Management of Apical Bone Loss Around a Mandibular Implant: A Case Report

Various terms, etiologies, and treatment strategies have been suggested in conjunction with bone loss limited only to the apical portion of an implant that remains otherwise well osseointegrated. Proposed etiologic factors include bone overheating, microbial involvement of adjacent teeth, pre-existing bone infection, and overload. However, the mandible and maxilla seem to have different predispositions in response to these causative agents. Treatment protocols for peri-implant infection have included minimally invasive approaches such as granulation tissue removal and detoxification of the implant surface, as well as more aggressive measures. This case report demonstrates the achievement of osseous healing and reosseointegration in a patient who presented with presented apical bone loss and signs of infection around a mandibular implant. Reosseointegration was achieved following an intraoral apicoectomy-like approach, ie, removal of the infected nonintegrated portion of the implant, and meticulous debridement of the granulation tissue. A literature review of 13 relevant published studies was conducted. The current understandings regarding the etiology and treatment strategies for management of apical bone loss around dental implants are summarized and presented. (Case Report) Keywords: apical bone loss, apicoectomy, bone-implant interface, dental implants, implant periapical lesion, osseointegration failure