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Histologic studies of a human mandible supporting an implant denture

1969; Elsevier BV; Volume: 21; Issue: 2 Linguagem: Inglês

10.1016/0022-3913(69)90093-6

1097-6841

Roy L. Bodine, Clive I. Mohammed,

Bone Tissue Engineering Materials

Detailed studies of a mandible with a clinically healthy 12 year implant denture revealed the following important findings: (1)The epithelium did not grow downward along the primary struts to encapsulate the peripheral frame as suggested by Nichols.2 In all areas, which were more than a few millimeters away from an oral metal penetration, there was complete absence of epithelium, and there was no evidence of inflammation. (2)The connective tissue in contact over, around, and under the buried metal generally was modified as evidenced by flattened, compressed fibers and cells whose nuclei were elongated. This compressed tissue consisting of a few layers of flattened elongated cells underlaid by normal connective tissue, is best described as “typical implant connective tissue.” The connective tissue located more than a few cell layers away from the metal is normal, dense, connective tissue. (3)The tissue around the implant abutment somewhat resembled a normal gingival crevice, 1 but it did present some important differences. After a number of years, epithelial tissue extends under the abutment and a few millimeters along the metal struts. In the specimen studied, this downgrowth of epithelium was slow and progressed only 2 or 3 mm. from the penetration in more than 12 years. (4)Inflammatory cells found in the tissues adjacent to the epithelialized space under and around the implant abutment were comparable to those found around gingival sulci of natural teeth. This inflammation is, in some way, related to the epithelial downgrowth as there is an increase in the number of inflammatory cells in the transitional area where the thin epithelium terminates. (5)The primary metal exposures at the abutment penetrations were sources for the downgrowth of epithelium. This means that only four abutments should be used, and secondary metal exposures must be avoided as they are additional regions for potential epithelial downgrowth. (6)No significant bone resorption or “settling” of the implant occurred in this patient. The small amount of “settling” and the small loss of occlusal vertical dimension are remarkable considering the strong masticatory habits of this patient over a period of 12 years. (7)There was a tendency for bone to grow over the borders of the implant periphery, especially in the region of the mandibular torus and the first molar. Immature bone was in direct contact with one part of the metal of the lingual periphery. (8)This superiosteal implant denture was remarkably well tolerated during the 12 year period before the patient died. There was no histologic evidence of damage to the approximating and adjacent tissues. The fact that this study is based on the findings in one quadrant of a single patient, who may or may not have been typical of implant patients in general, is a serious limitation. However, because of the rarity of autopsy material of this type, all obtainable information must be used to further the science of implantodontics.