Peri-implantitis Management in Posterior Mandible Part 2

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Posted on By Maurice Salama In Failures

Patient presented with severe perio infection around exisiting posterior implant supported bridge. Deep pocketing and suppuration noted around implant #28, a mesial abutment to a 3 unit implant supported bridge.
Diagnosis and clinical management performed. Implant Removed followed by Debridement, saline, tetracycline and then NdYag Laser followed by Bone graft and PRGF. Follow-up at 2 years. Thoughts? Comments? Strategies? Dr. Salama

Pa 2 years
Occlusal view

Labial view
PA Preop


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8 Comments

Mo. I feel you have done as well as can be expected here. It seems to me you have committed to maintain as is for as long as it lasts. I personally would not recommend a new bridge supported by these fixtures. I presume the patient is quite pleased maintaining their existing prosthesis. Great case! Thank you for the update. Best regards. Chuck


Reply

Chuck; I agree. Minimal probing dept and anterior cantilever adjusted without occlusal contact. Let's continue to follow up this case. Dr. Salama


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Do you have a CBCT of the healed area? The periapical radiograph looks better than the labial clinical view there appears to still have a boney defecit interproximally. There overall result is excellent, was the occlusion modified?


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This is 3 years post op now and the patient is still with original bridge...no post op CBCT. I think that the clinical view and minimal probing is the biggest factor. The radiograph is encouraging that the bone grafted appears to still be there although we do not know without histological evidence what we have? If I can get her back I will try to encourage a CBCT.


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Great conservative management I have one curiosity, what about the root left in the anterior bridge pontic? It looks in the 3 years control x-ray exactly in the same condition...
I would thought that root left there would became a problem but it seems ok.

Regards,


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Damir; Please read abut the Root Submergence Technique on DentalXP. We published it in 2007 and this root was left behind on purpose. Vital Root Submergence here to preserve the ridge. Thanks Dr. Salama


Reply

Dr. Salama, thank you for the great case presentations. Could you recommend a couple laser companies worth looking into. We are going to purchase a laser for treating peri-implantitis. We would like your input on which type to buy. Thank you.


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I would splint the remaining 3 implants and cantilever.


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