title: Managing an extreme peri-implantitis.
abstract: OBJECTIVE
  Peri-implantitis leads to gradual peri-implant bone loss. Severe and extreme cases lead to complete implant failure and imply lost implants have to be removed. The aim of the present report is to present a case where an extreme peri-implantitis, causing complete peri-implant bone loss, was managed successfully.
  
  
  METHODS
  A patient already rehabilitated with a prosthesis supported by two implants at positions 3.4 and 3.6 presented with severe peri-implantitis affecting both implants. Initial probing depths were 11 and 9 mm respectively. Implant at position 3.4 showed a bone-implant gap ≥3 mm all around it, but was kept firmly in place by the prosthesis, still supported by the other implant. The patient refused to have her prosthesis removed. In an attempt to save it anyway, after debridement, sandblasting and decontamination of both implant surfaces an enzyme-deantigenic collagenic bone substitute was grafted. Controls followed at 1, 3, 5 and 12 months after surgery.
  
  
  RESULTS
  Radiographic exams showed radio-opacity at the grafted sites to gradually increase over time. Postoperative probing depth gain, 7 and 6 mm respectively at position 3.4 and 3.6 remained unchanged at all follow-up controls. After 12 months the patient is asymptomatic and the failed implant can be considered restored.
  
  
  CONCLUSIONS
  The way we managed this extreme peri-implantitis case has allowed to give clinical success even if, to comply to the patient's will, the best clinical, evidence-based treatment, was not performed. The implant that was otherwise lost was successfully recovered. As an hypothesis, a new osseointegration process could have occurred between the implant and the newly formed bone.
authors.affiliation: DDS, Private Practice, Genoa, Italy - materni@maternipiano.it.
authors.forename: A
authors.initials: A
authors.lastname: Materni
mesh_terms: D000369:Aged, 80 and over; D016301:Alveolar Bone Loss / Q000209:etiology / Q000601:surgery; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001861:Bone Regeneration; D016025:Bone Transplantation; D002710:Chlorhexidine / Q000627:therapeutic use; D003646:Debridement; D019232:Dental Restoration Failure; D005260:Female; D006801:Humans; D009067:Mouthwashes; D016348:Osseointegration; D057873:Peri-Implantitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D010514:Periodontal Pocket / Q000209:etiology; D011859:Radiography; D013524:Surgical Flaps
chemical_list: D009067:Mouthwashes; D019980:Amoxicillin-Potassium Clavulanate Combination; D002710:Chlorhexidine