Perio-Implantitis

first of all...it was pleasure for me to meet u at Seoul dr Salama
regarding the case bone augmentation after cleaning the area from granulation tissue would be suggested therapy..but still we have to know the length of the remaining ossteointegrated part...
to know wether we have to remove it or to keep it and replace the resorbed bone
dr.muna abbadi

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Usually in this case ( the implant's body inner the bone wall and the bone peaks preserved) I proceed in this manner:
1- cleaning the area from granulation tissue
2 - decontamination of implant's surface 3' with 0,2% clorexidine
1' with tetracicline ( Or treating with laser)

3- rinsing and filling the area with biomaterial (I use bovine bone) and covering with resorbable membrane


This is my case
http://www.odontoiatrapetti.it/index.php?option=com_admirorgallery&view=layout&Itemid=71

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NEOBIOTECH I-BRUSH USED IT WILL BE GOOD

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Muna. Nice to meet you as well. Stefano, please post your case on this Forum for all to see your technique. This is not my case but one that was referred? Bone has been lost beyond the interproximal peaks and involves multiple implants. Ti brush is a good idea to assist debridement of implant surface, Tetracycline for antimicrobial and Nd Yag Laser to disinfect implant surface prior to regeneration.
But do to severity of bone loss we may not be able to have a long term maintainable situation.
Dr. S

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It's clear that final bone recovery depends by the residual surfaces of the bone walls around the implants.

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Dear dr salama. radiography can help us to design a treatment plan. please post the radiographies.
tnx.Ali

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Might want to check , Oclussion, anterior teeth don't seem periodo rally involved.

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I think it will be favorable in this case the protocol from Carlo Tinti and Stefano Parma-Benfenati.
First remove crowns and put on implantts the cover screw
Second decontamination with air flow an tetraciclineapplied two times for three min (tertacicline chloridrate 25o mg in less than 1 cc of phisiologic solution;
Third bone graft with puros cortical an cncellous bone
and GBR procedure with PTFE Membrane
after six months membrane pull-out and connective tissue graft with healin abutment.
Finally repositioning of abutements and crowns

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How prevent disease recurrence?

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Diode laser debridment, and GBR. Probably allograft as Mineross with membrane. I would not remove the crowns if only the buccal is involved but is a good option.
All suggestions seem reasonable!
Congrats for promoting continuos learning and sharing.
Carlos A. Vélez -Perú

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Carlos...I would NOT use a Diode laser. Too much HEAT.
Not the correct wavelength. More harm than good.
As for removal of crowns and Carlo Tinti technique, I like that idea very much and a "closed" environment for Regeneration gives us our best chance!!
Thanks for all the discussions from around the WORLD!!

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Just an idea,how about a thin tailored graft from the chin to be fixed to the buccal bone and particulate graft underneath around the implants?

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Firstly, the problem looks as if it was due to the implant width compared to the residual bone width at the time of placement. If we are interested in bone regeneration the healing should take place in a submerged environment. As this is hard to achieve and the patient will be without prosthesis for a long time, we should choose a more realistic treatment plan. This plan is the removal of the prosthesis and polishing of the contaminated part of the implant with the turbine engine as we are trying to obtain a machined titanium surface. Next decontaminate the tissue and implant with H2O2 3% and reposition of the soft tissues possibly in a more apical direction.

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In my opinion, First, and the most important It is look for the reason about why the bone resorption? traumatic, infectious, both of them
Second. evaluate the implants stability.
When I have seen similar cases, in the mayority of them a lack of attached gingiva by buccal zone is a important reason..
Well, If the implants have stability. I could make a cleaner and disinfection with eg, tetracicline, Then a GBR (but now, I would try with some allograft mix with Plasm rich fibrin, and resorbable membrane) and finally I return a enough amount of keratinized gingiva (and/or attached gingiva) with some surgical technique..(It could be, apically positioned flap with free grafting palatal).

Sincerely Dr. Andrés Gómez.

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in some cases after cleaning the defect and exposed part of implant we might do bone augmentaion, but i was wondering would.it be re-ossteointegration? some papers said its not its only bone refill!!!

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