tetracycline and Periapical-Diseases

Six dental implants in six patients with periapical lesions were inserted and underwent trepanation and thorough curettage. During surgery, the lesion area was irrigated with copious natural saline and chlorhexidine and the bone defects were treated with tetracycline paste. The six implants were stable and asymptomatic postoperatively. The implants were loaded after 3 months. Radiologically, the radiolucency in the apical part disappeared gradually. These prostheses have functioned satisfactorily with no further complication during the follow-up period. For cases in which small lesions initially appear soon after implant placement, trepanation and curettage of the periapical lesion without resection of the apical part of the implant or bone substitute material and/or autogenous bone grafting is an effective management option. A rapid and exact diagnosis is important for treating implant periapical lesions.

Topics: Acute Disease; Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Curettage; Dental Implant-Abutment Design; Dental Implants; Dental Prosthesis, Implant-Supported; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osseointegration; Osteotomy; Periapical Diseases; Tetracycline; Therapeutic Irrigation

Fracture of root tips in the maxillary premolar region is not an uncommon finding because of the high incidence of bifid and root dilacerations. Therefore, a retained root tip may serve as a nidus of infection when a dental implant is placed. The likely result is the development of an implant periapical lesion. This case report shows the successful management of a rapidly developing implant periapical lesion caused by an undetected retained root tip. Initially, systemic antibiotics failed to subdue the infection. A retained root fragment was retrieved surgically, together with the implant, and a new wide-body implant was engaged with DFDBA mixed with tetracycline. A 5-month follow-up showed increased radiographic density, and clinical reentry revealed the formation of bone with a hard consistency. The second case demonstrates the management of a retained root tip via a guided bone regeneration technique when it is detected prior to or during implant placement. Finally, a systematic therapeutic approach is proposed based on 17 case reports on implant periapical lesion management.

Topics: Aged; Anti-Bacterial Agents; Bone Regeneration; Bone Transplantation; Dental Fistula; Dental Implants; Follow-Up Studies; Guided Tissue Regeneration; Humans; Male; Middle Aged; Osteolysis; Periapical Diseases; Tetracycline; Tooth Fractures; Tooth Root