Regenerative Surgical Management of Retrograde Peri-implantitis: A Clinical Case Letter

Abstract

This letter explores the variety of clinical complications attributed to dental implant placement, while focusing on peri-implantitis and implant periapical lesions. Through the presentation of a clinical case of a 60-year-old healthy male patient receiving an implant in the mandibular right first molar region (#46), this letter explains the occurrence, diagnosis, and management of this case. Despite successful initial placement of a 4.8 × 9 mm Astra EV implant with a primary stability of 25 Ncm and an ISQ of 74, radiographic evaluation at three months revealed a periapical radiolucency with reduced ISQ values, while soft tissues remained healthy and asymptomatic. The case discusses a form of retrograde peri-implantitis, with possible contributing etiological factors including previous remaining infections, overheating during osteotomy preparation, residual infections, bacterial contamination, and other potential local or systemic influences. Subsequently, a surgery involving full-thickness flap elevation, mechanical debridement of granulation tissue, implant surface decontamination using a titanium brush and chlorhexidine irrigation, followed by guided bone regeneration using xenograft particles and a resorbable membrane was performed. Three months after surgery, ISQ values increased to 84, and radiographic evaluation demonstrated absence of the periapical lesion, allowing for successful restoration and long-term stability at one- and two-year follow-ups. These findings highlight the importance of recognizing early signs of peri-implant complications and demonstrate that appropriate surgical intervention and follow-up can preserve implant stability and restore peri-implant bone support.