Abstract
Titanium (Ti) corrodes clinically in the presence of bacteria. We investigated this phenomenon as a function of Ti particles found in biopsied tissues around peri-implantitis sites and surface roughness of failed Ti implants. Tissue biopsies were surgically collected from peri-implantitis sites, processed, and embedded in resin. The resin-embedded samples were hand trimmed to the region of interest and semi-thick (500 nm) sections were collected onto coverslips. One section was toluidine blue post-stained as a reference. The remainder sections were left unstained for energy-dispersive X-ray spectroscopy (EDX) analysis. Processed samples were examined under scanning electron microscopy (SEM) and EDX. Corresponding failed implants were also removed and examined under SEM and EDX. Five out of eight biopsied samples demonstrated the presence of Ti particles in the soft tissue, suggesting the true rate among all failures was between 24.5% and 91.5% (the lower bound of a 95% confidence interval for the true rate of Ti presence). SEM analysis of failed implant bodies also indicated changes in surface morphology and appeared less detailed with decreased weight percent of Ti on the surface of the failed implants. In conclusion, Ti particles were noted in 5/8 biopsied samples. Surface morphologies were smoother in failed implants compared with the reference implant.
Highlights
Peri-implantitis is an inflammatory disease that affects the peri-implant mucosa and the supporting bone [1,2]
Our study focused on learning about the association of titanium particles with peri-implantitis
We found a trend for higher presence of titanium particles in soft tissue biopsies associated with failed implants that had reduced titanium elements on their surfaces, except for sample WL4053
Summary
Peri-implantitis is an inflammatory disease that affects the peri-implant mucosa and the supporting bone [1,2]. A systematic report by Derks and Tomasi [3] reported a weighted mean prevalence of peri-implantitis of 22% based on a mix of reports in the literature with inconsistencies in case definitions and a large variation in disease prevalence. They emphasized the importance of conducting disease prevalence studies on large, randomly selected patient samples with adequate radiographic assessment of peri-implant bone loss. Derks and co-workers [4] conducted a combined retrospective analysis and cross-sectional clinical and radiologic examination on 588 patients and 2277 implants that were followed for nine years. They reported that 45% of all patients presented with peri-implantitis (defined as bleeding on probing/suppuration and bone loss >0.5 mm); and 14.5% of all patients presented with moderate/severe peri-implantitis (defined as bleeding on probing/suppuration and bone loss >2 mm).
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