Dental implant treatment can be complicated with
infection. A list of possible causes includes overheating during the
osteotomy, bacterial contamination from an adjacent tooth, residual bacteria from the infected tooth that previously occupied the site, bone
microfractures from overloading or loading too soon, and residual space left around the implant after it is seated. Most treatments entail surgical
debridement of the lesion and chemical detoxification of the apical or exposed portion of the implant surface with
citric acid,
tetracycline, or
chlorhexidine gluconate as well as guided tissue regenerative or guided bone regenerative procedures. This article describes the case of an active labiolateral
peri-implantitis from a previous infectious site at tooth 12 in a patient who was a chronic
steroid user. The patient was treated with surgical
debridement and no implant surface detoxification and regenerative procedures with xenograft of
PepGen P-15 and an absorbable
collagen membrane. The patient was advised to discontinue
steroid therapy. This resulted in resolution of the associated signs and symptoms of
infection and new bone formation in the radiograph. The negative effect of
corticosteroids on
calcium metabolism and bone regeneration is discussed. The potential implications of
steroid use for implant dentistry are critically appraised, and guidelines are proposed for pre- and postoperative management that may assist in the successful implant-supported rehabilitation of this patient category.