General information
3. Surgical technique
Dr Jean-Louis Giovannoli :
“In the scope of conservative treatment of periimplantitis, surgical intervention can be indicated,
combining the use of a bone substitute and a resorbable membrane, based on the concept of
Guided Bone Regeneration (GBR).
For this, it is necessary in a first session to bring the infection under control by applying all the
standard anti-infectious means used for periodontal decontamination. When the inflammatory
state of the superficial soft tissues is satisfactory, surgical intervention is possible, provided that
the morphology of the bone defect is favourable, and above all, that the mucosal situation allows
the membrane to be completely concealed during the entire tissue maturing phase. To achieve
this, it is absolutely necessary that a substantial height of keratinised mucosa is available.
In the following clinical case presented, two mandibular implants that had been in place for almost ten
years showed clinical and radiological signs characteristic for periimplantitis complicated by mucosal
recession.
This case illustrates the possibility of adapting the mucosal conditions by applying a free gingival
graft in a first surgical session and then treating the lesion in a second surgical session, observing the
technical principles of Guided Bone Regeneration.”
Fig. 2 Clinical situation 2 weeks after supra ingival
g
decontamination (removal of dental calculus, plaque
control).
Fig. 3 Removal of the prostheses reveals a substantial loss of periimplant supportive tissue.
Fig. 16 The peroxide solution is left in place for
several minutes.
Fig. 17 Placement of Geistlich Bio-Oss® which was
first impregnated with physiological serum, avoiding
excessive compaction.
Fig. 18a Perforation of the Geistlich Bio-Gide®
membrane using a rubber dam punch.
Fig. 4 Initial radiograph showing a crater-shaped
lesion at the implant in region 41. The miniature screw
is from a previous orthognatic surgery, 10 years prior.
Fig. 5 Free gingival graft taken from the palate.
View of the receiving site. The split-thickness flap
relieves tension and adhesions.
Fig. 6 The graft is placed and sutured to the site (6.0
resorbable thread) distally and mesially.
Fig. 18b Preparation of the mini-nails for fixation
and use of the nail holder.
Fig. 19 The Geistlich Bio-Gide® membrane is placed
in form of a “poncho” across the implants and is
stabilised using 2 mini-nails.
Fig. 20 The resorbable collagen membrane used has
low rigidity. In this case, its primary purpose is to
keep the bone substitute material in place.
Fig. 7 Healing of the wound 2 mont