Dealing with complications

Case 2. Ailing and failing implant associated with oroantral communication and endodontic lesions

The second speaker described a patient, who had presented with pain, fever and sinus suppuration along with oroantral communication and a 6mm vestibular bony dehiscence in a nearby implant (fig 5). Examination found multiple issues: possible bacterial contamination of the previous sinus graft, poor endodontic treatment and poor prosthetic treatment planning, all leading to biological failure (peri-implant bone loss and peri-implantitis) (fig 6).

It has been reported that sinus graft infection occurs in around 2.3% of all sinus grafting patients (Urban et al., 2012). The fist treatment objective was infection control. The failing implant at 16 was removed and pus was drained from the site. Simultaneously, the tooth at 15 was extracted and the peri-apical cyst was removed. The implant at 14 was kept (for the moment) to support a fixed temporary bridge along with a distal implant at the site of tooth 17. The root of 15 was then removed and granulation tissue was removed with thorough debridement. Six months later, re-entry was performed to place three more implants at 16, 15 and 14 with minor intra-alveolar sinus elevation. The implant showing buccal exposed threads was removed, and simultaneously a new implant was inserted. Guided Bone Regeneration with resorbable collagen membrane and a mixture of autologous bone and demineralized bovine bone was executed on the implant at 14. Simultaneous GBR was performed in 15, and all implants were immediately loaded with a new fixed provisional (fig 7–8). No connective tissue graft was required and prosthodontic treatment continued uneventfully. The speaker shared their four-year follow-up (fig 9–10).