Titanium release in peri-implantitis.

OBJECTIVES: The aim of this study was to investigate the titanium (Ti) content of biopsies from patients with severe peri-implantitis or controls without Ti exposure.

BACKGROUND: Peri-implantitis is considered to be an infectious disease, but recent studies have shown that Ti can aggravate inflammation in combination with bacterial products. The Ti content of peri-implantitis and periodontitis (controls) tissue is unknown.

METHODS: Thirteen patients referred for peri-implantitis and eleven for periodontitis treatment were included in the study. Disease severity was obtained from dental records. Biopsies were taken from both groups and chemically analysed with inductively coupled plasma mass spectrometry for Ti content. Additionally, two patients with peri-implantitis and two with periodontitis were recruited and their biopsies were analysed microscopically with light microscopy, transmission electron microscopy and scanning electron microscopy with element analysis to investigate the presence of particulate Ti.

RESULTS: All patients lost one or more implants despite undergoing peri-implant or treatment. Peri-implantitis tissue contained significantly higher concentrations of Ti than control samples with a mean ± SD of 98.7 ± 85.6 and 1.2 ± 0.9 μg/g, respectively. Particulate metal was identified in peri-implantitis and control biopsies, but element analyses could confirm only the presence of Ti in peri-implantitis tissue.

CONCLUSION: We showed that high contents of particulate and submicron Ti were present in peri-implantitis tissue. These high Ti contents in peri-implant mucosa can potentially aggravate inflammation, which might reduce the prognosis of treatment interventions.