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Histopathological and microradiological features of peri-implantitis. A case report

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Aim: The aim of this study was to describe the histological characteristics of a peri-implantitis case in the anterior maxilla. Case report: A dental implant inserted in the missing upper right lateral incisor region has been removed with its adjacent tissues. The samples were placed in 4% formalin for 10 days and, were embedded in methacrylate prior to sawing and grinding. The samples were processed with Donath´s sawing and grinding technique, stained with toluidine blue and mounted on high-sensitivity plates for histology and microradiography. The structure of the connective tissue revealed that there was a lack of collagen fibers running parallel to the implant surface. The connective tissue showed a loose granulation tissue with medium-density lymphocyte infiltration and neutrophilic leukocytes. In addition to the collagen loss in the infiltrated tissue, an excessive bone resorption was present. Peripherally, the light microscopy showed the osteoclasts and their adhesive apparatus which promote bone resorption. Conclusion: With the increasing number of implants being placed, peri-implantitis has become much more prevalent. Every additional study focusing on the characteristics of peri-implantitis would be beneficial to gain an understanding of bone and soft tissue behavior around the implant and could help to develop appropriate therapeutic approaches for peri-implant disease.
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Stomatologija, Baltic Dental and Maxillofacial Journal, 2017, Vol. 19, No. 3 97
Histopathological and microradiological features of
peri-implantitis. A case report
Mustafa Ayna1, Aydin Gulses2, Thomas Ziebart3, Andreas Neff3, Yahya Açil2
SCIENTIFIC ARTICLES
SUMMARY
Aim. The aim of this study was to describe the histological characteristics of a peri-implan-
titis case in the anterior maxilla.
Case report. A dental implant inserted in the missing upper right lateral incisor region has
been removed with its adjacent tissues. The samples were placed in 4% formalin for 10 days
and, were embedded in methacrylate prior to sawing and grinding. The samples were processed
with Donath´s sawing and grinding technique, stained with toluidine blue and mounted on
high-sensitivity plates for histology and microradiography.
The structure of the connective tissue revealed that there was a lack of collagen bers run-
ning parallel to the implant surface. The connective tissue showed a loose granulation tissue
with medium-density lymphocyte in ltration and neutrophilic leukocytes. In addition to the
collagen loss in the in ltrated tissue, an excessive bone resorption was present. Peripherally,
the light microscopy showed the osteoclasts and their adhesive apparatus which promote bone
resorption.
Conclusion. With the increasing number of implants being placed, peri-implantitis has become
much more prevalent. Every additional study focusing on the characteristics of peri-implantitis
would be bene cial to gain an understanding of bone and soft tissue behavior around the implant
and could help to develop appropriate therapeutic approaches for peri-implant disease.
Keywords: peri-implantitis, histology, dental implant.
CASE REPORT
Stomatologija, Baltic Dental and Maxillofacial Journal, 19: 97-100, 2017
INTRODUCTION
Dental implant failures could be related to peri-
operative causes such as overheating, contamination
and trauma during surgery, poor bone quantity and/
or quality, lack of primary stability and incorrect im-
mediate loading. Besides that, peri-implant diseases,
occlusal trauma, and overloading failures can result
in loss of dental implants in the long term (1, 2).
Peri-implant diseases are a common cause of com-
plications that may be associated with dental implant
failures. They are characterized by an in ammatory
reaction in the tissues surrounding an implant and pre-
sent in two forms – peri-implant mucositis and peri-
implantitis. In peri-implant mucositis, the presence of
in ammation is con ned to the soft tissues surrounding
a dental implant, however, no signs of loss of supporting
bone following initial bone remodeling are observed.
The term peri-implantitis refers to an in ammatory
process around an implant, which includes both soft
tissue in ammation and progressive loss of supporting
bone beyond biological bone remodeling (3).
The etiology of peri-implantitis remains still chal-
lenging and unfortunately the knowledge regarding the
histological hard and soft tissue changes in chronic
peri-implantitis situations in humans are limited to case
reports (4). Therefore, every additional report focusing
on the histological aspects of the condition in humans
is critical to gain an understanding of peri-implantitis
to develop appropriate therapeutic approaches.
The aim of this study was to describe the histo-
logical characteristics of a peri-implantitis case in
the anterior maxilla.
CASE REPORT
A 56 year old healthy, non-smoker female patient
admitted with the complaints of pain and swelling
around the dental implant at the missing upper right
lateral incisor region. Her history revealed that, 6
months following the extraction of the upper lateral
1Clinic of Implantology and Periodontology, Duisburg, Germany
2Department of Oral and Maxillofacial Surgery, Christian-
Albrechts-University, Kiel, Germany
3Department of Oral and Maxillofacial Surgery, UKGM Giessen/
Marburg, Marburg, Germany
Address correspondence to Aydin Gulses, Mevki Military Hospital
06130 Diskapi Altindag, Ankara, Turkey.
E-mail address: aydingulses@gmail.com
98 Stomatologija, Baltic Dental and Maxillofacial Journal, 2017, Vol. 19, No. 3
incisor due to an unsuccessfull endodontic
treatment, a dental implant of 3.5×13 mm
(NTI 13-SR, Hi Tec, München, Germany)
was placed in the corresponding area seven
years ago (Figure 1 A and B).
The intraoral clinical examination re-
vealed pus and swelling at the corresponding
area. A panoramic radiograph showed the
presence of the excessive bone loss around
the dental implant. (Figure 1 C) The probing
depths were 8 and 9 mm at the buccal and
palatinal sites respectively. The implant was
mobile and the bleeding index and the plaque
index were both 100%.
Owing to the excessive bone loss around
the dental implant, it was decided to remove
the implant under local anaesthesia after tak-
ing the local infection under control. A 1 g of
Amoxicillin (STADA Arzneimittel AG, Bad
Vilbel, Germany) and 0.4 mg Metronidazol
(×2 per day) were prescribed for 7 days
(ALIUD® PHARMA GmbH, Laichingen,
Germany).
On the fourth day following the drug
administration, a sulcular incison extending
from upper right canine to the upper left central
and vertical releasing incisons were performed
under local anesthesia. A full thickness muco-
periostal ap was elevated and the bone defect
was exposed. The implant was removed via
a Piezotome (Piezotome®2, Satelec Acteon)
with its adjacent tissues. The defect was curet-
ted and closed primarily via 3/0 silk sutures.
The healing period was uneventful and the
sutures were removed 5 days later.
Sample processing, sawing and grinding
The Implant and the adjacent tissues were
placed in 4% formalin for 10 days and embedded in
methacrylate prior to sawing and grinding. Sawing
and grinding was performed (5) and the samples were
placed in glass vessels lled with a monomeric resin
solution and incubated at 37°C to 40°C for 2 to 4 days
for resin impregnation. The sample was precut with a
band saw (Exakt, Norderstedt-Germany) and disks of
about 100 μm were obtained via an oscillating diamond
saw (Exakt, Norderstedt-Germany), grounded with the
Saphir 360 E grinder (ATM, Altenkirchen-Germany)
and highly polished with silicon carbide paper (grades
500, 1200, 2400 and 4000).
Staining
Stainings were made by using toluidine blue. The
ground surface was decalci ed with 0.1% formic acid
M. Ayna et al. CASE REPORT
and 20% methanol was applied for better cell and
soft tissue staining. Then the samples were rinsed in
distilled water and stained in a toluidine blue solution
for 2 minutes.
In this process, hard tissue has not stained or at
best assumed a light blue color whereas cells and
their nuclei, osteoid, cement lines and collagen bers
has stained blue, while mast cell granules, cartilage
matrix and early wound healing sites metachromati-
cally has stained red violet.
Microradiography
The samples were glued onto lm-coated light-
sensitive glass plates (High-Resolution Plates Type 1A,
Imtek) - depending on their thickness - and exposed to
18 kV and 5 mA for 8 to 10 minutes in the microradi-
Fig. 1. Preoperative OPTG (A). Immediate postoperative OPTG (B). A 7-
year postoperative OPTG revealed excessive bone loss around the dental
implant (C).
AB
B
C
Stomatologija, Baltic Dental and Maxillofacial Journal, 2017, Vol. 19, No. 3 99
CASE REPORT M. Ayna et al.
ography chamber (Faxitron X-ray Systems 43855A,
Hewlett Packard GmbH, Böblingen-Germany). The
lms were developed with an HRP developer and
xed in an A3000 xation bath (both by Kodak AG,
Stuttgart-Germany). After drying, the sensitive lm
layer was covered with a cover plate and mounted with
Eukitt®. The microradiograms were morphometrically
evaluated by using a digital image analyzer (Q500MC,
Leica, Cambridge-UK). A measuring frame was placed
on invariably identi able screw holes and the surface
area of newly formed bone was measured.
All components of the infra-bony pocket at the
buccal site could be successfully observed (Bony
structure, epithelium, in ammated connective tissue
and dental implant). The histological examination
revealed the absence of the osseointegration on both
buccal and palatal sites. In addition to the
collagen loss in the in ltrated tissue, an ex-
cessive bone resorption was seen. Adjacent to
the apical part of the peri-implant pocket, an
active bone resorption was observed (Figure
2 A). The microradiography revealed the lack
of bone-implant contact (Figure 2 B).
The peri-implant tissue was loosened
from the implant surface during the prepara-
tion of the histological specimen; however,
was congruent to the implant surface. The
ortho-keratinised epithelium of the gin-
giva could not be xed. The non-keratinized
junctional epithelium showed an attachment
of 2 mm. Oral sulcular epithelium showed
interlocking between the epithelium and the
underlying connective tissue. An increase of
in ammatory cell in ltration and the prolif-
eration of ulcerated granulation tissues were
present apico-laterally. The structure of the
connective tissue revealed that there was a
lack of collagen bers running parallel to the
implant surface, which are present around
successfully osseointegrated implants The
connective tissue showed a loose granula-
tion tissue with medium-density lymphocyte
in ltration and neutrophilic leukocytes and a
loose, cicatricial tissue which is rich of bro-
blasts and with a few angioblasts (Figure 3
A). Peripherally, the light microscopy showed
the osteoclasts and their adhesive apparatus
which promote bone resorption. In addition,
bone fragments dissolved from the bone
surface were detected (Figure 3 B). Adjacent
to the threads of the implants an increased
concentration of osteoclasts was seen. In the
time of the implant removal, the osteoclasts
showed various sizes of lacunas, which refers
to a progressing bone destruction (Figure 3 C).
DISCUSSION
Potential risk factors for peri-implant disease
were reported as poor oral hygiene, history of
periodontitis, smoking habit, diabetes, genetic triats,
implant related factors (surface characteristics and
implant placement-related factors), insuf cient width
of keratinized peri-implant mucosa and occlusal
overload (6-10). According to general health- and
oral hygiene status and past medical history of the
patient, none of the above mentioned risk factors was
present in the current case.
Similar to periodontitis, peri-implantitis occurs
primarily as a result of an overwhelming bacterial
Fig. 2. The histological examination revealed the loss of osseointegration
on buccal and palatal sites (A). The microradiography revealed the lack of
bone-implant contact (B).
Fig. 3. Peri-implant mucosa showing interlocking between the connective
tissue and the epithelium (Toluidin blue ×30) (A). Light microscope showing
active bone destruction (Toluidin blue ×30) (B). Resorption lacunas by the
osteoclasts. (Toluidin blue ×16) (C).
A
A
B
B
C
100 Stomatologija, Baltic Dental and Maxillofacial Journal, 2017, Vol. 19, No. 3
insult and subsequent host immune response (11).
Esposito et al have suggested that bacterial plaque
associated in ammation of peri-implant supporting
structures and consequent progressive peri-implant
bone loss are the main reasons for biologically in-
duced dental implant failures and account for up to
half of all late implant failures (12, 13).
In the literature, there are numerous articles fo-
cusing on the pathogenesis of peri-implantitis cases
(14). However, the knowledge regarding the histology
of the condition is limited to experimentally created
peri-implantitis studies (15, 16) and the histologi-
cal aspects of the condition are rarely evaluated in
humans (4).
According to the results of the experimental
studies on peri-implantitis histology, the increased
susceptibility for bone loss around implants may be
related to the absence of inserting collagen bers
into the implant (16). The same nding was also
observed in the current report, whereas the structure
of the connective tissue revealed that there was a
lack of collagen bers running parallel to the im-
plant surface.
Berglundh et al (17) have compared the histology
of periodontitis and peri-implantitis and described a
“self-limiting” process existing in the tissues around
natural teeth that resulted in a protective connective
tissue capsule of the supra-crestal gingival bers of the
tooth that separated the lesion from the alveolar bone.
According to their ndings, such a “self-limiting” did
not occur in peri-implant tissues and that the lesion
extended to the bony crest, which was different than
the periodontitis lesions (11).Similarly, the results of
the current study revealed that, adjacent to the threads
of the implant, where the bone resorption macro-
scopically not appears, an increased concentration
of osteoclasts was present. In addition, in the time
of the implant removal after 7 years of insertion, the
osteoclasts showed various sizes of lacunas, which
refers to progressive bone destruction. Therefore, it
might be concluded that, the bone loss secondary to
peri-implantitis is a progressive and continual process.
M. Ayna et al. CASE REPORT
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Received: 07 08 2016
Accepted for publishing: 28 09 2017
... After reading the full-text of the articles in detail, 16 studies were excluded according to the reasons listed in Table 2. The remaining 33 studies were included in this review (Ayna, Gulses, Ziebart, Neff, & Açil, 2017;Berglundh, Gislason, Lekholm, Sennerby, & Lindhe, 2004;Berryman et al., 2020;Buffoli et al., 2014;Bullon, Fioroni, Goteri, Rubini, & Battino, 2004;Carcuac & Berglundh, 2014;Cornelini et al., 2001;de Araújo et al., 2014de Araújo et al., , 2017Dionigi, Larsson, Carcuac, & Berglundh, 2020;Fretwurst et al., 2016Fretwurst et al., , 2020Fretwurst et al., , 2021Galarraga-Vinueza et al., 2020;Galárraga-Vinueza et al., 2020;Galindo-Moreno et al., 2017;Ghighi et al., 2018;Gualini & Berglundh, 2003;Karatas et al., 2020;Konermann et al., 2016;Kulakov, Kogan, Brailovskaya, Vedyaeva, & Zharkov, 2020;Lucarini, Zizzi, Rubini, Ciolino, & Aspriello, 2019;Mijiritsky et al., 2020;Obȃdan, Crȃiţoiu, Manolea, Hincu, & Iacov-Crȃiţoiu, 2018;Oh, 2017;Olmedo, Nalli, Verdú, Paparella, & Cabrini, 2013;Schwarz, Bieling, Nuesry, Sculean, & Becker, 2006;Silva, Félix, Rodriguez-Archilla, Oliveira, & dos Santos, 2014;Tawse-Smith et al., 2012;Wilson Jr et al., 2015;Zitzmann, Berglundh, Marinello, & Lindhe, 2001). ...
... The final score of methodological quality assessment ranged from 1 to 7 points (Table 3). Nineteen percent of studies were at low risk of bias with a final score of at least 5. Regarding sample selection, case reports were considered to have the highest risk of bias (Ayna et al., 2017;Oh, 2017); studies with a larger, justified sample size were considered to have a lower risk. ...
... While only a few microvessels were present in the submucosa of HI, increased vascular proliferation was evident in PI, particularly in the ICT (Bullon et al., 2004;Cornelini et al., 2001;de Araújo et al., 2014;Lucarini et al., 2019;Schwarz et al., 2006). Both the vascular proliferation and inflammatory infiltrates were more intense in the apical portion of the pocket area (Ayna et al., 2017;Berglundh et al., 2004;Carcuac & Berglundh, 2014;Mijiritsky et al., 2020). These parameters were also reported to be more severe in central portions of the ICT in comparison with marginal areas (Berglundh et al., 2004;Mijiritsky et al., 2020). ...
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Objective To conduct a systematic review of the inflammatory elements in peri-implantitis (PI) and peri-implant mucositis (PM) in comparison with healthy peri-implant tissues (HI) and periodontal disease. Design The PubMed, Embase, Web of Science, and Scopus databases were searched up to December 2020. English articles that evaluated human soft tissue biopsies of PI or PM were included. Values reported for the surface area of the infiltrated connective tissue (ICT) were pooled using the random-effect model meta-analysis to estimate the mean (95% CI). Results A total of 33 articles were included. Of 30 studies on PI, the majority evidenced significantly increased vascularization and inflammatory cell counts dominated by plasma cells in PI compared with HI. Studies that compared PI with chronic periodontitis primarily reported more severe inflammatory infiltrates in PI. This was confirmed by the meta-analysis results since the surface area of the ICT was significantly larger in PI (p<0.001). Only seven studies analyzed the PM lesions and reported increased inflammatory infiltrates and vascularization in PM compared with HI. Based on the meta-analysis results, the surface area of the ICT was 3.00 [1.50, 4.51] mm ² in PI and 0.23 [0.02, 0.44] mm ² in PM lesions. Based on the available evidence, presence of foreign body particles considerably increased the inflammatory infiltrate; however, smoking did not have a significant effect. Conclusions There was controversy regarding the prevalence of various inflammatory cell types in peri-implant diseases; however, a considerably high ICT surface area in PI indicates the aggressive nature of the disease.
... Therefore, topical administration of bacteria has been widely used to initiate periodontal diseases and later peri-implantitis in various animal models in recent years [9,10]. Sun et al. suggested that the in-vitro biofilm formation process prior to osseointegration does not relate to the human clinical situation; however, a "self-limiting" process existing in the tissues around natural teeth does not occur in peri-implant tissues [11], and the osseo-disintegration secondary to peri-implantitis is a progressive and continual process, in which rather marginal tissues, all osseous structures along the implant surface, were involved [12,13]. Therefore, in addition to the need for understanding the pathogenesis of the peri-implantitis-related bone loss around implants, the osseo-disintegration process warrants further research. ...
... A recent study focusing on the histological aspects of peri-implantitis [12] also revealed that not only supracrestally but also adjacent to whole threads of the affected implant caudally, where the bone resorption macroscopically did not appear, an increased concentration of osteoclasts was present. Therefore, the whole surface of the implant was contaminated with Enterococcus faecalis in the model described herein. ...
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... This phenomenon can be confirmed immunohistochemically by demonstrating the increased production of factors involved in the formation of the inflammatory infiltrate, such as nitric oxide, lymphocytes, and neutrophils. Moreover, similarly to periodontitis, lesions may show an almost 10-fold elevated concentration of matrix metalloproteinases (MMP), such as MMP-8, which can be used for diagnostic purposes [40,41]. Berglundh et al. analyzed the histological picture of periimplantitis foci. ...
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... Clinical validity was implemented using the histological classification of bone density at the implant recipient site. The tissue samples were evaluated according to the technique described by Donath and Breuner 13 and later developed by Açil et al. 14,15 Briefly, tissue samples were placed into 10% neutral buffered formalin for fixation for 4 days and embedded in methacrylate prior to sawing and grinding. Sawing and grinding were performed, and the samples were placed in glass vessels filled with monometric resin solution and incubated at 378C to 408C for 2 to 4 days for resin impregnation. ...
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The aim of this review was to offer a critical evaluation of the literature and to provide the clinician with scientifically-based diagnostic criteria for monitoring the implant condition. The review presents the current opinions on definitions of osseointegration and implant failure. Further, distinctions between failed and failing implants are discussed together with the presently used parameters to assess the implant status. Radiographic examinations together with implant mobility tests seem to be the most reliable parameters in the assessment of the prognosis for osseointegrated implants. On the basis of 73 published articles, the rates of early and late failures of Brånemark implants, used in various anatomical locations and clinical situations, were analyzed using a metanalytic approach. Biologically related implant failures calculated on a sample of 2,812 implants were relatively rare: 7.7% over a 5-year period (bone graft excluded). The predictability of implant treatment was remarkable, particularly for partially edentulous patients, who showed failure rates about half those of totally edentulous subjects. Our analysis also confirmed (for both early and late failures) the general trend of maxillas, having almost 3 times more implant losses than mandibles, with the exception of the partially edentulous situation which displayed similar failure rates both in upper and lower jaws. Surgical trauma together with anatomical conditions are believed to be the most important etiological factors for early implant losses (3.60% of 16,935 implants). The low prevalence of failures attributable to peri-implantitis found in the literature together with the fact that, in general, partially edentulous patients have less resorbed jaws, speak in favour of jaw volume, bone quality, and overload as the three major determinants for late implant failures in the Brånemark system. Conversely, the ITI system seemed to be characterized by a higher prevalence of losses due to peri-implantitis. These differences may be attributed to the different implant designs and surface characteristics. On the basis of the published literature, there appears to be a number of scientific issues which are yet not fully understood. Therefore, it is concluded that further clinical follow-up and retrieval studies are required in order to achieve a better understanding of the mechanisms for failure of osseointegrated implants.
Article
Objectives: The aim of this study was to analyse the proportions of peri-implant lesions at implants after 9-14 years of function. Material and Methods: Two hundred and ninety-four patients underwent implant therapy during the years 1988-1992 in Kristianstad County. These individuals were recalled to the speciality clinic I and 5 years after placement of the suprastructure. Between 2000 and 2002, 218 patients with 999 implants were examined clinically and radiographically. Results: Forty-eight per cent of the implants had probing depth >= 4 mm and bleeding on probing (peri-implant mucositis). In 20.4% of the implants, the bone level was located 3.1 mm apical to the implant shoulder. Progressive bone loss (>= 1.8 mm) during the observation period was found in 7.7% of the implants. Peri-implantitis defined as bone loss >= 1.8 mm compared with 1-year data (the apical border of the bony defect located at or apical to the third thread, i.e. a minimum of 3.1 mm apical to the implant shoulder), combined with bleeding on probing and or pus, were diagnosed among 16% of the patients and 6.6% of the implants. Conclusion: After 10 years in use without systematic supportive treatment, peri-implant lesions is a common clinical entity adjacent to titanium implants.
Article
Aim: The aim of this study was to measure, in adults, changes in crest bone level around single dental implants in the anterior maxilla and continuous eruption of adjacent teeth. Material and methods: In this prospective study, 50 patients received single-implant-supported crowns in the maxillary anterior region. Enrolled patients lacked maxillary anterior teeth as a sequel to trauma or agenesis in the maxillary anterior region. Participants were followed during a 3-year period. Baseline radiographs were taken at the time of loading and then repeated at one- and 3-year recalls. Radiographic parameters were recorded to assess changes in the skeletal bone structure and crest bone level. Results: Twenty-six patients attended for all recalls. Three patients were excluded owing to difficulties related to identifying the same radiographic landmark on the radiographs throughout the recall period. All implants were successfully integrated with no sign of peri-implantitis. The mean crest bone loss was 0.45 mm at the mesial aspect of the implant and 0.56 mm at the distal aspect. In smokers, there was significant bone loss on the distal aspect. Mean change between reference points on implant and adjacent tooth (continuous eruption of adjacent tooth) over the 3-year period was 0.67 mm. In women, mean change (0.79 mm) was statistically insignificantly higher, compared with men (0.59 mm). Conclusions: Radiographic evaluation of crest bone level showed slight bone loss after 3 years of functional loading. Some changes in the eruption of neighbouring teeth were seen. Being a smoker was associated with significant negative changes related to the crest bone level.
Article
To review the quality of reporting and the methodology of clinical research on the incidence, prevalence and risk factors of peri-implant diseases. A MEDLINE search was conducted for cross-sectional, case-control and prospective longitudinal studies reporting on peri-implant diseases. To evaluate the quality of reporting of the selected studies the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist was utilized. The search provided 306 titles and abstracts, out of which 40 were selected for full-text analysis. Finally, 16 studies were included out of which five assessed prevalence and only two the incidence of peri-implant diseases. 13 articles studied risk indicators for peri-implant diseases. None of the scrutinized articles adhered fully to the STROBE criteria. The large majority of articles did not (i) clearly state the applied study design, (ii) describe any effort to address potential sources of bias, (iii) explain how missing data were addressed, (iv) perform any kind of sensitivity analysis, (v) indicate the number of participants with missing data for each variable of interest. Collectively, the findings of this review indicate a need for improved reporting of epidemiological studies on peri-implant diseases.
Article
Little is known regarding the histologic hard and soft tissue changes that occur in chronic periimplantitis situations in humans. It is critical to gain an understanding of all aspects of periimplantitis to develop appropriate therapeutic approaches. An 83-year-old African American man presented with a fractured implant affected by severe, chronic periimplantitis and surrounded by keratinized gingiva. A trephine biopsy of the implant and surrounding tissues was analyzed histologically. Histological analysis of the periimplantitis specimen revealed significant inflammatory infiltrate consisting predominantly of lymphocytes and plasma cells. In addition, epithelial migration and bone loss to the apical vent were noted. This case report documents a single case of periimplantitis that was left untreated for 7 years. The presence of significant keratinized tissue and a smooth surface implant failed to prevent fibrous encapsulation of the implant.
Article
The aim of this study was to follow patient cases retrospectively in a longitudinal manner from the time of implant placement to the time they were diagnosed with peri-implant disease, and to identify associated clinical and microbiological features of peri-implant disease. A total of 281 patient cases were chosen from the archives of the Oral Microbiological Diagnostic Laboratory, Gothenburg, Sweden, based on bacterial samples taken from diseased implants. A form was designed and filled in separately for each case including data on patient, implant and disease profile. Most cases were severe peri-implantitis cases (91.4%). In 41.3% of the patients, peri-implantitis was developed early, already after having implants in function less than 4 years. The type of implant surface was significantly associated with the time in years implants were in function, before disease was developed (P < 0.05). The microbiological results by both culture and checkerboard analysis, although failed to fully correspond to the severity of the disease in terms of magnitude, proved to show that peri-implantitis is a polymicrobial anaerobic infection with increased number of AGNB (aerobic Gram-negative bacilli) in 18.6% of the patients. Peri-implantitis is a biological complication of implants in function that poses a threat to their long-term survival. It may develop earlier around implants with rough surfaces and it may represent a true infection. Microbiological sampling methods should be improved and uniformed so as to fully unveil the microbiological profile of the disease.
Article
To compare histopathological characteristics of peri-implantitis and periodontitis lesions. A search was conducted on publications up to July 2010. Studies carried out on human biopsy material and animal experiments were considered. While comprehensive information exists regarding histopathological characteristics of human periodontitis lesions, few studies evaluated peri-implantitis lesions in human biopsy material. Experimental peri-implantitis lesions were evaluated in 10 studies and three of the studies included comparisons to experimental periodontitis. Human biopsy material: the apical extension of the inflammatory cell infiltrate (ICT) was more pronounced in peri-implantitis than in periodontitis and was in most cases located apical of the pocket epithelium. Plasma cells and lymphocytes dominated among cells in both types of lesions, whereas neutrophil granulocytes and macrophages occurred in larger proportions in peri-implantitis. Experimental studies: placement of ligatures together with plaque formation resulted in loss of supporting tissues and large ICTs around implants and teeth. Following ligature removal, a "self-limiting" process occurred in the tissues around teeth with a connective tissue capsule that separated the ICT from bone, while in peri-implant tissues the ICT extended to the bone crest. Despite similarities regarding clinical features and aetiology of peri-implantitis and periodontitis, critical histopathological differences exist between the two lesions.