Dentaltown November 2021 - 54

The optimal running time for a complete
biofilm disruption is about three minutes; it
is recommended to take a short break every
60 seconds to prevent overheating of the
cooling liquid. (The temperature was found
to increase by about 10 degrees Celsius after
operating for three consecutive minutes.19
)
Clinical case
A 55-year-old patient with no medical
history was referred for suspected periimplantitis
affecting the implant on #11.
Peri-implant probing and preoperative
periapical X-ray examination confirmed
the diagnosis of peri-implantitis, suggesting
the presence of a large bone defect on the
buccal side (Figs. 4 and 5).
Because of its limited ability to prove
a detailed view of the three-dimensional
anatomical structures, periapical X-ray
examination may not provide full information
about important parameters such
as alveolar bone thickness, anatomy, size,
extension and location of bone defects. To
overcome this limitation, clinicians must
cross-correlate the data from X-ray examination
and peri-implant probing (Fig. 6).
Clinical parameters such as mBI, mPlI,
PD and implant mobility (IM) were registered
at baseline.
After removing both fixed partial prosthesis
and abutments, two cover screws were
placed on implants #11 and #13 to ensure a
spontaneous soft tissue regrowth, allowing
for a submerged surgical procedure (which
is scheduled after two weeks).
Surgery was performed as follows:
Antibiotic prophylaxis with 2 g amoxicillin/
clavulanic acid (Augmentin) one hour
before surgery, and then every 12 hours for
six days. Patient was also advised to rinse
mouth with 0.2% chlorhexidine for two
weeks after surgery. In addition, 100 mg
of nimesulide was administered one hour
before the surgery, then twice a day for
three days.
The surgical area was anesthetized using
40 mg/mL of articaine hydrochloride with
epinephrine 1:100,000.
According to the local anatomy, access
to the peri-implant defect is achieved using
54 NOVEMBER 2021 // dentaltown.com
Fig. 5
Fig. 8
a trapezoidal full-thickness flap delimited by
two slightly divergent vertical incisions; the
crestal incision is always carried out within
the keratinized tissue (Fig. 7).
After flap elevation, a large peri-implant
defect with the presence of nonintegrated
biomaterial granules, perhaps remaining
from a previous surgical procedure, was
detected (Fig. 8). Accurate debridement of
the granules embedded in reactive tissue
was carried out by means of a dedicated
ultrasonic tip (Fig. 9).
Horizontal bone thickness (HBT) and
vertical bone defect (VBD) around the
exposed part of the implant were measured
at the baseline with a periodontal probe,
then the cover screw was removed to decontaminate
both outer and inner surface of
the implant.
Fig. 4
Fig. 7
Fig. 6
Fig. 9

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Dentaltown November 2021

Table of Contents for the Digital Edition of Dentaltown November 2021

Dentaltown November 2021 - Intro
Dentaltown November 2021 - Cover1
Dentaltown November 2021 - Cover2
Dentaltown November 2021 - 1
Dentaltown November 2021 - 2
Dentaltown November 2021 - 3
Dentaltown November 2021 - 4
Dentaltown November 2021 - 5
Dentaltown November 2021 - 6
Dentaltown November 2021 - 7
Dentaltown November 2021 - 8
Dentaltown November 2021 - 9
Dentaltown November 2021 - 10
Dentaltown November 2021 - 11
Dentaltown November 2021 - 12
Dentaltown November 2021 - 13
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Dentaltown November 2021 - 15
Dentaltown November 2021 - 16
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Dentaltown November 2021 - 18
Dentaltown November 2021 - 19
Dentaltown November 2021 - 20
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Dentaltown November 2021 - Cover3
Dentaltown November 2021 - Cover4
Dentaltown November 2021 - Insert1_1
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