Resumen de Foreign Bodies Associated With Peri-Implantitis Human Biopsies
Thomas G. Wilson Jr ., Pilar Valderrama Illana, Maria Burbano, Jonathan Blansett, Robert A. Levine, Harvey Kessler, Danieli C. Rodrigues
Background: Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis.
Methods: Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer.
Results: At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells.
Conclusions: At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.
This descriptive pilot study examines the soft tissues from human biopsies obtained from patients diagnosed with peri-implantitis. This pathologic condition is characterized by clinical signs of inflammation and progressive bone loss (BL) and is a leading cause of implant failure.1 Some authors have described the etiopathogenesis of this problem as being similar to that of periodontitis. However, there are differences in the inflammatory infiltrates in the two types of lesions.2 Differences in host response may explain the progression of the lesions.3 As an example, ligature-induced periodontitis in animals is self-limiting in most cases after removal of the ligature, whereas rapid progression of the lesion is usually seen around implants.2 It has also been argued that peri-implantitis is a foreign body response not dependent on the presence of bacteria.4 A recent systematic review and meta-analysis found that the frequency of peri-implantitis was 18.8% of patients and 9.6% of implants.5 Even if these numbers are exaggerated, further elucidation of the pathogenesis of implant failure is needed to deal with this problem.
One of the contributing factors of peri-implantitis has been shown to be excess dental cement.6 Some authors have even described a specific condition, cement-related peri-implant disease, and shown high correlation between excess cement and peri-implantitis.7,8 The removal of excess cement usually results in resolution of inflammation. However, it is important to note that in some cases it takes years before an infection related to the excess dental cement is detected.6 Independent of the technique used for cementation9 and irrespective of the diameter and location of the implants, there is always excess cement, despite meticulous cleaning of the abutment/crown, after cementation.10 The amount of undetected cement increases significantly as the restoration margins are located deeper subgingivally.8 Excess dental cement has been associated with bleeding on probing, suppuration, and peri-implant attachment loss and BL.7 The effect of cement seen histologically has not been described; that is the aim of this paper.
