Modified Immediate Dentoalveolar Restoration (IDR) Technique For Peri-Implantitis Management

A 41-year-old female patient presented with complaints of recurrent fistula formation in the area of a previously placed implant in position 21. Clinical and radiographic evaluation, including cone-beam computed tomography (CBCT), revealed peri-implantitis with significant loss of the buccal bone wall. Given the esthetic demands of the case and the severity of the defect, a modified technique of Immediate Dentoalveolar Restoration (IDR) was selected. The IDR technique involves simultaneous implant placement, bone augmentation, and provisional restoration, ensuring both functional and esthetic rehabilitation. The protocol was modified by incorporating flap elevation in the surgical field. Stage 1: The previously placed implant in position 21 was removed. A new implant was immediately inserted into the site, followed by bone augmentation using the modified IDR technique. A provisional crown was placed to achieve immediate functional and esthetic outcomes. Stage 2: After six months, the provisional restoration was replaced with a definitive prosthesis. Adjacent teeth were restored with ceramic veneers/crowns to further enhance esthetics. The modified IDR technique resulted in successful implant placement in the peri-implantitis-affected site. Postoperative follow-up demonstrated excellent osseointegration, substantial bone regeneration, and soft tissue adaptation. This case highlights the efficacy and efficiency of the modified IDR technique for managing peri-implantitis in the esthetic zone. The combination of immediate implant placement with simultaneous bone augmentation ensured optimal restoration of both function and esthetics. The modification involving flap elevation proved advantageous in managing extensive defects, supporting successful outcomes in challenging clinical scenarios.