engleski

Apical (retrograde) periimplantitis– modified apicoectomy therapy

Implant periapical lesion (IPL) also known as retrograde peri-implantitis is a radiolucent lesion that forms around the apex of a clinically stable dental implant while the rest of the implant is surrounded with normal bone. According Reiserand Nevis the incidence of IPL is 10:3800 implants placed.Two different forms of IPL can be classified: inactive (noninfected) and active (infected) form. The first one is clinically asymptomatic lesion likely caused by placing implants shorter then prepared implant bed or by bone overheating. No treatment is required, only periodic monitoring. The infected form can be diagnosed by symptoms of swelling, tenderness, pain and presence of fistulous tract. The etiology is related to bone overheating, bacterial contamination, pre-exsiting bone pathology like cyst or granuloma, and implant surface contamination. Dental implant removal, resection of the apical implant part and debridement of the apical lesion followed by GBR are treatment modalitys proposed for IPL. Aim The aim of this case report was to present a 48-year-old female patient with subjective and objective problems associated with clinical entity of chronic sinusitis emerging 3 years after implant placement in premolar area on the right side of the upper jaw using a transcrestal/closed sinus elevation technique. Material and methods After the CBCT was done and the implant periapical periodontitis was diagnosed and after the patient has signed an informed consent, trapezoidal mucoperiosteal flap was raised. The modified apicoectomy (resection of the apical implant part with periapical debridement) using the lateral open window technique (a modification for sinus elevation procedure) with piezosurgery unit (PiezoMed, W&H, Austria, 2013.) was performed. Apical part of the implant was removed using low-speed surgical stainless steel bur on surgical handpiece. After apical implant part removal and excochleaiton of granulation tissue in periapical dental implant area, wound was covered with collagen resorbable membrane (Jason® membrane, Botiss Biomaterials, Germany). Soon after the treatment was done, the patient reported all signs and symptoms receding. Six months after the surgical procedure CBCT image presented a complete healing, with new bone formation in the periapical area of the dental implant. Result Soon after the treatment was done the patient reported all signs and symptoms symptoms receding, without any clinical complications. During follow-ups first and third month after surgery, no clinical or subjective complications were observed. Six months after the surgical procedure CBCT image presented a complete healing, with absence of any clinical signs and symptoms. Conclusions and clinical implications Modified apicoectomy of the osseointegrated dental implant may be the method of choise for retrograde periimplantitis treatment because of its safety and efficacy in clinical practise.

dental implant ; treatment ; peri-implantitis ; oral surgery

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