Dental code cement sepsis and dental code peri-implantitis charges

“Dental code cement sepsis” or “dental code peri-implantitis” are probably one of the search terms that lead you here. If so then you are in the right spot.

What are charges and codes for cement sepsis?

There are two ways you could remove the cement from a dental implant.  One way is to flap the area and fully debride the area.  The other way it to access the screw and remove the crown/abutment as one piece and clean it extra-orally.

If an implant is losing bone and was cemented on the first thing that should come to mind is cement sepsis.  For years the dental industry has sold dental implant cement that was resin.  I think that is the worst choice. It flows like water before set.  Resin cement is radiolucent and is very difficult to remove.  It is almost like the cement was designed to cause cement sepsis.

Dental code for cement removal without surgery or crown removal

D6081: Scaling and debridement in the presence of inflammation or mucositis of a single implant, including cleaning of the implant surfaces, without flap entry.

Dental code cement sepsis removal via incision and debridement

Place a flap and clean the cement off.  The steps involved would depend on the amount of bone damage that has already occurred.  The steps would be the same as the treatment of peri-implantitis and can be found on the previous link.  This method would be more favorable to those that do not do restorative work or if the implant lost some bone and you want to try to restore that bone.

Proper dental codes for cement sepsis that we can use when fixing it surgically include:

D6101 – debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure

D6102 – debridement and osseous contouring of a peri-implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces, including flap entry and closure

D6103 -bone graft for repair of peri-implant defect – does not include flap entry and closure

D6199 – Unspecified implant procedure, by report

You can bill like the following example.  I guess this might be somewhat fair if you had nothing to do with the dental implant. However, I find this fee to be outrageous for an implant placed by the doctor and restored by one of his referrals.   This would be done for free in almost every office in the country.  Furthermore these codes are not for dental implants.  Sorry, just a rant.

The cement is in red. Deep implant placement with no bone damage. This was the case that the above bill generated.

Dental code cement sepsis removal via crown/prosthesis removal

This would be almost identical to my dental code loose implant screw.

This is fairly straight forward and not that different from endodontic access.  The main thing to watch out for is implants in less than ideal position.  A CBCT would allow you to know if the implant is in the center of the crown or not.  Probing and PA could give you a really good idea and is arguably just as good.  If it’s an anterior crown and esthetics are very critical then take the CBCT.  This method would be more favorable to those that do not do surgical work.  We also use it if the implant hasn’t lost any bone or the esthetics of the access are not critical.  If you really, really need help you could fabricate an access guide based off of the CBCT. Lee JPD 2016

Proper dental codes for cement sepsis that we can use when doing it prosthetically include:

• D6080 – Implant maintenance procedure when removed and reinserted, includes cleaning of prosthesis and/or abutment
• D6199 – Unspecified implant procedure, by report

To see a couple cases of cement sepsis being repaired click the link.

Example of a screw access that is basically right in the middle, making it easier to find

Should you replace a loose dental screw?

In the perfect world you would replace the screw.  You should definitely replace a loose screw, as it has been undergoing flexure back and forth.  However, if you are removing the screw and know it was tight, reusing the same screw is probably just fine.

Should you charge to remove cement around a dental implant?

Not if it’s your work!  If you made the mess you owe it to the patient to clean it up.  If it is a referral of yours, I don’t think you should charge.  The doctor that did it needs to be educated on how to do screw-retained, screwmentable, or how to cement implant crowns properly.  You can charge but how you handle the situation is delicate and charging makes it more so. You can’t just say your restorative doctor screwed up, since you will likely lose that referral.

Dental code peri-implantitis treatment

You can find all the codes for treatment of peri-implantitis above.  In conclusion, I will briefly just give what I do and charge.

Step one of peri-implantitis treatment is diagnosis.

You can also use miscellaneous codes like radiographs and exams.

Step two in peri-implantitis treatment is removal of the prosthesis.

D6080 – Implant maintenance procedure when removed and reinserted, includes cleaning of prosthesis and/or abutment and I charge $400-500 depending on how complicated it is.

D6199 – Unspecified implant procedure, by report

Step three of peri-implantitis treatment is cleaning the area.

Cleaning the area with safe tipped piezo, cavitron, lasers, and/or hand scalers will use one of the following codes.  For these codes I charge slightly more than we do for the SRP codes.

D6101 – debridement of a peri-implant defect or defects surrounding a single implant, and surface cleaning of the exposed implant surfaces, including flap entry and closure

D6102 – debridement and osseous contouring of a peri-implant defect or defects surrounding a single implant and includes surface cleaning of the exposed implant surfaces, including flap entry and closure

Step four is optional.  Peri-implantitis treatment may include grafting.

We can use another set of codes for bone grafting and membrane placement.  However, I don’t know the membrane code.

D6103 -bone graft for repair of peri-implant defect – does not include flap entry and closure