A Regenerative Approach to Peri-implantitis
A 55-year-old man was referred to me by his general dentist. Upon initial clinical and radiographic findings, failing implant #9 showed signs of peri-implantitis that included BoP, Suppuration, 9+mm PD and radiographic bone loss affecting both the implant and the natural adjacent tooth. Patient stated that although his gums bleed, he does not have any pain. Gingival erythema was also found.
THE RISK PROFILE
|Low Risk||Medium Risk||High Risk|
|Patient’s health||Intact immune system||Light smoker||Impaired immune system|
|Patient’s esthetic requirements||Low||Medium||High|
|Height of smile line||Low||Medium||High|
|Gingival biotype||Thick – “low scalloped”||Medium – “medium scalloped”||Thin – “high scalloped”|
|Shape of dental crowns||Rectangular||Triangular|
|Infection at implant sight||None||Chronic||Acute|
|Bone height at adjacent tooth site||≤ 5 mm from contact point||5.5 – 6.5 mm from contact point||≥ 7 mm from contact point|
|Restorative status of adjacent tooth||Intact||Restored|
|Width of tooth gap||1 tooth (≥ 7 mm)||1 tooth (≤ 7 mm)||2 teeth or more|
|Bone anatomy of the alveolar ridge||No defect||Horizontal defect||Vertical defect|
Note: Peri-implantitis on implant #9 migrating to the mesial portion of root #8
The clinical goals were to eliminate the peri-implant infection, restore hard and soft-tissues and have long-term success. The technique utilized was a systematic regenerative approach to eliminate the underlying cause of the peri-implantitis infection and restore hard and soft-tissues to prior health.
My observation at the 1.5 year follow-up shows the elimination of peri-implantitis and complete peri-implant health was achieved showing a reduction in BOP, PD and most importantly soft tissue thickness stability. Radiographically, crestal bone shows no signs of progressive pathological loss and has maintained adequate volume.
Geistlich Fibro-Gide® was utilized to enhance the soft-tissues during a regenerative peri-implantitis approach. In my opinion, healthy, thick soft-tissue is easier for a patient to maintain and creates a better environment for long-term survival.Hector L. Sarmiento, D.M.D., MSc.
Hector L. Sarmiento, D.M.D., MSc.
Dr. Hector Sarmiento was awarded his D.M.D. degree by the University of Rochester. He is uniquely trained in both maxillofacial surgery and periodontics. He is a professor in the maxillofacial surgery department of trauma and reconstructive unit at the Regional Hospital in Mexico and is an Assistant Clinical Professor in periodontics at the University of Pennsylvania. Along with his periodontal degree, he also received his masters in oral biology from the University of Pennsylvania. Dr. Sarmiento is an international and national lecturer and has published numerous articles in peer reviewed journals and textbooks. His research focus includes infected dental implants such as peri-implantitis, sinus complications as well as bone biology. Dr. Sarmiento maintains his private practice in the upper east side of Manhattan in NYC.