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Introduction: Peri-implantitis is often regarded as a biologic complication that may lead to late implant failure. However, the influence of confounding factors in this disease remains unclear. This case report highlights the interaction of other factors in the phenomena of crestal bone loss (CBL) associated with implant placement and presents an interventional treatment strategy.Case Presentation: A 70-year-old female was diagnosed with peri-implantitis associated with an implant that was placed to replace a mandibular molar tooth. There was progressive CBL that continued despite the removal of the restoration. Peri-implant therapy included a surgical intervention with a modification of the restoration. Inflamed tissues were excised for histologic evaluation. Metal-like particles were shown in cytologic smears of peri-implant areas. Subsequent evaluation of the inflamed connective tissue using scanning electron microscopy identified localized black scattered material. Energy-dispersive spectrography anal...

Introduction: The role of bacteria in the etiology of peri-implantitis has been reported in the literature. However, the influence of confounding factors on the disease remains unclear. The following case series discusses the presence of metal particles in diseased peri-implant mucosa.Case Series: Four patients with peri-implantitis underwent surgical peri-implant therapy and diode laser surface decontamination procedures. Peri-implant mucosa was excised under local anesthesia and samples were prepared for histology, scanning electron microscopy (SEM), and energy dispersive spectroscopy (EDS) to evaluate peri-implant tissues and identify deposits of foreign materials. Histologic examination demonstrated cellular fibrous connective tissue, with or without overlying stratified squamous epithelium. An inflammatory infiltrate consisting of a mixture of acute and chronic inflammatory cells was observed. Numerous deposits of granular foreign material were scattered within the connective tissue immediately below...