Long-term peri-implantitis management: insights from a 9-year regenerative approach

Abstract

Peri-implantitis has emerged as a primary concern in dentistry over the past three decades due to its potential to lead to the loss of alveolar bone surrounding dental implants. However, treating peri-implantitis still poses numerous challenges for achieving lasting success. This case report represents a fusion of scientific knowledge and logical thinking structured to enable the application of a series of chemical and mechanical clinical procedures in the peri-implantitis treatment followed by regenerative/reconstructive approaches. The clinical report details the treatment sequence of peri-implantitis in a fully edentulous female patient who had been rehabilitated with a total fixed implant-supported prosthesis. Several years after prosthesis placement, the patient developed peri-implantitis, exhibiting probing pocket depths of 8 mm in the buccal, mesial, and distal aspects of the implant, bleeding upon probing, and significant alveolar bone loss around implant #43. The surgical approach included thorough debridement, scaling of the implant threads, bone decorticalization, implant thread decontamination to reduce the inflammatory process and fight infection disease. After disease treatment, the case was concluded by bone and soft tissue grafting. After four weeks, an increase in keratinized gingiva thickness was observed without bleeding upon probing. Probing pocket depth significantly decreased by around 5 mm in the buccal, mesial, and distal aspects of the implant. Nine years of follow-up revealed complete intrabone defect fill and stable bone levels. In fact, sharing such valuable and trustworthy information might led to improvement of procedures to help the medical community understand more about individualized medicine for managing peri-implantitis.