Successful Management of Early Peri-Implant Infection and Bone Loss Using a Multidisciplinary Treatment Approach.

Introduction: Peri-implant infections can occur any time postloading. Although management of peri-implant infections has been described extensively in the literature, no consensus exists on the best approach to its treatment. Infections and bone loss can also occur around implants prior to loading, leading to early implant loss. Little has been reported on the management of peri-implant infections occurring prior to loading. This report describes the identification as well as the surgical and restorative management of infection and bone loss around a preloaded dental implant.

Case Presentation: A 52-year-old systemically healthy, non-smoking white female had severe inflammation with bleeding on probing and bone loss around implant #28 (Universal Numbering System) 7 weeks after placement and augmentation with autogenous and deproteinized bovine bone and a resorbable collagen membrane (RCM). Surgical exposure revealed a deep bony crater around the entire implant. The implant was cleaned for 4 to 5 minutes with a tetracycline and saline slurry. Guided bone regeneration was performed with demineralized freeze-dried bone allograft and an RCM. Azithromycin, ibuprofen 800 mg three times daily, and 0.12% chlorhexidine gluconate rinse were given post-surgery. Postoperative healing was uneventful. Nearly complete bone fill was noted at 1 year of observation when implants were permanently restored. A combination of screw- and cement-retained restorations were placed. Tissues remained healthy 5.5 years postloading with maximum 3-mm probing depth and no changes in bone levels.

Conclusions: This case shows that it is possible to arrest early peri-implant infection, regenerate bone, and maintain health over 5.5 years postloading. Early detection and multidisciplinary care resulted in long-term success.