Academy of Laser Dentistry

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
272
C A S E R E P O R T
Fourteen days postoperatively,
at the time of suture removal, the
patient reported swelling and
tenderness at the surgical site. The
sutures were removed, and the site
was irrigated with saline. The
patient was advised to continue
cleaning the surgical area as
described above for 2 additional
weeks and to continue taking clindamycin
at the same dosage for
another 10 days.
At the 1-month follow-up evaluation,
the patient reported the
presence of a fistula related to the
implants at sites #11 and 12.
Severe bone loss was detected
around the implants at sites #11,
12, and 14; the pocket depths
varied from 6 to 8 mm (Figure 1).
Tooth #10 was vital, as confirmed
by a positive response to the electrical
pulp test. This recurrent
infection may have been associated
with the previously existing infection
in the left sinus area or in the
recently extracted infected teeth.
Preoperative radiographs from the
private dental office were not available
before the implant procedure
was performed. Retreatment at the
surgical site was planned for 2
months after placement of the
implants.
S U R G I C A L R E E N T RY
T R E AT M E N T A N D
L A S E R I M P L A N T
D E C O N TA M I N AT I O N
The patient began taking clindamycin
(150 mg four times daily)
one day before the surgery. The
patient’s vital signs were recorded.
After the administration of appropriate
local anesthetics, a
crestopalatal incision was made
over the implant area at sites #11
through 14, and a full-thickness
flap was reflected at the buccal side
to access the periimplant defect at
the location of the bone loss. All
granulation tissue in the defected
area was removed with hand
instruments. The threads were
carefully cleaned of the infected
tissue, and the exposed implant
Kutkut, Andreana, and Al-Sabbagh
Figure 2: Periimplantitis treatment
Figure 2a: Diode laser set in continuous
mode, 1.0 Watt in constant movement,
with a noninitiated tip approximately 5
mm away from the implant to decontaminate
the surfaces
Figure 2b: Tetracycline treatment paste
(250 mg in 2 ml sterile water) applied to
and left on the titanium surfaces for
approximately 2 minutes
surfaces were treated with an 810nm
diode laser (Odyssey ® 2.4G
Diode Laser, Ivoclar Vivadent,
Amherst, N.Y., USA), set in continuous
mode at 1.0 Watt, with a
400-micron diameter fiber and a
noninitiated tip used approximately
5 mm away from the
implant surfaces, with constant
movement. The total duration of
laser decontamination was approximately
4 minutes. Subsequently, a
tetracycline paste (250 mg in 2 ml
sterile water) was applied to the
titanium surfaces and left in place
for approximately 2 minutes; the
surfaces were then rinsed profusely
with sterile saline solution (Baxter
Healthcare, Deerfield, Ill., USA).
The defected surfaces were further
irrigated with an aqueous solution
Figure 2c: Bone graft. An allograft particulate
bone substitute, mixed with
medical-grade calcium sulfate hemihydrate,
placed in the defected areas
Figure 2d: Tension-free interrupted
nonresorbable sutures placed
of iodine and then irrigated with
saline. Tooth #10 was extracted
because of periodontal involvement
with grade C mobility. An allograft
of particulate bone substitute
(alloOss) was mixed with medicalgrade
calcium sulfate hemihydrate
and placed in the defected areas.
The grafted area was covered by a
resorbable collagen membrane
(conFORM ® , ACE Surgical Supply),
which was trimmed to cover the
defect completely. The flap was
sutured with nonresorbable sutures
(Cytoplast ® PTFE, Osteogenics
Biomedical, Lubbock, Texas, USA).
Submerged healing was allowed for
2 months (Figure 2).
Postoperatively, the patient was
advised to clean the surgical site as
described above twice daily for 2
weeks. For the first 3 days, the
patient took an antiinflammatory
drug (ibuprofen, 600 mg every 6
hours). The sutures were removed
after 14 days. Clinically, fixture