Successful Management of Peri-Implantitis Using a Titanium Brush and a Doxycycline-Saline Slurry for Surface...

The inflammation associated with peri-implantitis lesions can be difficult to manage and regeneration of lost bone is unpredictable. Unfortunately, opinions vary on the best method(s) for elimination of inflammation and restoration of residual osseous defects. This report describes the successful surgical management of a peri-implantitis lesion with reduction of inflammation and maintenance of nearly completely regenerated horizontal and vertical bone over 5 years.

A 55-year-old healthy, non-smoking, African-American female presented in 2013 with inflammation and >25% bone loss at implant site #18. Probing depths ranged from 6 to 13 mm with bleeding on probing (BOP). She was diagnosed with peri-implantitis. She reported a history of routine scaling every 6 months since implant and crown placement 3 years earlier (2010). Initial periodontal treatment consisted of non-surgical scaling and implant debridement. Deep pockets and BOP persisted at re-evaluation. Surgical treatment consisted of full thickness flap, soft tissue curettage with titanium curets, and detoxification of the implant surface with a doxycycline and sterile saline slurry using a titanium brush. Mineralized freeze-dried bone allograft and demineralized freeze-dried bone allograft in a 50:50 ratio was placed and covered with a resorbable collagen membrane. All postoperative visits were uneventful. Maximum probing depths around the treated implant at the 5+-year follow-up (2019) were 4 mm with no BOP and nearly complete bone fill.

This case illustrates that it is possible to successfully eliminate clinical inflammation associated with peri-implantitis, regenerate bone, and maintain health for >5 years.