Therapy of Advanced Periimplantitis - Case Presentation Clinical and Microbial Results after 10 Months

Abstract

Sve više bude postavljenih usadaka neizbježno je da će biti više komplikacija u vezi s takvim terapijskim postupkom. Jedna od komplikacija koju je najteže izliječiti i koja posljedično može dovesti do gubitka usatka jest bakterijski uzrokovan periimplantitis. U ovome prikazu slučaja opisat će se uspješna terapija uznapredovala periimplantitisa. Pacijent u dobi od 58 godina poslan je parodontologu zbog smetnji u usnoj šupljini u obliku neugodna zadaha te gnojenja oko zuba i usadaka. Prigodom parodontološkoga pregleda opaženo je da su oba usatka na mjestima 22 i 25 zahvaćena periimplantatnim mukozitisom te da postoji krvarenje i gnojenje pri sondiranju. Kod usatka u području 25 postojao je i problem potpunoga nedostatka keratinizirane gingive. Na temelju kliničkog i rtg nalaza te pozitivnog mikrobiološog nalaza na parodontopatogene dijagnosticiran je periimplatitis oko oba usatka. Inicijalna parodontološka terapija završena je u četiri posjeta. Pacijent je dobio upute kako da održava oralnu higijenu te je uključena antiseptička terapija, ispiranje klorheksidinom i uporaba klorheksidinskoga gela izravno u džepove oko usadaka. Kako i nakon takve terapije gnojenje nije prestalo, uključena je i antibiotska terapija te ispiranje džepova jodom. Nakon što je infektivni proces uspješno stavljen pod nadzor, u daljnjem terapijskom postupku proveden je parodontološki kirurški zahvat kako bi se oko usatka 25 pokušao ispraviti nedostatak keratinizirane gingive i dobiti nov pričvrstak. Pošto je režanj odignut, površina usatka očišćena je sterilnom vatom natopljenom u klorheksidin, a s nepca je uzet vezivni presadak te je postavljen na kosti i na izložene navoje usatka. Preko presatka postavljen je Gengigel (hijaluronska kiselina) radi boljeg cijeljenja rane. Pet mjeseci nakon operacije ponovljena je mikrobiološka raščlamba te više nije bilo parodontnih patogena, a klinička mjerenja su pokazala da je smanjena dubina sondiranja, da ne postoji krvarenje ili gnojenje i da je nastala zona keratinizirane gingive od 2 mm oko usatka 25.With the ever increasing number of placed implants it is inevitable that the number of complications connected with such therapeutic procedure will also increase. One of the complications which is hardest to treat and which consequently can lead to loss of the implant, is bacterial caused periimplantitis. This case presentation describes the successful therapy of advanced periimplantitis. The male patient, aged 58 years, was referred to the periodontist because of problems in the oral cavity in the form of unpleasant breath and suppuration around the tooth and implant. During the periodontal examination it was observed that both implants on places 22 and 25 were affected by periimplantic mucositis and bleeding and suppuration occurred during probing. With regard to the implant in area 25 the problem of complete loss of keratinised gingiva was also present. On the basis of the clinical and X-ray findings, and positive microbial test for periodontopathogens, periimplantitis was diagnosed around both implants. Initial periodontological therapy was carried out in four visits. The patient received instructions on the maintenance of oral hygiene and antiseptic therapy was included, rinsing with chlorhexidine and application of chlorhexidine gel directly into the pockets around the implants. As after this therapy the suppuration did not stop antibiotic therapy was included, with rinsing of the pockets with iodine. After successful control of the infective process, further therapy involved a periodontological surgical operation in order to correct the loss of keratinised gingiva around implant 25 and to obtain new attachment. After lifting the flap the surface of the implant was cleaned with sterile cotton wool soaked in chlorhexidine, and from the palate a connective transplant was taken and placed on the bone and the exposed thread of the implant. Gengigel (hyaluronic acid) was placed over the transplant for better healing of the wound. Five months after the operation microbial analysis was repeated. Periodontal pathogens were no longer present and clinical measurements showed reduced probing depth, absence of bleeding and suppuration, and the occurrence of zones of keratinised gingiva of 2 mm around implant 25