Implant periapical lesion: diagnosis and treatment

The implant periapical lesion is the infectious-inflammatory process of the tissues surrounding the implant apex. It may be caused by different factors: contamination of the implant surface, overheating of bone during drilling, preparation of a longer implant bed than the implant itself, and pre-existing bone disease. Diagnosis is achieved by studying the presence of symptoms and signs such us pain, swelling, suppuration or fistula; in the radiograph an implant periapical radiolucency may appear. A diagnostic classification is proposed to establish the stage of the lesion, and determine the best treatment option accordingly. The following stages are distinguished: acute apical periimplantitis (non-suppurated and suppurated) and subcacute (or suppurated-fistulized) apical periimplantitis. The most adequate treatment of this pathology in the acute stage and in the subacute stage if there is no loss of implant stability is apical surgery. In the subacute stage, if there is implant mobility, the extraction of the implant is necessary.