Reconstructive Approach for Treatment of Retrograde Peri-implantitis in Mandibular Canine Region
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Retrograde peri-implantitis (RPI) is a localized inflammatory lesion around the apex of a dental implant, typically occurring shortly after implant placement or prosthetic loading. This report describes the clinical management of RPI in a 62-year-old female patient who presented with tenderness and a sinus tract in the mandibular canine region. Radiographic examination confirmed a periapical radiolucency around implant #43, with intact crestal bone. A reconstructive approach was employed through a buccal window following flap elevation. Granulation tissue was removed, and implant surface decontamination was performed using a titanium brush and adjunctive tetracycline hydrochloride scrubbing. The defect was grafted with deproteinized porcine bone mineral and covered with a collagen membrane. Healing progressed favorably, with symptom resolution and radiographic bone fill observed at the 1.5-year follow-up. This case demonstrated that, when appropriate defect morphology and surgical access are present, RPI can be effectively treated using a reconstructive approach. Preoperative cone-beam computed tomography is essential to assess accessibility, and regular periapical monitoring is advised for patients with prior endodontic pathology to enable early diagnosis and intervention.
Abstract
Retrograde peri-implantitis (RPI) is a localized inflammatory lesion around the apex of a dental implant, typically occurring shortly after implant placement or prosthetic loading. This report describes the clinical management of RPI in a 62-year-old female patient who presented with tenderness and a sinus tract in the mandibular canine region. Radiographic examination confirmed a periapical radiolucency around implant #43, with intact crestal bone. A reconstructive approach was employed through a buccal window following flap elevation. Granulation tissue was removed, and implant surface decontamination was performed using a titanium brush and adjunctive tetracycline hydrochloride scrubbing. The defect was grafted with deproteinized porcine bone mineral and covered with a collagen membrane. Healing progressed favorably, with symptom resolution and radiographic bone fill observed at the 1.5-year follow-up. This case demonstrated that, when appropriate defect morphology and surgical access are present, RPI can be effectively treated using a reconstructive approach. Preoperative cone-beam computed tomography is essential to assess accessibility, and regular periapical monitoring is advised for patients with prior endodontic pathology to enable early diagnosis and intervention.