Open Flap Debridement and Bone Grafting for Peri-implantitis at #25 and #26
Grafting
Post-Operative Complication Management
Chief Complaint
Patient presents with discomfort and concern over implants at #25 and #26. History of aggressive oral hygiene practices reported.
Clinical Findings
Peri-implantitis around #25 and #26 implants.
Loose soft tissue cuff around #26 due to over-flossing and use of plastic tooth pick.
Food trap noted at #26 (mb).
Deep probing depths at #26 (mb), (m), and #25 (d).
Plaque accumulation on exposed threads of #26.
Bone loss evident in previous CBCT.
Soft tissue inflammation and granulation tissue present around both implants.
Treatment Plan
Open flap debridement and disinfection of implant surfaces at #25 and #26.
Bone grafting with autogenous bone.
Possible second surgery to harvest additional bone from distal buccal ridge of #47.
Pre-operative Assessment
CBCT reviewed, showing bone loss at #25 and #26.
Risks, procedures, and necessity of grafting and bone harvest explained.
Informed consent obtained.
Patient agreed to planned treatment.
Anesthesia
Local infiltration at #25 and #26.
Left Inferior Dental Nerve (IDN), Lingual Nerve (LN), and Long Buccal Nerve (LBN) blocks administered.
Surgical Procedure
Patient cleaned and draped.
Implant crowns at #25 and #26 removed.
Food trap and plaque removed.
Implant abutment sockets disinfected with hydrogen peroxide.
Cover screws placed.
Incisions made, buccal and palatal flaps raised.
Granulation and loose bone tissue curetted and removed.
Exposed threads of implants brushed and disinfected with laser.
Bleeding stimulated.
Bone harvested from distal buccal ridge of #47.
Harvested autogenous bone packed into defects at #25 and #26.
Osteon II collagen capsule (6.0mm x 10.0mm) placed over graft site.
Flaps released and repositioned.
Closure achieved with 4/0 BSS (x6) and 6/0 Surgipro Polypropylene sutures (x9).
Area irrigated with saline.
Hemostasis achieved.
Post-operative CBCT taken.
Post Operation Gallery
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Post-operative Assessment
CBCT reviewed, showing bone loss at #25 and #26.
Risks, procedures, and necessity of grafting and bone harvest explained.
Informed consent obtained.
Patient agreed to planned treatment.