Histopathologic observations on late oral implant failures.
Histopathologic observations on late oral implant failures.
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DOI：
10.1111/j.1708-8208.2000.tb00103.x
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发表时间：
2000-01-01
影响因子：
3.6
通讯作者：
Lekholm, U
中科院分区：
文献类型：
--
作者：
Esposito, M;Thomsen, P;Lekholm, U
背景：尽管口腔种植的骨整合成功率很高，但也有失败的情况。为了最大限度地减少损失，应该阐明失败的机制。PURPOSE：这项研究试图描述晚期失败的Branemark种植体周围组织的形态与其临床和放射学结果的关系，以更好地了解病因。材料和方法：从9名患者中连续取出10枚失败的种植体及其周围组织。在X光片上，可以看到9个临床可移动植入物周围有一条透明的放射线。七个可移动种植体的基牙螺丝拧紧引起疼痛。临床上未见其他视觉炎症体征或症状。瘘管起源于一个稳定的种植体，在X光片上被弥漫性骨质疏松包围。回收的植入物被电化学溶解。对完整的种植体薄(1微米)和超薄(70-80 nm)切片进行光镜和透射电子显微镜观察。结果：种植体周缘组织呈中度炎性浸润物，位于交界上皮附近和下方。1例口腔扁平苔藓患者表现为强烈的淋巴细胞/浆细胞主导的免疫反应。移动式种植体周围深层组织由致密的纤维组织包膜组成，炎症最小。在四个种植体周围观察到上皮细胞生长减退。在两个种植体的根尖部分发现了与种植体接触的小块非矿化骨。一个种植体几乎完全被细菌斑块定植，除了它的顶端部分，在那里可以观察到骨与种植体的接触。结论：临床、放射学和组织学研究结果表明，两种主要原因可能与种植体失效有关：与骨支持能力相关的咬合负荷过大，以及两例感染。
BACKGROUND: Despite good success rates of osseointegrated oral implants, failures do occur. To minimize losses, failure mechanisms should be elucidated.PURPOSE: This study sought to describe the morphology of tissues surrounding late failed Branemark implants in relation to their clinical and radiographic findings to acquire a better understanding of the etiologic factors.MATERIAL AND METHODS: Ten failed implants and their surrounding tissues were consecutively retrieved from nine patients after prosthesis placement (late losses). On radiographs, a radiolucent line was visible around nine clinically mobile implants. Tightening of the abutment screw evoked pain at seven mobile implants. Clinically, no other visual inflammatory sign or symptom was manifest. A fistula originated from one stable implant, surrounded on radiographs by a diffuse bone rarefaction. Retrieved implants were electrochemically dissolved. Intact tissue-implant thin (1 micron) and ultrathin (70-80 nm) sections were analyzed with light and transmission electron microscopy.RESULTS: Peri-implant marginal tissues displayed moderate inflammatory infiltrates located adjacent to and beneath the junctional epithelium. One patient affected by oral lichen planus displayed an intense lymphocyte/plasma cell-dominated immune reaction. Deep peri-implant tissues surrounding mobile implants consisted of a dense, fibrous tissue capsule with minimal inflammation. Epithelial downgrowth was observed around four implants. Small areas of nonmineralized bone in contact with the implant were noticed in the apical portion of two implants. One implant was almost entirely colonized by bacterial plaque with the exception of its apical portion, where bone-implant contact was observed. The stable implant was characterized by bone-implant contact.CONCLUSION: Altogether clinical, radiographic, and histologic findings indicated that two major etiologic factors might have been implicated in the failure process of the investigated implants: excessive occlusal load in relation to the bone-supporting capacity and, in two cases, infection.