A developed treatment of early abscessed implant

Inflammation due to oral bacteria could alter soft and hard tissues around dental implant. If this degradation remains untreated, a progressive loss of supporting tissue and supportive bone will occur. This inflammation is called peri-implantitis.[1] The irreversible changes in the crestal bone levels coupled to bleeding on probing, with or without pockets presence, are the most characteristic criteria of the peri-implantitis. In addition, peri-implantitis lesion suppuration could appear.[2] Some of the risk factors of peri-implant diseases are poor oral hygiene, smoking, and history of periodontitis.[3] Nevertheless, early failure of dental implant is the most problematic incident during the healing procedure after the implant installing. Several factors of early implant failure are the low primary stability leading to minimal or non-osseointegration, the contamination of implant material and/or surgical site by pathogenic bacteria. In a recent study, author presents that patients who received preoperative antibiotics showed fewer early implant failures.[4] Early failure rate of 0.6% is recorded in a study done by Brügger et al.[5] In another study, it is found that, among 150 failing implants in a total of 2796 implants, 57.3% of the implant failures were early no matter the cause of this failure.[6] The outcome of non-surgical periodontal treatment of periimplantitis is unpredictable. Nevertheless, several detoxification procedures are useful to decontaminate peri-implantitis affected implant surfaces including air-powder abrasion, saline wash, citric acid application, laser therapy, peroxide treatment, ultrasonic/ manual debridement, and application of topical medication. However, a definite gold standard could not be identified.[7] Debridement and decontamination of the infected implant surface and surrounding bone are standard in a surgical approach. Once the access to the infected site is achieved, the application of bone substitutes is the answer to a regenerative procedure. A well-defined crater-like defect may improve retention of the bone graft, thereby allowing an optimal healing.[8] In fact, a regenerative surgical therapy combined to bone graft associated to a membrane has reported clinical and radiographic improvements over 3-4 years.[9-12] The aim of the current paper is to shed the light on a case of early dental implant failure, treated by a simple protocol of a surgical peri-implantitis composed of the adjunction of implant surface detoxification by means of peroxide treatment and citric acid application to a regenerative procedure using a bone graft particles covered by a resorbable membrane. Abstract Early peri-implantitis is one of the major causes of implant surgery failure. Caused by various factors such as pathogenic contamination, this condition needs a specific and professional intervention to re-stabilize the implant and to recreate osseointegration in the defected site. This article describes a treatment protocol that restores the boneimplant contact and renders the implant reliable and functional at the long term. In the aim of treating a peri-implantitis state and saving the implant, we opted for a simple protocol that treats the implant surface and stimulates the bone regeneration and bone-implant osseointegration. 1-year after the application of hydrogen peroxide 15% and citric acid combined with bone graft and resorbable membrane, the ex-defected implant was loaded after a neo-osseointegration formation all around the implant. 2 years later, the implant is still functional, and the peri-implant tissues show a healthy state. In conclusion, the good diagnosis and the fast intervention using implant surface etching and regenerative intervention were the key to success in this case. This case study encourages the use of the combined procedure of bone and membrane to stabilize the graft into the bone crater, which is crucial for the formation of a neo-alveolar bone that surrounds the exposure surface of the defected implant.