Academy of Laser Dentistry

the periimplant soft tissues without
any marginal bone loss. 4 The rate of
occurrence of periimplant mucositis
ranges from 8% to 44%, and the
rate of occurrence of periimplantitis
ranges from 1% to 19%. 4
However, because of the loss of
osseointegration and the exposure of
the roughened implant surface structure,
decontaminating the defected
surface with conventional nonsurgical
treatment options is clinically
difficult. 5 Recent clinical studies of
the use of a soft tissue surgical laser
to decontaminate (i.e., disinfect)
rough implant surfaces, combined
with surgical bone augmentation
maintained by resorbable collagen
membrane, have achieved good
results with long-term success of the
treated implants. 6
The objective of this paper is to
report a case of implant complications
that were treated with
various methods aimed at
enhancing reosseointegration. The
main outcome variables were
reduction in probing depth and
filling of the defect.
C A S E R E P O R T
A 55-year-old woman presented at
the specialty dental clinics of the
School of Dental Medicine at the
State University of New York at
Buffalo with a history of severe
sinusitis in her left maxillary
sinus. Because of the severity of the
infection, teeth #11 through #15
had been extracted at a private
dental office. The patient had also
been treated by an otolaryngologist
(ENT). Nine months postoperatively,
this patient presented at our
clinic with an ill-fitting removable
partial denture. The patient stated
that she would like to have the
missing teeth replaced with teeth
that were fixed in the mouth. She
was informed about possible
complications associated with
implants and about the methods of
treating those complications and
consented to the most appropriate
treatment option.
The treatment plan was initi-
ated with ENT consultation to
verify the elimination of the infection
related to the left maxillary
sinus. The ENT report stated that
no signs or symptoms of infection
existed. Therefore, the dental treatment
plan proceeded: 3 implants
were placed at sites #11, 12, and
14, and a sinus lift via the crestal
approach was performed concurrently
at site #14.
S U R G I C A L T R E AT M E N T
The patient began taking clindamycin
150 mg (four times a day
for 10 days) one day before the
surgical procedure. On the day of
the procedure, the patient’s vital
signs were recorded. After the
administration of local anesthesia
(injection of Xylocaine 2% injection
with 1:100,000 epinephrine), a
papilla-saving crestal incision was
made and a full-thickness flap
C A S E R E P O R T
Figure 1: Hard and soft tissue loss around implants at sites #11, 12, and 14
Figure 1a: Preoperative panoramic view
of the planned sites of future implant
placements at sites #11, 12, and 14
Figure 1b: Periapical radiograph of periimplantitis
and sinus tract associated with
implants at sites #11 and 12 during the
healing period
Figure 1c: Periimplantitis soft tissue loss
and exposure of cover screw of implant
at site #14
Figure 1d: Periimplantitis bone loss associated
with implants at sites #11 and 12
reflected. Osteotomies for the insertion
of implants (4.3 x 13 mm,
NobelReplace , Tapered Groovy,
Nobel Biocare ® USA, Yorba Linda,
Calif., USA) were prepared in an
apicocoronal direction according to
the implant recommendations of
the manufacturer. Three dental
implants were placed in sites #11,
12, and 14. Crestal-approach sinus
elevation was performed at site #14
before the implants were placed.
The prepared site was grafted with
allograft particulate bone substitutes
(alloOss , ACE Surgical
Supply, Brockton, Mass., USA)
mixed with medical-grade calcium
sulfate hemihydrate 7 (DentoGen ® ,
OrthoGen, Springfield, N.J., USA).
Cover screws were placed, and flaps
were secured in a tension-free
manner with 4-0 polytetrafluoro -
ethylene (PTFE) sutures (ACE
Surgical Supply). The patient was
advised to clean the surgical area
gently with a disposable oral swab
(Toothette ® Oral Swab, Sage
Products, Cary, Ill., USA) moistened
with 0.12% chlorhexidine gluconate
four times daily for two weeks.
Kutkut, Andreana, and Al-Sabbagh
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