Retrograde peri-implantitis treatment

The term retrograde peri-implantitis has just recently been introduced through several case reports. It is defined as a clinically symptomatic peri-apical lesion (diagnosed as a radiolucency) that develops shortly after implant insertion while the coronal portion of the implant achieves a normal bone to implant interface (for a review, see Quirynen et al. 2003). A retrograde peri-implantitis is often accompanied by symptoms of pain, tenderness, swelling, and/or the presence of a fistulous tract . It should be distinguished from a clinically asymptomatic, peri-apical radiolucency, which is usually caused by placing implants that are shorter than the drilled cavity or by a heat-induced aseptic bone necrosis. Retrograde peri-implantitis can result from bacterial contamination during insertion, premature loading leading to bone micro-fractures, or the presence of a pre-existing inflammation (bacteria, inflammatory cells, and/or remaining cells from a cyst, granuloma). A peri-apical lesion from a nearby devitalized tooth, on the other hand, can encroach upon the implant and contaminate it (e.g. reactivation of a dormant peri-apical lesion or removal of the peri-apical endodontic seal). The treatment of periapical peri-implantitis is still empiric. The longitudinal study, together with the outcome in some case reports, seem to indicate that the removal of all granulation tissue is sufficient to arrest the progression of the bone destruction. The removal of the apical part of the implant does not seem mandatory.







Clinically stable after 9.5 years!>>