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Implants · patient case question

What is the first step in managing this patient's peri-implant inflammation?

Patient case: Implant Maintenance Problems

demo: 57-year-old female

chief: “The gums around my implants bleed and food gets stuck underneath.”

history: Edentulous maxilla restored with an implant-supported fixed prosthesis 3 years ago. Former smoker.

meds: None

findings: Bleeding on probing and erythema of the peri-implant mucosa at three sites. Radiographs show no bone loss beyond the initial remodeling. The intaglio of the prosthesis is concave, with food packing at the tissue interface.

  1. Mechanical debridement with irrigation using chlorhexidine
  2. Systemic metronidazole for 10 days
  3. Surgical flap access with implantoplasty
  4. Explantation of the affected implants
Show answer and explanation

Correct answer: A. Mechanical debridement with irrigation using chlorhexidine

  • A. Correct. Peri-implant mucositis is reversible. Non-surgical debridement with chlorhexidine irrigation plus reinforcement of home care is the appropriate first intervention.
  • B. Systemic antibiotics are an adjunct at most; they do not remove the biofilm.
  • C. Surgical intervention is escalated to only when bone loss has occurred and non-surgical measures fail.
  • D. Explantation for a reversible soft tissue condition would be indefensible.

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