This case report demonstrates the functional and esthetic reconstruction of a severe bone defect after peri-implantitis and periodontitis in the mandibular.
Introduction: Implant-prosthetic rehabilitation after previous implant loss due to peri-implantitis and periodontitis is considered to be challenging and risky, as the remaining alveolar process defects are often extensive and may also affect neighboring regions. A 68-year-old female patient with advanced peri-implantitis in region 44 and a severely atrophied alveolar ridge in region 32–41 requested a new fixed implant-prosthetic restoration of the lower jaw. The patient had an inconspicuous general medical history and previous periodontitis therapy had been performed. Subsequent to explantation at site 44, pronounced horizontal and vertical defects of the alveolar ridge in region 44 to 46 and in region 32 to 41 were identified both clinically and using 3D radiographic imaging (cone-beam computed tomography, CBCT). Prior to implant planning, the status of peri-implantitis and periodontitis was re-evaluated, as there was a suspicion of residual cement-associated peri-implantitis, which could have resulted in implant loss.
Material and Methods: Two patient-specific allogeneic bone grafts were made using CAD-CAM (maxgraft® bonebuilder, botiss, Zossen, Germany) and were securely introduced for bone defect reconstruction. Despite dehiscence in region 31, both transplants showed revascularization and integration after 6 months. Implant placement ensued in regions 31, 41, 44 and 46. Thereafter, a fixed implant-supported restoration could be successfully applied 3 months later.
Results: This case report demonstrates that satisfactory bone defect reconstruction, meeting both functional and esthetic criteria, is possible even subsequent to peri-implantitis, explantation and rigorous periodontal pretreatment of chronic marginal periodontitis by means of a two-staged surgical approach. A small dehiscence above the allograft did not curtail the overall result of the augmentation. Long-term studies must show the extent to which the augmentation result remains stable.