Surgical Procedure: Implantoplasty + Regenerative Treatment (Class Ib)1, 4, 5, 6
Background information
Soft Tissue Management: Collagen Matrix (Class Ib + II)1, 4, 5
PD Dr. Frank Schwarz:
„On the basis of our own clinical studies, peri-implant bone defects may be divided into definable
categories (3). In principle, one can distinguish an intraosseous (class I) from a supraalveolar (class
II) defect component (see Fig 6, s (a)). The appropriate choice of the treatment concept depends
on the appearance (or alternate: occurrence) of each defect component combination. The various
treatment concepts are presented below.“
2. Synopsis: Surgical Treatment of Peri-implantitis3, 7
Fig. 1 Baseline (implant regio 045): Thin
mucosal biotype suppuration / BOP +.
Ia
Ib
Fig. 1 Vestibular dehiscence
Fig. 2 Vestibular dehiscence + semi-circumferential
bone resorption
Fig. 2 Clinical Situation at Baseline:
Probing depth (PD): 6 mm suppuration / bleeding on probing (BOP) +.
Fig. 3 Modified papilla preservation
flap technique to access Class Ib defect configuration.
Fig. 3 Vestibular dehiscence + circumferential bone
resorption
Fig. 6 Geistlich Bio-Gide® application (collagen membrane).
Fig. 7 Clinical Situation at 12 months:
PD: 2 mm suppuration / BOP –.
Ie
Fig. 4 Vestibular and oral dehiscence + circumferential bone resorption
Fig. 5 Circumferential bone resorption
II
Fig. 7 The collagen matrix Geistlich
Mucograft® is placed on top of the collagen membrane Geistlich Bio-Gide®.
Fig. 8 Transmucosal wound healing (periand post-op administration of amoxicillin).
Fig. 9 Undisturbed wound healing at suture removal (10 days).
Fig. 10 Clinical Situation at 4 weeks.
Fig. 11 Clinical Situation at 4 months:
PD: 2mm suppuration / BOP–.
Fig. 12 Clinical Situation at 8 months
clearly indicating a clinically relevant gain
in mucosal thickness.
Fig. 6 Supracrestal exposure of structured implant
parts
Surgical Procedure: Implantoplasty + Regenerative Treatment (Control) (Class Ie + II) 1, 4, 5
2. Therapy: Clinical Procedure
Decontamination
In addition to the mechanical removal
of the biofilm, a decontamination or
conditioning of the exposed implant
surface is necessary to optimise the
removal of bacteria and lipopolysaccharides from the microstructured
implant surface. For this purpose, sterile saline-soaked cotton pellets may
be used to clean the exposed implant
surface. Clinical data support the effectiveness of this procedure. 7
Fig. 6 Collagen matrix Geistlich Mucograft® – to compensate for the thin mucosal biotype.
Fig. 8 Radiographic bone gain at 12
months.
Surgical Procedure: Implantoplasty + Regenerative Treatment (Class Ic)1, 4, 5, 6
Id
Fig. 4 Intrabony defect component (i.e.
class Ib) using Geistlich Bio-Oss® (0.25–1
mm).
Fig. 4 Implantoplasty to smoothen
exposed (i.e. vestibular aspect) implant parts.
Ic
Fig. 5 Augmentation of the defect
component (Class Ib) using Geistlich Bio-Oss® (0.25–1 mm).
Fig. 3 Implantoplasty at the supracrestal
component.
Fig. 5 Geistlich Bio-Gide® application according to the „double-layer“ technique.
Fig. 1 Funnel-form bone loss at implant regio 022.
Fig. 2 Combined Class Ib + II defect configuration.
Implantoplasty
Remodelling of exposed implant parts
by removal of the affected surface
region using diamond abrasives. Depending on the defect component,
this procedure may lead to reduced
bacterial plaque deposits and promote the formation of fibrous connective
ti ssue.7 This procedure is indicated for
supracrestal (class II), and vestibularoral exposed implant regions without
bony support (i.e. class Ia-Id).2, 6
Augmentation + GBR
An augmentation and GBR should
only be carried out in connection with
an intraosseous defect component.
In analogy to systematic periodontal
therapy, regenerative therapy should
be only considered after successful
pre-treatment and when symptoms
associated with acute inflammation
have subsided.
Fig. 1 Patelliform bone loss at implant regio 013.
Fig. 2 Clinical Situation at Baseline:
PD: 6 mm suppuration / BOP +.
Fig. 3 Class Ic defect configuration.
Fig. 4 A minor class Ia defect plus
class Ic component.
Fig. 1 Patelliform + supracrestal bone loss
at implants regio 024 and 025.
Fig. 9 Situation at suture removal
indicating a slight exposure of the
collagen membrane (should be managed by local antiseptic therapy,
i.e. chlorhexidine gel for 10 days).
2
Fig. 6 Class Ic defect component
using Geistlich Bio-Oss® (0.25–1
mm).
Fig. 10 Clinical Situation at 12
months: PD: 2 mm suppuration /
BOP –.
3
Fig. 7 „Double-layer“ membrane
technique at both vestibular and lingual aspects.
Fig. 11 Radiographic bone gain at 6
months.
Fig. 3 Both implants revealed clinical
signs of suppuration.
Fig. 4 Combined Class Ie and Class II defect configurations.
Fig. 5 Implantoplasty to smoothen exposed supracrestal implant parts.
Fig. 5 Implantoplasty to smoothen
exposed implant parts.
Fig. 2 Fistula 025.
Fig. 6 Augmentation of the intrabony
defect component plus contour augmentation.
Fig. 7 „Double-layer“ membrane technique at both vestibular and lingual aspects.
Fig. 8 Transmucosal wound healing (periand post-op administration of amoxicillin).
Fig. 9 Implant 024 – Clinical Situation at
12 months: PD: 2 mm suppuration / BOP–.
Fig. 10 Implant 025 – Clinical Situation at
12 months: PD: 3 mm suppuration / BOP–.
Fig. 11 Radiographic bone gain at 12
months.
Fig. 8 Transmucosal wound healing.
Fig. 12 Radiographic bone gain at 12
months.
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