Initial placement of a dental implant and revision therapy following complications are not the same. Changes in the bone anatomy, biology, and physiology of healing following dental implant complications requires a different approach during its revision therapy. Peri-implantitis is now the number one complication in implant dentistry resulting in bone and gum tissue loss and pain. If detected early, it may be possible to treat, however with advanced conditions, explantation (implant removal) may be the only viable option. The condition of bone and gum tissue is often compromised and hence requires a slow, methodical, and staged treatment to restore the missing tissue and replace with a new dental implant. It is also vital to identify the contributing factors to the initial complication and design a treatment strategy with those in mind.
This patient was experiencing pain and swelling around his dental implant for some time and initial hygiene therapies were not successful. Removal of restoration showed advanced plaque colonies which was responsible for the inflammation and bone loss characteristic of advanced peri-implantitis. The implant was removed using reverse torque technique and grafted to restore the missing bone. After 6 months of healing, a new dental implant was placed following total digital planning and guided placement approach. Much emphasis was placed on creating a thick bone and gum tissue and absolute proper positioning of the dental implant. The design and fabrication of a custom abutment and an anatomical crown by the restorative dentist was also an important step for proper access for hygiene and maintenance. And finally, a thorough review of home hygiene care and professional care which is critical in long-term stability and health.
Revision therapy in implant dentistry can be successful but must be performed with patience, a well thought-out protocol, and in a slow and staged fashion.
Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD