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Blue Curved Tubes
Advanced Peri-Implantitis Management Using the R-Brush

Case Summary 🔎

Patient Information

  • Patient: 51-year-old male

  • Chief Complaint(C.C): The patient reported discomfort around the left maxillary area.

  • Dental history: Implants placed on #25, #26, and #27


Treatment Plan

  • Branemark-type implants in the left maxillary posterior area presented with advanced peri-implantitis and severe bone loss.

  • A treatment plan was formulated to address the condition using the R-Brush for decontamination and regeneration.


Results

  • Before & After


Products Used

  • A regular size of R-Brush (Neobiotech, Korea) was used to mechanically decontaminate the contaminated rough surface.

Neobiotech's R-Brush

Case Presentation

1️⃣ Pre-Op

  • fig 1. Three Branemark-type external implants were placed in the left maxillary posterior area with a sinus graft.

  • fig 2. 8 years later, advanced chronic peri-implantitis with severe bone loss was identified around the middle implant.


  • fig 3. The 3-unit SCRP (Screw & Cement Retained Prosthesis) was removed through the screw hole. The soft tissue surrounding the bridge looked fine.

  • fig 4. A severe defect was noted: an 8mm vertical defect with no buccal or lingual walls.



❔Key Question:

How can the contaminated rough surface be cleaned and decontaminated mechanically and chemically, and could this enable reosseointegration?

2️⃣ 1st Surgery - Peri-Implantitis Management

  • fig 1. Before using the R-Brush, the original screw from the prosthesis was inserted to a protection cap.

  • fig 2. The protection cap was connected to the screw hole to prevent bristle penetration into the screw hole.


  • fig 3. A regular size of R-Brush was connected to a 1:1 contra-angle handpiece and rotated at approximately 8000 RPM with copious irrigation using water or chlorhexidine solution. Each thread required 30–60 seconds to clean. It took about 5 minutes to clean 8 threads.

  • fig 4. A clean surface resembling machine surface was achieved. The R-Brush effectively eliminated the original contaminated surface and created a new surface.


  • fig 5. An allogenic graft (RegenOss) was used to fill the large defect, with the implant itself serving as a space maintainer.

  • fig 6. A collagen membrane was placed to cover the graft material.

  • fig 7. It was submerged and sutured using Supramid suture material.


  • fig 8. A radiograph taken immediately after surgery

fig 8. A radiograph taken immediately after surgery

3️⃣ 2nd Surgery

  • fig 1. 4 months after 1st surgery, the site was covered with healthy gingiva without showing no signs of inflammation.

  • fig 2. A radiographic taken 4 month after the 1st surgery.

  • fig 3. A remarkable clinical outcome was observed, with full regeneration of hard bone around the previously affected peri-implantitis site.


4️⃣ Final Restoration

  • Buccal view: After the delivery of the definitive restoration, the gingiva appeared healthy.

  • Radiographic View: Periapical radiograph confirmed bone regeneration around the peri-implantitis affected area 4 months post-surgery.


5️⃣ Follow-up

  • 8 months follow-up

  • Periapical radiographs taken during the follow-up showed a stable bone structure around the treated area, indicating successful regeneration.

8 months follow-up periapical radiographs

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