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Peri-implantitis in an HIV positive patient

This male patient was referred to the Periodontology department of the Eastman Dental Insitute in London in 2004. I was allocated this case. He was a HIV patient which main complain was bscess in a implant in 26. He received implant therapy in Barcelona in 1995 (see report of the surgeon), nd at that time he was diagnosed with chronic periodontitis. However, he did not receive periodontal therapy and He moved to London looking for a job as nurse. There he was infected with HIV. Thus, this is a case to see the natural progression of peridontitis and peri-implantitis in 8 years follow-up. Moreover in that time without dental care he was a heavy smoker. I treat the patient for periodontitis and peri-implantitis, this one according to the CIST guidelines of Lang (2000). After phase 1 of perio treatment I discussed surgical options for the 26. Explantation of the implant would be risky for an oral-antral communication. Resective surgery would compromise adjacent teeth. I performed GBR procedure with Bio-Oss and Bio-Gide and cleanig the surface with clorhexidine and saline, and US device. The healing was good. HOwever, 6 months after surgical treatment I detected a red lession on the palate, that later was confirmed as a Kaposi´s Sarcoma. then he went for antiretroviral therapy and 2 years later the lession dissappeared. Please, note that 18 months x-ray of the area it looks like radiographically is getting worse, and this was the time when the patient CD4 counts were loww and was under antiretroviral medication. HOwever, 3 years later when the CD4 counts were up there was an improvement in the radiographic status of the implant 26, and the prognosis had been improved. Now I am waiting for the 10 years follow-up x-ray