PMC6748190_01
Draining sinus tract over implant-supported restoration.
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A patient presented in 2009 with the main complaint of a fistula and tenderness on chewing and touching of the tissues above the implant restoration (Figure 1).
PMC6748190_02
Bleeding on probing.
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Intraoral observation revealed deep pockets up to 8 mm; also, profuse bleeding on probing was recorded (Figure 2).
PMC6748190_03
(a, b) Radiographic examination with different positions of the holder.
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No cement remnants could be noticed; also, the bone level of adjacent teeth indicated that the patient is not periodontally involved (Figures 3(a) and 3(b)).
(a) Undetected cement remnants in peri-implant sulcus; (b) removed cement excess and size of undercut of the restoration.
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Surprisingly, a big piece of cement rest was located in the buccal site of the implant, thus invisible to radiographic examination (Figures 4(a) and 4(b)). An extensive undercut between the cementation line on the standard abutment (lower arrow) and emergence profile of the restoration in the buccal side (upper arrow) was present (Figure 4(b)).
PMC6748190_04
(a) Peri-implant sulcus after removal of cement excess, (b) healing abutment connection, and (c) radiographic verification.
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There was a bedsore in peri-implant tissues, where cement remnants were resting (Figure 5(a)). Then, chlorhexidine gel (PerioAid Gel, Dentaid, Barcelona, Spain) was applied on the healing abutment, and it was tightened to the implant (Figures 5(b) and 5(c)).
PMC6748190_05
Sinus tract has healed.
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The removed restoration was screwed back to the implant, and occlusal entrance was isolated with polytetrafluorethylene tape and adhesively covered with composite (Figure 6).
PMC6748190_06
(a) Reference radiograph in 2009; (b) partial remineralization of the bone defect in 2010; (c) full reestablishment of the bone level in 2012; (d) stable bone after 10 years.
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Radiological examination showed bone remineralization of the previously infected implant (Figure 7(b)). After 2 years, a full regrowth of the crestal bone around the implant was observed (Figure 7(c)). In 2019, 10 years after, a new periapical X-ray reveals stable bone around implant #24 (Figure 7(d)).
Clinical appearance of implant-supported restoration 10 years after treatment.
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