A Novel Treatment Decision Tree and Literature Review of Retrograde Peri‐Implantitis

Abstract

Background: Although retrograde peri‐implantitis (RPI) is not a common sequela of dental implant surgery, its prevalence has been reported in the literature to be 0.26%. Incidence of RPI is reported to increase to 7.8% when teeth adjacent to the implant site have a previous history of root canal therapy, and it is correlated with distance between implant and adjacent tooth and/or with time from endodontic treatment of adjacent tooth to implant placement. Minimum 2 mm space between implant and adjacent tooth is needed to decrease incidence of apical RPI, with minimum 4 weeks between completion of endodontic treatment and actual implant placement. The purpose of this study is to compile all available treatment modalities and to provide a decision tree as a general guide for clinicians to aid in diagnosis and treatment of RPI. Methods: Literature search was performed for articles published in English on the topic of RPI. Articles selected were case reports with study populations ranging from 1 to 32 patients. Any case report or clinical trial that attempted to treat or rescue an implant diagnosed with RPI was included. Results: Predominant diagnostic presentation of a lesion was presence of sinus tract at buccal or facial abscess of apical portion of implant, and subsequent periapical radiographs taken demonstrated a radiolucent lesion. On the basis of case reports analyzed, RPI was diagnosed between 1 week and 4 years after implant placement. Twelve of 20 studies reported that RPI lesions were diagnosed within 6 months after implant placement. A step‐by‐step decision tree is provided to allow clinicians to triage and properly manage cases of RPI on the basis of recommendations and successful treatments provided in analyzed case reports. It is divided between symptomatic and asymptomatic implants and adjacent teeth with vital and necrotic pulps. Conclusions: Most common etiology of apical RPI is endodontic infection from neighboring teeth, which was diagnosed within 6 months after implant placement. Most common findings, radiographically and clinically, are lesions around implant apex and sinus tract. A small number of implants did not improve with treatment. Decision tree provides a path to diagnose and treat lesions to facilitate their management. Further studies are needed to focus on histologic data around periapical microbiota to establish specific etiology and differential diagnoses compared with marginal peri‐implantitis and other implant‐related conditions.

Patient‐Centered Perspectives and Understanding of Peri‐Implantitis

“…Individuals (61 males and 74 females, aged 21 to 89 years; mean age: 61.8 years) provided with implant restorative therapy and undergoing implant maintenance at the Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, between March 1, 2016 and August 31, 2016, were selected for the study. Inclusion criteria were as follows: 1) single or multiple implants placed and restored for >12 months; 2) individuals with/without regular periodontal and/or peri‐implant maintenance; and 3) individuals with/without peri‐implant pathology, such as retrograde peri‐implantitis (radiolucency around implant apex secondary to endodontic lesion), 14 mucositis, and peri‐implantitis.…”

Injectable Biomaterials for Dental Tissue Regeneration

“…Besides, EMD has been successfully used to treat large periradicular lesions of endodontic origin located adjacently to dental implants with regressive peri-implantitis [145]. Sarnast et al [146] found that regressive peri-implantitis (basically, an endodontic infection from neighbouring teeth) can be treated by initiating infected tooth apicoectomy with dental implant decontamination. This treatment can be performed by EMD application which aids in periapical lesion healing.…”

Incidence of retrograde peri‐implantitis in sites with previous apical surgeries: A retrospective study

“…Previous studies reported an incidence of 0.26% for RPI, 36 increasing to 7.8% if adjacent teeth had previous root canal therapy 7 and 13.6% if the tooth extracted had a periapical lesion 15 . Other studies showed the chance of RPI occurring in an implant adjacent to a tooth with an apical lesion to be about 25% (OR = 8.0) 37 …”

“…Epstein‐Barr virus is occasionally associated with the pathogenesis of symptomatic periapical lesions in endodontically involved teeth and should likewise be expected to play a role when implants are placed in the same sites 44 . Additionally, an HIV‐related infection had been described as an etiological factor for RPI as well 37 …”