Etiology and treatment of periapical lesions around dental implants

Abstract

The widespread use of oral implants in recent years has resulted in various types of complications. One of those complications is the periapical implant lesion. Different factors have been proposed to play a role in the development and emergence of a periapical implant lesion. To date, there is no consensus on the etiology and therefore periapical lesions around dental implants are considered to have a multifactorial etiology. The diagnosis of an implant periapical lesion should be based on both clinical and radiological findings. Additionally, in order to apply the best treatment strategy the evolution of the lesion should be taken into account. The treatment of this kind of lesion, however, is still empiric. Data, primarily from case reports, seem to indicate that the removal of all granulation tissue is a first step to arrest the progression of the bone destruction. The removal of the apical part of the implant seems a valuable treatment strategy.

A Radiographic Classification for Retrograde Peri-implantitis

“…The clinical manifestations of RPI include pain, inflammation, fistula formation, and swelling or in advanced cases implant mobility. 31 The clinical features may not clearly indicate/ corelate with the actual extent of the lesion. Radiographic features include a radiolucency surrounding or including the implant apex with relatively normal marginal bone.…”

“…The clinical features are not definite or omnipresent and vary greatly. 31 Sometimes, the lesion may be asymptomatic. Although radiographic changes may not be present in the acute initial stages, the late and symptomatic stages always demonstrate the presence of an apical radiolucency.…”

“…Radiographic features include a radiolucency surrounding or including the implant apex with relatively normal marginal bone. 31 This article introduces a simple and descriptive classification for RPI. The interprofessional communication can be benefited from such a classification system, which clearly differentiates lesions based on their severity.…”

“…Although radiographic changes may not be present in the acute initial stages, the late and symptomatic stages always demonstrate the presence of an apical radiolucency. 31 Hence, radiographic features were taken as the basis of this classification.…”

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

“…It has been described as a radiolucent lesion involving the apex of the dental implant [6]. The clinical signs of active IPL include intense pain, inflammation, percussion pain and mobility [7][8][9][10]; signs of infection may also be observed, such as the presence a fistula in the soft tissue covering the implant, discomfort in the region of the implant, or the presence of purulent material [11]. Reiser et al classified implant periapical lesions in two groups: inactive form (not infected) and active form (infected) [1].…”