Periapical implantitis and management

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Posted on By narayan tv In Implants

40 year old female referred for management of a periapical lesion on Maxillary left canine, involving an endosseous implant in the first premolar region. On examination, the implants in the premolar region were stable, with acceptable soft tissue contours crestally. However, there was a sinus tract apically. Radiographic examination revealed a collision between the implant and the canine. On further inquiry, the patient gave a history of having had severe sensitivity and pain on the canine after implant placement and subsequently underwent endodontic therapy for the canine (about 2 years ago). Considering the implants were otherwise stable, I decided to attempt a periapical surgery on the tooth as well as the implant. Its early days still, but she seems to be holding out well. Looking forward to your comments and critique. Have a nice day. Narayan

Pre-op Clinical & radiograph
Apicoectomies

Separated apices
Piezo surgical Curretage


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7 Comments

Good work and documentation Narayan, compliments. Since the patient was asymptomatic did you consider re-endo on canine before apico. I feel if the canals are not cleaned and filled up to apical constriction, doing re-endo with proper cleaning may solve the periapical pathology, please let me know your opinion on this. Thanks for sharing this case.


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Ashok thanks for your comments. The problem doesn't remain an endodontic one anymore, once the implant surface is involved. Even the best endodontic treatment will not decontaminate the involved implant surface and hence the decision to amputate. This is a grey area with no conclusive literature or evidence on how to handle it best and short of explantation, which may be the eventual outcome, this was the best I could come up with.


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Well managed case Narayan,as usual documentation is stunning.As you said there isn't much literature support for decontamination it's a good idea to resect the exposed implant as well as the root apex.I have done a few cases were peri apical lesion had created lesion around the middle third of the implant and had to be treated with only endo treatment ..these cases are under follow up will post it soon..


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Thanks Tarun. Will be interesting to see how this turns out. Also your cases on follow up.


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Did you consider explant affected implant, curetage and socket preservation combined with endodontic retreatment of the canine. After Healing, replace with new implant at correct length and 3D positionning?


Reply

Thanks for your comments Laurent. That was the first option offered to the patient but she was not willing to go through with that particularly considering it has a crown on it. This was done with the full disclosure that it may still need to be explanted.


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Thanks for the explanation Narayan. Good work.


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