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Treatment Solutions
- 2-Stage Implant Placement(1)
- Gain of Keratinized Tissue(1)
- GBR Procedure(3)
- Peri-Implantitis Therapy(2)
- Recession Coverage(4)
- Ridge Preservation(5)
- Sinus Floor Elevation(1)
- Soft Tissue Thickening(6)
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Found 21 Results

Andrea Ravidà, DDS, MS, PhD
Anu Viswanathan DDS, MDS

Prosthetic-Surgical Approach to Regenerative Treatment for Peri-Implantitis

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Clinical presentation of tooth #31 showing radiographic evidence of bone loss, profuse bleeding on probing (BOP), deep probing depths, and suppuration, indicative of peri-implantitis with a Class I-infraosseous (c) circumferential-type defect, as described in the study by Monje et al. (2019) Clin Implant Relat Res, 21(4)635-643.

Crown removal by the prosthodontist, followed by placement of a healing abutment for non-surgical therapy using PerioFlow®. After therapy, a cover screw was placed, and the tissue was allowed to heal over the implant for eight weeks.

Surgical treatment initiated with a midcrestal incision and full-thickness flap elevation. Granulation tissue was removed using a surgical curette, revealing a deep infrabony defect.

Implant thoroughly decontaminated using Perioflow® with erythritol powder to ensure a clean surface for regeneration.

rhPDGF-BB was used to hydrate bone grafting materials (vallos® Demineralized Cortical Granules and Geistlich Bio-Oss®), which were first hydrated with sterile water before rhPDGF-BB was added. The materials were mixed in a 1:1 ratio and allowed to sit for 10 minutes before being applied to the deep infrabony defect to promote regeneration.

Flap closed primarily with 5-0 PTFE horizontal mattress and single interrupted suture for secure closure.

Collagen membrane stabilized with 5-0 chromic gut sutures using the lasso technique.

After 5 months of healing, significant bone gain is evident. Geistlich Bio-Oss® was placed on the buccal site to enhance thickness, covered with an amnion-chorion membrane. A healing abutment was placed at this stage.

Two-year follow-up shows disease resolution with shallow probing depths, no bleeding or suppuration, and complete bone gain. A new crown was fabricated with an increased final abutment height (>2mm), contributing to optimal maintenance and long-term stability based on evidence supporting its role in promoting long-term success. A second surgery may be necessary to gain additional tissue thickness or cover residual thread exposure to achieve the desired long-term results.

Baseline Radiograph

Flap reflection showing the defect tooth #30

Defect dimensions from the lingual aspect

Defect filled and graft is extended beyond margins, 1-2mm on the buccal aspect

Suturing with 5/0 polypropylene sutures. Primary closure is attained.

Radiograph 1-year post-op showing almost complete bone fill

Flap reflection showing defect on the mesial and distal of central incisor (#25)

Flap reflection showing 6mm deep infrabony one wall defect on tooth #25

Regenerative treatment: Allograft + rhPDGF-BB

Amnion/chorion membrane used to cover the graft

Polypropylene 6-0 used for suture placement

At 7 months, pocket depth reduced to 3 mm, with 90% bone fill and 3mm attachment gain. Patient had no mobility due to splinting and good compliance.

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