What is this about?
- Peri-implantitis treatment in a case with a cement-retained restoration, exhibiting inflammation, deep pockets, and a bone defect.
- Treatment strategy combining GalvoSurge® decontamination system, surgical debridement, and conversion of the prosthesis to a screw-retained crown to prevent cement-related complications.
- Clinical results showing resolution of infection, favorable tissue healing, and stable peri-implant health at follow-up.
Introduction
The following clinical case report describes the successful management of peri-implantitis around a failing implant using GalvoSurge® electrolytic decontamination. This approach allowed for effective infection control, preservation of the implant, and restoration with a screw-retained crown, ensuring long-term peri-implant tissue stability and meeting the patient’s functional expectations.
Initial situation
A 61-year-old female patient presented with a chief complaint of persistent discomfort and pain associated with her implant-supported, cement-retained restoration in the region of tooth 46. The implant had been placed and restored eight years ago. Her main concern was the potential loss of the implant, as she expressed a strong desire to preserve it and find a long-term solution that would prevent similar complications in the future. Her expectations were therefore focused on maintaining implant function, ensuring peri-implant health, and avoiding further disease recurrence. Financially, she was able to undergo regenerative and restorative procedures.
The medical history revealed no systemic risk factors. The patient denied smoking and alcohol consumption. Her dental history was significant for localized periodontitis, stage II, previously treated with scaling and root planing.
On clinical examination, the peri-implant site demonstrated plaque accumulation of approximately 20% and localized inflammation in the affected quadrant. Probing depths around implant 46 ranged between 6 and 7 mm, with bleeding on probing and suppuration. Figure 1 illustrates the pretreatment occlusal view of cement-retained implant restorations in sites 36 and 46.
Clinical and radiographic assessment demonstrated a poorly adapted cemented restoration with a pronounced gap at the abutment–crown interface in site 46. This condition was associated with a moderate peri-implant crater-type bone defect reaching the level of the third implant thread (Figs. 2,3).
The prognosis for the remaining dentition was considered good, with stable periodontal support. Clinical and radiographic evaluation led to the diagnosis of peri-implantitis at 46 associated with a deficiently cemented restoration.
Treatment planning
The treatment plan included the removal of the existing restoration and GalvoSurge® detoxification of the implant surface. After infection control and successful resolution of peri-implant disease, a new screw-retained crown was planned and delivered. The favorable bone defect resolution and new definitive restoration re-established function while minimizing biological risks and ensuring long-term peri-implant tissue stability.
Author’s testimonial
In my experience with this case, GalvoSurge® was essential to control the progression of peri-implantitis. After detoxifying the implant surface and bone grafting, the peri-implant tissues responded positively, and we were able to move forward with confidence in the re-restoration. Implant stability after 12 months in function confirms how valuable this approach has been in maintaining the health of the implant.
Surgical procedure
The existing implant was treated by flap access and guided bone regeneration (GBR). The flap was repositioned and sutured, and postoperative medications for pain and inflammation were prescribed. Follow-up visits were scheduled to monitor wound healing and tissue stability.
The patient was premedicated with acetaminophen/ibuprofen to ensure post-surgical comfort and control of inflammation. Local anesthesia was administered. The restoration was removed through crown preparation to reach the abutment screw, confirming an open, ill-fitting abutment–crown interface with cement voids and biofilm both at the junction and within the implant connection. A full-thickness flap was elevated to provide access to the affected implant site, paying attention to preserving keratinized tissue (Figs. 4,5).
Granulation tissue was meticulously debrided from the circumferential crater-like defect. The flap was extended sufficiently to allow complete visualization of the defect and protect the tissues during implant surface detoxification. The implant collar was noted to be slightly coronal to the interproximal bone crest, limiting the potential for significant bone regeneration. The implant surface was decontaminated using GalvoSurge®, with a two-minute cycle applied to the exposed threads; metal instruments were avoided to prevent interference with current conduction (Figs. 6,7).
GBR was performed, and the flap was repositioned and sutured. Postoperative medications were prescribed to manage pain and inflammation. Follow-up appointments were arranged to monitor healing.
At the 6-month follow-up, the clinical examination showed no signs of inflammation, with resolution of bleeding on probing and suppuration, and probing depths less than 3 mm. (Fig. 8). Radiographically, there was favorable defect resolution, with bone regenerated approximately to the first major thread (Fig. 9).
Prosthetic procedure
The implant was restored with a screw-retained crown, minimizing the risks associated with cement-retained restoration. Occlusion and emergence profile were adjusted to ensure proper function and cleansability.
At the 10-month follow-up, clinical examination confirmed stable peri-implant tissue health, with no signs of inflammation, no bleeding on probing, and minimal probing depths (Figs. 10,11).
Radiographic evaluation demonstrated good, but incomplete, defect resolution, consistent with the slightly supracrestal position of the implant collar relative to the bone height of the adjacent premolar 45 (Figs. 12,13).
Treatment outcomes
The treatment achieved excellent clinical and radiographic outcomes. Peri-implantitis was effectively managed using GalvoSurge® decontamination system, resulting in stable peri-implant tissues and successful restoration with a screw-retained crown. Key outcomes included the absence of bleeding and suppuration on probing, a reduction in probing depth from 7 mm at baseline to less than 3 mm, and radiographic evidence of bone level improvement at the 10-month follow-up.
This case demonstrates that thorough implant decontamination combined with appropriate surgical management can preserve implant health, and restore full function, highlighting the effectiveness of this treatment approach.
Main learnings from this case
- Effective control of peri-implantitis using GalvoSurge® detoxification, leading to stable peri-implant tissues and successful restoration with a screw-retained crown.
- Favorable tissue healing, healthy soft tissue contours, and absence of inflammation or bleeding on probing.
- Thorough detoxification is an essential step in surgical procedures commonly used to manage peri-implantitis, whether they involve debridement, GBR or adjunctive soft tissue procedures.