Perimplantitis 3 years following Lateral Wall Sinus Lift and implants

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Posted on By Ronald Katz In 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

Preop Pano
Preop CT

Preop CT Coronal
Postop Sinus

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More than likely a tissue issue that lead to perio breakdown from inflammation. Tough call. Your thoughts on removing bridge, detoxify implant surfaces after debridement with tetracycline and laser low energy is a good plan. Then bone and soft tissue graft. Closed healing environment much preferred for best results. Good luck Dr. Salama


Check the bite!!!!! Remove existing crowns. Cure periimplantitis, GBR, and make temporary bridge. For three months make new permanent BRIDGE-connect all three crowns above the implants.


Henry Schein