Electron microscopic analysis of necrotic bone and failed implant surface in a patient with medication-related osteonecrosis of the jaw

Ji Young Ha; Mi Young Eo; Buyanbileg Sodnom-Ish; Kezia Rachellea Mustakim; Hoon Myoung; Soung Min Kim

doi:10.1186/s40902-023-00402-9

Electron microscopic analysis of necrotic bone and failed implant surface in a patient with medication-related osteonecrosis of the jaw

Maxillofac Plast Reconstr Surg. 2023 Oct 3;45(1):34. doi: 10.1186/s40902-023-00402-9.

Authors

Ji Young Ha^#¹, Mi Young Eo^#¹, Buyanbileg Sodnom-Ish¹, Kezia Rachellea Mustakim¹, Hoon Myoung¹, Soung Min Kim^{2

3}

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea.
² Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea. smin5@snu.ac.kr.
³ Oral and Maxillofacial Microvascular Reconstruction Lab, Brong Ahafo Regional Hospital, Ghana Health Service, P.O. Box 27, Sunyani, Brong Ahafo, Ghana. smin5@snu.ac.kr.

^# Contributed equally.

Abstract

Background: Bisphosphonates (BP), a commonly used medication for various bone diseases, have been known to have severe complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Failure of dental implants has also been found in patients with medication-related osteonecrosis of the jaw (MRONJ). In this study, we analyzed the necrotic bone tissues and the surface of the failed implants removed from the jaw in patients treated with BPs and antiresorptive agents.

Results: Chronic inflammatory cells with collagen and fibrous tissues and bone sequestrum were shown at 5.0 × , 10.0 × , 20.0 × , and 40.0 × magnified histologic sections in the bone and fibrotic scar tissues removed from patients with MRONJ due to osteonecrosis. Hardened bone tissues with microcracked bony resorbed lacunae were observed in SEM. Unlike the previously published comparative data where immune cells, such as dendritic cells, were found in the failed implant surface, these immune cells were not identified in the BRONJ-related peri-implantitis tissues through the TEM investigations. Furthermore, EDS revealed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, silicon, and sulfur elements were found.

Conclusion: Hardened bone tissues with microcracked bony resorbed lacunae were observed in the SEM findings, which were considered as the main characteristic of the osteonecrosis of the jaw. Immune cells, such as dendritic cells were not identified in the TEM. EDS showed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, and silicon elements were found. Furthermore, it was revealed that sulfur was found, which was considered to be one of the complicated causes of implant failure in patients with BRONJ.

Keywords: Bisphosphonate-related osteonecrosis of the jaw; Energy dispersive X-ray spectroscopy; Failed implant; Medication-related osteonecrosis of the jaw; Necrotic bone.