Dr. Stephane Berg challenging Case of a right maxillary fractured molar and replacement by an implant after GBR with biphasic calcium sulfate and vertical sinus lift.

52 years old female presented with fractured right maxillary first molar in September 2018. It was decided to proceed with extraction and GBR with biphasic calcium sulfate cement (Bond Apatite®, Augma Biomaterials Ltd) in order to avoid the resorption of the alveolar bone and to maintain the crestal width. The exposed graft was covered by a collagen sponge secured in place. On March 2019, the regenerated bone allows the placement of an implant in conjunction with a crestal sinus lift and sinus filling by biphasic calcium sulfate cement (Bond Apatite – Bone Graft Cement by Augma Biomaterials – bond-apatite).

“There is presently a lack of information if and how titanium (Ti) particles from dental implants affect the tissues in the oral cavity, particularly peri-implant tissues such as bone and connective tissue cells” (Happe et al 2019).

Concerns:

• Ti particle pollution may be perceived clinically as discoloration of the marginal tissues and histologically, we see lymphocytes in the peri-implant tissues with increased Ti concentration (Zipprich et al 2018)
• Ti particles can provoke a dual effect, reducing bone formation due to inhibition of osteoblast proliferation and increasing bone resorption by IL-6 osteoblast-mediated osteoclastogenesis (Goodman et al 2016)
• Titanium wear microparticles shown to activate osteoclastogenesis (Mishra et al 2011)
• A recent cell culture experiment demonstrated a cytotoxic effect of Ti debris on human osteoblasts and gingival fibroblasts (Happe et al 2019)
• If Ti particles create an inflammatory cell response or induce bone resorption they may play an important role in peri-implant disease.