PIXE micro-beam mapping of metals in human peri-implant tissues

Previous investigations did not agree about the possible presence of titanium and other metals in the tissues around endosteal dental implants and joint prostheses. Indeed, while some authors reported diffusion of metals into the tissues, some others did not find evidence of this phenomenon. In the present study, four dental titanium implants, removed with the surrounding tissues from patients at various time intervals after the insertion, were studied by means of the micro-beam proton-induced X-ray emission (PIXE micro-beam) technique, which draws maps showing the tissue distribution of elements with a detection limit of about 1 ppm. One implant was built in commercially pure titanium, two others in titanium coated with titanium plasma spray, and the fourth in Ti-Al-V alloy. Their composition was confirmed by the PIXE micro-beam analyses. The removed samples were embedded in epoxy and processed with a cutting-grinding appliance, mounted on plastic holders, and ground up to a thickness of about 35 microm. Optical microscope examinations were also carried out, to compare the optical findings with the elemental maps obtained with the PIXE micro-beam. One implant, removed after 70 days because the patient had developed peri-implantitis, had some inflammatory soft tissue attached, with no evidence of metal leakage. The other three implants had been removed after 6, 7 and 9 years of valid clinical service, because of the fracture of the prosthetic abutment or the implant stem. At the optical microscope, all these fixtures were embedded in mature bone. The elemental maps indicated small titanium deposits in about 5% of the bone bordering the implants, while aluminum, when present in the fixture, leaked diffusely into the surrounding bone and vanadium was not found in the tissues. These results suggest that titanium may be found occasionally in peri-implantar tissues, but has very little tendency to spread, while the presence of aluminum in the implant alloy may cause an important leakage of this metal.