Surgical Management of a Severe Early Implant Complication: A 19-Year Follow-Up Case Report

Introduction: Reports on long-term response to treatment of different implant complications with a span of more than 15 years are scarce. This case report presents a patient with early severe bone loss around an unloaded dental implant, with treatment and 19-year follow up.

Case presentation: A 60-year-old male non-smoker with no known systemic contributory history presented for replacement of the mandibular right first molar. The tooth was replaced with a titanium plasma-sprayed (TPS) implant using a non-submerged healing approach. Eight weeks post-surgery the patient reported discomfort in the area, followed by swelling, suppuration, and deep probing depths (PDs). A full-thickness flap revealed a bone defect that was thoroughly debrided until its deepest extension. The implant surface was scaled and subjected to air-powder treatment, followed by rubbing the TPS surface with a cotton pellet soaked in HCl-tetracycline. Guided bone regeneration was accomplished with use of an allograft followed by placement of a non-resorbable membrane. Follow-up after 19 years showed stability of the bone gain and reduction of PDs.

Conclusion: The 19-year successful long-term result calls attention to the potential benefit of the combined anti-infective/regenerative approach and lasting effects of surgical management of early implant complications.