Endodontic Pathosis Responsible for Peri-Implantitis in Adjacent Implant?
Anon. asks:
There are some opposing views on whether or not an endodontic pathosis on a natural tooth can cause a retrograde peri-implantitis in an adjacent implant. This is controversial because there is little controlled research in this area. I have referenced 3 articles below in which it appears as though an endodontic pathosis was responsible for the peri-implantitis of adjacent implants. I would like to know what is the experience out there in the clinical world. Have any of you seen this? What do you think?
Quirynen M, Vogels R, Alsaadi G, Naert I, Jacobs R, van Steenberghe D. Predisposing conditions for retrograde peri-implantitis. Clin Oral Implants Res. 2005 Oct;16(5):599-608.
Tözüm TF, Sençimen M, Ortakoğlu K, Ozdemir A, Aydin OC, Keleş M. Diagnosis and treatment of a large periapical implant lesion associated with a natural tooth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Jun;101(6):e132-8
Tseng CC, Chen YH, Pang IC, Weber HP. Peri-implant pathology caused by a periapical lesion of an adjacent natural tooth. Int J Oral Maxillofac Implants. 2005 Jul-Aug;20(4):632-5.
10 Comments on Endodontic Pathosis Responsible for Peri-Implantitis in Adjacent Implant?
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Bruce G Knecht
2/12/2008
I hope Dr Robert Miller chimes in on this. He has told me many times that he had a perfectly good implant fail due to an adjacent failing RC. I will leave it at that and hope that he reads this and further edifies you in his past experience.
Dr. Posada
2/12/2008
I've had 2 cases in which implants adjacent teeth with aparently working, not contaminated endodontic treatments, lead to periimplant infection and posterior need of implant removal.
From that cases I learned to be overcautelous in those cases, and in case of any doubt, refer for endodontic retreatment before the implant placement.
Dr. Gerald Rudick
2/13/2008
Anon opens a very interesting discussion about the effect of endodontic pathosis of an existing tooth affecting a healthy implant.
I would like to delve further into this problem, by asking the readers to consider implants being affected by previously existing granulomatous tissue around extracted, and whether these cells can be reactivated (assuming they are lying dormant in the edentulous bone) to affect well placed implants in bone that was meticulously debrided and allowed to heal before the implant placement.
Gerald Rudick dds, Montreal
Thomas B. Dodson, DMD, MP
2/13/2008
Our research group (Center for Applied Clinical Investigation, Massachusetts General Hospital)is presenting a poster at the upcoming AO meeting. The results suggest implants placed in proximity to radiolucent lesions, i.e. at the site of implant insertion or at adjacent sites, are associated with an increased risk of implant failure at one-year after insertion.
In brief, in a sample of 198 subjects having 1144 implants placed, the unadjusted one-surivial rates (Kaplan-Meier estimates) for implants placed in proximity to radiolucent lesions was 86% and for the control implants was 92% (p
L. Scott Brooksby,DDS, DI
2/13/2008
I have lost a number of successfully integrated implants, read in place for several years with no problems to teeth that have abscessed.
Infection next to an implant is disastrous. I have had one case where I did RCT on the infected tooth and an apicoectomy on the implant and it has survived ten years.
mohan
2/13/2008
I had a case of an implant failing due to a failing root canal adjacent to the implant. I sincerely believe that the entire area should be free of any infection.
Robert J. Miller
2/14/2008
We do a fair number of extraction/immediate implant cases. When using a surgical operating microscope we have found that, regardless of how well the RCT appears to be obturated, in 100% of the cases there is a remnant of an apical granuloma. It is not exactly clear why this occurs. Some may be associated with small apical canals that we know exist when looking at resin filled/decalcified teeth. Another possibility is a nidus of vegetative bacteria that are resistant to antibiotics. These vegetative forms may become activated by the release of cytokines post-surgically. I have lost several implants as a result of endodontic lesions adjacent to implants and now look at virtually all RCT's as suspect when performing implant placement in close proximity. Early detection is critical before infection vents up the implant body. Apicoectomy and treament with diode lasers can eliminate this latent threat even in the vegetative state.
Dutchy
2/15/2008
To R.J. Miller,
You talk about using a diode laser to treat the bacteria in vegetative state. Does this means you use it to desinfect your bone during implant placement or with the apicotomy? And should we do an apicoectomy at all teeth with an endodontic treatment next to an implant place even when the endodontic treatment is looking oké? nSo should this be a new standard to avoid a faling implant?
Robert J. Miller
2/15/2008
There may be more than the usual bacterial pathogens present. A new study (Dr. Nordquist, CA)implicates oral spirochetes as the main culprit in peri-implantitis and implant failure. They are often found in a vegetative (spore) state that makes them resistant to antibiotic therapy. Lasers (both Erbium and Diode based) are the only modality that can effectively denature/deproteinate these spores and render them incapable of reproducing. The untreated accessory canals as well as bone intertices can be treated to depth. I would be careful about recommending apicos on teeth adjacent to implants as it is probably not indicated in a majority of cases. However, if a granuloma is visualized radiographically in an area adjacent to a planned implant site, I would certainly consider doing a prophylactic apico in those cases since you will be doing surgery in the area anyway. While I would not consider this to currently be the standard of care in these cases, those of us who use these instruments have seen our complication rates from endodontic pathosis almost disappear. RJM
berto
2/20/2008
It has been occured with me twice.
