Inflammatory implant periapical lesion: etiology, diagnosis, and treatment--presentation of 7 cases.

PURPOSE To investigate implant periapical lesions, and to describe their treatment. The hypothesis of this evaluation is that implant periapical lesions are disorders of the area surrounding the apex of a dental implant, and that their etiology can be multifactorial (ie, vascular impairment, vascular ischemia, overheating of bone during drilling, and implant surface contamination). The diagnosis is based on the clinical manifestations and x-ray findings. The x-ray findings usually involve a periapical radiotransparency. MATERIALS AND METHODS Seven patients with implant periapical lesions (3 in the upper jaw, and 4 in the mandible) after implant placement are described. All patients reported pain, and 3 suffered from inflammation. Upon percussion, the 3 nonsubmerged implants produced a dull sound, with no mobility. A panoramic x-ray study showed periapical transparencies around 5 implants, whereas in 1 case, computed tomography showed a maxillary sinus reaction. The diagnosis was acute apical peri-implantitis (nonsuppurative in 2 cases, and suppurative in 5 cases). RESULTS The clinical manifestations did not subside with antibiotics. In all cases, treatment consisted of implant periapical surgery, after which the symptoms disappeared. The radiotransparencies showed progressive resolution. CONCLUSION The possibility of implant periapical lesions must be taken into account. A rapid diagnosis should be established to treat the lesions at an early stage, hence preventing the need for implant extraction.