Management of peri-implantitis with a reconstructive approach: Guided bone regeneration using the open membrane technique: A case study.

Abstract

Background: The restoration of the healthy peri-implant tissue and re-osseointegration represent the goals of reconstructive procedures for treating peri-implantitis. Peri-implant regeneration is a field that requires further optimization to increase predictability. The submerged approach has been shown to yield superior defect fill compared to the non-submerged approach. Nevertheless, primary closure in the submerged approach can result in diminished keratinized tissue. This case study presents an alternative approach to managing advanced peri-implantitis, with the use of open membrane technique.

Methods: A 71-year-old female presented with #30 peri-implantitis, exhibiting 10 mm probing depth, suppuration upon probing, and severe bone loss. The implant prosthesis was removed prior to the surgery to gain access to instrumentation. Subsequent to the debridement of the defect and implant detoxification, a mix of xenograft and enamel matrix derivatives was used to fill the defect. High-density polytetrafluoroethylene membrane was placed over the defect. The flaps were replaced without attempting primary closure, and the membrane was intentionally left exposed.

Results: Disease resolution with significant radiographic bone fill was achieved and remained stable with 20 months follow-up. In addition, keratinized tissue was adequately preserved after surgery.

Conclusion: Reconstructive surgery using the open membrane approach can be an alternative for managing advanced peri-implantitis defects, with the advantages of preserving keratinized tissue and reducing intrasurgical trauma.

Key points: The open membrane technique may serve as a viable alternative to primary closure in guided bone regeneration for peri-implant reconstructive procedures. Advantages include reduced surgical trauma, shorter procedure time, and preservation of keratinized tissue. Careful case selection is essential for achieving predictable outcomes. Factors to consider include defect configuration, the number of remaining bony walls, and the size of the wound opening. In more challenging cases, combination therapy and the adjunctive use of biologics may be considered to enhance regenerative potential and improve clinical results.

Plain language summary: This case study presents the regenerative treatment of chronic inflammation and bone loss around a dental implant using the open membrane technique. To manage the condition, the crown portion of the dental implant was removed, and the implant surface was thoroughly cleaned and disinfected. The space around the implant was then filled with bone graft and biological agents and covered with a membrane. Unlike typical regenerative procedures, the membrane was intentionally left partially exposed rather than being fully covered by the gum during healing. After the procedure, the infection was resolved, and the area remained healthy for up to 20 months. This case suggests that the open membrane technique may be a successful option for treating severe implant infections, especially when the goal is to preserve protective gum tissue.