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case_images: Baseline presentation in case 1. (a) Intraoral view of the maxillary left second premolar on the buccal side. (b) Periapical radiograph of maxillary left second premolar. (c) Pretreatment intraoral view of the maxillary left second premolar on the buccal side after removing the superstructure. Bleeding and pus are observed around the maxillary left second premolar implant. (d) Cone-beam computerized tomography (CBCT) image of maxillary left second premolar on the buccal area. Bone resorption defect is noted on the buccal side.
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case_images: Tokyo Medical and Dental University (TMDU) hospital with signs of inflammation around the maxillary left second premolar (Figure 1(a)-(d)). The patient had no smoking history and good general health, with no financial issues or cultural beliefs that prevented her from receiving the reported treatments. Clinical and radiographic examinations revealed bone resorption, which mainly comprised suprabony defect with 7-mm PD and BOP at the mesial-buccal and middle-buccal sites of the implant 25 (Figure 1(b)-(d)).
case_images: Intraoral view of the maxillary left second premolar on the buccal side that received nonsurgical therapy in case 1. (a) Intraoral view of using Er:YAG laser irradiation, on the buccal side. Local anesthesia was administered. An Er:YAG laser device (Erwin AdvErL, J. Morita) with a crystal contact tip (600 mum in diameter, C600 F, J. Morita) was used with the following parameters: 60 mJ/pulse (10.6 J/cm2) and 20 Hz frequency, with water spray. The expected pulse energy at the chip was approximately 30 mJ/pulse. (b) Intraoral view during irrigation with 0.2% BTC on the buccal side.
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case_images: Irrigation was then performed with 0.2% benzethonium chloride (BTC) solution (Neostelin Green, Nippon Shika Yakuhin KK, Shimonoseki, Japan) (Figure 2(a) and (b)).
case_images: Intraoral view of the maxillary left second premolar that received surgical therapy in case 1. (a) Intraoral view of the maxillary left second premolar on the buccal side at 4 months post nonsurgical therapy on the buccal side. The reduction in inflammation was confirmed, and no KM was observed and gingival recession is confirmed. (b) Intraoral view of using Er:YAG laser irradiation for decontamination and degranulation around dental implants on the buccal side. (c) Intraoral view of IP using diamond bur for decontamination of dental implant surface on the buccal side. IP was performed on the exposed thread of implant surfaces at buccal and supracrestal area. (d) Intraoral view of IP using Arkansas bur for decontamination of dental implant surface on the buccal side. (e) Intraoral view immediately after IP on the buccal side. (f) The FGG sutured by periosteal sutures.
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case_images: In addition, the patient complained of mucosal pain during brushing, which we attributed to the lack of KM and VD around the implants (Figure 3(a), Table 1). The removal of granulation tissue and debridement of the contaminated implant surface in the suprabony and infrabony defects were performed with Er:YAG laser irradiation (Figure 3(b)), with the same conditions as mentioned above. The implant threads in the suprabony defect around implant 25 were removed and polished with diamond (144, SHOFU, Kyoto, Japan) and Arkansas bur (FG57, SHOFU, Kyoto, Japan) (Figure 3(c)-3(e)). Akiyama Co., Tokyo, Japan) and a polyglactin absorbable 4-0 simple suture (Vicryl rapide, Johnson & Johnson Medical S.p.A., Rome, Italy) (Figure 3(f)).
case_images: Intraoral view and radiograph of the maxillary left second premolar taken 1-year postsurgical therapy in case 1. (a) Intraoral view of the maxillary left second premolar on the buccal side taken 1-year postresective therapy on the buccal side. (b) Periapical radiograph of the maxillary left second premolar. (c) CBCT of the maxillary left second premolar.
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case_images: The patient followed up every 3 months for oral prophylaxis (Figure 4(a)-(c)).
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case_images: Baseline presentation in case 2. (a) Intraoral view of the maxillary right molar area on the buccal side. (b) Periapical radiograph of maxillary right molar area.
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case_images: A 63-year-old female patient with no significant medical history presented to TMDU hospital with discomfort around her maxillary right molars after brushing (Figure 5(a) and (b)). Clinical and radiographic examinations revealed signs of peri-implantitis with 6 mm PD with BOP and bone resorption, mainly comprising suprabony defects at both implant sites, and pus at the middle-buccal site of implant 15 and at the mesial-buccal site of implant 16 (Figure 5(b)).
case_images: Intraoral view of the maxillary right molar area that received surgical therapy in case 2. (a) Intraoral view of the maxillary right molar area on the buccal side at 1 month after nonsurgical therapy on the buccal side. The continuing inflammation and gingival recession were confirmed. (b) Intraoral view of post-IP on the buccal side. (c) The FGG sutured by periosteal sutures.
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case_images: Tooth 14 was replaced with a temporary crown for periodontal treatment (Figure 6(a)). Thus, the same procedures as in case 1 were performed (Figure 6(b) and (c)).
case_images: Intraoral view and radiograph of the maxillary left molar area taken 1-year postsurgical therapy in case 2. (a) Intraoral view of the maxillary right molar area on the buccal side taken 1-year postresective therapy on the buccal side. (b) Periapical radiograph of the maxillary right molar area.
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case_images: The peri-implant problems were not observed at the 1-year follow-up (Figure 7(a) and (b)).
case_images: Bacterial composition at the phylum level.. The percentage abundance of each phylum is indicated in a line chart for the two cases, divided into healthy implant (HI) and peri-implantitis implant (PI) sites. The chart is independently shown for baseline, 1 month after nonsurgical treatment (only for peri-implantitis sites), and 1-year follow-up after surgery. The lowermost 'Unclassified' is the taxon that is not classifiable at the phylum level but is classified in the domain of bacteria.
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case_images: Nine phyla were assigned, whereas 0.80-4.4% of taxa were unclassifiable at the phylum level (Figure 8).
case_images: Bacterial composition at the genus level.. The percentage abundance of each genus is shown in the same manner as Figure 8. Genera are listed according to their upper rank of phylum. The 'Unclassified' in each phylum is the taxon that is not classifiable at the genus level but is classifiable at a rank higher than genus, in the domain of Bacteria.
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case_images: A total of 69 genera were assigned at the genus level (Figure 9).