Combined resective–reconstructive and mucogingival management of peri-implantitis with a buccal soft-tissue dehiscence at an anterior implant supporting a full-arch restoration: a 3-year case report

Background. Peri-implantitis combining supracrestal or dehiscence-type bone loss with a buccal mucosal dehiscence presents two simultaneous problems: an infected, supracrestally exposed implant surface, and a soft-tissue phenotype too thin to be maintained by the patient or to mask the underlying titanium. Protocols that address only the osseous component leave the aesthetic and plaque-control problem unresolved. Case presentation. A 60-year-old male patient presented with persistent discomfort at an anterior implant, one of six abutments of a full-arch fixed restoration placed at least 15 years earlier. Examination showed a buccal soft-tissue dehiscence with the polished collar and part of the rough implant surface exposed, a buccal probing depth of 6 mm, bleeding on probing, suppuration, and a keratinised tissue width below 2 mm. Periapical radiography showed no interproximal bone loss; the osseous component of the defect was confined to the buccal aspect, where it is not resolvable on two-dimensional imaging. The diagnosis was peri-implantitis with a concomitant buccal soft-tissue dehiscence. After non-surgical pre-treatment and oral-hygiene instruction, a single-stage combined procedure was performed: partial-thickness flap elevation, removal of infected granulation tissue, implantoplasty of the supracrestally exposed surface with rotary instruments, chemical decontamination with an EDTA gel, grafting of the intraosseous component with a particulate bone xenograft, placement of a subepithelial connective tissue graft harvested from the palate, and closure with a coronally advanced flap. Outcomes. At 3 years the site showed a buccal probing depth of 2 mm, no bleeding on probing, no suppuration, complete coverage of the previously exposed implant surface, and a clinically evident but unquantified increase in mucosal thickness and keratinised tissue width. Patient-reported aesthetic satisfaction rose from 2 to 8 on a 0–10 visual analogue scale. No further surgical intervention was required and the implant remained in function. Conclusions. In this single case, combining implantoplasty of the supracrestal surface, xenograft reconstruction of the intraosseous defect, and soft-tissue phenotype modification with a connective tissue graft and coronally advanced flap in one session achieved disease resolution and coverage of the dehiscence that was stable at 3 years. Single-case outcomes cannot establish efficacy, and the trade-offs of implantoplasty — particle release and reduced implant wall thickness — remain unresolved. Files. Bruschi_peri_implantitis_case_report.pdf — manuscript (13 pages, with Figure 1 and the CARE checklist); Bruschi_peri_implantitis_case_report.docx — editable source of the same text; Bruschi_figure1_source_photographs.zip — the seven unretouched intraoral photographs (panels A–G of Figure 1) at full capture resolution, with a README. The report follows the CARE guideline for case reports. Self-archived manuscript; not peer reviewed.