PMC4443933_01
Clinical situation of the peri-implantitis affected implant, before treatment procedures. A mesial PD of 11 mm and a distal PD of 12 mm were recorded.
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The patient showed swelling of the peri-implant soft tissues, associated with BOP and probing depth (PD) > 10 mm around an ITI-Bonefit (Straumann, Waldenburg, Switzerland) implant (4.1 mm in diameter and 12 mm in length), placed three years earlier in position 46 (Figure 1).
Preoperative intraoral radiography. A typical peri-implantitis crater-like defect was evident.
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No clinical signs of mobility were recorded; however the periapical radiograph revealed a radiolucent area delimitating the implant (Figure 2).
Clinical situation after the elevation of a mucoperiosteal flap. Granulation tissue delimitating the peri-implantitis defect was clearly visible around the implant.
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The latter consisted in the elevation of a full-thickness flap to have access to the bone defect and to mechanically remove the granulation inflammatory tissue around the implant (Figures 3 and 4).
Clinical situation after the careful removal of the granulation tissue. The typical crater-like peri-implantitis bone defect was present circumferentially around the implant.
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The latter consisted in the elevation of a full-thickness flap to have access to the bone defect and to mechanically remove the granulation inflammatory tissue around the implant (Figures 3 and 4).
The bone defect was packed with heterologous DBBM graft.
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The bone defect was then grafted with deproteinized bovine bone mineral (DBBM) (Bio-Oss, Geistlich Pharma AG, Wolhusen, Switzerland) (Figure 5) and a resorbable collagen membrane (Bio-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) was placed to protect the graft from the surrounding soft tissue cells penetration (Figure 6).
A bioabsorbable collagen membrane was placed in order to create a secluded space over the DBBM graft.
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The bone defect was then grafted with deproteinized bovine bone mineral (DBBM) (Bio-Oss, Geistlich Pharma AG, Wolhusen, Switzerland) (Figure 5) and a resorbable collagen membrane (Bio-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) was placed to protect the graft from the surrounding soft tissue cells penetration (Figure 6).
Postoperative intraoral radiography. The graft filled into the bone defect was observable in close contact with the implant surfaces. During the healing period the implant was left unloaded.
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After 6 months the crown was replaced and an intraoral radiography was taken, showing increased radiopacity and complete filling of the defect with newly formed mineralized bone around the implant (Figure 7).
Clinical situation during the follow-up recall. Peri-implant soft tissues appeared healthy, with no sign of inflammation and suppuration.
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The peri-implant soft tissues presented no clinical signs of inflammation and BOP, and a physiological PD of 1.5 mm was measured (Figure 8).
17-year follow-up intraoral radiography. The peri-implant marginal bone levels appeared radiographically stable, without any sign of bone resorption mesially and distally to the implant.
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The mesial and distal levels of the peri-implant marginal bone were radiographically stable as demonstrated by the follow-up periapical X-rays (Figure 9).