Implant-related orofacial pain managed with implant apicoectomy: A case report.

[BACKGROUND] In recent years, the use of implants has emerged as a widely accepted method for the replacement of missing teeth. Although rare, chronic pain associated with implant placement has been reported in the literature. Conversely, apicoectomy, the removal of the apical portion has been integrated into the implantology field in cases with retrograde peri-implantitis, allowing for cleaning and reconstructing the affected area without losing the implant. This case report aims to introduce an alternative treatment for managing orofacial pain associated with a buccally positioned implant with its apex outside the bone contour through the technique of apicoectomy.

[METHODS] A 63-year-old Asian female presents with chronic pain localized to the left side of her face, accompanied by nasal discharge and tenderness upon palpation of the surrounding soft tissues of implant #9. The cross-sectional view from cone-beam computed tomography (CBCT) demonstrated that implant #9 was positioned too buccally, leading to insufficient facial bone coverage, with the apex of the implant situated outside of the bone contour. Implant apicoectomy and soft tissue augmentation with connective tissue graft (CTG) was performed.

[RESULTS] Two weeks following the surgical procedure, the patient reported a complete resolution of her chronic orofacial pain and nasal discharge.

[CONCLUSIONS] An apicoectomy approach may be a viable method for addressing an implant without retrograde periimplantitis yet having the apex out of the bone housing. This approach allows for the retention of an implant that is fully integrated within the oral cavity.

[KEY POINTS] Implant apicoectomy may relieve chronic pain when the implant apex extends beyond the bone, offering a conservative alternative to full implant removal. Minimally invasive microsurgery and ultrasound imaging support precise diagnosis, flap design, and soft tissue preservation. This enables targeted access, implant apex removal, and enhanced healing. Tunneling with connective tissue grafting effectively augments peri-implant soft tissue without disrupting the mucosal margin or interdental papilla.

[PLAIN LANGUAGE SUMMARY] Dental implants are a popular solution for replacing missing teeth. While it is uncommon, some patients do experience persistent pain after the placement of an implant. An apicoectomy, which removes the implant's tip, can effectively treat infections localized in the implant's apex, allowing cleaning, and reconstructing the affected area while preserving the implant itself. This case report presents an alternative treatment for orofacial pain caused by a misaligned implant with its apex extending beyond the bone contour, utilizing the apicoectomy technique. A 63-year-old Asian female experienced persistent left-side facial pain, along with nasal discharge and tenderness around her upper left central implant. A 3D X-ray (cone beam computed tomography [CBCT]) revealed improper implant positioning, leading to inadequate bone coverage, with its tip extending outside the bone contour. Implant apicoectomy and soft tissue augmentation with a palate graft was performed. Two weeks post-surgery, the patient reported complete relief from her orofacial pain and nasal discharge. This technique offers a practical option for addressing an implant that is not infected but has its tip outside the bone contour, allowing for the retention of a fully integrated implant in the oral cavity.