Apicoectomy and Scanning Electron Microscopy Analysis of an Implant Infected by Apical (Retrograde) Peri-implantitis: A Case Letter

A specific surgical procedure to remove the apices in the upper jaw

This clinical case report focuses on a case of surgery performed on a patient with the aim of cutting the dental apices in the patient's upper jaw. Mineral trioxide aggregate (MTA) was used as a filling material, and monitoring the condition showed that the operation was successful.

A novel histopathological classification of implant periapical lesion: A systematic review and treatment decision tree

BACKGROUND

Implant periapical lesion (IPL), as a peri-implant disease originating from implant apex, maintains coronal osseointegration in the early stage. With the understanding to IPL increasingly deepened, IPL classification based on different elements was proposed although there still lacks an overall classification system. This study, aiming to systematically integrate the available data published in the literature on IPL associated with histopathology, proposed a comprehensive classification framework and treatment decision tree for IPL.

METHODS AND FINDINGS

English articles on the topic of "implant periapical lesion", "retrograde peri-implantitis" and "apical peri-implantitis" were searched on PubMed, Embase and Web of Science from 1992 to 2021, and citation retrieval was performed for critical articles. Definite histopathology and radiology of IPL are indispensable criteria for including the article in the literature. The protocol was registered in PROSPERO (CRD42022378001). A total of 509 papers identified, 28 studies were included in this review. In only one retrospective study, 37 of 39 IPL were reported to be at the inflammatory or abscess stage. 27 cases (37 implants) were reported, including acute non-suppurative (1/37, developed to chronic granuloma), chronic granuloma (5/37), acute suppurated (2/37), chronic suppurated-fistulized (6/37), implant periapical cyst (21/37), poor bone healing (2/37), foreign body reaction (1/37). Antibiotics alone did not appear to be effective, and the consequence of surgical debridement required cautious interpretation because of the heterogeneity of lesion course and operation. Implant apicoectomy and marsupialization were predictable approaches in some cases.

CONCLUSIONS

The diversiform nature of IPL in the case reports confirms the need for such histopathological classification, which may enhance the comparison and management of different category.

Case Report: One alternative surgical treatment of retrograde peri-implantitis

Background

Retrograde peri-implantitis is an infection at the apex of an implant, leading to progressive bone loss. We present a surgical technique that is an alternative to implant removal or “implantoplasty.”

Case

A 47-year-old patient developed retrograde peri-implantitis 18 months after implant placement. As the infection was localized to the apex of the implant, an apicoectomy was performed on the implant. Post-operative serial periapical radiographs showed reparative tissue within 4 months, and a follow up radiograph showed complete bone restoration 2 years later.

Practical Implications

The findings of this case suggest a viable alternative to condemnation and removal of an implant with a periapical infection. It may be viable to resect the contaminated portion of the implant, graft the defect, and gain long term retention and service of the implant.

Implant Periapical Lesion: A Narrative Review

Implant periapical lesion (IPL) is an infectious-inflammatory alteration surrounding an implant apex. It is a multifactorial disease that may ultimately cause implant failure. The diagnosis of IPL is based on examination of clinical manifestations and apical radiolucency. Many etiologies have been attributed to IPL, including preexisting microbial pathology and surgical trauma. Moreover, many systems have been used to classify IPL based on different parameters. To date, non-surgical and surgical treatment, as well as removal of failed implants, have been considered to successfully manage IPL. However, prevention of IPL surpasses all modes of treatment. An increased number of IPL cases are expected as implants have become standard for tooth replacement in dentate arches. Therefore, it is necessary to understand IPL more comprehensively. Herein, an introduction to IPL, including its etiology, diagnosis, classification, treatment, and prevention, has been undertaken.