Peri-implant and systemic release of metallic elements following insertion of a mandibular modular endoprosthesis in Macaca fascicularis

Abstract

The aim of this study was to assess the release of metal elements from a Ti6Al4V modular endoprosthesis for mandibular reconstruction. Ten monkeys were included, seven of the animals had an endoprosthesis inserted and three served as controls. Mucosa, regional lymph nodes and distant organs, were assessed after the implant had been in place for 12 months, using light (LM) and transmission electron microscopy (TEM) and inductively coupled plasma optical emission spectroscopy (ICP). Blood was also drawn from all animals for elemental analysis using ICP. LM and TEM evaluation showed no detectable metal particles in the mucosa surrounding the endoprosthesis, nor in the regional lymph nodes and distant organs. Blood analysis revealed that titanium and vanadium were detectable in comparable amounts in the test (Ti: 1.63 ± 0.54, Va: 0.42 ± 0.08) as well as in the control group (Ti: 2.07 ± 0.55, Va: 0.37 ± 0.07). The amount of aluminum appeared to be higher in the control group (31.77 ± 11.67) compared with the test group (20.41 ± 9.13), but this difference was not statistically significant. ICP showed that no titanium, vanadium or aluminum was detectable in the mucosa surrounding the endoprosthesis. In addition, no titanium and vanadium were found in the lymph nodes and distant organs using ICP. On the other hand, using ICP, the aluminum content was found to be higher in the right regional lymph nodes and all examined distant organs as compared to the control group (lymph nodes: 11.55 ± 22.15 vs. 0.36 ± 0.61, lung: 6.24 ± 11.28 vs. 1.40 ± 2.15, liver: 1.66 ± 0.99 vs. 0, kidney: 15.69 ± 24.88 vs 0, spleen: 2.75 ± 3.09 vs. 0.49 ± 0.43). However, only for the kidney and liver the higher amount of aluminum was statistically significant. In conclusion, this study quantified the release of only aluminum in lymph nodes and distant organs, when using a modular endoprosthesis made of Ti–6Al–4V for mandibular reconstruction.