Active Implant Periapical Lesions Leading to Implant Failure: Two Case Reports

Abstract

Implant periapical lesion (IPL), an inflammatory lesion surrounding the apex of a dental implant, has been previously reported as a possible cause for implant failure. This article describes 2 successive cases of active IPL that were diagnosed early by clinical signs and radiologic findings. Lesions were treated surgically with implant removal and debridement. The etiology, findings, and treatment approaches for IPL are discussed in comparison with other reports.

An implant periapical lesion associated with presence of residual root fragments: report of case treated with apicoectomy

“…Our case involved the region of the upper left second premolar, corroborating Park et al, who state that IPL affects maxillary implants more than mandibular, predominantly in the premolar region [16]. The clinical signs associated with the x-ray findings provide information on IPL diagnosis [17]. IPL may be characterised by suppuration, formation of fistulas and loss of alveolar bone, however pain and fistula formation may not always be present [2,5].…”

“…In a literature review, Romanos et al found that out of 32 reported cases of IPL, apicoectomy of the implant was carried out in 3 cases to gain access to the walls of the defect and allow complete debridement [19]; however in one of those cases the implant failed after apicoectomy. Other authors stress the importance of surgical debridement or the removal of sources of infection, including contaminated implants and apical lesions [17,22]. Buhara et al reported two clinical cases of implant failure due to IPL [17]; in both cases they decided to remove the implant and carry out very careful debridement in order to stop the rapid progression of the lesion and prevent damage to vital structures, promoting a definitive cure and resolving the patients' continuous pain.…”

“…Other authors stress the importance of surgical debridement or the removal of sources of infection, including contaminated implants and apical lesions [17,22]. Buhara et al reported two clinical cases of implant failure due to IPL [17]; in both cases they decided to remove the implant and carry out very careful debridement in order to stop the rapid progression of the lesion and prevent damage to vital structures, promoting a definitive cure and resolving the patients' continuous pain. It is important to treat the lesion before it extends to coronal, since once it reaches the part of the implant with the internal screw thread; apicoectomy of the implant is no longer possible since there may be a channel providing communication between the oral cavity and the bone, which will permit bacterial migration [5].…”

“…Many premature failures can probably be explained by incorrect surgical technique [7]. Careful planning, careful handling of contaminants and the use of irrigation systems during perforation of the bone to avoid overheating during implant installation surgery all help to prevent IPL [1,17,20].…”

A Radiographic Classification for Retrograde Peri-implantitis

“…Twelve of the articles were excluded as they had no IOPAs of the lesion. 7,11,24,25,33,35,[37][38][39]45,48,53 A total of 54 IOPAs from 36 articles were compiled. One periodontist (SR) and one implantologist (TAB) independently analyzed the IOPAs.…”