Prevalence and treatment of retrograde peri-implantitis: a retrospective cohort study covering a 20-year period

Abstract

Objectives The aims of this retrospective study were to report data on the prevalence of retrograde peri-implantitis (RPI) in a single-center in a 20-year observation period and to evaluate implant survival after surgical treatment. Materials and methods A retrospective cohort study was conducted screening all patients who underwent implant treatment in a private practice. Patients were enrolled if they had one or more implants showing a radiolucency around the implant apex, without implant mobility. Furthermore, clinical symptoms of RPI and days from symptoms’ appearance after implant placement were also collected, as well as periodontal and endodontic status of nearby teeth. All patients were treated with the same surgical approach: antibiotic therapy, mechanical curettage, chemical decontamination and xenograft application. Results Out of the 1749 implants placed, only 6 implants were classified as affected by RPI, with a prevalence of 0.34%. Clinical symptoms of RPI (pain, swelling, dull percussion or fistula presence) varied among patients and were reported after a mean period of 51.83 ± 52.43 days. Conclusions RPI was successfully treated with surgical curettage and bone substitute application and all implants are still in place after a mean follow-up of 8.83 ± 5.34 years. Clinical relevance Bacteria from teeth with failed endodontic treatment or residual lesions might be reactivated by drilling for implant osteotomy, with subsequent colonization of the implant apex and possible failure before prosthetic loading. Therefore, it might be recommended to take a periapical x-ray at implant placement and after 6–8 weeks in order to intercept RPI before prostheses delivery.

Endodontic remnants are found more than other radiopacities in proposed implant sites

“…Socket curettage must be performed if endodontic remnants were present. Periapical X-ray at implant placement was recommended to intercept residual infection [29]. The combination of local and systemic risk factors reveals significantly lower implant survival [30].…”

“…Drilling for implant osteotomy may reactivate bacteria from failed endodontic treatment or residual lesions. Colonization at the implant apex may cause implant failure [29]. Implantologists should examine carefully proposed implant sites for the presence of these radiopaque remnants and consider them during the preparation [32,33].…”

Implant Periapical Lesion: A Narrative Review

“…Bacteria from endodontic-failed tooth or residual lesion might be reactivated by implant site osteotomy and subsequent colonization on implant apex [16,37]. There was a significant difference observed between the presence and absence of IPL in terms of endodontic failure at implant site and/or adjacent location [10].…”

“…Radiolucency surrounding implant apex usually appears between 7 and 16 days after implant placement; however, in some cases, radiolucency has appeared even up to 3 months post-surgery [6,9]. The mean period for the appearance of clinical symptoms of IPL was 51.83 days [16]. Moreover, a mean period of 21.7 days was reported for the diagnosis of early IPL after dental implant placement [14].…”

“…The prevalence of IPL varies from 0.26% to 9.9%, and its incidence may reach 7.8% if adjacent teeth receive endodontic treatment [6,7,9,12,13]. Additionally, recent studies have shown that IPL occurs with a frequency of 0.34-3.8% [14][15][16]. In the maxilla and mandible, the incidence reported were 0.28-5.8% and 0.42-2.7%, respectively [11,14,15].…”