A patient already rehabilitated with an implant/tooth-supported bridge presented with severe bleeding on probing and vertical bone loss. After periodontal/peri-implant probing and intraoral X-ray evaluation, a peri-implantitis was diagnosed. A treatment plan was carried out, calling for the extraction of an adjacent lost element, soft tissue healing, fixture decontamination and vertical GBR. Controls followed at 1, 8 and 12 months after regenerative surgery. At 8 months a second implant was placed and the patient definitively rehabilitated.
Radiographic exams at 8 and 12 months showed radio-opacity at the grafted sites to gradually increase over time and bone levels preservation. The regenerated bone allowed for the successful insertion and osseointegration of the second implant.
When vertical GBR is performed according to a strict, detailed protocol it can be successfully applied to manage also bone loss due to peri-implantitis. Using an equine enzyme-deantigenic bone graft may be helpful in achieving the formation of proper newly-formed bone that could allow fixture osseointegration. Its association with resorbable collagen membranes spares the patient a second surgery. Further studies should be performed to investigate the association of these two biomaterials in the management of vertical bone loss due to peri-implantitis according to GBR principles.
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