Immediate Re-Implantation Protocol (iRIP) - Case Report and Proof of Principle.

Abstract

Background: This case highlights a novel approach to managing a failing implant in the maxillary posterior region, emphasizing the simultaneous approach of implant removal, immediate implant placement and bone reconstruction by guided bone regeneration (GBR).

Case presentation: A 39-year-old male presented with a failing implant at position #15 due to peri-implantitis, characterized by bleeding on probing, suppuration, and inflammation, with probing pocket depths (PPD) of up to 9 mm. Radiographic assessment revealed significant periimplant bone loss, with only 4 mm of residual osseointegration. Pre-surgical 3D planning ensured precise implant positioning, avoiding sinus perforation and optimizing stability. During surgery, the failing implant was removed using minimally traumatic techniques, and a new tissue-level implant was immediately placed, achieving a primary stability torque of 27 Ncm. The circumferential bone defect was treated with deproteinized bovine bone mineral combined with hyaluronic acid and covered with a resorbable collagen membrane to initiate bone reconstruction. The implant site was submerged, and healing was uneventful. Three months post- surgery, the implant was uncovered, and a screw-retained monolithic zirconia crown was placed, restoring masticatory function and esthetics. At the 12-months follow-up appointment the patient presented a healthy implant site and no remaining bone defect.

Conclusions: The approach achieved successful osseointegration, significant clinical and radiographic improvements and stability after 12 months. The approach achieved successful osseointegration, significant clinical and radiographic improvements and stability after 12 months. This case highlights the potential of a protocol achieving immediate resolution of peri-implantitis by the use of a new sterile implant.