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16 published cases · 119 figures, in the order the authors published them. Click any figure to open it full size. Back to the deck in the other tab.

Fernandes 2025

The Novel iMPACT Tool and Quadrant Protocol for Peri-Implantitis: Surface Refinement and Re-Osseointegration Validated by SEM/EDS and Long-Term Clinical Case Reports Medicina 2025 doi:10.3390/medicina61061094

Fernandes et al. 2025. Reproduced under CC BY.

impact tool new treat peri implantitis through
Figure 1(a) iMPACT tool (new tool) to treat peri-implantitis through implantoplasty; (b) pin for connection and stabilization of the tool screwed in the dental implant; (c) (A) the cutting tool’s rotational motion, (B) preparing the area for treatment, (C) springs positioned above the working area, (D) fine-tuning the cutting depth and blade position is achieved using an adjustment nut; (d) detailed illustration showing the iMPACT’s blade in position for a standardized implantoplasty. The iMPACT, featuring the precision cutting blades, was used for simultaneous implantoplasty and controlled bone modification
contaminated implant layer removed meticulously under
Figure 2(a) The contaminated implant’s layer was removed meticulously under controlled con-ditions, with power control and accurate cutting, to achieve a smooth surface. (b) Large titanium particles generated during the process are easily detectable clinically. (c) New implant surface with an area average roughness (Sa) value of ~0.5 µm–binding energy of 459 eV; (d) The restored sur-face exhibits increased hydrophilicity using iMPACT (water drop angle 12.769◦); (e) Compared to traditional methods of implantoplasty (tungsten bur—water drop angle 49.086◦)
applying quadrant protocol impact tool utilized
Figure 3Applying the Quadrant protocol, the iMPACT tool was utilized to treat a case of peri-implantitis. After using iMPACT, the new implant surface was machined to be smooth
sem eds analysis displaying dental implant
Figure 4SEM and EDS analysis displaying the dental implant surface after treatment. The tests were conducted in triplicate
periapical radiographies re osseointegration impact quadrant protocol
Figure 5Periapical radiographies showing the re-osseointegration after using iMPACT and the Quadrant protocol. From the platform to the bone-implant contact (BIC), 9.1 mm was found
initial clinical assessment sites
Figure 6Initial clinical assessment of sites #46 and #47
periapical taken region complaint relevant bone
Figure 7The periapical image taken for #46 and #47 (region of the complaint) shows relevant bone loss around the implants (red arrows showing the bone loss found, considering as reference the implant platform)
initial panoramic radiograph reveals oral rehabilitation
Figure 8The initial panoramic radiograph reveals oral rehabilitation and bone loss in the lower posterior teeth
removing screwed crowns site evaluation
Figure 9Removing the screwed crowns and for the site evaluation
bsf incision raised moved buccal lingual
Figure 10(a) BSF incision; (b) BSF raised; (c) BSF moved from buccal to lingual; (d) BSF raised exposing the implants and local bone
quadrant protocol steps novel impact tool
Figure 11Quadrant protocol’s steps for the novel iMPACT tool application
bone graft allograft xenograft place collagen
Figure 12The bone graft (allograft + xenograft) is in place, and the collagen membrane covers the bone graft for the GBR
interrupted suture bridge reattachment ensuring surgical
Figure 13Interrupted suture and bridge reattachment, ensuring surgical site protection and oc-clusal function
periapical evolution red arrows distance implant
Figure 14Periapical images showing the evolution of the case (red arrows show the distance from the implant platform to the bone—(A) Baseline; (B) After 14 months; (C) After 43 months)
clinical findings months
Figure 15Clinical findings after 43 months
panoramic radiographic cone beam computed tomography cbct
Figure 16Panoramic radiographic view (a) and cone-beam computed tomography (CBCT) (b), revealing bone loss at baseline at tooth #41, respectively, 8.5 mm and 9.0 mm (red arrows)
step by step treatment peri implantitis impact quadrant protocol
Figure 17Step-by-step treatment for peri-implantitis using the iMPACT and Quadrant protocol. (a) Initial clinical evaluation; (b) Removing the abutments for peri-implantitis treatment; (c,d) BSF raised for implant exposition; (e) Insertion of the hinge (pin), which was crewed into the implant; (f) Hinge in position; (g,h) iMPACT adapted to the hinge; (i) iMPACT spinning for implantoplasty; (j) The implant surface was smoothed, and bone around the implant was gently cut (osteotomy); (k) occlusal view showing the osteotomy; (l) implantoplasty finished—implant surface is completely smoothed (machined); (m) Bone graft; (n) Suture and abutments were repositioned
month follow up
Figure 1812-month follow-up (#41)
initial clinical assessment periapical x ray presenting
Figure 19(a) Initial clinical assessment; (b) Periapical X-ray presenting the measurements (red arrows) from the platform to the bone; (c) The panoramic view shows the vertical bone loss found at baseline
fourth quadrant condition fixed prosthesis removal
Figure 20Fourth-quadrant condition after fixed prosthesis removal
bsf performed raised reflected lingual side
Figure 21(a) BSF performed; (b) BSF raised and reflected to the lingual side, exposing the implants
impact tool placed implantoplasty spinning remove
Figure 22(a) iMPACT tool was placed for implantoplasty; (b) iMPACT spinning to remove the contaminated threads, machining the implant surface; (c) Result obtained after treatment
radiographic bone level probing depth comparing
Figure 23Radiographic bone level and probing depth comparing the baseline and 12-month results
clinical follow up months radiographic outcome
Figure 24(a) Clinical follow-up after 12 months; (b) Radiographic outcome after 12 months