A lesion near the tip of an implant raises a different question from inflammation at the gum margin. The assessment needs to locate the bone change and examine the neighboring natural teeth, rather than assume that every problem beside an implant starts at its crown or abutment.
The term retrograde, or apical, peri-implantitis describes a lesion at the implant apex. It does not identify the cause by itself. A useful referral separates the location of the finding from the explanation proposed for it.
Two reports, different treatment paths
Sarmast and colleagues' 2019 case series described two apical implant lesions associated with necrotic adjacent teeth. Nonsurgical root canal treatment of those teeth was followed by clinical and radiographic resolution of the implant lesions, with follow-ups of 18 months and two years. This supports considering an adjacent endodontic source in selected cases. It does not mean every apical implant lesion can be treated through a neighboring tooth.
In a 2024 report by Oh and Tordik, apical periodontitis of a maxillary central incisor extended toward the apex of a neighboring implant that had functioned for 16 years. Root canal treatment was followed by root end surgery. The authors reported osseous healing around both apices on a two-year postoperative radiograph.
The contrast is the treatment sequence: one report described nonsurgical management, while the other included surgery after root canal treatment. They are clinical accounts rather than a comparison trial. Neither tells another patient which approach they need, and the second case shows why a long-functioning implant should not exclude an adjacent-tooth investigation.
Keep the tooth and implant findings separate
Before a treatment discussion, request a location-based explanation of the images. Where is the lesion relative to the implant apex, the neighboring tooth roots and the crestal bone near the gum? Then ask what the examination established about the tooth's endodontic status. Proximity on an image is evidence to interpret, not proof of a route of infection.
For the implant, the team should explain which findings concern the apical region and which concern the marginal tissues or restoration. A crown that feels stable does not answer every question about the surrounding bone. Conversely, an image showing an apical change does not, on its own, establish the condition of the implant-abutment connection.
The existing guide to bleeding around an implant addresses the marginal examination. That assessment remains useful, but it should not replace investigation of a separately identified apical lesion.
Bring a timeline, not a presumed cause
A short chronological record can help an endodontist and implant clinician discuss the same site. Include the implant placement and restoration dates when known, earlier root canal treatment on adjacent teeth, the first symptoms and the dates of relevant images. Add the actual treatment records rather than reconstructing a missing history from the appearance of a crown.
- Identify each tooth and implant consistently across the referral, photographs and images. Ask the clinic to clarify numbering if records came from different countries.
- Keep the original imaging files and reports with their dates. A screenshot cropped to the dark area can lose useful anatomical context.
- List procedures already performed and whether symptoms or radiographic findings changed afterward. Record an unknown outcome as unknown.
- State the question for the receiving clinician: source assessment, management options or evaluation of healing after a particular intervention.
This is an editorial communication aid, not a diagnostic classification or a treatment protocol. New pain, swelling or drainage warrants dental assessment rather than waiting for a scheduled maintenance visit.
Define what the next review will compare
When treatment is proposed, ask which findings support the suspected source and what would prompt reconsideration. The published cases do not establish a universal need for implant removal, surgery or antibiotics. The clinical decision requires the current examination and the actual site anatomy.
A follow-up plan should identify the clinical and imaging findings being compared with the baseline. If CBCT is considered, the guide to implant-related imaging artifacts explains why visibility and measurement uncertainty deserve a place in that conversation. Retain the resulting report with the original referral so the next review can follow the sequence.
Sources and editorial provenance
Sources checked and article prepared November 4, 2026. The displayed timestamp, 2026-10-29 at 09:15 Europe/Kyiv, is an assigned editorial timestamp. Actual production release provenance is recorded separately. Published clinical experiences belong to the cited authors. Both clinical reports are summarized from their published abstracts. No diagnosis or universal treatment pathway is inferred. This educational article does not replace individual clinical assessment.
First production release recorded: . The date at the top is the editorial date.