Journal of Oral Implantology June 2014 - (Page 325)

CASE REPORT Active Implant Periapical Lesions Leading to Implant Failure: Two Case Reports Oguz Buhara, DDS ˘ Lokman Onur Uyanık, DDS, PhD* Aysa Ayalı, DDS Melek Aydın, DDS Implant periapical lesion (IPL), an inflammatory lesion surrounding the apex of a dental implant, has been previously reported as a possible cause for implant failure. This article describes 2 successive cases of active IPL that were diagnosed early by clinical signs and radiologic findings. Lesions were treated surgically with implant removal and debridement. The etiology, findings, and treatment approaches for IPL are discussed in comparison with other reports. Key Words: implant periapical lesion, implant failure INTRODUCTION I mplant periapical lesion (IPL) has been described as an inflammatory lesion involving the apical portion of a dental implant.1,2 It is also known as apical or retrograde periimplantitis, and it was first introduced by McAllister et al in 1992.3 In addition, IPL has been reported to interfere with the osseointegration process, and progression of the lesion may cause implant failure.4-8 The etiology of IPL has been described as having a multifactorial background. Proposed factors that induce IPL formation include bone overheating, bacterial contamination of the implant surface, presence of preexisting pathology, and poor bone quality.6,9,10 Diagnosis of IPL is based on clinical signs such as pain, tenderness, swelling, and fistulous tract formation; radiographic findings such as periapical radiolucency may also be present.4,5 When the radiographic findings are not associated with clinical symptoms, it is considered to be inactive and no treatment is needed if they remain stable in Department of Oral and Maxillofacial Surgery, School of Dentistry, Near East University, Nicosia, North Cyprus. * Corresponding author, e-mail: lokmanonur@gmail.com DOI: 10.1563/AAID-JOI-D-11-00127 the periodic follow-ups. On the other hand, active infected lesions are expansile and grow by time.1,9 Active lesions are also capable of spreading coronally or laterally, and they are usually accompanied by clinical symptoms.1,4,10 For the treatment of the active IPL, surgical approaches have been suggested, including implant removal, apicoectomy, curettage, and guided tissue regeneration.2,5,7,8 The aim of this article is to describe 2 interesting cases of IPL that occurred successively and that resulted in failure of 4 implants. In addition, possible etiology and treatment options will be discussed. CASE REPORTS Two cases are presented. The patients underwent surgery on consecutive days by different surgeons in the same operating room of Department of Oral and Maxillofacial Surgery. Four 13 3 4.0 mm Astra ¨ Tech implants (Astra Tech Dental, Molndal, Sweden) were placed in the 2 patients. Both patients demonstrated type 2 bone quality. A 2-stage surgical procedure was planned without the use of an interim prosthesis in each case. The implants had never been loaded during the first stage of the treatment. After surgery, both patients were asked to rinse with an antimicrobial mouth rinse. Patients were also prescribed a nonsteroidal anti-inflammaJournal of Oral Implantology 325

Table of Contents for the Digital Edition of Journal of Oral Implantology June 2014

Controlled Early Inflammation and Bone Healing—Potential New Treatments
Zygomatic Implants: The Impact of Zygoma Bone Support on Biomechanics
A Comparative Study on Microgap of Premade Abutments and Abutments Cast in Base Metal Alloys
Topical Simvastatin Improves the Pro-Angiogenic and Pro-Osteogenic Properties of Bioglass Putty in the Rat Calvaria Critical-Size Model
Assessment of the Correlation Between Insertion Torque and Resonance Frequency Analysis of Implants Placed in Bone Tissue of Different Densities
Benefits of Rehabilitation With Implants in Masticatory Function: Is Patient Perception of Change in Accordance With the Real Improvement?
A Method for Fabrication of Implant-Supported Fixed Partial Dentures
Safe Sinus Lift: Use of Acrylic Stone Trimmer to Avoid Sinus Lining Perforation
The Effects of Sinus Membrane Pathology on Bone Augmentation and Procedural Outcome Using Minimal Invasive Antral Membrane Balloon Elevation
Cellular Responses to Metal Ions Released From Implants
A Two-Stage Surgical Approach to the Treatment of Severe Peri-Implant Defect: A 30-Month Clinical Follow-Up Report
Eight-Year Follow-Up of a Fixed-Detachable Maxillary Prosthesis Utilizing an Attachment System: Clinical Protocol for Individuals With Skeletal Class III Malocclusions
Active Implant Peri-Apical Lesion: A Case Report Treated Via Guided Bone Regeneration With a 5-year Clinical and Radiographic Follow-up
Flapless Implant Placement: A Case Report
Active Implant Periapical Lesions Leading to Implant Failure: Two Case Reports
A Review of Platelet Derived Growth Factor Playing Pivotal Role in Bone Regeneration
LETTER TO THE EDITOR
REVIEW OF CURRENT LITERATURE

Journal of Oral Implantology June 2014