Energy-Dispersive X-ray Spectroscopic Investigation of Failed Dental Implants Associated with Odontogenic Maxillary Sinusitis

Self Cite

Background Even though dental implants are a reliable choice for dental rehabilitation, implant failures due to various etiologies have been reported. Early implant failures account for 2 to 6% of installed implants and are reported to have a higher rate than late failures, regardless of loading time. We herein report three cases of acute sinusitis and early implant failure with implants that failed within 1 month after installation. The aim of this study was to evaluate the surface properties of early failed implants and peri-implant tissue to determine the early osseointegration pattern in acute sinusitis-related failed implants as well as the possible role of surface contamination in the failure of osseointegration. Results A combined histological, electron microscopy, and X-ray spectroscopy approach was used to characterize the surface of non-osseointegrated titanium implants and the surrounding biological tissues. Morphologic scanning electron microscopy revealed a heterogeneous surface and irregular osseointegration. The implant surface was covered mostly by carbon- and oxygen-rich organic matter. Energy-dispersive X-ray spectroscopy surface analysis of three implants showed the incorporation of some contaminants in both the upper and apical regions. Carbon, nitrogen, sodium, silicon, chlorine, sulfur, gold, and zirconium were detected on the surface of one or more failed implants. Fibrosis, lymphocytic, and macrophage infiltrates and a high activation of osteoclasts surrounding the bone graft particles were detected in the surrounding tissues. Conclusions The etiology and mechanism of early implant failure, especially in sinus-related cases, as well as the proper management interventions to minimize the rate of early implant failures, are of great concern. No matter how confident and accurate the surgeon’s operation, there may be unknown errors in the whole procedure that no one knows about. Rather than errors related to the implant surface, it is expected that there were invisible problems during the evaluation of the patient’s own unique sinus mucosal inflammation or the operator’s own procedure. Furthermore, well-designed researches are necessary to reveal the effect of material-related factors on acute sinus complication and early implant failure.

Section: Discussionmentioning

confidence: 97%

Analysis of acute sinusitis-related early failed implant surface: a combined histological, electron microscopy, and X-ray spectroscopy approach

Nguyen

Seo

et al. 2022

Self Cite

“…Several causes may contribute to implant failure. In a prior investigation into the late stages of chronic sinusitis-related implant failure, it was found that long implant apex perforation into the sinus, microbe infection, and contamination of potentially toxic elements may be major factors in dental implant failure linked to maxillary sinusitis [ 21 , 22 ]. According to Kim et al case report, who performed lateral sinus irrigation on two patients with maxillary sinusitis after implant surgery, it was observed that all opaque images on cone beam CT decreased significantly 2 weeks after sinus irrigation [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Sinus irrigation as an adjunctive therapy for odontogenic maxillary sinusitis — an in-depth analysis

Jaiswal,

Ha,

Hwang

et al. 2024

Background Odontogenic maxillary sinusitis (OMS) is widely acknowledged in both the dentistry and otolaryngology fields. Recently, iatrogenic odontogenic maxillary sinusitis cases can be encountered frequently. The purpose of this study was to evaluate the effect of intraoral sinus irrigation using the small lateral window approach in patients with odontogenic maxillary sinusitis by comparing pre- and postoperative volumetric measurement of CBCT and symptoms. We surveyed 21 patients who visited the Oral and Maxillofacial Surgery Department at PNUDH from 2016 to 2022. All the patients’ information was extracted from an electronic database. The patients with a follow-up period of 2 months or more were included. The three-dimensional volumetric measurement was performed using the ImageJ program (National Institute of Health, University of Wisconsin). Results Among 21 patients, 16 (76.1%) were male, and 5 (23%) were female. The most common type of surgery was general anesthesia (16 cases) in which oroantral fistula was present in 7 cases. In the causes of maxillary sinusitis, there were seven implant-related patients, five patients of tooth extraction, seven patients of bone grafting, and two patients in other groups. Radiographic opacity decreased by 40.15% after sinus irrigation especially in bone graft and tooth extraction cases. Clinically, symptoms improved in 17 patients (80.9%). Conclusion By this study, it can be concluded that maxillary sinus irrigation using the small lateral window approach is a clinically and radiologically effective treatment method for odontogenic maxillary sinusitis.

“…The presence of the long-term corrosion not only leads to the release of ions into the peri-implant tissue but also a disintegration of the implant that contributes to material fatigue and even fracture of the abutments, implant body, or both. From our recent study [ 15 , 16 ], Ti, C, and O from EDS analysis are not harmful elements due to the chemical composition of the implant. However, inorganic impurities such as Al, zinc (Zn), Si, and magnesium (Mg), with other elements such as nitrogen (N), F, P, Cl, and Na contribute to the corrosion process.…”

Section: Discussionmentioning

confidence: 99%

“…Cells undergoing degeneration and cell death with lipid formation were observed prevent excessive bone resorption in osteoporosis and cancer metastasis, is known as a drug that induces osteonecrosis, which may cause implant failure after tooth extraction in the jaw [12,13]. According to the AAOMS, BRONJ is defined as follows: (1) present or a history of treatment with antiresorptive or antiangiogenic agents, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for more than 8 weeks, and (3) no history of radiation therapy to the jaws or obvious metastatic disease to the jaws [11,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Electron microscopic analysis of necrotic bone and failed implant surface in a patient with medication-related osteonecrosis of the jaw

Ha,

Eo,

Sodnom-Ish

et al. 2023

Self Cite

Background Bisphosphonates (BP), a commonly used medication for various bone diseases, have been known to have severe complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Failure of dental implants has also been found in patients with medication-related osteonecrosis of the jaw (MRONJ). In this study, we analyzed the necrotic bone tissues and the surface of the failed implants removed from the jaw in patients treated with BPs and antiresorptive agents. Results Chronic inflammatory cells with collagen and fibrous tissues and bone sequestrum were shown at 5.0 × , 10.0 × , 20.0 × , and 40.0 × magnified histologic sections in the bone and fibrotic scar tissues removed from patients with MRONJ due to osteonecrosis. Hardened bone tissues with microcracked bony resorbed lacunae were observed in SEM. Unlike the previously published comparative data where immune cells, such as dendritic cells, were found in the failed implant surface, these immune cells were not identified in the BRONJ-related peri-implantitis tissues through the TEM investigations. Furthermore, EDS revealed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, silicon, and sulfur elements were found. Conclusion Hardened bone tissues with microcracked bony resorbed lacunae were observed in the SEM findings, which were considered as the main characteristic of the osteonecrosis of the jaw. Immune cells, such as dendritic cells were not identified in the TEM. EDS showed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, and silicon elements were found. Furthermore, it was revealed that sulfur was found, which was considered to be one of the complicated causes of implant failure in patients with BRONJ.