Management and Prevention of Retrograde Peri-Implant Infection from Retained Root Tips: Two Case Reports

Digitally guided root removal and simultaneous implant placement: A case study

BACKGROUND

Encountering a retained root tip post-extraction and prior to implant placement is a possible clinical complication. There are numerous approaches for removing retained roots that may be traumatic or atraumatic. Regardless of the approach, careful treatment planning is important to minimize complications, reduce morbidity, and preserve bony structures. The aim of the current case study is to introduce a technique and digitally generated device used for identifying and atraumatically removing a retained root tip and simultaneously placing a stable dental implant.

METHODS

A 63-year-old female with a history of myocardial infarction, hypertension, and acute pancreatitis presented for implant placement at site #5. Clinical examination revealed adequate interocclusal, mesiodistal, and buccolingual dimensions for implant placement. Radiographic examination using cone beam computed tomography revealed that retained root #5 interfered with implant placement. Digital planning was used to extract the root tip with minimal trauma to maintain adequate bone for simultaneous implant placement with good primary stability.

RESULTS

The follow-ups at 1, 3, and 6 weeks and 4, 8, and 10 months revealed good bone preservation with an osseointegrated implant.

CONCLUSIONS

Employment of digital planning to create a palatal window allowed excellent accuracy in removing the retained root while maintaining the bony foundation for a well osseointegrated dental implant.

KEY POINTS

Pre-planning using cone beam computed tomography scan merged with an intraoral digital scan is necessary for precise location of a retained root and correct implant placement with excellent primary stability. A digitally planned 3D surgical guide is a useful method for extracting retained roots during implant placement to minimize bone damage. Digital planning provides a precise and minimally invasive implant surgery.

Treatment and Resolution of an Implant Periapical Lesion (IPL) with Guided Bone Regeneration

Background

Implant periapical lesion (IPL) is a rare condition that can affect dental implants. Several different approaches have been proposed for the treatment of this condition. Awareness and literature discussing this condition and possible treatment options have grown significantly in the last 25 years. Case Presentation. The present case report describes the treatment of an implant periapical lesion with a combined approach consisting of surgical lesion removal, mechanical instrumentation with titanium brush, detoxification with tetracycline, and guided bone regeneration (GBR) with demineralized allograft bone and cross-linked collagen membrane. The patient was followed up for 6 months postoperatively, showing complete resolution of the buccal fistula. No signs or symptoms of discomfort or pathology were reported.

Conclusions

The case report presented a combined approach that can be successful in the surgical treatment of an IPL in which the implant stability is maintained.

A novel histopathological classification of implant periapical lesion: A systematic review and treatment decision tree

BACKGROUND

Implant periapical lesion (IPL), as a peri-implant disease originating from implant apex, maintains coronal osseointegration in the early stage. With the understanding to IPL increasingly deepened, IPL classification based on different elements was proposed although there still lacks an overall classification system. This study, aiming to systematically integrate the available data published in the literature on IPL associated with histopathology, proposed a comprehensive classification framework and treatment decision tree for IPL.

METHODS AND FINDINGS

English articles on the topic of "implant periapical lesion", "retrograde peri-implantitis" and "apical peri-implantitis" were searched on PubMed, Embase and Web of Science from 1992 to 2021, and citation retrieval was performed for critical articles. Definite histopathology and radiology of IPL are indispensable criteria for including the article in the literature. The protocol was registered in PROSPERO (CRD42022378001). A total of 509 papers identified, 28 studies were included in this review. In only one retrospective study, 37 of 39 IPL were reported to be at the inflammatory or abscess stage. 27 cases (37 implants) were reported, including acute non-suppurative (1/37, developed to chronic granuloma), chronic granuloma (5/37), acute suppurated (2/37), chronic suppurated-fistulized (6/37), implant periapical cyst (21/37), poor bone healing (2/37), foreign body reaction (1/37). Antibiotics alone did not appear to be effective, and the consequence of surgical debridement required cautious interpretation because of the heterogeneity of lesion course and operation. Implant apicoectomy and marsupialization were predictable approaches in some cases.

CONCLUSIONS

The diversiform nature of IPL in the case reports confirms the need for such histopathological classification, which may enhance the comparison and management of different category.

Tetracycline impregnated bone grafts in the management of peri-implantitis and guided bone regeneration around dental implants: A systematic review

Background

Rehabilitation of dental arches with the help of dental implants has been revolutionary and a significant part of research is devoted to increasing its success rate. One of the most common causes of failure of dental implants is peri-implantitis caused due to microbial invasion. Newer strategies are being adapted for the treatment of peri-implantits and recent surgical management with the help of antibiotic-impregnated bone grafts shows a promising future.

Aim and objectives

This study aimed to test the efficacy of bone grafts incorporating tetracycline and its derivatives in the treatment of peri-implantits and guided bone regeneration with the estimation of clinical and radiographic parameters.

Methods

A thorough search was made on eminent databases such as PubMed, Embase, Scopus, and Cochrane Library database for published literature on tetracycline impregnated bone grafts used either in the management of peri-implantitis or for guided bone regeneration around dental implants.The measures of outcome were clinical attachment loss or probing depth around dental implants and radiographic bone height.

Results

Nine potentially eligible full-text published articles including case reports, case series, observational studies, and randomized controlled trials were selected for review. Most of the studies reviewed; reported a reduction in probing depth and an increase in bone height and density after placement of tetracycline bone grafts around the dental implant.

Conclusion

The incorporation of tetracycline into the bone grafts shows promising results as an agent of local delivery around dental implants in the management of peri-implantitis and for guided bone regeneration. Future trials are required to produce a body of evidence and to facilitate the translation of this procedure into clinical practice.

Effectiveness of Different Chemotherapeutic Agents for Decontamination of Infected Dental Implant Surface: A Systematic Review

Aim: To evaluate the most effective chemotherapeutic agent for decontamination of infected dental implants. Material and methods: A systematic electronic literature search in MEDLINE (PubMed) and Google scholar between January 2010 to December 2021 was carried out by using the PRISMA guidelines. A total of five studies related to chemical decontamination of the dental implant were evaluated. The search strategy was based on the PICOS framework. Randomized controlled trials (RCT’s) and cohort studies evaluating the effectiveness of different chemotherapeutic agents for the decontamination of dental implants were included in the study. The outcome variable examined was the most effective chemotherapeutic agent(s) for dental implant surface decontamination after comparing the chemotherapeutic agents used in the qualifying studies. Result: Out of the basic database of 1564 records, 1380 articles were excluded due to irrelevance, unavailability, and repetition. Furthermore, 134 articles were excluded from 184 studies for various reasons. After further filtration, 13 studies were shortlisted. Two investigators (SSA and SA) appraised the quality of the selected studies using the risk of bias assessment tool. After excluding eight studies, five articles were finally included in the present systematic review. Conclusion: The data reported for the efficacy of chemotherapeutic agents in cleaning contaminated titanium surfaces are scarce, thus it is not possible to draw a definite conclusion. However, chlorhexidine (CHX) (0.2%, 0.12%), citric acid (40%) and sodium hypochlorite (1%) are the most commonly used chemotherapeutic agents; amongst them, citric acid showed the highest potential for biofilm removal from the contaminated implant surface. All three agents [CHX (0.2%, 0.12%), citric acid (40%), and sodium hypochlorite (1%)] can be recommended as therapeutic agents along with their curbs.

Window Approach for Simultaneous Root Fragments Removal and Implant Placement (WASRIP): Two Case Reports

INTRODUCTION

Root fracture during extraction is not uncommon due to the presence of multiple and thin roots, which are often divergent and curved. The retained root fragments (RF) are usually radiographic incidental findings and often asymptomatic without associated pathology. However, careful and conservative surgical strategies for the removal of RF must be incorporated to allow for simultaneous implant placement and to avoid potential complications such as compromised osseointegration or retrograde peri-implantitis. Conventional RF removal techniques may lead to a significant amount of bone removal, involving more trauma and a prolonged healing period.

CASE REPORTS

In these two case reports, the Window Approach for Simultaneous Root Fragments Removal and Implant Placement (WASRIP) technique was used to extract RF in a minimally invasive fashion to preserve both the coronal and apical bone, which are critical components in providing mechanical stability for simultaneously placed implants. All implants presented in both cases showed adequate primary stability and successfully achieved osseointegration at a 3-month follow-up period.

CONCLUSION

Through the buccal window, sufficient access was provided to remove RF atraumatically with maximal retention of surrounding bone that led to predictable implant placement. This article is protected by copyright. All rights reserved.

Implant Periapical Lesion: Clinical and Histological Analysis of Two Case Reports Carried Out with Two Different Approaches

Periapical implantitis (IPL) is an increasingly frequent complication of dental implants. The causes of this condition are not yet entirely clear, although a bacterial component is certainly part of the etiology. In this case series study, two approaches will be described: because of persistent IPL symptoms, a patient had the implant removed and underwent histological analysis after week 6 from implantation. The histomorphometric examination revealed a 35% bone-implant contact area involving the coronal two-thirds of the implant. The apical portion of the fixture on the other hand was affected by an inflammatory process detectable on radiography as a radiolucent area. The presence of a probable root fragment, detectable as an imprecise radiopaque mass in the zone where the implant was later placed, confirms the probable bacterial etiology of this case of IPL. On the other hand, in case number 2, the presence of IPL around the fixture was solved by surgically removing the implant apical third as well as the adjacent tooth apex. It may be concluded from our histological examination that removal of the apical portion of the fixture should be considered an effective treatment for IPL since the remaining implant segment remains optimally osseointegrated and capable of continuing its function as a prosthetic abutment. Careful attention, however, is required at the implantation planning stage to identify in advance any sources of infection in the edentulous area of interest which might compromise the final outcome.

Socket shield technique: A systemic review and meta-analysis

PURPOSE

The aim of the present study was to evaluate the clinical feasibility of the socket shield technique (SST).

STUDY SELECTION

An electronic search of the PubMed, Cochrane Central Register of Controlled Trials, and Wiley Online Library databases, and a manual reference search for articles published up to September 2020 was conducted. Meta-analysis was performed to estimate marginal bone loss (MBL), changes in buccal bone width (cBBW), pink esthetic score (PES), implant stability quotient (ISQ), implant failure rate, and complication rate between SST and conventional immediate implant placement (IIP). All pooled analyses were based on random effects models.

RESULTS

Sixteen relevant studies were ultimately selected by two independent reviewers: four randomized clinical trials (RCTs), four case-control studies, and eight retrospective studies. Meta-analysis revealed a trend toward lower MBL and cBBW and higher PES in the SST group. ISQ, implant failure rate, and complication rate were similar between the groups.

CONCLUSIONS

The included studies provided evidence that SST may be a feasible treatment option. However, this technique should not be used as a routine clinical protocol due to the lack of evidence-based consensus guidelines, large-scale RCTs, and long-term follow-up data. Therefore, there is an urgent need for well-conducted RCTs in this field.

Implant Periapical Lesion: A Narrative Review

Implant periapical lesion (IPL) is an infectious-inflammatory alteration surrounding an implant apex. It is a multifactorial disease that may ultimately cause implant failure. The diagnosis of IPL is based on examination of clinical manifestations and apical radiolucency. Many etiologies have been attributed to IPL, including preexisting microbial pathology and surgical trauma. Moreover, many systems have been used to classify IPL based on different parameters. To date, non-surgical and surgical treatment, as well as removal of failed implants, have been considered to successfully manage IPL. However, prevention of IPL surpasses all modes of treatment. An increased number of IPL cases are expected as implants have become standard for tooth replacement in dentate arches. Therefore, it is necessary to understand IPL more comprehensively. Herein, an introduction to IPL, including its etiology, diagnosis, classification, treatment, and prevention, has been undertaken.

Knowledge and Attitude towards Retrograde Peri-Implantitis among Italian Implantologists: A Cross-Sectional Survey

BACKGROUND

Retrograde peri-implantitis (RPI) is a pathological entity with an unclear etiology (e.g., overheating during implant insertion, residual infection of the tooth replaced by the implant or the endodontic lesion of neighboring teeth) and an extremely low prevalence and has been scarcely investigated. Therefore, the aim of this cross-sectional survey was to evaluate the knowledge and attitude of Italian implantologists regarding RPI.

METHODS

An anonymous questionnaire was sent via email to implantologists randomly selected, including a section about demographic information and questions related to RPI origin, radiographic representation, symptoms and treatment options. All questions were multiple answer and close-ended. Binomial logistic regression was performed to investigate the relationship between correct answers and the following independent variables: age, years of experience and number of dental implants placed per year.

RESULTS

In total, 475 implantologists completed the questionnaire, with a response rate of 46.3%. Based on the results of the study, incorrect answers were associated with less experienced participants (<80 implants/year) for all questions evaluated, with the exception of treatment strategies. Furthermore, 26.7% of the survey takers did not recognize radiographic representation of RPI and 35.5% picked "implant removal" when asked about treatment modality.

CONCLUSIONS

The majority of participants were able to recognize symptoms and indicated the probable causes of RPI; however, around 30% of them showed very limited knowledge of available management strategies.

What Is the Role of Endodontic Predisposing Factors in Early Implant Failure?

We aimed to investigate a possible relationship between early implant failure (EIF) and an adjacent root canal-treated tooth and/or tooth with a periapical lesion (PL), considering the duration between implantation and root canal treatment (RCT). The importance of prior RCT and/or presence of a PL before implantation was also investigated. A total of 810 implants from 342 patients were included and scored according to the implant failure before abutment connection, adjacent root canal treated teeth, adjacent teeth without RCT, no adjacent teeth, adjacent teeth with PL, extraction of teeth with PL, and/or RCT before implantation. The durations between the extraction and implantation and between RCT and implantation adjacent to the root canal-treated teeth were recorded. The time from the RCT of adjacent teeth to implant placement was categorized into 5 groups: less than 4 weeks before implantation, 4-12 weeks before implantation, at least 12 weeks before implantation, within 4 weeks after implantation, and at least 4 weeks after implantation. Among the endodontic predictors, a prior PL on the tooth extracted was associated with an increased risk of EIF (P < .05, odds ratio: 4.37; 95% confidence interval: 1.604-11.891). Furthermore, EIF was more likely to occur when the RCT of an adjacent tooth was performed within 4 weeks of implantation (P < .05). Additional investigations with larger sample sizes are necessary to validate our findings.

Incidence of retrograde peri-implantitis in sites with previous apical surgeries: A retrospective study

BACKGROUND

Retrograde peri-implantitis (RPI) is a rapidly progressing periapical infection that forms around the implant apex. It is usually associated with sites adjacent to teeth with apical lesions; previous endodontic failures, retained root fragments, etc. This study aimed to study the incidence of RPI in sites with a history of apical surgeries.

METHODS

Patients with sites treated for both apicoectomy and implant placement presenting to the University of Michigan School of Dentistry from 2001 to 2016 were screened. A total of 502 apicoectomies were performed, only 25 of these fit the predetermined eligibility criteria and were thus included in this retrospective analysis.

RESULTS

Implants that were placed in sites with a previous apical surgery had a cumulative survival rate of 92%. The incidence of peri-implantitis was 8%, while the incidence of RPI was 20%. There was an increased trend for RPI in cases where the cause of extraction was persistent apical periodontitis (35.7%), but this increase didn't reach the level of statistical significance (P = 0.061).

CONCLUSION

Implants placed in sites with previous apical surgery are not at an increased risk of implant failure or RPI.

Periapical implant lesion: A systematic review

Background

The aim of this study was to systematically review the evidence for periapical implant lesion, which makes a patient more susceptible to the periapical lesion, frequency, symptoms, signs (including radiological findings) and possible treatment options.

Material and Methods

A systematic literature review and analysis of publications included in PubMed, Embase and Cochrane; articles published until March 2016; with a populations, exposures and outcomes (PEO) search strategy was performed, focused on the issue: “In patients with periapical lesion to the implant during the osseointegration, what symptoms, signs, and changes in complementary examination manifested, for according to that stage, be intervened with the appropriate approach?”. The set criteria for inclusion were peer-reviewed articles.

Results

From a total of 212 papers identified, 36 studies were included in this systematic review, with 15461 implants evaluated and 183 periapical implant lesions. Which 8 papers included more than 5 cases and 28 included equal or less than 5 cases. Analysis of the papers revealed that periapical implant lesion is classified according to evolution stages into acute (non-suppurated and suppurated) and subacute (or suppurated-fistulized). In the acute stage and in the subacute if there is no loss of implant stability, the correct treatment approach is implant periapical surgery. In the subacute stage associated with implant mobility the implant must be removed.

Conclusions

Evidence on the subject is very limited, there are few studies with small sample, without homogeneity of criteria for diagnosing the disease and without design of scientific evidence. Currently etiology lacks consensus. The early diagnosis of periapical implant periapical lesions during the osseointegration phase and early treatment, will lead to a higher survival rate of implants treated, hence preventing the need for implant extraction.

Key words:Apical peri-implantitis, retrograde peri-implantitis, inflammatory peri-implantitis lesion.

Fractured root tips during dental extractions and retained root fragments. A clinical dilemma?

Root tip fracture can occur during the extraction of teeth. The clinician must then decide to either leave the root fragment in situ, or to attempt its removal. A similar decision is made when retained root fragments are found incidentally on oral radiographs. The prevalence of retained root fragments is reported as 11-37%. This article aims to highlight the risk benefit matrix of the removal or retention of retained root fragments, in light of the present evidence base.

Assessment of Intraobserver and Interobserver Agreement of a New Classification System for Retrograde Periimplantitis

BACKGROUND

Retrograde periimplantitis (RPI) is the inflammatory disease that affects the apical part of an osseointegrated implant while the coronal portion of the implant sustains a normal bone-to-implant interface. The aim of the current study was to assess the intraexaminer and interexaminer reliability of a proposed new classification system for RPI.

MATERIALS AND METHODS

After thorough electronic literature search, 56 intraoral periapical radiographs (IOPA) of implants with RPI were collected and were classified by 2 independent reviewers as per the new classification system into one of the 3-mild, moderate, and advanced-classes based on the amount of bone loss from the apex of the implant to the most coronal part as a percentage of the total implant length. The IOPAs were assessed twice by the same examiners and both were blinded to each other's observations.

RESULTS

The intraobserver agreement ranged from 0.85 to 0.91, which falls under the category of almost perfect agreement. The interexaminer agreement was found to be 0.83, also considered as almost perfect agreement.

CONCLUSION

The proposed classification shows good intraexaminer and interexaminer reliability and can be used for treatment planning and prognosis in cases of RPI.

Successful treatment of a large implant periapical lesion that caused paraesthesia and perimandibular abscess

Successful treatment of a large implant periapical lesion (IPL) that caused paraesthesia and perimandibular abscess. IPL is a pathologic phenomenon that rarely involves implants. This event first described in 1992 with an incidence rate of 0.26-9.9% and the origin is not well known. The most likely suggested causes are presence of preexisting bone pathology, contamination of implant surface, bone overheating during implant surgery, vascular ischemia, excessive tightening of the implant, fenestration of the buccal plate and different implant surface designs. In the present case report, we describe relatively large periapical lesions involving several implants caused severe abscess accompanied by transient inferior alveolar nerve paraesthesia and its successful management. A brief review of the literature and a discussion of possible causes and different treatment plans are also included.

A Radiographic Classification for Retrograde Peri-implantitis

BACKGROUND

Retrograde peri-implantitis (RPI) is an inflammatory disease that affects the apical part of an osseointegrated implant, while the coronal portion of the implant sustains a normal bone-to-implant interface. It is a diagnostic and therapeutic dilemma for implantologists. There is lack of a standard classification system and a definite treatment algorithm for the same. This article aims to introduce a classification system for RPI based on the radiographic amount of bone loss around an implant apex.

MATERIALS AND METHODS

A search of PubMed database was conducted with the keywords "retrograde peri-implantitis" and "implant periapical lesion." Preoperative intraoral periapical (IOPA) radiographs of implants with RPI in case reports/case series were compiled. A total of 54 lOPAs from 36 articles were compiled and were assessed.

RESULTS

Three different classes were proposed. The amount of bone loss from the apex of the implant to the most coronal part of radiolucency was calculated as a percentage of the total implant length and classified into one of the three classes: Mild, moderate, and advanced. Treatment options and prognosis have been suggested for each class.

CONCLUSION

The proposed classification may allow for an easy and reproducible radiographic assessment of the RPI lesion and may serve as a guideline to prognosis and treatment planning.

Biomaterials with Antibacterial and Osteoinductive Properties to Repair Infected Bone Defects

The repair of infected bone defects is still challenging in the fields of orthopedics, oral implantology and maxillofacial surgery. In these cases, the self-healing capacity of bone tissue can be significantly compromised by the large size of bone defects and the potential/active bacterial activity. Infected bone defects are conventionally treated by a systemic/local administration of antibiotics to control infection and a subsequent implantation of bone grafts, such as autografts and allografts. However, these treatment options are time-consuming and usually yield less optimal efficacy. To approach these problems, novel biomaterials with both antibacterial and osteoinductive properties have been developed. The antibacterial property can be conferred by antibiotics and other novel antibacterial biomaterials, such as silver nanoparticles. Bone morphogenetic proteins are used to functionalize the biomaterials with a potent osteoinductive property. By manipulating the carrying modes and release kinetics, these biomaterials are optimized to maximize their antibacterial and osteoinductive functions with minimized cytotoxicity. The findings, in the past decade, have shown a very promising application potential of the novel biomaterials with the dual functions in treating infected bone defects. In this review, we will summarize the current knowledge of novel biomaterials with both antibacterial and osteoinductive properties.

Active implant peri-apical lesion: a case report treated via guided bone regeneration with a 5-year clinical and radiographic follow-up

Implant peri-apical lesion (IPL) is a periapical lesion, usually asymptomatic, in which the coronal portion of the implant achieves a normal bone to implant interface. A case of IPL following immediate implant placement and treated with guided bone regeneration (GBR) principles is described. Five-year clinical and radiographic follow-up with cone-beam assessment showed complete healing of the bone. GBR principles applied to IPL could completely solve the lesion.

Doxycycline counteracts bone morphogenic protein 2-induced osteogenic mediators

BACKGROUND

Microbial colonization during wound healing may exaggerate the inflammatory response and could adversely affect the outcome of periodontal regeneration. Bone morphogenic proteins (BMPs) directly augment bone regeneration. Interestingly, inhibitors of tissue collagenases, such as sub-antimicrobial-dose doxycycline, also indirectly promote hard-tissue regeneration. In this study, it is hypothesized that BMP2-mediated bone regeneration would be positively affected by simultaneous treatment of sub-antimicrobial-dose doxycycline.

METHODS

Human periodontal ligament (PDL) cells were stimulated with: 1) 10 ng/mL BMP2; 2) 1 μg/mL doxycycline; or 3) a combination of the two. The expressions of alkaline phosphatase, osteocalcin, osteonectin, and osteopontin were analyzed along with in vitro mineralized nodule formation and calcium accumulation.

RESULTS

BMP2 was a potent inducer of osteocalcin/osteopontin (statistically significant at P <0.01) and osteonectin in PDL cells relative to stimulation with doxycycline. However, doxycycline relative to BMP2 (statistically significant at P <0.001) upregulated the expression of alkaline phosphatase and in vitro mineralized nodule formation. Contrary to expected results, combined BMP2 and doxycycline induced a statistically significant (P <0.001) downregulation of alkaline phosphatase, osteocalcin, osteonectin/osteopontin, and in vitro mineralized nodule formation compared to stimulation with either BMP2 or doxycycline alone.

CONCLUSIONS

Combined treatment of BMP2 and doxycycline in PDL cells counteracts the osteogenic mediators. Molecular interaction of growth factors should be explored before using a combination of these biologic molecules. It is important and clinically relevant to determine whether tetracycline and its other derivatives also counteract BMP functions. Animal models should be used to confirm these in vitro results.

Trepanation and curettage treatment for acute implant periapical lesions

Six dental implants in six patients with periapical lesions were inserted and underwent trepanation and thorough curettage. During surgery, the lesion area was irrigated with copious natural saline and chlorhexidine and the bone defects were treated with tetracycline paste. The six implants were stable and asymptomatic postoperatively. The implants were loaded after 3 months. Radiologically, the radiolucency in the apical part disappeared gradually. These prostheses have functioned satisfactorily with no further complication during the follow-up period. For cases in which small lesions initially appear soon after implant placement, trepanation and curettage of the periapical lesion without resection of the apical part of the implant or bone substitute material and/or autogenous bone grafting is an effective management option. A rapid and exact diagnosis is important for treating implant periapical lesions.

Treatment of peri-implantitis with deproteinised bovine bone and tetracycline: a case report

OBJECTIVE

The objective of this study is to evaluate the use of tetracycline in a patient with peri-implantitis.

BACKGROUND

Tetracycline is widely used in regeneration procedures owing to its positive effect with bone graft material, regeneration of extraction socket bone and its traditional antibacterial effect. However, there have been limited reports on bone graft procedures combined with tetracycline application in peri-implantitis.

MATERIALS AND METHODS

The detoxification procedure was performed with chlorhexidine and tetracycline, and the defect area was grafted with a 4:1 volume ratio combination of deproteinised bovine bone mixed with tetracycline.

RESULTS

Soft tissue healing was uneventful, and the treatment yielded improved clinical results with a reduced probing depth.

CONCLUSIONS

Tetracycline was used in the treatment of peri-implantitis by burnishing the implant surface and applying tetracycline in conjunction with an osseous graft to the defect area. The treatment of peri-implantitis with tetracycline seemed to show improved clinical results up to the follow-up period.

Implant reversible complications: classification and treatments

Failures of dental implants are detrimental to both patients and dental providers. These failures are often preceded by complications at various levels of the treatment phases. Early detection of the complications that are amenable to rescue therapies may reverse the fate of the implant. This review article discusses diagnosis, classification, and treatment aspects of the reversible complications commonly encountered during routine dental implant-related procedures.