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Case study

Loss of a transplant due to alveolitis

29.11.2017
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First peri-implantitis occurs, then alveolitis following explantation. How should this case be treated?

Ass. Prof. Michael Stimmelmayr | Germany

The 28-year-old patient presented during our consultation hours with peri-implantitis in region 12 with a buccal probing depth of 10 mm and, therefore, loss of the buccal bone lamella. After multiple antiseptic rinses and regression of the inflammation from acute to chronic, the implant and the inflamed tissue were removed under antibiotic protection (3000 mg amoxicillin one hour preoperatively).

To prevent a collapse of the soft tissue, the socket was filled with collagen fleece (Lyostypt®, B. Braun) and covered with a combination of epithelialised subepithelial connective tissue graft as specified in socket seal surgery. After three days the wound healing manifested as free of irritation with superficial epithelial exfoliation.

After one week, however, necrosis started to occur, and the transplant was totally lost. There was also alveolitis, which was treated by inserting drain gauze for four weeks. This inflammation was the likely cause for completely losing the transplant. The consequence of the peri-implantitis, the alveolitis and the loss of the transplant was a massive three-dimensional (3D) collapse of the socket.

The following reconstruction of this hard and soft tissue defect was done using bone shield technique (modified F. Khoury-technique) three months later. Five months following the augmentation the implant (Camlog Screwline Promote Plus; Ø 3.8 mm/length 11 mm) was inserted, and to expand volume a subepithelial connective tissue transplant was inserted.

The implant was uncovered after five months of healing using the rolled flap technique. Using the autologous veneer method and connective tissue transplantation, the 3D hard and soft tissue defect was successfully reconstructed. The patient has recently had a therapeutic prosthesis fitted for the purpose of shaping the soft tissue.

Why has this particular treatment been chosen?

In such a complication it is crucial to wait until the tissue has completely healed. The waiting period prior to the second augmentation was three months. In the event of major bone defects the bone shield technique described by Prof. Khoury produces predictable results for 3D alveolar ridge regeneration and, compared to cortical block augmentation, vital regeneration.

 

 

Ass. Prof. Michael Stimmelmayr

Ass. Prof. Michael Stimmelmayr | Germany

Practice for Oral Surgery, Cham
Polyclinic for Dental Prosthetics
Ludwig Maximilian University, Munich

Illustration Header: Alessandro Holler / Quaint

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