Dealing with complications
Case 4. Dental pathology contributing to implant failure
The speaker presented the case of a 55-year-old patient, complaining of pain and swelling at tooth 12 (which had previously received root canal treatment and apiceptomy in 1998). Then, in 2007, an implant had been placed at tooth 11. Now, percussion testing on tooth 12 was positive and a probing depth of 9mm was measured between teeth 12 and 11. Imaging confirmed both peri-implant infection and apical pathology of tooth 12. A surgical approach was undertaken in an attempt to debride the peri-implant defect and to revise the previous apicectomy – this revealed a communication between the apical area of the tooth and the distal and apical defect of the implant.
The prevalence of apical lesions around implants has been estimated to be around 0.3 to 8.2%. When implants are used to replace teeth which have previously had periapical lesions and/or been endodontically treated, the prevalence of these lesions increases to nearly 14%. Furthermore, when adjacent teeth have periapical lesions, the reported prevalence can reach 25%. However, since the aetiology is multifactorial, no consensus can be found in the literature regarding treatment.
According to the recommended decision-making flowchart devised by Chan et al. (2011) (fig 17), surgical intervention was planned in order to:
- access and debride the peri-implant lesion
- decontaminate the implant surface
- graft the defect
- eliminate the associated periapical pathology by performing a new apiceptomy
However, the surgical sites failed to heal and the patient continued to complain of local inflammation and pain. The decision was then made to remove the implant and the tooth. A free gingival graft was placed on the socket and a fixed bridge was planned to replace the missing teeth. The speaker stated that to avoid these types of complications when placing implants, the presence of neighbouring periapical lesions should be taken into account as sources of bacterial contamination. The extraction socket should be thoroughly curetted in order to eliminate granulation tissue, and longer healing periods should be observed following endodontic treatments.
The speaker stated that to prevent this complication when placing implants, the presence of neighbouring periapical lesions should be taken into account as sources of bacterial contamination. The extraction socket should be thoroughly curetted in order to eliminate granulated tissue, and a longer healing period should be observed after endodontic treatments. Maintenance is key to control this kind of problem from the beginning.