Apical peri-implantitis: possible predisposing factors, case reports, and surgical treatment suggestions

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.
Purpose: 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.
Materials and 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.