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

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

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

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

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.

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

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

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?

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.

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).

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