Peri-Implant Bone Necrosis: Clinical Considerations and Histological Evaluation
Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involved. This case series reports on the successful management of PIBN during early and late implant placement and peri-implantitis-associated bone necrosis, with likely causes being bone overcompression during implant placement or a consequence of peri-implantitis. This case series presents 5 cases of peri-implant bone necrosis, with 3 cases occurring immediately after implant placement and the other 2 presenting a delayed inflammatory process of peri-implantitis between 1 and 5 years after implant placement. Clinical presentation and histopathological evaluation data present 10 failed implants managed with the removal of implants and the associated necrotic bone. All the cases were successfully managed without any signs of recurrence. Two cases confirmed bone necrosis via biopsy, illustrating the typical pattern of bone necrosis: multiple nonvital bone fragments surrounded by acute and chronic inflammatory cells and empty lacunae. All cases were successfully managed by removing necrotic bone and associated implants, with no indication of bone necrosis recurrence. This case series report highlights the unusual early and delayed implant failure associated with peri-implant bone necrosis. This condition most likely results from bone overcompression during implant placement or is a sequela of the inflammatory process of peri-implantitis.
A 57-year-old female patient underwent clinical and radiographic examination, which revealed peri-implant marginal bone necrosis 3 months following implant placement. The implant placement steps included: (a) a clinical photo showing the pilot drill during implant placement at #19; (b) a periapical radiograph demonstrating the same area; (c) another periapical radiograph demonstrating the condition of the bone and the implant after placement; (d) clinical photo 3 months after implant placement showing severely inflamed peri-implant mucosa; (e) a periapical radiograph demonstrating the same area demonstrating distal bone sequestrum (indicated by a yellow arrow); (f) bone sequestrum after removal.
Depicts 2 cases of peri-implant marginal bone necrosis, 1 in a 49-year-old female patient and another in a 52-year-old male patient. A 49-year-old female patient underwent clinical and radiographic examination, which revealed peri-implant marginal bone necrosis exposed to the oral cavity. The examination included: (a) a coronal cut cone beam computed tomography radiograph demonstrating the pattern and level of bone loss, with a separated interproximal bone sequestrum; (b) a clinical photo showing the degree of peri-implant mucosal dehiscence with exposed marginal bone around #20 and #21 implants; (c) the 2 implants were removed with the necrotic bone attached to 1 implant; (d) clinical photo showing the bony defect after bone and implant removal; (e) the second case a 52-year-old male patient presented with same condition at #21 implant site; (f) the bone and implant were removed and the wound was closed with nonresorbable suture.
A 69-year-old female patient underwent clinical and radiographic examination, which revealed peri-implant marginal bone necrosis in the form of chronic osteomyelitis. The photos included: (a) a pre-operative clinical photo showing the condition of the gum amount of keratinized gingiva around #30 and #31 implant sites; (b) showing the 2 implants were placed with the healing abutment attached to them; (c) the buccal view of the implant site 3 months after implant placement, poor oral hygiene was evident; (d) shows the patient after 1 year from implant restoration, the patient presented with jaw pain and signs of infection; (e) shows a periapical radiograph demonstrating the pattern and level of bone loss; (f) shows another periapical radiograph after 3 years follow-up demonstrating bone sequestrum; (g) the 2 implants with the adjacent tooth were removed with associated peri-implant bone necrosis; (h) the site was grafted (Puros cancellous bone, ZimVie, Palm Beach Gardens, FL) and covered with Absorbable Collagen Wound Dressings (Colla-Tape, BioMend Extend, ZimVie); (i) immediate postoperative clinical view after primary wound closure; (j) clinical photo showing 6 months mucosal healing; (k) periapical radiograph after 6 months shows lesion had disappeared and site was healed uneventfully.
Same patient in Figure 3. Shows the microscopic view of soft tissue excisional biopsy. (The Specimen preserved in formalin consists of multiple fragments of brown/tan soft and hard tissue measuring 2.0 × 0.5 × 0.4 cm in aggregate, sections stained with Hematoxylin Solution). (a) Microscopic view of soft tissue excisional biopsy. The connective tissue contained moderately dense chronic and acute inflammatory cell infiltrate. (b) Microscopic view of the hard tissue excisional biopsy under low magnification—nonvital bone surrounding chronically inflammatory cells. Black arrows show the chronic inflammatory cells, and blue arrows show the nonviable bone that contains empty lacune.
A 58-year-old female patient underwent clinical and radiographic examination, which revealed an advanced stage of peri-implantitis with peri-implant marginal bone necrosis. The examination included: (a) a clinical photo showing the degree of peri-implant mucosal dehiscence, deficiency in width of keratinization, high frenulum attachment around #3 and #4 implants; (b) a palatal view of the same area; (c) a periapical radiograph demonstrating the pattern and level of bone loss, with a separated interproximal bone sequestrum; and (d) a close-up facial clinical photo showing another buccal bone sequestrum (indicated by a yellow arrow).
Contributor Notes