César Neto João Batista, Dos Reis Isabella Neme Ribeiro, Lazarin Rafael Oliveira, Naenni Nadja, Villar Cristina Cunha, Pannuti Claudio Mendes
Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.
Department of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
Clin Adv Periodontics. 2024 Aug 9. doi: 10.1002/cap.10310.
Peri-implantitis poses significant challenges in clinical practice, necessitating effective therapeutic strategies. This case report presents a comprehensive treatment approach for managing peri-implantitis, focusing on resective surgery, including implantoplasty and long-term maintenance.
We describe the case of a 50-year-old female patient with peri-implantitis affecting a maxillary full-arch implant-supported rehabilitation. The treatment strategy involved resective surgery with implantoplasty, a new maxillary overdenture, and a regular maintenance care schedule of three to four visits per year. Clinical and radiographic assessments were performed over a 10-year follow-up period.
Post-treatment, all maxillary implants demonstrated no probing depths exceeding 4 mm, absence of bleeding on probing or suppuration, minimal plaque accumulation, and no further bone loss. Resective surgery with implantoplasty seems to have effectively provided submucosal decontamination and created a supra-mucosal implant surface conducive to oral hygiene. Despite regular maintenance, some mandibular implants exhibited bone loss during the follow-up period and were managed using the same approach as for the maxillary implants.
The comprehensive treatment approach yielded favorable long-term clinical and radiographic outcomes, underscoring the effectiveness of the combined strategies in managing peri-implantitis. Nevertheless, the potential for recurrence or the development of peri-implantitis in new implants, even after a decade of successful treatment and strict maintenance, highlights the importance of ongoing, diligent care and regular evaluations to promptly diagnose and address these issues.
Why is this case new information? The long-term effectiveness of peri-implantitis treatments, particularly involving implantoplasty, remains under-documented. This case provides insights from a 10-year follow-up on the efficacy of a comprehensive approach for managing peri-implantitis. Furthermore, these findings illustrate the potential for new peri-implantitis to develop, regardless of sustained peri-implant health and rigorous maintenance. This finding highlights the critical role of continuous monitoring for the early diagnosis and treatment of new implants exhibiting peri-implantitis. What are the keys to the successful management of this case? The success of this case hinged on a comprehensive treatment approach that combines surgical intervention associated with implantoplasty to remove implant threads, thereby creating smoother surfaces, less retentive for plaque accumulation. A critical aspect of this approach was also the redesign of prosthetic components to improve hygiene accessibility, continuous monitoring, and consistent maintenance care. What are the primary limitations to success in this case? The primary challenge in achieving success in this case was the prevention of new implants with peri-implantitis, despite the patient's consistent adherence to the maintenance program. Moreover, a critical evaluation of implant characteristics, particularly their susceptibility to mechanical failures, is paramount when performing implantoplasty. Furthermore, aligning patient expectations with the realistic esthetic and functional outcomes of the treatment is often challenging.
Peri-implantitis, an inflammatory disease affecting dental implants, is quite challenging to treat. This case report describes how a 50-year-old woman with this condition was successfully treated and maintained over 10 years. The approach included a surgical method called resective surgery, which involved reshaping the bone defect (osteoplasty) and smoothing the implant surface (implantoplasty). Additionally, she was fitted with a new upper denture and had regular follow-up visits three to four times a year. After ten years, her upper implants were stable with no signs of infection or further bone loss, and they were easy to keep clean. Some of her lower implants did experience inflammation with progressive bone loss during this time, but they were managed using the same surgical procedure as for her upper implants. This 10-year case report highlights positive and stable clinical results after resective surgery for treating peri-implantitis and the importance of an interdisciplinary approach and regular check-ups for maintenance, early diagnosis, and management of peri-implantitis over the long term.
种植体周围炎在临床实践中带来了重大挑战，需要有效的治疗策略。本病例报告介绍了一种治疗种植体周围炎的综合治疗方法，重点是切除性手术，包括种植体oplasty和长期维护。
我们描述了一名50岁女性患者的病例，该患者患有种植体周围炎，影响上颌全牙弓种植体支持的修复体。治疗策略包括切除性手术联合种植体oplasty、新的上颌覆盖义齿以及每年三到四次的定期维护护理计划。在10年的随访期内进行了临床和影像学评估。
治疗后，所有上颌种植体的探诊深度均未超过4毫米，探诊时无出血或化脓，菌斑积聚极少，且无进一步的骨质流失。切除性手术联合种植体oplasty似乎有效地实现了黏膜下清洁，并创造了有利于口腔卫生的龈上种植体表面。尽管进行了定期维护，但一些下颌种植体在随访期间仍出现骨质流失，并采用与上颌种植体相同的方法进行处理。
综合治疗方法产生了良好的长期临床和影像学结果，强调了联合策略在治疗种植体周围炎中的有效性。然而，即使经过十年的成功治疗和严格维护，新种植体仍有发生种植体周围炎复发或发展的可能性，这凸显了持续、勤勉护理和定期评估以迅速诊断和解决这些问题的重要性。
为什么这个病例是新信息？种植体周围炎治疗的长期有效性，特别是涉及种植体oplasty的治疗，文献记载仍然不足。本病例提供了对一种治疗种植体周围炎综合方法疗效的10年随访见解。此外，这些发现表明，无论种植体周围健康状况持续良好和维护严格，新的种植体周围炎仍有可能发生。这一发现凸显了持续监测对于早期诊断和治疗出现种植体周围炎的新种植体的关键作用。本病例成功管理的关键是什么？本病例的成功取决于一种综合治疗方法，该方法结合了与种植体oplasty相关的手术干预，以去除种植体螺纹，从而创造更光滑的表面，减少菌斑积聚的滞留。该方法的一个关键方面还包括重新设计修复组件，以改善卫生可达性、持续监测和一致的维护护理。本病例成功的主要限制是什么？在本病例中取得成功的主要挑战是预防新的种植体周围炎，尽管患者始终坚持维护计划。此外，在进行种植体oplasty时，对种植体特征，特别是其对机械故障的易感性进行严格评估至关重要。此外，使患者期望与治疗的实际美学和功能结果相一致往往具有挑战性。
种植体周围炎是一种影响牙种植体的炎症性疾病，治疗颇具挑战性。本病例报告描述了一名患有这种疾病的50岁女性如何在10年期间成功接受治疗和维护。治疗方法包括一种称为切除性手术的外科方法，该方法涉及重塑骨缺损（骨oplasty）和平滑种植体表面（种植体oplasty）。此外，她佩戴了新的上义齿，并每年进行三到四次定期随访。10年后，她的上颌种植体稳定，没有感染或进一步骨质流失的迹象，并且易于保持清洁。在此期间，她的一些下颌种植体确实出现了炎症并伴有进行性骨质流失，但采用与上颌种植体相同的外科手术进行处理。这份10年的病例报告突出了切除性手术后治疗种植体周围炎的积极稳定临床结果，以及跨学科方法和定期检查对于长期维护、早期诊断和管理种植体周围炎的重要性。
