case_images: PMC6748190_01
case_images: Draining sinus tract over implant-supported restoration.
case_images: CRID2019-7210837.001.jpg
case_images: PMC6748190_01_CRID2019-7210837.001.jpg
case_images: fig1
case_images: A patient presented in 2009 with the main complaint of a fistula and tenderness on chewing and touching of the tissues above the implant restoration (Figure 1).
case_images: PMC6748190_02
case_images: Bleeding on probing.
case_images: CRID2019-7210837.002.jpg
case_images: PMC6748190_02_CRID2019-7210837.002.jpg
case_images: fig2
case_images: Intraoral observation revealed deep pockets up to 8 mm; also, profuse bleeding on probing was recorded (Figure 2).
case_images: PMC6748190_03
case_images: (a, b) Radiographic examination with different positions of the holder.
case_images: CRID2019-7210837.003.jpg
case_images: PMC6748190_03_CRID2019-7210837.003.jpg
case_images: fig3
case_images: No cement remnants could be noticed; also, the bone level of adjacent teeth indicated that the patient is not periodontally involved (Figures 3(a) and 3(b)).
case_images: (a) Undetected cement remnants in peri-implant sulcus; (b) removed cement excess and size of undercut of the restoration.
case_images: CRID2019-7210837.004.jpg
case_images: PMC6748190_03_CRID2019-7210837.004.jpg
case_images: fig4
case_images: Surprisingly, a big piece of cement rest was located in the buccal site of the implant, thus invisible to radiographic examination (Figures 4(a) and 4(b)). An extensive undercut between the cementation line on the standard abutment (lower arrow) and emergence profile of the restoration in the buccal side (upper arrow) was present (Figure 4(b)).
case_images: PMC6748190_04
case_images: (a) Peri-implant sulcus after removal of cement excess, (b) healing abutment connection, and (c) radiographic verification.
case_images: CRID2019-7210837.005.jpg
case_images: PMC6748190_04_CRID2019-7210837.005.jpg
case_images: fig5
case_images: There was a bedsore in peri-implant tissues, where cement remnants were resting (Figure 5(a)). Then, chlorhexidine gel (PerioAid Gel, Dentaid, Barcelona, Spain) was applied on the healing abutment, and it was tightened to the implant (Figures 5(b) and 5(c)).
case_images: PMC6748190_05
case_images: Sinus tract has healed.
case_images: CRID2019-7210837.006.jpg
case_images: PMC6748190_05_CRID2019-7210837.006.jpg
case_images: fig6
case_images: The removed restoration was screwed back to the implant, and occlusal entrance was isolated with polytetrafluorethylene tape and adhesively covered with composite (Figure 6).
case_images: PMC6748190_06
case_images: (a) Reference radiograph in 2009; (b) partial remineralization of the bone defect in 2010; (c) full reestablishment of the bone level in 2012; (d) stable bone after 10 years.
case_images: CRID2019-7210837.007.jpg
case_images: PMC6748190_06_CRID2019-7210837.007.jpg
case_images: fig7
case_images: Radiological examination showed bone remineralization of the previously infected implant (Figure 7(b)). After 2 years, a full regrowth of the crestal bone around the implant was observed (Figure 7(c)). In 2019, 10 years after, a new periapical X-ray reveals stable bone around implant #24 (Figure 7(d)).
case_images: Clinical appearance of implant-supported restoration 10 years after treatment.
case_images: CRID2019-7210837.008.jpg
case_images: PMC6748190_06_CRID2019-7210837.008.jpg
case_images: fig8