Resolution of an active peri-implantitis in a chronic steroid user by bone augmentation with PepGen P-15 and a barrier membrane

Dental implant treatment can be complicated with infection. A list of possible causes includes overheating during the osteotomy, bacterial contamination from an adjacent tooth, residual bacteria from the infected tooth that previously occupied the site, bone microfractures from overloading or loading too soon, and residual space left around the implant after it is seated. Most treatments entail surgical debridement of the lesion and chemical detoxification of the apical or exposed portion of the implant surface with citric acid, tetracycline, or chlorhexidine gluconate as well as guided tissue regenerative or guided bone regenerative procedures. This article describes the case of an active labiolateral peri-implantitis from a previous infectious site at tooth 12 in a patient who was a chronic steroid user. The patient was treated with surgical debridement and no implant surface detoxification and regenerative procedures with xenograft of PepGen P-15 and an absorbable collagen membrane. The patient was advised to discontinue steroid therapy. This resulted in resolution of the associated signs and symptoms of infection and new bone formation in the radiograph. The negative effect of corticosteroids on calcium metabolism and bone regeneration is discussed. The potential implications of steroid use for implant dentistry are critically appraised, and guidelines are proposed for pre- and postoperative management that may assist in the successful implant-supported rehabilitation of this patient category.