Peri‐Implant Bone Loss and Its Uncommon Causes: A Case Report

Abstract

Introduction: Peri‐implantitis is often regarded as a biologic complication that may lead to late implant failure. However, the influence of confounding factors in this disease remains unclear. This case report highlights the interaction of other factors in the phenomena of crestal bone loss (CBL) associated with implant placement and presents an interventional treatment strategy.Case Presentation: A 70‐year‐old female was diagnosed with peri‐implantitis associated with an implant that was placed to replace a mandibular molar tooth. There was progressive CBL that continued despite the removal of the restoration. Peri‐implant therapy included a surgical intervention with a modification of the restoration. Inflamed tissues were excised for histologic evaluation. Metal‐like particles were shown in cytologic smears of peri‐implant areas. Subsequent evaluation of the inflamed connective tissue using scanning electron microscopy identified localized black scattered material. Energy‐dispersive spectrography analysis confirmed the presence of not only titanium particles but also gold, copper, and silver particles, with more particles at the epithelial junction.Conclusions: This report highlights the interplay between different confounding factors in the development and progression of peri‐implantitis and the importance of histologic examination in the management of peri‐implant diseases. Peri‐implantitis is no longer a biologic complication in which plaque is the sole factor. Functional wear and implant surface deterioration may need to be taken into account when analyzing the causes of CBL and implementing a multidisciplinary treatment plan. Future intervention studies need to pay more attention to the increasingly crucial role played by the mechanical properties of the surrounding bone and dental implants.