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Periapical implantitis (IPL) is an increasingly frequent complication of dental implants. The causes of this condition are not yet entirely clear, although a bacterial component is certainly part of the etiology. In this case series study, two approaches will be described: because of persistent IPL symptoms, a patient had the implant removed and underwent histological analysis after week 6 from implantation. The histomorphometric examination revealed a 35% bone-implant contact area involving the coronal two-thirds of the implant. The apical portion of the fixture on the other hand was affected by an inflammatory process detectable on radiography as a radiolucent area. The presence of a probable root fragment, detectable as an imprecise radiopaque mass in the zone where the implant was later placed, confirms the probable bacterial etiology of this case of IPL. On the other hand, in case number 2, the presence of IPL around the fixture was solved by surgically removing the implant apical third as well as the adjacent tooth apex. It may be concluded from our histological examination that removal of the apical portion of the fixture should be considered an effective treatment for IPL since the remaining implant segment remains optimally osseointegrated and capable of continuing its function as a prosthetic abutment. Careful attention, however, is required at the implantation planning stage to identify in advance any sources of infection in the edentulous area of interest which might compromise the final outcome. [ABSTRACT FROM AUTHOR]

Implant periapical lesion (IPL) is an infectious-inflammatory alteration surrounding an implant apex. It is a multifactorial disease that may ultimately cause implant failure. The diagnosis of IPL is based on examination of clinical manifestations and apical radiolucency. Many etiologies have been attributed to IPL, including preexisting microbial pathology and surgical trauma. Moreover, many systems have been used to classify IPL based on different parameters. To date, non-surgical and surgical treatment, as well as removal of failed implants, have been considered to successfully manage IPL. However, prevention of IPL surpasses all modes of treatment. An increased number of IPL cases are expected as implants have become standard for tooth replacement in dentate arches. Therefore, it is necessary to understand IPL more comprehensively. Herein, an introduction to IPL, including its etiology, diagnosis, classification, treatment, and prevention, has been undertaken. [ABSTRACT FROM AUTHOR]

Background: Retrograde peri-implantitis (RPI) is a pathological entity with an unclear etiology (e.g., overheating during implant insertion, residual infection of the tooth replaced by the implant or the endodontic lesion of neighboring teeth) and an extremely low prevalence and has been scarcely investigated. Therefore, the aim of this cross-sectional survey was to evaluate the knowledge and attitude of Italian implantologists regarding RPI., Methods: An anonymous questionnaire was sent via email to implantologists randomly selected, including a section about demographic information and questions related to RPI origin, radiographic representation, symptoms and treatment options. All questions were multiple answer and close-ended. Binomial logistic regression was performed to investigate the relationship between correct answers and the following independent variables: age, years of experience and number of dental implants placed per year., Results: In total, 475 implantologists completed the questionnaire, with a response rate of 46.3%. Based on the results of the study, incorrect answers were associated with less experienced participants (<80 implants/year) for all questions evaluated, with the exception of treatment strategies. Furthermore, 26.7% of the survey takers did not recognize radiographic representation of RPI and 35.5% picked "implant removal" when asked about treatment modality., Conclusions: The majority of participants were able to recognize symptoms and indicated the probable causes of RPI; however, around 30% of them showed very limited knowledge of available management strategies.