Perimplantitis 3 years following Lateral Wall Sinus Lift and implants
In August of 2018 this patient presented with a failing 5 unit fixed upper left bridge and an atrophic posterior maxillary alveolar ridge. Pt is a female healthy non-smoker w/ no systemic diseases or illnesses. The patient's prosthodontist removed the bridge and temporized. The surgical plan was for placement of implant #12 in a 2 stage fashion and lateral wall sinus augmentation. Autogenous Bone was harvested with a bone-scraper and mixed with Allogeneic bone and PRF (Choukroun i-PRF and a-PRF + membranes). Sinus lift surgery was without complication. We allowed 4 months for bone healing and maturation. Then in Dec 2018, Zimmer TSVT implants were placed in the 13 and 14 positions, again in a 2 staged fashion. Stage 2 implant surgery 4 months later. All torque-tested 35Ncm clockwise and counterclockwise.
Prosthodontist's hygienist notes purulence from #13 last week. Arrestin was deposited in 6 sites bilaterally. Other sites in mouth apparently with bone loss/pockets. Occlusion is good, contacts adjusted by Pros. Patient c/o food traps. How would you approach this case? Remove crowns, detoxify implant smear layer Citric acid or laser was my thought then graft again PRF. Any thoughts on Emdogain? Thanks