Clinical, Radiographic, and Histopathologic Features of Human Perigraftitis

Perigraftitis is a biologic complication associated with dental implants placed in grafted bone, distinct from peri-implant mucositis and peri-implantitis. This report further characterizes its clinical, radiographic, and histopathologic features.

Three patients presented with discomfort around a single implant placed following tooth extraction and alveolar ridge preservation. Surgical access was obtained, and the implant fixture and surrounding defect were thoroughly debrided. Tissue fragments were submitted for histology, and sections from two previously reported cases were reexamined. Clinically, perigraftitis presented with signs of inflammation and radiographically as a radiolucent defect centered on the grafted bone rather than the implant fixture, containing radiopacities consistent with grafted bone and graft particulates. Histologically, grafted bone, composed of graft particulates surrounded by mature host bone, demonstrated microbial colonies and inflammatory cells. The hallmark histopathologic feature, irrespective of graft type, was microbial aggregates adherent to the surfaces and within the intertrabecular spaces of grafted bone, accompanied by inflammatory infiltrates. Sulfur granules and amoebae were novel observations.

Perigraftitis arises from microbial colonization of grafted bone and is not restricted to a specific graft material. Implant recipient site grafting should be performed judiciously. Management requires complete removal of infected grafted bone and associated inflammatory tissue.