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Periimplantitis surgical treatment in the esthetic area, with miniinvasive surgery and tissue reconstruction.

Jacques MALET, Periodontist, Paris. jacquesmalet@perio.fr

Peri-implantitis is a plaque-induced pathology of peri-implant tissues, characterized by inflammation of the peri-implant mucosa and subsequent progressive loss of the bone support. The diagnosis of peri-implantitis is based on the following signs:

  • presence of bleeding and/or suppuration on probing
  • probing depth ≥ 6 mm
  • peri-implant bone level located more than 3 mm apical to the most coronal portion of the intraosseous coronal portion of the implant [1]

The treatment of periimplantitis includes control of the etiological factors, decontamination of the implant surface and, if necessary, reconstruction of the periimplant tissues (bone and soft tissue) [2] There is still no consensus on the surgical approach for the treatment of peri-implantitis.

As thin biotypes are associated with more soft tissue recession around implants, a sufficient thickness of soft tissue is recommended, especially in the aesthetic area [3]. This clinical case takes into account the etiology, the treatment proposals and the risk factors.

Figure 1: Initial situation. A 39 year old male patient presents with an esthetic complaint on implant #12. The implant supported prosthesis was placed 2 years ago.
Figure 2: Initial situation. Note the inflammation of the buccal mucosa
Figure 3: Initial situation Xray. Distal intrabony defect
The proposed treatment plan is:
  • Initial therapy (inflammation control) : oral hygiene and global scaling and polishing
  • Mini-invasive surgery: bony lesion curetage, implant decontamination
  • Bone reconstruction if necessary
  • Soft tissue reconstruction (connective tissue graft)
  • Periodontal supportive therapy
Figure 4: 6 weeks situation after initial therapy. Note the inflammation reduction and the buccal volume defect
Figure 5: 6 weeks situation. Xray
Figure 6: 6 weeks situation. Residual suppuration following digital pressure
Figure 7: Surgery. Mini-invasive approach with papilla preservation. Note the presence of residual sealing cement wich is a potential risk factor for periimplantitis [4].
Figure 8: implant surface aspect after cement elimination and ultra sonic cleaning
Figure 9: Implant surface treatment with 35% phosphoric acid gel / 1 min, rinsing (saline) and cleaning (saline)
Figure 10: Connective tissue graft harvested from the tuberosity
Figure 11: Sutures with 6/0 polypropylene, 13 mm needle
Figure 12: Clinical aspect at 10 days (suture removal)
Figure 13: Clinical aspect at 1 year
Figure 14: 1 year Xray
Figure 15: Clinical aspect at 2 years. Note soft tissue stability.
Figure 16: 2 years Xray

References

  1. Berglundh, T., et al., Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol, 2018. 45 Suppl 20: p. S286-S291.
  2. Berglundh, T., J.L. Wennstrom, and J. Lindhe, Long-term outcome of surgical treatment of peri-implantitis. A 2-11-year retrospective study. Clin Oral Implants Res, 2018. 29(4): p. 404-410.
  3. Chackartchi, T., G.E. Romanos, and A. Sculean, Soft tissue-related complications and management around dental implants. Periodontol 2000, 2019. 81(1): p. 124-138.
  4. Staubli, N., et al., Excess cement and the risk of peri-implant disease - a systematic review. Clin Oral Implants Res, 2017. 28(10): p. 1278-1290.

Jacques Malet

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