Perigraftitis treatment and histology: A case report.

Abstract

Background: Currently, the two diagnoses of inflammatory peri-implant diseases are peri-implant mucositis and peri-implantitis. The etiology of peri-implant mucositis and peri-implantitis is bacterial colonization of the implant. Thus, removal of the implant should eliminate the infection and allow the inflammation to resolve. However, at least three publications have reported unresolved infection and persistent inflammation following removal of implants diagnosed with peri-implantitis. Perigraftitis is an emerging concept introduced to explain specific biologic complications observed at sites where implants have been placed into grafted bone. Perigraftitis is defined as inflammation induced by bacterial contamination of nonresorbing grafted bone and/or residual graft particulates. Since perigraftitis is an emerging concept reported only in a few publications, the purpose of this paper is to present a case of perigraftitis with treatment and supporting histology.

Methods: A 41-year-old healthy, nonsmoking, Asian female presented with pain and exudate at site #19, which had a history of multiple bone grafts, implant placements and implant removals. The site exhibited mixed density with an overall radiolucency containing a radiopaque mass in the middle and multiple small radiopacities consistent with graft particulates. The site was diagnosed with perigraftitis and surgically accessed. A hard tissue specimen and the surrounding inflammatory tissue were removed and submitted for histology. The site was thoroughly debrided and allowed to heal naturally.

Results: One year postdebridement, an implant was successfully placed and subsequently restored.

Conclusions: Perigraftitis may be resolved simply by removing all grafted bone and surrounding inflammatory tissue and allowing the site to heal naturally.

Key points: Implant failure and persistent infection at a site that had been previously augmented with bone graft material(s) may suggest the presence of perigraftitis. Perigraftitis may be resolved by thoroughly removing all grafted bone, graft materials, and surrounding inflammatory tissue. Once the perigraftitis lesion has been thoroughly debrided, resolution is most predictably obtained by allowing the site to heal naturally, without the addition of biomaterials or biologics.

Plain language summary: A patient had persistent pain and infection at a site in the lower left jaw that has had two bone grafts and two failed implants. The site was diagnosed with perigraftitis-inflammation due to infection of the grafted bone. The site was opened. All the grafted bone, bone graft, and inflammatory tissue were removed. The site was cleaned down to bone and allowed to heal naturally. After 3 weeks, the infection had resolved, and the patient was no longer in pain. After 1 year, a third implant was placed. At the time of implant placement, a gum graft was placed to compensate for jawbone deficiency. After 8 months of healing, the implant was successfully restored with a crown. Perigraftitis may be resolved simply by removing all grafted bone and surrounding inflammatory tissue and allowing the site to heal naturally.