A case report about the reconstruction procedures of the previously failed cylinderical implants site using distraction osteogenesis

Abstract

We report the eventually successful treatment of a huge bone defect and peri-implantitis following reconstruction of a previously failed intra-mobile cylinder implant system (IMZ) implant site using distraction osteogenesis (DO). In the anterior mandible, two IMZ implants failed and surgical debridement was performed in accordance to the patient's needs. Thereafter, mobility and suppuration were decreased and the patient visited the dental clinic on a regular basis for oral health maintenance. However, the inflammation did not resolve, and the bone destruction around the implants progressed for 4 years. Finally, the implants failed and a severe bone defect remained after implant removal. To reconstruct the bone defects, we attempted bone graft procedures. Titanium mesh was unsuccessfully used to obtain bone volume regeneration. However, DO subsequently was used to obtain sufficient bone volume for implant placement. The new implants were then installed, followed by prosthetic procedures. In conclusion, progression of peri-implantitis could not be arrested despite surgical intervention and repeated maintenance care for 3 years. Reconstruction of the peri-implantitis site was complicated due to its horizontal and vertical bone defects. Lesions caused by implant failure require an aggressive regenerative strategy, such as DO. DO was successful in reconstruction of a peri-implantitis site that was complicated due to horizontal and vertical bone defects.

Keywords: Distraction osteogenesis; Implant; Peri-implantitis.

Fig. 1. Panorama, periapical X-ray and clinical views. A. Initial visit. B. Four years after the initial visit. C. Before periodontal surgery. D. Two years after periodontal surgery. E. Before implant removal. F. Three months after bone grafting. G, H. Before distraction osteogenesis procedure. I, J. Computed tomographic views.

Fig. 2. Clinical views and periapical X-ray. A. Measurement of vertical defect before the distraction osteogenesis (DO) procedure. B. Incision. C. Exposed osteotomy site. D. A trapezoidal osteotomy was made on the anterior mandible site. E. Distractors were applied on the transport and basal segments with microplates and screws. The transport segment was placed on the most basal portion. F. Suture. G. Ten days after DO. H. Twenty-one days after DO. Screw loosening and plate exposure occurred on the left side of the transport segment in this period.

Fig. 3. Clinical views and periapical X-ray. A, B. Incision and flap reflection. C. Implant placement. D. Bone grafting. E, F. Suture. G. After implant insertion. H. Final prosthetic restoration after 6 months.