An Unusual Bone Loss Around Implants
The patient was a 57-year-old man who had lost his teeth because of caries, and had been referred to the dental school of Tehran university to replace them by implants in 2005. He had a history of controlled high blood pressure and controlled diabetes. Clinical examination showed that teeth number 18, 19, 30 and 31 had been lost. A comprehensive treatment plan was given to the patient and he was first referred for endodontic, periodontal and restorative treatment of the remaining teeth, and then for placement of dental implants.\nImplant surgery was preformed under local anesthesia (2% lidocaine, 1:100000 epinephrine). On the right side of the mandible, two Replace Select wide platform implants (10mm × 5mm), were placed in teeth 30 and 31 positions. A 10mm × 4.3mm Replace Select regular platform implant was placed in tooth number 19 position on the left side of the mandible and for position 18, a Replace wide platform implant (10mm × 5mm) was inserted.\nThere were no complications during implant placement. The type of bone in the implant areas was type 1.\nA post-operative antibiotic regime of 500mg amoxicillin was prescribed three times daily for 7 days, 400mg gelofen 4 times a day for 3 days and a chlorhexidine mouth rinse 2 times a day for 14 days was also prescribed for the patient. The sutures were removed 10 days later. After initial healing and taking a panoramic radiograph an appointment was set for the patient for impression taking, but he did not refer until 6 years later, in 2011, to continue the treatment. After clinical examination, the implants on the left mandibular side were healthy, BOP was negative without suppuration, with a pocket depth of 2 to 3 mm and without a radiographic sign of bone loss. However, on the right mandibular side, implants 30 and 31 had 7 to 9 millimeter pockets, respectively and were BOP and suppuration positive. Wide crater-like lesions were seen on radiographic images around both implants (). Scaling was performed and after 2 weeks open flap surgery was carried out in the involved area.. A sulcular incision was made from the distal area to the mesial of tooth number 28 with a #15 blade. A sulcular incision was made from the distal area to the mesial area of tooth number 28 with a #15 blade. All around the implants were debrided. Then the implants were taken out and the remaining sockets were decorticated with a round bur and grafting material was placed (0.5 gr bio-oss large particle) in the area and covered by a membrane (bio guide 25 × 25mm) by a saddle shape technique. The flap was coronally replaced and sealed with a horizontal mattress and figure-c sutures (silk 3-0). After surgery, 500mg amoxicillin three times daily for 7 days and also 400mg gelofen 4 times a day for 3 days and a chlorhexidine mouth rinse 2 times a day for 2 weeks was prescribed.