Apicoectomy of an implant?
05/11/2022
The Community
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When the endodontic lesion involves the apex of an implant in addition to the one of the tooth, a retrograde peri-impantitis can be established.
Retrograde peri-implantitis (RPI) is a primary microbial inflammatory condition that affects only the apical portion of an osseointegrated implant, which retains normal bone-to-implant contact in its coronal portion. Currently, no uniformly accepted definition or classification exists for RPI.
Therapeutic options include antibiotics, open-flap implant debridement, and apical resection including apicoectomy of endodontically affected adjacent teeth.
A 42-year-old patient had pain on chewing in sector 2.
The pre-operative x-ray shows a large lesion positioned on the apex of elements 2.5 and 2.6.
First of all, an orthograde retreatment of the element 2.5 was performed to remove most of the bacteria inside the canal and to optimize the success of surgical endodontics.
Then we continue with a surgical approach that must involve the apex of both 2.5 and 2.6.
Diagnosis: Acute apical periodontitis of 2.5 and Retrograde peri-implantitis (RPI) of 2.6
Fig. 1
Pre operative x-ray
Fig. 2
X-ray after the orthograde retreatment of the premolar
Fig. 3
After anesthesia, a flap was made with preservation of the papilla and the cyst wall was exposed
Fig. 4
The cystic content was drained and the entire wall was subsequently detached to allow the removal of all the granulation tissue
Fig. 5
apical resection of tooth and implant
Apical obturation with super-EBA
Fig. 6
detail of the removed implant apex
Fig. 7
The flap was repositioned and sutured with an absorbable thread by applying single detached stitches
Fig. 8
Healing of the peridontium after 7 days
Fig. 9
Immediate post operative x-ray
Fig. 10
The author: Dr Jacopo Francinelli
Conclusions
When the endodontic lesion involves the apex of an implant in addition to the apex of the tooth, a retrograde peri-impantitis can be established.
In these cases it is necessary to treat both the tooth and the implant with apical surgery, removing all the irritating factor
Bibliography
Mohamed JB, Shivakumar B, Sudarsan S, Arun KV, Kumar TS. Retrograde peri-implantitis. J Indian Soc Periodontol. 2010 Jan;14(1):57-65. doi: 10.4103/0972-124X.65444. PMID: 20922082; PMCID: PMC2933532.
Burdurlu MÇ, Dagasan VÇ, Tunç O, Güler N. Retrograde peri-implantitis: evaluation and treatment protocols of a rare lesion. Quintessence Int. 2021;52(2):112-121. doi: 10.3290/j.qi.a45264. PMID: 33433077.
