SUCCESSFUL BONE FILL IN LATE PERI-IMPLANT DEFECTS USING GUIDED TISSUEREGENERATION - A SHORT COMMUNICATION

SEVERE LOSS OF PERI-IMPLANT SUPPORTING BONE traditionally leads to the removal of the affected implant, but this may not be necessary in ail cases. This paper presents a novel treatment approach aimed at the su ccessful regeneration of bone lost to peri-implantitis using guided ti ssue regeneration (GTR). Four years after implant placement two patien ts presented with severe peri-implant tissue breakdown. Clinical signs of disease included bleeding on probing, suppuration, increased probe able pocket depth (4 to 9 mm) and a decreased level of clinical attach ment (2 to 10 mm). Radiographic analysis revealed 2.6 to 7.1 mm loss o f supporting bone. Treatment of these lesions included raising flaps, wound debridement, and rinsing with sterile saline and 0.2% chlorhexid ine digluconate. Subsequently, ePTFE membranes were adapted around the necks of the implants and the flaps sutured around the necks of the i mplants, allowing for transmucosal healing. Both patients were placed on a 10-day antibiotic regimen and instructed to rinse twice daily wit h a 0.12% chlorhexidine solution. They were reevaluated every 3 weeks at which time professional plaque control was performed. After 4 1/2 a nd 6 1/2 months, respectively, the membranes required removal due to i nfection. The radiographic analysis 1 year after membrane removal reve aled 1.5 to 3.6 mm of bone gain. As a result of regenerative therapy t he implants in both these patients were successfully maintained. It ca n be concluded that implants with severe loss of bone resulting from p eri-implantitis need not always be extracted. A potential approach for the treatment of peri-implant bone destruction is GTR therapy using s trict attention to good antimicrobial therapy.