Peri-Implant Bone Necrosis: Clinical Considerations and Histological Evaluation

Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involved. This case series reports on the successful management of PIBN during early and late implant placement and peri-implantitis-associated bone necrosis, with likely causes being bone overcompression during implant placement or a consequence of peri-implantitis. This case series presents 5 cases of peri-implant bone necrosis, with 3 cases occurring immediately after implant placement and the other 2 presenting a delayed inflammatory process of peri-implantitis between 1 and 5 years after implant placement. Clinical presentation and histopathological evaluation data present 10 failed implants managed with the removal of implants and the associated necrotic bone. All the cases were successfully managed without any signs of recurrence. Two cases confirmed bone necrosis via biopsy, illustrating the typical pattern of bone necrosis: multiple nonvital bone fragments surrounded by acute and chronic inflammatory cells and empty lacunae. All cases were successfully managed by removing necrotic bone and associated implants, with no indication of bone necrosis recurrence. This case series report highlights the unusual early and delayed implant failure associated with peri-implant bone necrosis. This condition most likely results from bone overcompression during implant placement or is a sequela of the inflammatory process of peri-implantitis.