Apical/Retrograde Periimplantitis/Implant Periapical Lesion: Etiology, Risk Factors, and Treatment Options

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To review the literature on retrograde periimplantitis symptoms, risk factors, and treatment methods and to propose a decision-making tree of retrograde periimplantitis management.

Materials and Methods:

An electronic literature search was conducted on the MEDLINE and EMBASE databases for articles published between 1990 and 2015. Clinical human studies in the English language were included.


The search resulted in 44 case reports published by 27 authors. The average time of the diagnosis of the pathology was found to be 26.07 weeks after implant placement (SD ± 39.7). Fistula formation was found to be the most common clinical symptom, statistically significantly more often occurring in the maxilla (P = 0.04). A negative correlation was found between pain and the adjacent tooth with incomplete endodontic treatment/endodontic pathology (r = −0.4; P = 0.009) and a positive correlation between the later risk factor and implant removal (r = 0.3; P = 0.028). Regenerative treatment (45.2% of the cases) or implant removal (35.7% of the cases) was the most common treatment techniques used. A decision-making tree of retrograde periimplantitis management is suggested.


The etiology of retrograde periimplantitis is most often infectious. A decision-making tree aimed at managing patients with retrograde periimplantitis according to the possible etiology and symptoms of the disease can be a useful tool in the treatment of the pathology.

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