A successful treatment of implant periapical lesion: surgical re-entry after 12 years from the reconstructive approach

AIM: This poster describes a 12 years follow up case-report of reconstructive bone surgery on Implant Periapical Lesion (IPL). METHODS: A 49 woman, at 3-month control after #4.6 implant placement, manifested a fistula at the vestibular side of the area. Clinical and radiographic exams led to active IPL diagnosis. The aim was to preserve the entire fixture, eliminating the acute infection at the apical portion of the implant and creating the biological conditions for osseointegration. The surgical-pharmacological treatment was performed in October 2005 at the Department of Periodontology and Implantology of Bologna University. After intrasulcular incision a vestibular full-thickness flap was raised and a careful soft tissue curettage of the defect was carried out. Confirmed the primary stability of the fixture, decontamination of the bone cavity and of the exposed implant portion was performed with a chlorhexidine irrigant. Finally, the area was filled with a particulate allograft added with tetracycline and the flap sutured. Chlorhexidine rinse and antibiotic-analgesic therapy were prescribed. The healing was uneventful and a complete resolution of the lesion was clinically and radiographically recorded. The minimally invasive approach and the definitive prosthetic finalization led to a full patient satisfaction. Stability of the result was confirmed for several years until a new periimplantitis scenario manifested. Another surgical approach was consequently planned to treat the periimplantitis. RESULTS: This surgery allowed a direct observation of the vestibular cortical area confirming a complete resolution of the previous IPL bone lesion. CONCLUSION: In conclusion this case-report shows that active IPL, even for extensive implant involvement, can be successfully resolved with a “preserving approach”. More clinical confirmations of this observation are anyway demanded.