Prosthetic and Surgical Managements of Peri-implantitis at the Flap Reconstruction Site

Patient: A 70-year-old edentulous woman with a flap reconstruction presented Kyushu University Dental Hospital for a masticatory dysfunction because of insufficient retention and stability with her complete denture. She had received 5 implants in the mandible for an implant-supported fixed prosthesis. Although an implant-supported fixed prosthesis could provide improved stability and function, the fixed prosthesis and lack of keratinized mucosa led to the difficulty of cleaning. To improve oral hygiene, an implant-supported overdenture was fabricated after free gingival graft from palate. However, a failure in the graft union and the subgingival plaque resulted in peri-implantitis. The patient received open flap debridement and was treated with antibiotics. Although the patient had used this prosthesis with a slight inflammation for 5 years, a deep pocket was observed around the implant. As a treatment of peri-implantitis, abrasive debridement with beta-TCP was performed. Up to the present, the patient healed uneventfully.Discussion: The implant-supported prosthesis is an alternative to the conventional removable denture and is used to provide predictable retention, stability and function in a flap reconstruction patient. However, we should consider the patient's cleaning ability and the condition of soft tissue around implants.Conclusion: Prosthodontic treatment planning is a complex process that involves various factors such as the surgical factors, occlusion, superstructure and oral hygiene. If we make a plan in the light of these factors, implant-supported prosthesis must offer better function, comfort and predictable result to the patients.