Integrated Management Of Implant Apical Infection And Adjacent Lesions

Implant apical infections may spread to adjacent teeth, requiring multidisciplinary intervention. This case demonstrates the retention of an infected implant (31) with concurrent periapical lesions in tooth 32 through combined surgical and endodontic approaches. A 55-year-old male developed swelling and purulent discharge at implant 31 three months post-placement using bone condensation (initial bone width <5 mm). CBCT revealed vertical bone loss (>3 mm) at the implant apex, reduced bone density, and periapical radiolucency at tooth 32. Treatment included: Stage 1: Apical flap debridement with EDTA gel biofilm removal, minocycline local delivery, and Bio-Oss/collagen membrane bone regeneration. Stage 2: Microscopic root canal therapy on tooth 32. Successful osseointegration occurred at six months, followed by zirconia crown restoration with light occlusal contact. Key pathological mechanisms: Bidirectional infection: Implant apical pathogens spread via trabecular bone to tooth 32 apex, forming a cross-contamination cycle; Surgical risks: Bone condensation-induced microfractures and thermal injury during osteotomy exacerbated bone resorption and pathogen colonization. Innovative strategies: Targeted apical therapy: Direct debridement of deep implant apicitis using EDTA/minocycline instead of superficial cleaning; Staged bone grafting: Delayed grafting post-infection control minimized graft contamination and addressed bone condensation/thermal damage. This protocol establishes a multidisciplinary framework for managing implant-related apical complications: Dual-pathway infection control (implant debridement and root canal therapy) prevents cross-contamination. Sequential bone grafting minimizes inflammatory interference. Emphasizes preventive measures (low-speed drilling, intermittent irrigation) to avoid thermal damage.