bone to implant without seeing exudate and it still is periimplantitis. None the less this to me radiographically is deeper then 2.5mm that the poster stated
Gregori Kurtzman, DDS, MA
3/8/2016
Do you have a radiograph at placement so we can compare bone levels and density? Smokers have more healing issues then nonsmokers for several reasons among them less circulation in the gingival tissue and the residue from the tobacco sticks to the surfaces preventing bone attachment or soft tissue in those crestal areas. The area in question is about 1/2 the length of the implant around it that is less dense. I would flap the area clean out any tissue down to bone with a laser then place citric acid gel in the area after 1 min rinse and repeat 3x. then pack the area with bone, place a membrane and get primary closure and let it heal eval in 2 months to verify that bone is where its supposed to be. if it doesnt heal well or improve I would be leary of restoring it
DrT
3/8/2016
With such a problem at this early stage, I think it wisest to explant, curet socket thoroughly and return to place another implant in 3-6 months. If you try to treat this problem now you will probably end up chasing your tail for many months only to end up removing the fixture anyway. Best to cut bait now.
Gregori Kurtzman, DDS, MA
3/8/2016
I dont have issue with explanting but should graft the socket at that time or there wont be any bone to place an implant later. I also think following grafting and getting primary closure you can renter in 2 months to place a new implant but would use a wider one and then bury it and wait 6 months before restoring
shahram vaziri
3/8/2016
If you look at the pano, and magnify the picture you will notice at distal of the implant there is almost 75% bone loss. You also can notice the apex is not fully integrated with the bone graft. This is quite common in smokers due to poor osteogenesis. I think it is beter to remove it before trying to augment it again as the chance of regeneration around the implant will be low and you will put yourself in hope and wonder situation. Good luck
DrT
3/8/2016
Re-entering in 2 months in this area of the mouth feels a bit premature, what with type 4 bone and a smoker. Could you kindly explain your rationale for waiting only 2 months before reentry. Thank you
Gregori Kurtzman, DDS, MA
3/8/2016
re-enter and use osteotomes after the pilot drill to laterally condense the bone to improve the density (quality) to close to the implants diameter then use the implant to do the final osseocompression as its placed. put a membrane voer it and get primary closure. will work fine
Paul Newitt
3/8/2016
Just out of curiosity, how did you perform the Crestal lift and how many mm's did you lift? Do you have a CBCT prior to surgery? What was the width of the ridge and what diameter Implant did you place?
Pham Minh Duc
3/8/2016
Thanks for all of your comments. Finally I found the CTCB disc of the patient. I will post it down here. This is CTCB The pano is right after implant placement and hydraulic sinus lift. The implant is 5.0x10. Torque 30N/cm Well, after placing implant, i thought it was a good case so i forgot to recall every month. And the peri apical x-ray is after six month recall.
Yasser
3/10/2016
this is very common in such low bone density cases. when u need to do such an implant , go for less speed around 500, im sure you ll know what i mean, once you remember how soft was the bone. and always drill less in such cases , cause they will take longer time and wait . now what to do .. i had previous cases like that and if patient not complaining about any problem . i guess you should inform the client the possibility of loosing this implant as we as placing the crown as a (survival implant). meaning that it might by you few years instead of re opening again .however, going into recent publication BNP is recomanded in such cases but i didnt use it before.
John Kong, DDS
3/18/2016
I would extract the implant, re-graft, then once the bone has healed, place the dental implant again. (You won't need to do the sinus augmentation again as it's already been done).
Phil Mathers
3/23/2016
It would be interesting to know the type of graft used and if that had any bearing on the outcome. Bovine ceramic, Cadaver other Xenograft or synthetic etc.? Phil Mathers UK Dental dealer and grafting enthusiast

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