In an enlightening session of the "Tell Me More About" series, Isabella Rocchietta, joined by esteemed guests, delved into the intricate decision-making process regarding the treatment of infected implants in the aesthetic zone. This challenging scenario not only tests the clinician's expertise but also poses a significant dilemma for patients who have invested in their dental health both financially and emotionally.
The Critical Challenge of Peri-implantitis The focus of the discussion was on peri-implantitis, a problematic infection that compromises both the aesthetics and functionality of implants. Isabella Rocchietta emphasized the dual challenge it presents: clinically for the dentist and emotionally for the patient. This condition, particularly troubling in the aesthetic area, demands a nuanced approach because it involves not just restoring health but also maintaining or enhancing the visual appearance of the implants.
Expert Insights and Case Studies The session featured Anne-Marie Rose Jansica, a specialist renowned for her research on long-term outcomes of dental implants and the treatment of peri-implantitis. Jansica, also a black belt in karate, brought a disciplined and meticulous approach to her treatment strategies. Alongside her was Rafael Cavalcanti, noted for his expertise in periodontology and an adjunct professor at the University of Catania. Cavalcanti, with a lighter note on his culinary skills, juxtaposed his precise surgical skills with his humorous claim of not being able to fry an egg.
Diverse Treatment Perspectives Two contrasting cases were presented to underscore the complexity of treating infected implants:
Eva's Case: Presented by Anne-Marie, involved an infected implant with significant aesthetic concerns due to a widened crown used to close a diastema. Despite substantial bone loss and infection, the patient opted to keep the implant after being informed of all risks, including potential recurring infections and aesthetic compromises. Laura's Case: Handled by Rafael, involved an aesthetically compromised implant with major bone resorption. Unlike Eva, Laura was determined to restore her aesthetic appearance at any cost, leading to the decision to remove the implant and undergo extensive reconstructive procedures to achieve desirable cosmetic results. Critical Decision-Making Factors The experts highlighted several factors critical to deciding whether to keep or remove an infected implant:
Patient's Aesthetic Expectations: High aesthetic demands often necessitate more aggressive interventions, including implant removal, especially if the implant placement is flawed. Implant Stability and Infection Severity: The extent of bone loss and the stability of the implant play crucial roles in determining whether an implant can be salvaged. Patient's Emotional and Financial Investment: These aspects significantly influence patient decisions and must be carefully considered when formulating treatment plans. Audience Engagement and Professional Insights The session was interactive, with live audience polling on potential treatment options for the presented cases. This engagement helped highlight differing opinions and approaches within the dental community, reflecting the complexity and varied preferences in managing such challenging clinical scenarios.
Conclusion The treatment of infected implants in aesthetic zones remains a highly complex and debated topic within dentistry. It requires a balanced approach that considers clinical evidence, patient preferences, aesthetic outcomes, and long-term functionality. As demonstrated in the session, each case must be evaluated on its unique merits, and treatment plans should be tailored to meet the specific needs and expectations of each patient. This thoughtful discussion underscored the importance of a multidisciplinary approach in achieving optimal outcomes in the treatment of peri-implant diseases.