Treatment of peri-implantitis with granulation tissue removal and mechanical cleansing using R Brush and i Brush


Dr. Yukihisa TAKAHASHI, DDS, PhD

Art of Oral Science
Tokyo, Japan

- A severe buccal dehiscence of the surrounding bone with granulation tissue
- Marginal bone loss of over 2/3
- Maintained vertical height of bone wall (except for the buccal aspect)
- HDD (horizontal defect dimension) of less than 2mm
- PD 10mm, BOP +, Pus discharge −, Implant mobility −
R Brush was used for the granulation tissue removal and mechanical cleansing at 8,000rpm with copious irrigation.

i Brush was used for the granulation tissue removal and mechanical cleansing in the narrow and deep noncircumferential defect area. After the decontamination by chlorhexidine gluconate solution, SLA surface was treated with phosphate etching for 10 seconds, and washed by saline.

In order to promote remineralization on the implant surface, β−TCP powder was applied by air abrasion over the implant surface.

Bio-Oss (granule size of 1 to 2mm) was applied around the cleansed implant and in the bone defect.

Cement retained 2-unit prosthesis.

To assure effective hygiene procedure of the implant, the superstructure connection, which was the cause of this periimplantitis, was modified.

4-month outcome: PD 3mm, BOP −, Pus –

- Before treatment: over 2/3 marginal bone loss, PD: 10mm, BOP:+, Pus discharge: −, Implant mobility: −
- Vertical height of bone wall, except the buccal aspect, was maintained and HDD (horizontal defect dimension) was less than 2mm
- “Save the implant” treatment was chosen. Treatment outcome is good.
- There are opinions that implant should be removed if the surrounding bone loss is over 2/3. However, many implant may be saved if treated by using R-brush and i-brush.
- More detailed protocols to judge “save or remove the implant” based on the detailed evaluation of the marginal bone condition will be necessary.
Although a compromised status of implant with more than 2/3 marginal bone loss caused by periimplantitis might have to be removed, the prognosis is good to guarded, depending on the proper treatment of periimplantitis as presented in this case. 

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