I am pleased to share the fifth case in our biweekly clinical series. After exploring the treatment of periodontitis in our previous four cases, we now introduce another important condition: peri-implantitis and its contemporary treatment strategies.

Peri-implantitis is diagnosed based on clinical signs of inflammation and/or suppuration, progressive loss of supporting bone, and increasing probing depths. Treatment of peri-implantitis focuses on thorough bacterial decontamination of the implant surface that is no longer in contact with bone, as well as surgical tissue management aimed either at reconstructing lost bone and/or reducing peri-implant pocket depth.

The present case began with the diagnosis of peri-implantitis at implant #10, which exhibited active suppuration, deep pocketing, and radiographic bone loss. Both the referring doctor and I repeatedly recommended explantation, site development, and implant replacement following completion of orthodontic therapy. However, the patient was adamant in attempting to treat the peri-implantitis.

Implant surface decontamination was performed using titanium brushes, ultrasonic instrumentation, and chlorhexidine. Reconstructive therapy was carried out with a bone allograft, and a connective tissue graft was added to minimize postoperative soft-tissue dehiscence and enhance the horizontal ridge contour.

The referring doctor, the patient, and our team were very pleased with the outcome, which included significant radiographic bone gain and resolution of active disease without notable soft-tissue dehiscence.