Patient: 52-year-old female, implants placed 3 years ago, patient was transferred from another clinic. Clinical situation/Diagnosis: a three-unit bridge supported by two implants in the #45 and #47 tooth position, implant #45 has lost two-thirds of its vertical bone support due to advanced and severe peri-implantitis. The infected implant presents a circumferential defect with 3 mm vertical loss of the buccal plate. The patient wants to try and keep her old bridge and implants. Treatment plan: removal of the old bridge over implants #45 and #47, flap opening, removal of granulation tissue, cleaning and detoxification of the implant surface with the GalvoSurge Dental Implant Cleaning System, extraction of tooth #44 with immediate implant placement and immediate loading, followed by the placement of the old bridge, sterilized in the autoclave during the surgery time. Four months later, a final crown will be made on the new implant (#44) Patient follow-up: after surgery, the patient was medicated with Amoxicillin with Clavulanic acid for seven days and ibuprofen 600 mg. After 12 days the sutures were removed, the patient was seen each month for 4 months, and the final prosthesis was placed after 5 months. Surgery date: July 5, 2021 Total treatment time: 5 months with 9 months of follow-up Implant position: 45
Case courtesy of Dr. José Camelo Ferreira.
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Initial clinical situation - Clinical pictures at diagnosis
Screw-retained implant supported 3-unit bridge with the implants in position #45 and #47, unknown implant brand with external hex platform (left).
Removal of the prosthesis prior to the surgery. Suppuration is visible. The bridge was cleaned and sterilized in the autoclave during the surgery time (right).
Initial clinical situation - Radiograph at diagnosis
CBCT scan, 6.9 mm bone loss around implant #45 (left).
6.9 mm bone loss (central).
Severe root decay under the distal part of the metal/ceramic crown causing impactation of food in that zone (right).
Flap elevation and removal of the granulation tissue.
Opening of full thickness flap without releasing incisions, removal of the granulation tissue using a small mold and curette. There was no hard deposit on the implant (left).
Implant after removal of the granulation tissue (right).
Electrolytic cleaning with GalvoSurge.
Decontamination of the implant surface using the GalvoSurge Dental Implant Cleaning System. Cleaning time 2 minutes. ! Metallic instruments should be kept at least 2 cm from the implant being cleaned.
Gas bubbles are forming around the implant. The implant connector is in contact with the implant and completely soaked in liquid throughout the cleaning process. The cleaning solution was continually suctioned away during the procedure. ! The sponge was removed for better visibility.
Before electrolytical cleaning - Implant before cleaning (left).
After electrolytical cleaning - Decontaminated implant surface after two minutes' cleaning with the GalvoSurge Dental Implant Cleaning System (right).
Guided bone regeneration.
Removal of the crown tooth #44 and immediate placement of a new NobelActive® implant (left).
Covering of implants with healing abutments. Bone augmentation with bone cement (right).
Suture and placement of the existing bridge.
Suture without membrane (left).
Removal of the healing abutments (center).
Placement of sterilized old bridge just after surgery, and a temporary crown on the new implant #44 (right).
Initial clinical situation - Swelling of peri-implant soft tissues, bleeding on probing, probing depth of 9mm and suppuration (left).
After 9 months healing time - No swelling of peri-implant soft tissues, no bleeding on probing, decreased probing depth of 3 mm. No more pus discharge (right).
X-ray initial clinical situation. X-ray at diagnosis: Diagnosed peri-implantitis, bone loss 6.9 mm with two-thirds of the implant surface without bone contact (left).
X-ray: after 9 months of healing time. Significant bone gain, bone level stable over 5 months with maintained bone peak on the distal of the #44 immediate implant (right).
Clinical situation 5 months after the surgery.
Removal of temporary crown & placement of NobelProcera® Implant Crown (left).
Clinical Image: 5 months after surgery, healthy peri-implant tissues, no suppuration (right).