Implant Failure Apical Lesion! Apicoectomy or Removal? 5 year Follow-up

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Posted on By Maurice Salama In Failures

Periapical Lesion around healed and Osseointegrated implant in the Esthetic Zone Lateral Incisor 18 months fater loading. Implant is stable and the restoration esthetically pleasing to patient. Interesting, the patient was post-ortho to create space for the laterals. I did the ortho. When we pulp tested the Central and Lateral following the discovery of this lesion they both tested Non-Vital. There was no contact of the implant with the adjacent teeth and this was verifed on the CBCT images. I have treated this case as shown with Apicoectomy of implant, thorough debridement, collagen membrane to close nasal floor communication, and PRGF ONLY for Bone regeneration. 2 Year post op PA shows COMPLETE bone fill and Healing. Thoughts on Treatment?
Thanks Dr. Salama

Preop CBCT
Apico implantectomy

PA preop
PA post op


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8 Comments

My thoughts: it is so important to share our cases and complication management. Apicoectomy seems to be a valuable treatment possibility for implants. This shows a literature, Cristian Rotaru has shared a case http://forum.dentalxp.com/case/details/fistula-after-implant-placement/6060
I have successfully treated a few implants in this way (no documentation), but your case was really difficult (adjacent teeth, cavum nasi....). You have also confirmed that there was no need for bone or bone substitute augmentation.
Great result, thank you so much for sharing
Snjezana


Reply

Yes, with the additional nasal floor communication it appears that without additional bone grafting and using only collagen membrane and membrane tacks we were able to regrow bone and re-establish a normal nasal floor contour. regards Dr. Salama


Reply

Mo,

Nice work- what are your thoughts as far cause- nasal floor involve? and you mentioned non vital - 8&10- When were RCT done?

Cheers,

Richard


Reply

Richard; Take a look at upper right for Part 1 of this post from a few years back 2013. regards Mo


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Mo. This is one of my favorites. It doesn't get any better or cleaner. Congratulations! Best wishes. Chuck


Reply

Thanks Chuck, we all learn together here at XP!! regards Mo


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Maurice,
Well diagnosed case! Often it is not easy to establish relation between nose fistula and infection and it is IMO, difficioult to rule out. On the nose it is often found the stafilococcus aureus quite a resistent germ that can provoque frequent acute inflammation on a chronicle sorrounding.
So your choice was great and nicely managed(as usual)
The apical implant reduction allowed above mucosa to heal promoting the bone healing: your case proved once more that when diagnosys and relative treatment are right biology is a friendly companion.
Good to have met you and your brother in NY : the event was excellent reflecting the innovation on dental way of learning.
Best regards.
Armando


Reply

Armando, yes thank you for your kind words. Diagnosis is always key, especially in these cases. The CBCT was KEY!! Great to finally meet you and we appreciate all you do. regards Mo


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