Management of the Implant Periapical Lesion: A Case Report

Management of the Implant Periapical Lesion: A Case Report
March 2003
Oh, Tae-Ju DDS, MS*; Yoon, Joongkyo DDS, PhD**; Wang, Hom-Lay DDS, MSD***
Implant Dentistry: Volume 12(1) March 2003 pp 41-46
Lippincott Williams & Wilkins
*Clinical Assistant Professor, Department of Periodontics/Prevention/Geriatrics, University of Michigan School of Dentistry, Ann Arbor, MI.
**Adjunct Assistant Professor, Department of Oral Medicine, Yonsei University School of Dentistry, Seoul, South Korea; Private Practice, Seoul, South Korea.
***Professor and Director of Graduate Periodontics, Department of Periodontics/Prevention/Geriatrics, University of Michigan School of Dentistry, Ann Arbor, MI.
Reprint requests and correspondence to:
Hom-Lay Wang, DDS, MSD
Department of Periodontics/Prevention/Geriatrics
University of Michigan School of Dentistry
1011 North University Avenue
Ann Arbor, Michigan 48109-1078
Phone: (734) 763-3383
Fax: (734) 936-0374
E-mail: homlay@umich.edu
The authors claim to have no financial interest in any company or any of the products mentioned in this article.
Abstract
The implant periapical lesion (IPL), a possible cause for implant failure, may occur from the presence of pre-existing microbial pathology such as endodontic/periodontal lesions. This case report presents a case history related to IPL, which was caused by a pre-existing endodontic lesion. In addition, other possible causes such as surgical trauma and the management strategies of IPL are suggested. For the treatment of the infected form of IPL, a sequential surgical therapy can be utilized. This includes surgical removal of the implant or implant apical region, thorough debridement of the infected lesion, systemic antibiotics, and/or guided bone regeneration. The implant therapy should be directed to minimize the occurrence or consequences of IPL by careful diagnosis, systematic treatment planning, and appropriate treatment procedures.
Endosseous dental implants have been utilized as a successful treatment modality for the restoration of missing dentition over three decades. A high implant success rate has been reported. 1-3 Nevertheless, a significant number of implant failures have also been reported. 4-6 The etiology and mechanism of implant failure are multifactorial, and the implant periapical lesion (IPL) has been suggested as a possible cause for some implant failures. 7-9
IPL is a periapical lesion of a dental implant often associated with implants that may have been inserted traumatically by bone overheating or excessive tightening the implant during implant surgery, or implants that are located adjacent to a tooth with endodontic/periodontal lesions. 5,7,8,10 Suggested causes of IPL may include the presence of pre-existing microbial pathology, 10-12 surgical trauma, 8 contaminated implants, 12 and fenestrated vestibular bone. 8 The incidence of IPL appears to be somewhat low, as shown in a study where 10 periapically infected implants were found among 3,800 implants examined. 7 However, the increased use of dental implants has resulted in a considerable number of implant periapical lesions, as demonstrated by recent case reports. 6,8,13-16
IPL can be classified into the inactive (non-infected) and infected forms. 7 There is no treatment that is required for the inactive form, but periodic monitoring of the lesion is recommended. For the treatment of the infected form of IPL, surgical approaches have been advocated, including implant removal, resection of infected implant apices, and guided bone regeneration. 5,7,10,17-18 This case report presents, in a chronological manner, a case history of an implant periapical lesion, which was caused by a pre-existing endodontic lesion. In addition, possible causes and management strategies of IPL will be suggested.
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