The Custom Endosteal Implant: Histology and Case Report of a Retrieved Maxillary Custom Osseous-Integrated Implant Nine Years in Service
The Custom Endosteal Implant (CEI) is a custom-cast osseo-integrated implant that has evolved to replace the “old” fibro-integrated subperiosteal variant. This newly developed implant achieves osseous integration by utilizing a hydroxyapatite (HA) coating, and a specialized grafting technique that produces much improved success rates relative to its fibro-integrated subperiosteal predecessor. This case reported here represents a maxillary CEI implant that was placed and in functional service for 9 years before being retrieved and processed for histologic examination subsequent to the patient's demise. In addition, due to infection that occurred shortly after placement, an early provisional procedure with fluoridated HA was also performed. Histologic analysis of the postmortem specimen revealed a fully integrated new bone formation intimately surrounding the previously dehisced implant strut. The latter had previously been decontaminated and grafted with a thin layer of fluorapatite (FA) material. Results including histologic analysis confirmed complete osseo-integration of the implant following successful FA graft revision.
Figure 1 shows an osseous-integrated hydroxyapatite (HA) coated titanium strut in dog mandible. Figure 2 shows osseous integration of fluorapatite crystals in an HA coated titanium custom endosteal implant in a dog mandible. Figure 3 shows the pretreatment panographic X ray. The maxillary bone is so atrophic that it is almost entirely indiscernible on this X ray. Figure 4 shows the maxillary and mandibular implants in place after 2 years of service.
Figure 5 shows the finished Vitallium Custom Endosteal Implant (CEIT) implant preceding the HA coating process. Figure 6 shows the placed CEI implant subsequent to grafting. Notice the grafting material just covers the implant struts and is not liberally applied. Figure 7 shows a distinct randomized ''honeycomb'' bone structure integrated to the surface of the HA coated Vitallium implant struts. Figure 8 shows the osseous integrated HA strut plus HA granules complete engulfed in viable bone. Figure 9 shows bone growth around grafted fluoridated HA granules used in a revision surgery to correct bone loss due to infection after 9 years in service. Also note the osseous integration of the implant strut.
Contributor Notes