title: Apical peri-implantitis: possible predisposing factors, case reports, and surgical treatment suggestions.
abstract: BACKGROUND
  Apical peri-implantitis is often diagnosed by clinical findings such as pain, redness, tenderness, swelling, and sometimes the presence of a fistulous tract. There are few theories about how such a lesion occurs. Hence, the current clinical treatment protocols are scanty.
  
  
  OBJECTIVE
  The aim of this report was to evaluate and confer a more extended surgical protocol and to discuss possible predisposing factors for the development of retrograde peri-implantitis.
  
  
  METHODS
  Two patients were extensively evaluated with regard to clinical signs, implant treatment, postoperative complications, and surgical treatment. The surgical protocol comprised debridement, with the additional removal of the apical portion of the affected implant. Postoperative checkup included clinical examination and radiographs. The follow-up period ranged from 1 to 3 years following surgical debridement. The possible predisposing factors are also discussed in the article.
  
  
  RESULTS
  Both cases healed uneventfully with no further symptoms. Radiographs revealed complete bone fill into the resected area and continuous stable bone levels around the previously affected implants.
  
  
  CONCLUSIONS
  It is concluded that recommendations for treatment of apical peri-implantitis are still minimal. In the present study, a surgical approach with resection of the apical portion of the affected implants in combination with debridement is suggested. Our experience was that partially resected oral implants remain osseointegrated and also function well clinically with a follow-up period up to 3 years.
authors.affiliation: Department ENT & Oral and Maxillofacial Surgery, NAL Medical Centre Hospital, Trollhättan 461 85, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Dahlin
authors.forename: Hossein
authors.initials: H
authors.lastname: Nikfarid
authors.forename: Bengt
authors.initials: B
authors.lastname: Alsén
authors.forename: Hossein
authors.initials: H
authors.lastname: Kashani
mesh_terms: D000328:Adult; D001861:Bone Regeneration; D003646:Debridement; D003758:Dental Implantation, Endosseous / Q000009:adverse effects; D019250:Dental Implants, Single-Tooth / Q000009:adverse effects*; D019232:Dental Restoration Failure; D006801:Humans; D008297:Male; D010485:Periapical Periodontitis / Q000209:etiology* / Q000601:surgery*; D012307:Risk Factors; D055815:Young Adult