Selective Explantation in Advanced Peri-Implantitis: Clinical Healing, Exploratory Inflammatory Profiling, and SEM/EDS Analysis of One Retrieved Implant—A Case Report

Abstract

Background: This case report documents selective explantation in advanced peri-implantitis, early clinical healing, and exploratory blood and retrieval observations. Methods: A 71-year-old woman with hypertension had radiographic peri-implant bone defects around six mandibular implants. Implants 35 and 42 had evidence of suppuration, probing depths up to 8 mm, clinical mobility, and bone loss exceeding 66% at one or more surfaces, including full-length mesial defects, and were removed. Treatment combined professional hygiene and mechanical debridement, explantation, curettage, adjunctive Er:YAG irradiation of the post-explantation defect walls, chlorhexidine, systemic amoxicillin, and supportive care. The first blood sample was collected on the day of surgery, 2 weeks after the initial hygiene consultation. A second sample was obtained at 6 weeks, while four implants with radiographic defects remained in situ. Results: Both explantation sites showed uncomplicated soft-tissue healing over 2 months; no osseous healing outcome was assessed. At 4 months, the retained implants showed no bleeding on probing, suppuration, or clinically detectable mobility, without establishing long-term disease control. The blood findings were descriptive observations from one patient and showed no consistent downward inflammatory pattern. Ex vivo scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDS) was performed on implant 35. Conclusions: SEM/EDS analysis of the retrieved implant revealed surface alterations consistent with mechanical wear and localized variations in elemental composition, providing additional insight into the structural and chemical characteristics of an implant affected by advanced peri-implantitis. Blood-derived inflammatory markers may offer complementary information about the patient’s general systemic inflammatory status and contribute to a more comprehensive clinical assessment. However, their specific diagnostic and prognostic value in peri-implantitis remains to be established through larger prospective clinical studies.