Therapeutic Area: Peri-Implantitis

BIOBRIEF

Clinical Efficacy of Geistlich Mucograft® in Regeneration of Oral Mucosa Combined with the Surgical Treatment of Peri-implantitis in Implants with Lack of Keratinized Tissue

Dr. Alberto Ortiz-Vigón
Dr. Erik Regidor Correa

THE SITUATION

Adult patient, non-smoker and without relevant systemic history, attends to clinic referring peri-implant tissue inflammation, bleeding and brushing discomfort around her implant in the upper jaw. Clinically peri-implant pocket depth > 5 mm, bleeding and suppuration on probing were observed. Furthermore, the implant presented < 2 mm of keratinized mucosa and radiographic horizontal bone loss.

THE RISK PROFILE

Low RiskMedium RiskHigh Risk
Patient’s healthIntact immune system 
Non-smoker		Light smokerImpaired immune system 
Heavy smoker
Patient’s esthetic requirementsLowMediumHigh
Height of smile lineLowMediumHigh
Gingival biotypeThick – “low scalloped”Medium – “medium scalloped”Thin – “high scalloped”
Shape of dental crownsRectangularTriangular
Infection at implant sightNoneChronicAcute
Bone height at adjacent tooth site≤ 5 mm from contact point5.5 – 6.5 mm from contact point≥ 7 mm from contact point
Restorative status of adjacent toothIntactRestored
Width of tooth gap1 tooth (≥ 7 mm)1 tooth (≤ 7 mm)2 teeth or more
Soft-tissue anatomyIntactCompromised
Bone anatomy of the alveolar ridgeNo defectHorizontal defectVertical defect
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THE APPROACH

Intrasulcular incision was made and a mucosal partial thickness flap was raised. The recipient site was prepared by sharp disection in order to create a periosteal bed free of any muscle attachment. Peri-implant granulation tissue was removed and implantoplasty was performed. Finally, Geistlich Mucograft® was used to support the gain of keratinized tissue. Thus, the collagen matrix was sutured with the resulting flap apically at the base of the newly created vestibulum.

Pathological peri-implant pocket depth combined with bleeding on probing.
Partial thickness flap in order to create a periosteal bed free of any muscle attachment and apically positioned.
Implantoplasty of the exposed rough implant surface using burs and silicon carbide polishers.
Xenogeneic collagen matrix structure (Geistlich Mucograft®).
Future position of the xenogeneic collagen matrix facilitated by prosthodontic abutment.
Suture of xenogeneic collagen matrix around the abutment and over the recipient bed.
Buccal view of xenogeneic collagen matrix and apically positioned flap.
Occlusal view of xenogeneic collagen matrix and apically positioned flap.
Lateral view of xenogeneic collagen matrix and apically positioned flap.
Peri-implant tissue health and maintenance of keratinized tissue after one year of surgical treatment.
Periimplant tissue health and maintenance of keratinized tissue after 2 years

Absence of > 2 mm of keratinized mucosa was associated with peri-implant soft-tissue inflammation, bleeding and discomfort on brushing.

THE OUTCOME

After two years follow-up, the successful outcome can be observed in terms of clinical peri-implant parameters, gain of keratinized mucosa without significant graft shrinkage and stability of vertical position of the mucosal margin.

The use of Geistlich Mucograft® xenogeneic collagen matrix for regeneration of oral mucosa, combined with the surgical respective approach to peri-implantitis provides an improvement in clinical parameters and increase of the peri-implant keratinized mucosa minimizing the risk of recession in the esthetic area.”

Dr. Erik Regidor Correa & Dr. Alberto Ortiz-Vigón

The use of soft-tissue substitutes may play an important role in patient perception and satisfaction without jeopardizing the final clinical outcome.”

Dr. Erik Regidor Correa & Dr. Alberto Ortiz-Vigón

Dr. Alberto Ortiz-Vigón

  • DDS from the University of the Basque Country
  • MSc and PhD in bone regeneration from the University Complutense of Madrid (UCM)
  • Master in Periodontology and Implant dentistry from the EFP
  • Research fellowship at the University of Gothenburg
  • MBA from the Deusto Business School
  • Assistant professor and clinical researcher at UCM and ThinkingPerio Research
  • PerioCentrum Clinic in Bilbao
  • Co-founder of ARC Healthtech Innovation Holding
  • Socially engaged & NGO co-founder of Smile is a Foundation

Dr. Erik Regidor Correa

  • DDS from the University of the Basque Country
  • MSc from the U. of the Basque Country
  • Master in Periodontology and Implant Dentistry U. of the Basque Country
  • PhD student in the U. of the Basque Country
  • Assistant professor and clinical researcher ThinkingPerio Research

WEBINAR

CLINICAL CASE

Initial situation, patient presented with radiographic and clinically traditional signs of peri-implantitis, including bleeding on probing, suppuration, radiographic progressive bone loss and clinical pathologic probing depths.
Mechanical debridement was achieved using titanium scalers, an ultrasonic device with an implant protective cap and titanium brushes to remove all of the visible contaminants of the implant surface. Citric acid was then placed on shreds of a non-woven gauze and applied to the surface for approx. 1min. Copious irrigation was done using saline solution and the surface was ablated using the Er:YAG laser at 20pps/50mj.
After the surface was prepped and no signs of residual granulation tissue was noted, the defect was grafted with Geistlich Bio-Oss®. Attention was given towards not augmenting beyond the bony envelope.
A protective Geistlich Bio-Gide® membrane was placed over Geistlich Bio-Oss®.
Geistlich Fibro-Gide® was placed over Geistlich Bio-Gide® to enhance soft-tissue volume and quality. Geistlich Fibro-Gide® was trimmed and adapted to the defect site ensuring a tension free closure.
Geistlich Fibro-Gide® was place on the top of the bone graft to enhance soft-tissue thickness. Geistlich Fibro-Gide® is porous. We can observe the rapid penetration of blood through the matrix.
Closure with a tension-free flap was achieved by releasing incisions and secured using 4-0 chromic gut sutures.
1.5 year post-operative photo and radiograph show the healing of the soft-tissues with no signs of peri-implantitis and adequate tissue thickening. Radiographic bone levels have maintained stable over the course of the year.