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Objectives:
Dental peri-implantitis is characterized by a multifactorial etiology. The role of metal elements as an etiological factor for peri-implantitis is still unclear. The aim of this study was to investigate the incidence of metal elements in bone and mucosal tissues around dental Grade 4 CP titanium implants with signs of peri-implantitis in human patients.
Methods:
In this prospective pilot study, all patients were enrolled consecutively in two study centers. Bone and soft tissue samples of patients with peri-implantitis with indication for explantation were analyzed for the incidence of different elements (Ca, P, Ti, Fe) by means of
synchrotron radiation X-ray fluorescence spectroscopy (SRXRF) and polarized light microscopy (PLM). The existence of macrophages and lymphocytes in the histologic specimens was analyzed.
Results:
Biopsies of 12 patients (seven bone samples, five mucosal samples) were included and analyzed. In nine of the 12 samples (75%), the SRXRF examination revealed the existence of titanium (Ti) and an associated occurrence with Iron (Fe). Metal particles were detected in peri-
implant soft tissue using PLM. In samples with increased titanium concentration, lymphocytes were detected, whereas M1 macrophages were predominantly seen in samples with metal particles.
Conclusion:
Titanium and Iron elements were found in soft and hard tissue biopsies retrieved from peri-implantitis sites. Further histologic and immunohistochemical studies need to clarify which specific immune reaction metal elements/particles induce in dental peri-implant tissue.
Purpose: The implant-abutment connection of a two-piece dental implant exhibits complex micromechanical behavior. A microgap is evident at the implant-abutment interface, even in the virgin state, and its width varies when an external mechanical load is applied. Materials and Methods: This study used high-resolution synchrotron-based radiography in combination with hard x-ray phase-contrast mode to visualize this gap and estimate its size. Commercially available implants with different internal conical implant-abutment connections were imaged. Pairs of implants were imaged as manufactured (new) and after fatigue loading (5 million cycles up to 120 N). Then, different static loads were applied at different angles relative to the implant-abutment assemblies, and the implant-abutment microgaps were measured and compared. Results: Microgaps existed in all systems. Fatigue loading extended the size of the microgap and increased the possibility of micromovement of the implant-abutment complex. The cone angle of the connection also influenced the stability of the abutment, with flatter cones appearing to be more stable. Conclusion: Cyclic loading at medium force (120 N) induces plastic deformation of titanium implants and abutments.
Biocompatible materials such as titanium are regularly applied in oral surgery. Titanium-based implants for the replacement of missing teeth demand a high mechanical precision in order to minimize micro-bacterial leakage, especially when two-piece concepts are used. Synchrotron-based hard x-ray radiography, unlike conventional laboratory radiography, allows high spatial resolution in combination with high contrast even when micro-sized features in such highly attenuating objects are visualized. Therefore, micro-gap formation at interfaces in two-piece dental implants with the sample under different mechanical loads can be studied. We show the existence of micro-gaps in implants with conical connections and study the mechanical behavior of the mating zone of conical implants during loading. The micro-gap is a potential source of implant failure, i.e., bacterial leakage, which can be a stimulus for an inflammatory process.