Histological characteristics of advanced peri-implantitis bone defects in humans

Abstract

Background: Inflammatory osteolysis is the clinical hallmark of peri-implantitis. The morphology of the remaining peri-implant bone and the level of osseointegration, however, remain unknown. Our aim was to characterize advanced peri-implantitis bone defects in humans. Methods: Four patients (3 female and 1 male) were diagnosed with peri-implantitis. A total of 5 implants with machined surfaces and a mean loading time of 12 ± 6 years were removed due to advanced bone loss. The defect extension, the peri-implant bone density (bone area per tissue area in percentage), bone-to-implant contact (%), and the number of filled and empty osteocyte lacunae were calculated based on undecalcified histological specimens. Results: The defect extension was on average 4.2 mm (95% CI 0.8-3.4). Remaining peri-implant bone showed a high density of 85.5% (95% CI 79.1-91.3) and covered in total 74% (95% CI 70.5-77.5) of the implant surface. Filled and empty osteocyte lacunae density was on average 191 and 165/mm 2 (95% CI 132-251; 103-225), respectively. Histology further revealed signs of ongoing bone formation and resorption. Conclusion: There are signs that suggest that once the original cortical bone is lost due to peri-implantitis, the remaining apical trabecular bone is reinforced and transformed into cortical bone that might take over the functional load.

Consequences of Peri-Implant Bone Loss in the Occlusal Load Transfer to the Supporting Bone in terms of Magnitude of Stress, Strain, and Stress Distribution: A Finite Element Analysis

“…In this regard, this study assumes that marginal bone loss results from an active peri-implant disease, and therefore, based on histological studies, from the osteoclastic activity of the cortical bone characterized by the presence of Howship's lacunae with numerous resident osteoclasts [ 34 – 36 ]. Nevertheless, some studies have shown partial bone corticalization in peri-implant defects preestablished by a biomechanical reinforcement of the residual trabecular bone [ 37 ].…”

“…In this regard, this study assumes that marginal bone loss results from an active peri-implant disease, and therefore, based on histological studies, from the osteoclastic activity of the cortical bone characterized by the presence of Howship's lacunae with numerous resident osteoclasts [34][35][36]. Nevertheless, some studies have shown partial bone corticalization in periimplant defects preestablished by a biomechanical reinforcement of the residual trabecular bone [37]. The analysis of the results of the magnitude of stress transferred to the bone in the three models shows that the maximum stress is transferred to the cortical bone of the control model without bone loss, similar to numerous finite element analyses of single implants without bone loss [21,[27][28][29].…”

Macrophage polarization in peri-implantitis lesions

“…Peri-implantitis has been characterized as a plaque associated inflammatory pathological condition occurring in tissues around dental implants [11][12][13][14]. A few histological studies have reported on the cellular composition at peri-implantitis sites in humans [15,16].…”

Evaluation of Gingival Tissue Pathological Changes in Human Peri-implantitis: Histological, Immunohistochemical and Ultrastructural Study

“…Compromising the quality and quantity of the soft and hard tissues surrounding an implant are important and recognizing complications that occur in implant therapy and include inflammation of soft tissues, resorption of bone and eventually the loss of the implant itself (12) .…”